RFP 25-106A Full Service Partnership FINAL.pdf

Request For Proposals for

Full-Service Partnership

Joshua Dugas, Acting Director Department of Behavioral Health

San Bernardino County Department of Behavioral Health Contracts Administration 550 Hospitality Way, 1st Floor San Bernardino, CA 92415-0026

RFP-DBH 25-106A

ePro Document ID # DBHE26-ADMN-6240

Request for Proposals San Bernardino County Department of Behavioral Health Title: Full Service Partnership RFP DBH # 25-106A/ePro Bid # DBHE26-ADMN-6240 i

TABLE OF CONTENTS

I. INTRODUCTION

A. Purpose B. Period of Contract C. Proposal Conference D. Questions E. Correspondence F. Admonition to Proposers G. Proposal Submission Deadline H. Assistance to Proposers with a Disability

II. PROPOSAL TIMELINE

III. PROPOSAL CONDITIONS

A. Proposer B. Authorized Signatures C. Contingencies D. Term of Offer E. Required Review F. Right of Rejection G. Best Value Evaluation Process H. Amendments/Addendums to RFP I. Proposal Submission J. Reserved K. Incurred Costs L. Public Records Act M. Clarification of Offers N. Formal Agreement O. Independent Contractor Status P. Pre-Award On-Site Visits Q. Level of Service R. Termination of Awarded Contract S. Priority Population T. Iran Contracting Act of 2010 U. Executive Order N-6-22-Russia Sanctions V. Final Authority

IV. PROGRAM REQUIREMENTS (SCOPE OF WORK)

A. Definitions B. Background C. Program Description

V. CONTRACT REQUIREMENTS

A. General B. Indemnification and Insurance Requirements C. Right to Monitor and Audit Performance and Records

VI. EQUAL EMPLOYMENT OPPORTUNITY/CIVIL RIGHTS

A. Equal Employment Opportunity Program B. Civil Rights Compliance C. Policy Prohibiting Discrimination, Harassment, and Retaliation

VII. EMPLOYMENT OF FORMER COUNTY OFFICIALS

VIII. IMPROPER CONSIDERATION

Title: Full Service Partnership RFP DBH # 25-106A/ePro Bid # DBHE26-ADMN-6240 ii

IX. DISCLOSURE OF CRIMINAL AND CIVIL PROCEEDINGS

X. SUBCONTRACTOR STATUS

XI. PROPOSAL SUBMISSION

A. General B. Proposal Presentation C. Proposal Format

XII. PROPOSAL EVALUATION AND SELECTION

A. Evaluation Process B. Evaluation Criteria C. Negotiations and Notice of Intent to Award D. Appeal and Award E. Final Authority

ATTACHMENTS:

A. Proposal Submission Checklist B. Table of Contents C. Statements of Certification D. Reportable Conditions E. Disclosures, Exceptions, and California Public Records Act Exemptions to RFP F. Subcontractor Information G. Financial Capability H. Indemnification and Insurance Requirements Affidavit I. Budget Sample J. Budget Cover Page K. References Form L. Attestation Regarding Ineligible/Excluded Persons M. Data Security Requirements N. Certification Regarding Debarment or Suspension; California Secretary of State Business Entity

Registration

Title: Full-Service Partnership RFP DBH 25-106A

I. INTRODUCTION

A. Purpose

San Bernardino County Department of Behavioral Health (DBH), which may also be referred to as the “County” is soliciting proposals from qualified and experienced organizations to provide High-Fidelity Assertive Community Treatment (ACT) and Intensive Case Management (ICM) services. These services will support up to 400 participants with an estimate of 50 ACT level services within the 400, with serious mental illness and/or co-occurring substance use disorders across one or more regions within San Bernardino (County) County.

This RFP is to identify providers capable of delivering evidence-based, person-centered, and recovery-oriented services that align with California’s behavioral health standards and the County’s commitment to wellness, recovery, and resiliency. Services must be delivered with fidelity to the ACT and ICM models and tailored to meet the diverse needs of the County.

B. Period of Contract

Specific services to be provided under this Request for Proposals (RFP) are outlined under Section IV, Program Requirements. The Contract period will be for a five (5) year period beginning on July 1, 2026, through June 30, 2031. The total aggregate amount available for all awards under this RFP shall not exceed $8,116,130 annually or in the amount not to exceed $40,580,650 over the course of 5 years. The County may award contracts to one or more proposers and allocate funding at its sole discretion, subject to Board of Supervisors approval and funding availability.

C. Proposal Conference

1. A proposal conference will be held via Microsoft Teams on: Tuesday, March 24, 2026, at 2:00 PM PST at:

https://teams.microsoft.com

Meeting ID: 222 358 444 469 95

Meeting password: Tv976Ef3 Join by phone: +1-415-655-0002 United States Phone Conference ID: +1 661-568-6806,,164726664#

2. Attendance at the proposal conference is strongly recommended, as important information regarding this RFP will be discussed and questions will be addressed.

