RFR for BH Treatment and Referral Platform.docx

Commonwealth of Massachusetts Executive Office of Health and Human Services

Request for Responses for a Behavioral Health Treatment and Referral Platform

Issue Date: May 24, 2022

Document Number: 22EHSBHTRPSRFR

Bid Number: BD-22-1039-EHS01-EHS01-74235

This procurement is subject to the World Trade Organization Government Procurement Agreement, established January 1, 1996, to encourage worldwide trade by ensuring fairness, non-discrimination, and equal treatment of laws, regulations and procedures in the government procurement process. View WTO notice here.

Table of Contents

SECTION 1. INTRODUCTION AND BACKGROUND

1.1 Overview and Background

The Executive Office of Health and Human Services (EOHHS) is seeking responses from qualified Bidders to implement, maintain, and support a Behavioral Health Treatment and Referral Platform (BH TRP).

The Commonwealth is seeking a vendor to improve operational efficiencies among providers, health insurance carriers, and the Commonwealth by automation of the referral screening process to move patients more quickly through the emergency department (ED) evaluation and referral process for those seeking behavioral health (BH) treatment, reducing the length of stay in EDs by:

· Enabling the electronic transmission of standardized admissions information: The BH TRP software being procured will replace a highly manual process, minimizing the need for phone calls, fillable .pdfs, email-based systems, and faxing. This will support the routine inpatient psychiatric and community based acute treatment admissions process as well as the Department of Mental Health (DMH) Expedited Psychiatric Inpatient Admission (EPIA) process.

· Creating a real-time, transparent view of behavioral health patients referred to inpatient psychiatric treatment and community based acute treatment: Stakeholders (EDs, inpatient psychiatric facilities, health insurance carriers (“carriers”), and state agencies) will have a real-time, transparent view of behavioral health patients in EDs across the state. Different stakeholders will have access to certain (applicable to them) identifiable or de-identified information, as appropriate.

Massachusetts continues to experience significant challenges with patients waiting in EDs for inpatient psychiatric admission (otherwise known as “boarding”) and other treatment for their behavioral health condition, including community based acute treatment. In response, Massachusetts developed the Expedited Psychiatric Inpatient Admission (EPIA) policy, which aims to streamline communication across all stakeholders, reduce the length of stay in the ED for behavioral health patients needing an inpatient level of care, ensure that no one is boarding without an advocate, and establish baseline information for behavioral health patients with long stays in EDs for monitoring and policy purposes.

Entities (referred collectively herein as “participant organizations”) within the scope of this project, as further identified in RFR Attachment 5, will include:

· All acute care hospitals with emergency departments in Massachusetts

· All providers in the statewide behavioral health crisis intervention system that provide 24/7/365 assessment and stabilization help for those experiencing a mental health or substance use disorder crisis

· All Massachusetts psychiatric units and freestanding psychiatric facilities in Massachusetts

· All health insurance carriers in Massachusetts

· MassHealth and its contracted Managed Care Entities (MCEs) and PACE

· Department of Mental Health (DMH), Department of Children and Families (DCF), Department of Developmental Services (DDS), Department of Youth Services (DYS); and other agencies within the Executive Office of Health and Human Services secretariat, as needed or determined

The EPIA Protocol seeks to engage all stakeholders in finding the appropriate placement for behavioral health patients awaiting admission by instructing EDs and behavioral health crisis intervention providers to notify carriers that one of their members is awaiting inpatient psychiatric admission or community based acute treatment, and request assistance from the carriers as well as the behavioral health crisis intervention providers in finding a bed within twenty-four (24) hours. If the carrier and the treating provider(s) cannot secure appropriate inpatient or community based acute treatment within sixty (60) hours, or as otherwise required in accordance with the current EPIA Protocol (3.0), the case is escalated to DMH for additional engagement.

While there have been improvements since implementing this process, challenges remain. EPIA is currently a fully manual process that lacks a centralized and consistent source of information. This means that ED staff must take time away from patient care and bed searches to detail information that carriers, MassHealth and its MCEs and PACE organizations will need for their own searches, as required by the EPIA Protocol. The information provided to carriers and hospitals may be provided through a variety of avenues, including phone calls, emails, and faxes—increasing the risk of missing vital information on a particular case and providing such information inconsistently, which hinders data collection efforts.

