RFP 4164 SBHC Behavioral Health Therapists QI_R.docx.pdf

RFP 4164 – SBHC Behavioral Health Therapists

Vendor Questions/Inquiries and Responses 1: Can MMSD provide historical utilization, payer mix, reimbursement, and denial-rate data demonstrating that insurance billing has historically covered the costs exceeding the district's $60,000 contribution per therapist?

RESPONSE: Of data requested, utilization and payer mix from the past two school years are available:

Intended Outcome 2025-26* 2024-25 Total # of students served 174 112 Total # of sessions provided 1584 1321 Public Insurance Type (BadgerCare/Medicaid)

68% 69.8%

Insurance Type (Private) 26% 25.8% Uninsured 6% 4.4%

*Data based on 3 therapists working across 4 schools until 4th therapist was hired and started in early December

Importantly, the model remains agnostic to student insurance status: students may access services whether they are publicly insured, privately insured, uninsured, or experiencing gaps in coverage. The partner agency provides financial assistance for families without insurance. This approach is essential to the equity purpose of the program because students with the greatest mental health needs may also experience the greatest barriers to community-based care, including insurance limitations, transportation challenges, caregiver availability, and provider shortages.

2: If insurance reimbursements are insufficient to cover the remaining therapist costs, is the provider expected to absorb the shortfall, or are there any district-funded mechanisms to address funding gaps?

RESPONSE: Each party is fully responsible for covering their 50% of the direct costs. Each party is also expected to do their own fundraising in order to cover any potential shortfalls in meeting this expectation. Given the collaborative nature of this partnership, MMSD will closely work with the vendor to fundraise and build community support for this program. We understand the dynamic nature of revenue cycles and see financial sustainability as a joint effort. MMSD’s contribution to the clinic’s shortfall is negotiated on a year by year basis, through the MOA development process, and is dependent on meeting fundraising goals.

3: What activities does MMSD consider "non-reimbursable services" covered by the

$60,000 payment, and what percentage of a therapist's expected workload falls within those non-billable activities?

RESPONSE: Our ultimate program goal is for our SBHC therapists to spend 80% of time in direct, reimbursable services. That leaves 20% of time for non-billable activities.

MMSD funds the non-billable components necessary for effective school-based integration.

These include care coordination, consultation with teachers and student services staff, collaboration with Student Services teams, family/provider communication, and program administration. These services are critical to ensuring that clinical care is not simply located in a school building, but meaningfully integrated into school systems that support student well-being, attendance, belonging, engagement, and readiness to learn.

4: Can the district please provide incumbent information and current bill rates for contracts in place for similar services?

RESPONSE: Current partner agency is UW Health Behavioral Health Youth & Family. This RFP mirrors current contract rates.

5: What licensure credentials are acceptable (LCSW, LPC, LMFT, Psychologist, etc.)?

RESPONSE: Vendor agency will be responsible for monitoring therapist credentials.

Behavioral health therapists must hold appropriate licensure for practice in Wisconsin from the State of Wisconsin Department of Safety and Professional Services. Vendor agency will also be responsible for ensuring appropriate therapist credentialing for insurance billing and reimbursement.

6: Will therapists provide individual counseling only, or also group counseling, crisis intervention, and family support services?

RESPONSE:

The SBHC therapist is a licensed mental health provider who delivers primarily individual behavioral health interventions and occasionally may offer group interventions that reflect a culturally responsive approach that facilitates the connection of students and families with their ‘natural supports’, strengths, and culturally specific resources.

Crisis intervention occurs on an as needed basis.

7: What gaps in behavioral health services is MMSD most trying to address through this solicitation?

RESPONSE: Continuation of established program: Embedded therapists from a community agency provide specialized mental health and substance use disorder (AOD) interventions for students who experience systemic barriers to community-based care, including limited insurance coverage, transportation challenges, and language access needs.

Target populations for services include students who have significant behavioral health concerns that are interfering with learning and engagement and have barriers to accessing supports in our community. Services are integrated with the school's social-emotional and behavioral supports. Community-based behavioral health professionals team with school-based staff on site at the selected schools to provide specialized support. By providing such services at the school, more students will receive the treatment they need, thereby improving student availability for learning.