D. Questions

Questions regarding the contents of this RFP must be submitted in writing on or before 12 noon PST on Monday, March 30, 2026 and directed to the individual listed in Section I, Paragraph E, facsimiles and e-mails are acceptable. The subject line of the facsimile (fax) or e-mail must read: RFP DBH 25-106A. All questions submitted timely and in writing will be answered and both the questions and answers will be posted in through the San Bernardino County Electronic Procurement Network (ePro) system.

E. Correspondence https://teams.microsoft.com/ tel:+16615686806,,164726664

All correspondence, including proposals and questions, are to be submitted through ePro or to the RFP contact:

San Bernardino County Department of Behavioral Health ATTN: Contracts Administration

RE: RFP-DBH 25-106A

550 Hospitality Way, 1st Floor San Bernardino, CA 92415-0026 Contact: Desiree Alfaro Phone: (909) 388-0932 E-mail: Desiree.Alfaro@dbh.sbcounty.gov Fax: (909) 890-0470

Fax number and e-mail address may be used to submit questions only. Proposals will not be accepted by fax or e-mail.

F. Admonition to Proposers

Once the RFP has been issued, the individual identified above is the sole contact point for any inquiries or information relating to this RFP. Failure to adhere to this policy may result in disqualification of the Proposer and rejection of proposal.

G. Proposal Submission Deadline

1. All proposals or bids must be received no later than 4:00 P.M. Wednesday, April 8, 2026 PST. Late or incomplete proposals or bids will not be accepted.

2. An electronic proposal or bid can be submitted through ePro https://epro.sbcounty.gov/bso/. Submittals in ePro will be opened from the system’s “encrypted lock box” after the deadline and evaluated as stated in this solicitation. If the proposal or bid is submitted through ePro, the proposal or bid may also be withdrawn OR retrieved, adjusted, and re-submitted by the Vendor at any time prior to the scheduled deadline for submission of the proposal or bid. If the proposal or bid is submitted through ePro, the proposer/bidder acknowledges that its electronic signature is legally binding. OR

3. Hard copies of the proposal or bid containing original signatures will also be accepted at the location identified in this solicitation in Paragraph E above. Postmarks will not be accepted in lieu of actual receipt. The proposal or bid can be withdrawn at any time prior to the scheduled deadline for submission of the proposal or bid.

4. Proposals must be received by the designated date and time. All Proposers must register with the ePro system prior to the date and time to receive the proposal or they will be disqualified. Late or incomplete proposals will not be accepted.

Electronic response must be submitted through ePro: https://epro.sbcounty.gov/bso/.

System-related issues in ePro shall be directed to the Purchasing Department at (909) 387-2060. For procurement questions involving ePro, please contact the RFP Contact identified in Section I, Paragraph E - Correspondence.

H. Assistance to Proposers with a Disability mailto:Desiree.Alfaro@dbh.sbcounty.gov https://epro.sbcounty.gov/bso/ https://epro.sbcounty.gov/bso/

Proposers with a disability may request accommodation regarding the means of communicating this RFP or participating in the procurement process. For more information, contact the RFP Contact no later than ten (10) days prior to the Deadline for Proposal.

II. PROPOSAL TIMELINE

RFP Release Date March 10, 2026

Proposal Conference

Tuesday March 24, 2026 2:00pm PST

Deadline for Submission of Questions March 30, 2026, by 12 noon PST **Questions may be submitted in writing prior to the Proposal Conference

Deadline for Submission of Proposals April 8, 2026 by 4:00 p.m. PST

Tentative Start Date for Contract(s) July 1, 2026

The above dates are subject to change as deemed necessary by San Bernardino County.

III. PROPOSAL CONDITIONS

A. All Proposers must:

1. Be a non-profit, for-profit organization or other legally constituted business entity.

2. Have a current Medi-Cal Certification or have the ability to become Medi-Cal Certified, if applicable.

3. Have no record of unsatisfactory performance with any government agency or County Department including DBH in the twenty-four (24) month period immediately preceding the date of issuance of this RFP. Proposers who are or have been seriously deficient in contract performance during this period, in the absence of circumstances properly beyond the control of the Proposer, shall be presumed to be unable to meet this requirement.

4. Register in the County’s Electronic Procurement Network (ePro) system.

5. Meet other presentation and participation requirements listed in this RFP.

B. Authorized Signatures

All proposals must be signed by an individual authorized to bind the Proposer to the provisions of the RFP.

C. Contingencies

Funding for this program is contingent on funding from the appropriate office of the State of California and is subject to reimbursement under Federal and State laws. This RFP does not commit the County to award a Contract. Cost, while not necessarily the primary factor used in the selection process, is an important factor. The County will award a Contract based on the proposal that best meets the needs of the County.

D. Term of Offer

Proposals shall remain open, valid, and subject to acceptance anytime within nine (9) months after the proposal opening.

E. Required Review

Proposers should carefully review this RFP for defects and questionable or objectionable material.