EOHHS is soliciting competitive responses for a Behavioral Health Treatment and Referral Platform that will support automation of the ED BH referral screening, evaluation, and referral process, enable the electronic transmission of standardized admissions information (“Admissions Packet”), and create a real-time, transparent view of patients seeking BH treatment for participant organizations.

Specifically, EOHHS seeks to implement a cloud-hosted, industry-standard software solution to enable the participant organizations in this process to more efficiently and effectively perform the following functions:

· Identify patients with a psychiatric diagnosis waiting in a Massachusetts ED seeking inpatient psychiatric treatment and/or community based acute treatment. Provide visibility at any point in time into who is waiting, at which facility, and for how long. It is envisioned that this would be supported by an ED Dashboard containing information about patients awaiting inpatient psychiatric and/or community based acute treatment placement allowing participant organizations to maintain an active queue of patients while decreasing administrative processes for patients who have not yet been placed and further, will enable the tracking of those patients who have been stabilized and diverted.

· Communicate and share required information and referral forms as part of the admissions process for inpatient psychiatric treatment or community based acute treatment and in compliance with the DMH EPIA process, including the transfer of Admissions Packets between relevant stakeholders.

· Enable robust, on-demand analytics and reporting to identify current and past boarding trends that can inform workflows and policies that lead to better patient care.

· Allow for integration with technology partners, including connection to the Statewide Event Notification Service (ENS) Framework, and integration with future bed finding solutions to show where available beds, including but not limited to, psychiatric treatment beds (including inpatient and other levels of care) exist for expedited placement.

· Safeguard confidential information received, stored, and transmitted and permit access to information minimally necessary to accomplish the objectives above to participant organizations based on applicable federal and state privacy and security laws as well as contractual obligations such as business associate agreements.

The Commonwealth seeks a Vendor that will (i) implement and/or leverage its existing relationships with organizations participating on the platform (including but not limited to, those identified in RFR Attachment 5), and implement and manage all necessary contractual arrangements such organizations, including but not limited to participation or business associate agreements, and (ii) accommodate potential billing structures where such organizations may be billed directly by and make payment to Vendor for such organizations use of the platform.

1.2 Definitions

The following terms and acronyms are used throughout the RFR and shall have the meaning stated in this section, unless the context clearly indicates otherwise.

Admission Packet: standardized data set used to inform and support the Expedited Psychiatric Inpatient Admission Protocol 3.0 (EPIA). See EPIA 3.0 Protocol Attachment 1, attached here to as RFR Attachment 3.

ADT: refers to the HL7 ADT (Admission, Discharge, Transfer) event notification data standard.

American Rescue Plan Act (ARPA): federal law (H.R. 1319) § 4001, enacted on March 11, 2021, including §9901, which created the Coronavirus State Fiscal Recovery Fund (FRF) and all other sections and related regulations promulgated thereunder which authorize and govern the ARPA programs.

Behavioral Health Crisis Intervention System: refers to the community providers and facilities that support the 24/7/365 statewide mobile and community-based crisis assessment and intervention.

Bidder: an entity that submits a Bid or Response to this EOHHS BH Treatment and Referral Platform RFR.

Change Order or Change Request: a written amendment to the SOW, directing the Bidder to change the contract price, Requirements, or project schedule. Such changes must be within the scope of the SOW and this RFR.

COMMBUYS: the Commonwealth of Massachusetts' sole online procurement record site.

Commonwealth Data: all data used or owned by EOHHS or the Commonwealth to which the Bidder gains access through a contract resulting from this RFR.

Deliverable: any work product that Vendor delivers for the purposes of fulfilling its contractual obligations.

Department of Children and Families (DCF): strives to protect children from abuse and neglect and supports young adults, age 18-22, who are transitioning from DCF custody to independent living. DCF works toward establishing the permanency and well-being of children by providing supports and services to families at home when it is safe to do so. When necessary, DCF provides foster care and, if parental reunification is not possible, finds new permanent families through kinship, guardianship or adoption.

Department of Developmental Services (DDS): provides an array of supports for individuals with intellectual and developmental disabilities including Autism Spectrum Disorder to enhance opportunities to become fully engaged members of their community. Among other things, DDS operates three home and community based services waivers for adults with intellectual disabilities so they can live in their communities, as well as an Autism Waiver Program for eligible children.