8: What are the expected caseload and productivity metrics?

RFP 4164 – Request for Proposal for School-Based Health Centers (SBHC): Behavioral Health Therapists (Inquiries/Questions and Responses)

RESPONSE: BHA Clinician is expected to effectively deliver responsive, flexible, and integrated services that meet caseload expectations (anticipated caseload of 32-40 students; 40-60 students seen yearly).

Vendor is able to effectively deliver responsive, flexible, and integrated services that meet caseload and billable hours expectations in order to support the financial sustainability of the program. Caseload and total students served varies depending on presenting issues, school context/needs, and availability of effective referral pathways.

9: Does MMSD expect the awarded vendor to bill Medicaid or other third-party payers?

RESPONSE: Yes

10: What documentation is required to support reimbursement requests?

RESPONSE: The mental health agency directly bills the student’s insurance company.

In addition, The District shall pay the Provider upon submission of monthly invoices as stated in the invoices. Provider will note the clinician FTE provided during the applicable month in each invoice.

11: Will the district review other service classifications if submitted with the vendor proposal?

RESPONSE: No

12: What are the district expectations of contract providers to assist in Medicaid reimbursement documentation services?

RESPONSE: The mental health agency directly bills the student’s insurance company.

FROM VENDOR CONFERENCE HELD ON 7/30

13: Does crisis intervention include only identified clients or any student within the school? Does crisis intervention include time outside of a scheduled session?

RESPONSE: Crisis interventions are for identified clients on the therapist’s caseload. Crisis intervention may occur outside of session time within reason while honoring the therapist's already scheduled clients.

14: Is it direct billing to Medicaid?

RESPONSE: Yes

15: Is the caseload expectation of 32-40 students per therapist? Is this number variable based on the needs of the students?

RESPONSE: There is an expected caseload of 32-40 students per 1.0 FTE therapist at each school. Caseloads and total students may vary depending on the presenting issues, school needs, and the effectiveness of the referral pathways. Caseload numbers and billable hours are also dependent on the vendor's ability to support financial sustainability of the program.

16: Are non-billable hours including regularly scheduled meetings with teachers and student service teams, and individual student case consults? Are therapists expected to attend IEP meetings for students on their caseload and is this included in the non-billable hours?

RESPONSE: At this time, expectations are set at 80% direct, reimbursable patient hours and 20% non-billable patient hours as this program is continuing to emerge and adapt. At a minimum, providers are expected to hold weekly check in meetings with their school’s coordinator to discuss operations and coordinate caseloads. Additional required non-billable commitments include quarterly site visit meetings and program-wide implementation meetings. Other non-billable hours vary based on caseload and school specific needs.

Because this program relies on an embedded service model, providers are expected to integrate closely with school teams. When invited to an IEP meeting for a student on their caseload, providers should coordinate attendance with their school coordinator while balancing their existing session schedule.

17: Is the insurance coverage data provided in question 1 an accurate representation of the district as a whole?

RESPONSE: This model remains agnostic to student insurance status: students may access services whether they are publicly insured, privately insured, uninsured, or experiencing gaps in coverage. The partner agency provides financial assistance for families without insurance. This approach is essential to the equity purpose of the program because students with the greatest mental health needs may also experience the greatest barriers to community-based care, including insurance limitations, transportation challenges, caregiver availability, and provider shortages. Due to the equity purpose of this program, the payer mix may not represent the district as a whole. That being said, the payer mix has remained stable over the years of the program.

18: Have there been times where there have not been enough clients referred to meet the full time caseload expectation?

RESPONSE: Referral pathways are jointly worked on with both the district and the provider agency. Based on the data from the past school year (shared in question 1), caseloads have been fairly adequate. The number of students served and total session numbers have increased each year of the program.

Vendor agencies may have differing thresholds for caseload and billable hours metrics they find financially sustainable. Billable hours during summers and holiday breaks tend to be substantially reduced compared to times when school is in session.

19: How are barriers to participation in the program (including referrals, paperwork completion, caregiver communication, and intake scheduling) handled? What is the expectation of the agency to problem solve and what role does the school team play?

RESPONSE: Caseload numbers are a joint responsibility. The school team and provider are expected to work together to problem solve within this embedded model.