Comments from Proposers concerning defects and objectionable material in this RFP must be made in writing and received by the RFP contact prior to the deadline for submission of questions identified in Section II or at least ten (10) calendar days before the Deadline for Proposals (whichever occurs last). This will allow issuance of any necessary amendments or addendums to the RFP. It will also help prevent the opening of a defective Proposal and exposure of Proposals upon which an award could not be made. Protests based on any omission or error, or on the content of this RFP, may be disallowed if not submitted in writing to the attention of the RFP Contact, prior to the deadline for submission of questions identified in Section II or at least ten

(10) calendar days before the Deadline for Proposals (whichever occurs last).

F. Right of Rejection

Proposals must comply with all of the terms of the RFP, and all applicable local, State, and Federal laws, codes, and regulations. County may reject as non-responsive any proposal that does not comply with all of the material and substantial terms, conditions, and performance requirements of the RFP. Further, the County may reject a proposal from any entity that is a parent, affiliate, or subsidiary, or that is under common ownership, control, or management with any other entity submitting a Proposal in response to this RFP.

Proposer may not qualify the proposal nor restrict the rights of the County. If Proposer does so, the proposal may be determined to be a non-responsive counter-offer and the proposal may be rejected.

No proposal shall be rejected, however, if it contains a minor irregularity, defect or variation and if the irregularity, defect or variation is considered by the County to be immaterial or inconsequential, the County may choose to accept the proposal.

Minor informalities may be waived by the County when they:

• Do not affect responsiveness;

• Are merely a matter of form or format;

• Do not change the relative standing or otherwise prejudice other offers;

• Do not change the meaning or scope of the RFP;

• Are trivial, negligible, or immaterial in nature;

• Do not reflect a material change in the work; or

• Do not constitute a substantial reservation against a requirement or provision;

In such cases the Proposer will be notified of the deficiency in the proposal and given an opportunity to correct the irregularity, defect or variation or the County may elect to waive the deficiency and accept the proposal. The decision to provide a waiver shall in no way modify or compromise the overall purpose of the submittal, nor excuse the Proposer from compliance with all requirements if awarded a Contract.

This RFP does not commit the County to award a contract. County reserves the right to reject any or all proposals if it is in the best interest of the County to do so. County also reserves the right to terminate this RFP process at any time.

G. Best Value Evaluation Process

As established in this RFP, the County realizes that criteria other than price are important and will award contract(s) based on the proposal that best meets the needs of the County. The County seeks the optimal combination of quality, price, and various qualitative elements of the required Services that will provide the County the greatest or best value for its money.

H. Amendments/Addendums to RFP

The County reserves the right to issue addenda or amendments to this RFP if the County considers that changes are necessary or additional information is needed. Only those proposers registered in ePro will receive addenda or amendments issued after the Conference.

Changes to a Proposal or withdrawal of a Proposal will only be allowed if a request is received prior to the Deadline for Proposals. No amendments or withdrawals will be accepted after the Deadline for Proposals.

I. Proposal Submission

To be considered, all proposals must be submitted in the manner set forth in this RFP. Submission of a Proposal indicates that the Proposer has read and understands the entire RFP, including all appendixes, attachments, exhibits, schedules, and addenda (as applicable) and that all concerns regarding the RFP have been resolved. It is the Proposer’s responsibility to ensure that its complete proposal arrives on or before the specified deadline. All proposals and materials submitted become the property of the County.

J. Reserved

K. Incurred Costs

The County is not obligated to pay any costs incurred by Proposer in the preparation of a proposal in response to this RFP. Proposer agrees that all costs incurred in developing this proposal are the Proposer’s responsibility.

L. Public Records Act

All proposals and other material submitted become the property of the County and are subject to release according to the California Public Records Act (Government Code § 6250). All Proposal information, including cost information, will be held in confidence during the evaluation and negotiation process. Thereafter, Proposals are subject to becoming a non-exempt public record.

If a Proposer believes that any portion of its Proposal is exempt from public disclosure, it must indicate the specific portions believed to be confidential and not subject to disclosure on Attachment E. The Proposer also must include a brief description that sets out the reasons for exemption from disclosure. Each stated exemption must include a citation to supporting legal authority, including statutory authority or case law, to support exemption from the Public Records Act. Requested exemptions that do not meet the requirements of this section will not be considered.

The County will use reasonable means to ensure that such information is safeguarded, but will not be held liable for inadvertent disclosure of the information. Proposals marked “Confidential” in their entirety will not be honored, and the County might not deny public disclosure of any portion of Proposals so marked.

By submitting a Proposal with portions identified in Attachment E as “Confidential,” Proposer represents that it has a good faith belief that such portions are exempt from disclosure under the California Public Records Act. Proposer may be requested to obtain legal protection from disclosure should a Public Records Act request be received. In the event the County does not disclose the information marked “Confidential,” Proposer agrees to reimburse the County for, and to indemnify, defend (with counsel approved by County) and hold harmless the County, its officers, employees, agents, and volunteers from and against any and all claims, damages, losses, liabilities, suits, judgments, fines, penalties, costs and expenses, including without limitation, attorneys’ fees, expenses and court costs of any nature arising from or relating to the County’s non-disclosure of any such designated portions of a Proposal.

M. Clarification of Offers

1. The County may require the potential Proposer(s)/Contractor(s) selected to provide additional information or clarifications on any area contained in this RFP or which might be used to evaluate vendors. This may include cost, technical, or other clarifications needed to make a decision.

2. In order to determine if a Proposal is reasonably susceptible for award, communications by the Facilitator for the evaluation panel are permitted with a Proposer to clarify uncertainties or eliminate confusion concerning the contents of a Proposal. Clarifications may not result in a material or substantive change to the Proposal. The evaluation by the panel may be adjusted as a result of a clarification under this section.

N. Formal Agreement

Proposer will be required to enter into a formal Contract with the County. This RFP sets forth some of the general provisions which will be included in the final contract. In submitting a response to this RFP, Proposer will be deemed to have agreed to each clause unless the proposal identifies an objection and County agrees to a change of language in writing. All objections to any provisions of the final contract should be listed on Attachment E – Disclosures, Exceptions, and Public Records Act Exemptions to RFP, or any exception thereto shall be waived.

O. Independent Contractor Status

Any Proposer that is awarded a Contract will be considered an independent Contractor(s), wholly responsible for the manner in which it performs, and will assume exclusively the responsibility for the acts of its employees who will not be entitled to any rights and privileges of County employees nor be considered in any manner to be County employees.

P. Pre-Award On-Site Visits

Site visits may be conducted to verify information submitted in the RFP and to determine if the proposed facilities are appropriate for the proposed services to be provided.

Q. Level of Service

For any Contract awarded as a result of the RFP, no minimum or maximum number of referrals or enrollments can be guaranteed by the County.

R. Termination of Awarded Contract

The Contract between the County and selected Proposer(s) will contain specific language which addresses the option of both the selected Proposer(s) or County to terminate the Contract without cause, termination for the convenience of the County, and termination for cause.

S. Priority Population

The priority population to be served by Full-Service Partnership program services are San Bernardino County residents who are unserved, high-risk adults who are at risk of hospitalization, incarceration, and homelessness and/or are frequent users of emergency psychiatric services.

Individuals who also have backgrounds of acute or long-term institutionalization and find it difficult to engage in services, yet can succeed in the community with sufficient linkage, structure and support are also served.

T. Iran Contracting Act of 2010

In accordance with Public Contract Code Section 2204(a), the Proposer certifies that at the time the proposal is submitted, the Proposer signing the proposal is not identified on a list created pursuant to subdivision (b) of Public Contract Code Section 2203 (https://www.dgs.ca.gov/PD/Resources/Page-Content/Procurement-Division-Resources-List- Folder/List-of-Ineligible-Businesses) as a person [as defined in Public Contract Code Section 2202(e)] engaging in investment activities in Iran described in subdivision (a) of Public Contract Code Section 2202.5, or as a person described in subdivision (b) of Public Contract Code Section 2202.5, as applicable.

Proposers are cautioned that making a false certification may subject the Proposer to civil penalties, termination of existing contract, and ineligibility to bid on a contract for a period of three

(3) years in accordance with Public Contract Code Section 2205. Proposer agrees that signing the Proposal shall constitute signature of this Certification.

U. Executive Order N-6-22 – Russia Sanctions

On March 4, 2022, Governor Gavin Newsom issued Executive Order N-6-22 (the EO) regarding Economic Sanctions against Russia and Russian entities and individuals. “Economic Sanctions” refers to sanctions imposed by the U.S. government in response to Russia’s actions in Ukraine (https://home.treasury.gov/policy-issues/financial-sanctions/sanctions-programs-and-country-information/ukraine-russia-related-sanctions), as well as any sanctions imposed under state law (https://www.dgs.ca.gov/OLS/Ukraine-Russia). By submitting a bid or proposal, Proposer represents that it is not a target of Economic Sanctions. Should it be determined Proposer is a target of Economic Sanctions or is conducting prohibited transactions with sanctioned individuals or entities, that shall be grounds for rejection of the Proposer’s bid/proposal any time prior to contract execution, or, if determined after contract execution, shall be grounds for termination by the County.

V. Final Authority

The final authority to award a Contract as a result of this RFP rests solely with San Bernardino County Board of Supervisors, or as delegated by the Board of Supervisors.

https://www.dgs.ca.gov/PD/Resources/Page-Content/Procurement-Division-Resources-List-Folder/List-of-Ineligible-Businesses https://www.dgs.ca.gov/PD/Resources/Page-Content/Procurement-Division-Resources-List-Folder/List-of-Ineligible-Businesses

IV. PROGRAM REQUIREMENTS (SCOPE OF WORK)

A. Definitions

1. The terms Proposer, Contractor, Provider, or Vendor/Applicant are used interchangeably throughout this document referring to the entity submitting a response and may subsequently become a Contractor.

2. The terms beneficiary, client, member, participant, or patient are used interchangeably throughout this document and refers to the individual(s) receiving services.

3. Definition of May, Shall, and Should. Whenever in this document the words “may”, “shall”, and “should” are used, the following definitions shall apply: “may” is permissive; “shall” is mandatory; and “should” means desirable.

4. Alcohol and Other Drug (AOD) refer to a continuum of alcohol and other drug services.

5. Assertive Community Treatment (ACT) is an Evidenced-Based Practice (EBP) to support members living with complex and significant behavioral health needs with a treatment history that may include psychiatric hospitalization and emergency room visits, residential treatment, involvement with the criminal justice system, homelessness, and/or lack of engagement with traditional outpatient services. ACT is a community-based service delivered by a multidisciplinary team. Services include a full range of behavioral health treatment, psychological rehabilitation, care coordination and community support services designed to support recovery.

6. Case Management is a service that assists a member to access needed medical, educational, social, prevocational, vocational, rehabilitative, or other community services.

The service activities may include, but are not limited to, communication, coordination, and referral; monitoring service delivery to ensure patient access to service and the service delivery system; monitoring of the member’s progress; placement services and plan development. Case Management may be either face-to-face or by telephone with the adult or significant support persons and may be provided anywhere in the home or community. The services should be well defined dependent on the ACT service model under Cal Aim for billable time as well as those outlined for ICM if the proposal is to provide both services.

7. Community Collaboration is a process by which participants and/or families receiving services, other community members, agencies, organizations, and business work together to share information and resources in order to fulfill a shared vision and goals.

8. Co-Occurring Disorder (COD) refers to the simultaneous existence of substance use and mental disorders. Individuals with COD have one or more disorders relating to the use of alcohol and/or other drugs of abuse as well as one or more mental disorders. A diagnosis of COD occurs when an individual has both mental illness and a substance use disorder.

From a treatment perspective, both disorders are primary. Although the disorders may impact each other, neither is merely a symptom of the other.

9. Full Spectrum of Community Services is the mental health and non-mental health services and supports necessary to address the needs of the client, and when appropriate, the client’s family, in order to advance the client’s goals and achieve outcomes that support the client’s recovery, wellness, and resilience.

10. Full-Time Equivalent (FTE) is a 40 hour work week and the percentage of time a staff position works in a week is represented as a decimal. A full-time person is 1.00 FTE, a half-time person is 0.50 FTE, and a quarter-time person is 0.25 FTE.

11. Evidenced Based Practice is the integration of the best available research with clinical expertise in the contest of patient characteristics, culture, and preferences.

12. Full-Service Partnership is recovery-oriented, comprehensive services targeted to individuals who are unhoused or at risk of becoming unhoused and who have a severe mental illness often with a history of criminal justice involvement and repeat hospitalizations.

13. Housing First is an evidenced based approach to ending homelessness that centers on providing homeless people with housing quickly and then provides services as needed.

Housing First does not require persons to “earn” their housing or demand sobriety or health/mental health treatment as a condition for access to housing. Housing First utilizes these critical elements.

a) A focus on helping individuals and families access and sustain permanent rental housing as quickly as possible.

b) A variety of services are delivered primarily following housing placements to promote housing stability and individual well-being.

c) Services are time-limited or long-term depending upon individual need.

d) Housing is not contingent on compliance with services. Instead, participants must comply with a standard lease agreement and are provided with the services and support necessary to help them do so successfully.

14. Housing Plan

a. Evaluation of the client’s current needs to transition from homelessness and establish strategies and methods to meet those needs. Outlines what the housing counseling agency and the client will do to meet the client’s housing goals and address their housing problems.

b. Identifies the client’s need or problem (e.g., potential foreclosure, homelessness, or pre-purchase goals).

c. Includes specific time-framed steps for both the client and the counselor to take (e.g., saving a certain amount, improving a credit score or eliminating debt).

d. Document referrals to other resources, such as job training or legal assistance, if needed.

e. It is tailored to the client’s unique financial circumstances, goals, and needs.

15. Individual Services and Supports Plan (ISSP) is the plan developed by the client and when appropriate the client’s family with the Case Manager to identify the client’s goals and describe the array of services and supports necessary to advance these goals based on the client’s needs and preferences and, when appropriate, the needs and preferences of the client’s family to support the client’s recovery, wellness and resilience.

16. Individual Placement and Support (IPS) is a structured, evidenced-based approach to supported employment that integrates vocational services with behavioral health treatment. IPS emphasized rapid job search, competitive employment, and individualized, ongoing support.

17. Intensive Case Management (ICM) services is a structured approach to metal health that focuses on individuals who have severe and persistent mental health issues. It aims to help these individuals navigate complex systems of care, ensuring they receive the support they need to improve their quality of life. ICM typically involves a team of professionals who work collaboratively to address the various needs of clients including mental health treatment, housing, and social services.

18. Managed Care Plan (MCP) contracts for health care services through established networks of organized systems of care, which emphasize primary and preventive care.

Managed care plans are a cost-effective use of health care resources that improve health care access and assure quality of care.

18. Mental Health services: interventions designed to provide the maximum reduction of mental disability and restoration or maintenance of functioning consistent with the requirements for learning, development, independent living and enhanced self-sufficiency. Service shall be directed toward achieving the individual’s goals/desired results/personal milestones, and minimum guidelines for the provision of coordinated services under the rehabilitation and targeted case management options are set forth below as indicated in the ICM model for step down and/or level of service needs. Not all of the activities need to be provided for a service to be billable:

a. Assessment is a service activity where providers shall use their clinical expertise to complete initial assessment and subsequent assessments in accordance with each member’s clinical needs and generally accepted standards of practice. The diagnosis, current mental status, medication history, and assessment of relevant conditions and psychosocial factors affecting the member’s physical and mental health must be completed by a provider operating within their scope of practice under California state law, who is licensed, registered, waivered , and/or under the direction of a licensed mental health professional.

b. Plan Development is a mental health service plan developed for a member, including modifying goals, assessing progress, planning transitions, and addressing other needs. Services can be provided by someone other than a physician who is a clinical, professional, or other specialist once a diagnosis from a licensed or licensed waivered individual has been made.

c. Therapy is a therapeutic intervention that focuses primarily on symptom reduction and restoration of functioning as a means to improve coping and adaptation and reduce functional impairments. Includes the application of cognitive, affective, verbal or nonverbal strategies based on the principles of development, wellness, adjustment to impairment, recovery and resiliency to assist a member in acquiring greater personal, interpersonal and community functioning or to modify feelings, thought process, conditions, attitudes or behaviors. Therapy should also be provided in a culturally relevant manner taking into consideration the individual’s or group’s cultural practices and beliefs.

d. Psychosocial Rehabilitation is a recovery or resiliency focused service activity that addresses a mental health need that can be provided to a member or group of beneficiaries. The service provides assistance in restoring, improving, and/or preserving a member’s functional, social, communication or daily living skills to enhance self-sufficiency or self-regulation that may include any or all of the following:

i. Assist members to develop coping skills by using a group process to provide peer interaction and feedback in developing problem-solving strategies.

ii. Interventions that utilize self-expression such as art, recreation, dance or music to develop or enhance skills.

iii. Support resources and/or medication education.

iv. Assessment of job-related interests and abilities based on a complete education and work history. This assessment shall consider the effects of the participant’s mental illness on employment, with identification of specific behaviors that interfere with the participant’s work performance and development of interventions to reduce or eliminate the behaviors.

v. Psychoeducation to assist members in recognizing the symptoms of their mental health condition to prevent, manage or reduce such symptoms. May include contact with significant support persons or other collaterals if the purpose of their participation is to focused on the treatment needs of the member.

vi. Individual supportive counseling to assist the participant to identify and cope with the symptoms of mental illness that may interfere with daily functioning.

e. Collateral is contact with one or more significant support person in the life of the individual which may include consultation and training to assist in better utilization of services and understanding of mental illness. Collateral services include, but are not limited to, helping significant support persons to understand and accept the individual’s condition and involving them in service planning and implementation of service plan(s).

f. Crisis Intervention includes being the first-line crisis responder and evaluator for all incoming crisis calls and addressing crisis calls using a trauma-informed, recovery-based approach. Teams are expected to provide crisis intervention in a timely manner to help prevent the need for emergency department visits and hospitalizations. If a member is involuntarily detained in a hospital (e.g., a 5150 emergency evaluation) or under observation in a crisis stabilization unit (CSU), the team should be notified and deployed to the hospital or CSU where the member is receiving services.

g. Medication Support Services is the prescribing, administering, dispensing and monitoring drug interactions and contraindications of psychiatric medications necessary to alleviate the suffering and symptoms of mental illness. These services can include assessing the appropriateness of reducing medication usage when clinically indicated. This service includes one or more of the following service components

i. Evaluation of the need for medication

ii. Evaluation of the clinical effectiveness and side effects of medication

iii. Obtaining informed consent or court order iv . Medication education including; discussing risks, benefits, and alternatives with the individual or significant support persons, and plan development related to the delivery of these services.

19. Permanent Supportive Housing in which housing assistance (e.g., long-term leasing or rental assistance) and supportive services are provided to assist households with at least one member with a disability to achieve housing stability.

20. Severe Persistent Mental Illness (SPMI) refers to a collection of mental disorders that usually affect people in early adulthood and often have profound effects on family relations, educational attainment, occupational productivity, and social role functioning over the life course.

21. Tool for Measurement of Assertive Community Treatment (TMACT) is the fidelity tool utilized to assure compliance with this level of care.

22. Transitional Rent provides up to six months of rental assistance in interim and permanent settings to Members who are experiencing or at risk of homelessness, have certain clinical risk factors, and have either recently undergone a critical life transition (such as existing an institutional or carceral setting or foster care), who meet other specified eligibility criteria.

23. Underserved participants who have been diagnosed with a serious mental illness and are receiving some services but are not provided the necessary or appropriate opportunities to support their recovery, wellness, and/or resilience. These participants include, but are not limited to, those who are so poorly served that they are risk of homelessness, institutionalization, incarceration, or other serious consequences; members of ethnic/racial, cultural, and linguistic populations that do not have access to mental health programs due to barriers such as poor identification of their mental health needs, poor engagement and outreach, limited language access, and lack of culturally competent services; and those in rural areas, Native American rancherias and/or reservations who are not receiving sufficient services.

24. Unserved individuals who may have serious mental illness and are not receiving mental health services. Individuals who may have had only emergency or crisis-oriented contact with and/or services from the County may be considered unserved.

B. Background

The FSP program consists of crisis intervention/stabilization, family education, peer support, and treatment programs that address behavioral health conditions in an integrated fashion and has 24/7 access to an interdisciplinary team of behavioral health professional staff and peer advocates. The program is a collaborative relationship between the FSP provider and participants, through which the contractor plans and provides the full spectrum of community services (mental and non-mental health services), so that the client can achieve their identified goals.

FSP includes evidence-based services and treatment models to provide mental health service activities, as appropriate, such as Level of Care Assessment (LOCUS), behavioral health assessment, therapy, psychosocial rehabilitation, referrals and linkages, crisis intervention, employment and education support services, medication support services, outreach, and other support services, i.e., provision of childcare during therapy sessions, etc. The program may include ACT as the highest intensity level, and FSP ICM services, which can be a standardized step-down level from ACT or provided to individuals requiring a lower level of care than ACT. The program will include components that adhere to ACT fidelity utilizing the TMACT service tool, a step down to ICM and include coordination with the county and managed care plan for transitional rent and housing interventions.

i. As a requirement of Behavioral Health Services Act (BHSA) the County is to provide FSP services. Services will be comprehensive and include onsite and field-based behavioral health treatment and supportive services designed to support long term housing stability, reduce behavioral health symptoms, and improve community functioning. Services implemented must be evidence-based and recovery-oriented practices; and adhere to TMACT fidelity with stepdown services that include ICM. If the proposed services are to provide both ACT and ICM levels of care within the program, there must be a clear understanding of how each of the services will be addressed within the program model.

C. Program Description

1. Program Objective

The foundation of FSP programs is doing “whatever it takes” to help individuals on their path to recovery and wellness. FSP program is expected to provide as many services beyond the scope of traditional mental health outpatient services to guide/assist clients while they transition to self-sufficiency, recovery, and connecting to their community. The long-term goal is to reduce the recidivism rate for intensive and acute psychiatric services by integrating these community-based mental health services with housing, vocational, peer support and case management. The Department of Behavioral Health (DBH) anticipates that the recommended contract will provide FSP program services annually to approximately 400 Adults (age 26 or older) and Transitional Age Youth (ages 18-25).

The Contractor will provide FSP to the participants in permanent supportive housing (PSH) for homeless individuals throughout the County funded by United States Department of Housing and Urban Development (HUD). The Provider shall be capable of delivering evidence-based, person-centered, and recovery-oriented services that align with California’s behavioral health standards and the County’s commitment to wellness, recovery, and resiliency. Services must be delivered by a multidisciplinary team with fidelity to the ACT and

ICM models and tailored to meet the diverse needs of residents across all regions of the County.

2. Program Requirements

Program design must meet Tool for Measurement of Assertive Community Treatment (TMACT) Fidelity and/or ICM program evidenced based practices. Proposer may opt to provide services to all 400 adults within the population throughout the County, designating slots for either or both ACT and ICM and must specify the projected numbers, or may opt to provide an aspect of the services being offered and must specify the slots being proposed. The Proposer is responsible for ensuring that their proposal meets the following:

a. Organizational Qualifications

i. Experience with ACT and ICM or similar programmatic evidenced based practices

ii. Licensure, certifications, and credentialing documentation

iii. Staffing plan

b. Program Design

i. Service Delivery model

ii. Client engagement and retention strategies

iii. Use of evidence-based practices

iv. Co-occurring service plan

v. Housing and Placement coordination

vi. ICM-plan

c. Implementation Plan

i. Timeline for service rollout

ii. Staff Training and supervision

iii. Quality assurance and fidelity monitoring

d. Budget and Cost Proposal

a. Detailed line-item budget

b. Justification of costs

c. Leveraging of other funding sources

e. Data and Reporting

i. Outcome measures

ii. Reporting tools and frequency

iii. Use of electronic health records (EHR)

f. Service Area

i. Proposals must address one or more of the following County regions where services shall be provided to County residents. The County is divided into the following regions: High Desert, East Valley, West Valley, Morongo Basin, and Mountain Region. Proposers should propose how they would provide services, in separate sections within the proposal, for separate service areas. The service area narrative will include a five-year budget for that specific service area. In addition, include the community’s need for FSP services with requested staffing patters, facility location, and transportation, taking into account the large geographic region of the County. Proposers may propose one or multiple geographic region to be served.

Examples of the cities located within each region are as follows including but not limited to:

Region Examples of Cities

High Desert Victorville, Hesperia, Adelanto, Spring Valley Lake, Oak Hills, Phelan, Barstow

East Valley East Fontana, Rialto, Bloomington, Colton, Grand Terrace, San Bernardino, Loma Linda, Redlands, Yucaipa, Highland

West Valley West Fontana, Chino Hills, Chino, Ontario, Upland, Rancho Cucamonga, Etiwanda

Morongo Basin Yucca Valley, Joshua Tree, 29 Palms

Mountain Region Big Bear, Sugar Loaf, Lake Arrowhead, Lucerne Valley

3. Priority Population

The target population includes 400 adults with SMI many of whom may also be experiencing homelessness, justice involvement, or co-occurring substance use disorders. Services must be trauma-informed and recovery focused. Individuals living with complex and significant behavioral health needs who require the highest level of services and are willing to engage in frequent, intensive, community-based contacts.

a. ACT may be appropriate for Medi-Cal members who:

i. Are over the age of 18.

ii. Have a diagnosis consistent with SMI or co-occurring SMI and substance use disorder (SUD), according to current Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Statistical Classification of Diseases and Related Health Problems criteria and as determined by a clinician.

iii. Have significant functional impairment, defined as one or more of the following:

a) Consistent inability to perform practical daily tasks needed to function in the community such as maintaining personal hygiene; meeting nutritional needs; caring for personal business affairs; obtaining medical, legal, and housing services; recognizing and avoiding common dangers or hazards to oneself and one’s possessions.

b) Persistent or recurrent failure to perform daily living tasks, except with significant support or help from others such as friends, family, or relatives.

c) Consistent inability to be employed at a self-sustaining level or to carry out homemaker roles; and/or

d) Inability to maintain a safe living situation (e.g., repeated evictions or loss of housing, or under a mental health (Lanterman-Petris-Short [LPS] conservatorship); and

iv. Have an indicator of continuous, high-service needs, as evidenced by one or more of the following:

a) High use of psychiatric hospitalization or psychiatric emergency services. Intractable (persistent or recurrent) severe major symptoms (e.g., affective, psychotic, suicidal);

b) Co-existing SUD of significant duration;

c) High risk or a recent history of being involved in the criminal justice system; o Living in sub-standard housing, experiencing homelessness, or at imminent risk of becoming homeless;

d) Clinically assessed to be able to live more independently if intensive services are provided; and/or

e) Inability to participate in office-based services.

c. Requirements for ICM:

i. Adults 18 and over

ii. Significant impairment, where impairment is defined as distress, disability, or dysfunction in social, occupational, or other important activities.

iii. Frequent inpatient psychiatric care or emergency department visits (e.g., 30+ days inpatient in 12 months).

iv. Chronic homelessness or recent release from incarceration.

v. History of arrest, conviction, probation, or parole.

ACT is typically not appropriate for members solely diagnosed with SUD, personality disorder(s), or intellectual/development disabilities (I/DD), however a portion of the individuals served may have co-occurring disorders.

4. Assessment in which Providers shall use their clinical expertise to complete initial assessment and subsequent assessments in accordance with each member’s clinical needs and generally accepted standards of practice. The diagnosis, current mental status, medication history, and assessment of relevant conditions and psychosocial factors affecting the member’s physical and mental health must be completed by a provider operating within their scope of practice under California state law, who is licensed, registered, waivered, and/or under the direction of a licensed mental health professional.

a. Maintain flexibility to increase service intensity in response to client need.

b. Ensure service delivery is flexible, culturally responsive and field-based including community settings, housing and other locations where individuals naturally spend time. Level of care must be determined by utilizing the LOCUS and services must match the level of care requirement under the evidence-based practice model.

c. Have access to participants in psychiatric in-patient facilities and participate in client case conference and treatment planning.

d. Provide symptom assessment, case management and supportive counseling.

e. Provide ongoing assessment of participant needs to include vocational and educational needs.

f. Provide appropriate psychoeducation regarding participant mental illness and medication management.

g. Have rapid and flexible response to participant crisis.

h. Provide support to the maximum extent possible for client needing screening, extended crisis evaluation bed, crisis housing, short-term care and inpatient treatment.

i. Provide services in the areas of medication prescription, administration monitoring and documentation.

j. Multidisciplinary team psychiatrist will assess all participant not already linked to a provider, prescribe medication, regularly review client progress and monitor, treat and document any medication side effects.

k. The multidisciplinary team will ensure that the participant obtains and maintains the basic necessities of life, including but not limited to safe, clean, and affordable housing, food and clothing, medical and dental services, appropriate financial support in participant access to their entitlements, social services, transportation and legal advocacy and representation.

l. The multidisciplinary team will develop and support client participation in recreational and social activities and relationships.

m. The highest priority shall be given to supporting and helping individual participants to establish positive social relationships and activities in normative community settings.

Such services shall include but are not limited to assisting clients in:

i. Developing social skills and where needed, the skills to develop meaningful personal relationships.

ii. Planning appropriate and productive use of leisure time including familiarizing participants with available social and recreational opportunities and increasing their use of these activities;

iii. Interacting with landlords, neighbors and others effectively and appropriately;

iv. Developing assertiveness and self-esteem;

v. Using existing self-help centers, self-help groups and other social, church and recreational groups to combat isolation and withdrawal experienced by many persons coping.

n. Mental health services and supports include, but are not limited to:

i. Peer support.

ii. Supportive services to assist the client, and when appropriate the client’s family, in obtaining and maintaining employment, housing, and/or education.

iii. Wellness Centers.

iv.…