Department of Mental Health (DMH): assures and provides access to services and supports to meet the mental health needs of individuals of all ages; enabling them to live, work and participate in their communities. DMH oversees 27 site offices in 5 different geographic areas across the Commonwealth. In addition, DMH operates 4 Continuing Care facilities at Worcester Recovery Center, Taunton State Hospital, The Hathorne Units at Tewksbury State Hospital, and the Metro Boston Mental Health Units at Lemuel Shattuck Hospital. DMH also operates six Community Mental Health Centers in Boston, Brockton, Fall River, and Cape Cod.

Department of Youth Services (DYS): a multi-faceted agency that serves youth committed as juvenile delinquents or youthful offenders and detained youth awaiting judicial action. All DYS programs address the unique educational, psychological and health needs of youth in our care and custody across a continuum of supervision and services. Dividing the state geographically into five regions, DYS operates (as of September 2018) 48 residential programs ranging in security levels and 22 district offices strategically located in each region to provide comprehensive supervision and support to DYS committed and detained youth. DYS strives to serve youth as close as possible to their home communities and families.

Executive Office of Health and Human Services (EOHHS): the largest secretariat in state government, EOHHS services directly touch the lives of more than 1 in 4 residents in the Commonwealth. EOHHS provides access to medical and behavioral health care, substance use treatment, long term services and supports, and nutritional and financial benefits to those with low incomes. EOHHS connects individuals to housing and supportive services. EOHHS supports individuals who are developmentally disabled, mentally ill, blind, deaf, or hard of hearing. EOHHS oversees 12 constituent agencies, including the Department of Mental Health (DMH), the MassHealth program, the Department of Developmental Services (DDS), the Department of Children and Families (DCF) and the Department of Youth Services (DYS).

Expedited Psychiatric Inpatient Admission (EPIA): Escalation Protocol for Securing Appropriate Placement for Individuals Boarding in Emergency Departments who require Inpatient Psychiatric Hospital Level of Care (For further information, please see EPIA 3.0, attached hereto as RFR Attachment 3)

EOHHS IT: EOHHS’ Information Technology Unit that provides a range of centralized IT services for EOHHS and its constituent agencies.

Executive Office of Technology and Security Services (EOTSS): provides a range of centralized IT services; oversees IT policies, standards and architecture; and promotes cross-agency collaboration and adoption of shared services.

Fast Healthcare Interoperability Resources (FHIR): emerging HL7 standard using web services, defines how healthcare information can be exchanged between different computer systems regardless of how it is stored in those systems.

Coronavirus State Fiscal Recovery Fund: the Coronavirus State Fiscal Recovery Fund (FRF) established under Section 9901 of ARPA that funds state, local, and Tribal governments across the country to support their response to and recovery from the COVID-19 public health emergency.

HL7: standards used to transfer and share data between various healthcare providers.

Insurance Carrier: any commercial payer registered in the Commonwealth of Massachusetts.

Key Personnel: personnel directly responsible for management of the contract; or those personnel whose professional/technical skills are determined to be essential to the successful implementation of the contract.

Length of Stay: the amount of time (measured in hours) that a patient has spent in an emergency department awaiting psychiatric admission or placement. This time frame starts from the moment of admission to the emergency room and ends when a patient leaves the emergency department.

Maintenance and Operations Support Services: technical support services for the operation and maintenance of the BH TRP.

MassHealth: the medical assistance and benefit programs administered by the MassHealth agency pursuant to Title XIX of the Social Security Act (42 U.S.C. 1396a et seq.), Title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.), M.G.L. c. 118E, and other applicable laws and waivers to provide and pay for medical services to eligible members.

MassHealth Managed Care Entity: an entity contracted with EOHHS as a Managed Care Organization, Accountable Care Organization, One Care Plan, Senior Care Organization, or the MassHealth Behavioral Health Vendor.

Mobile-friendly: all web-based applications provide information, including text, images, video, and links, that is easily and readily accessible across all different platforms and, most particularly, on the much smaller screen of smartphones and tablets.

Patient: in the context of this project, it is defined as any person, including a child/adolescent, who is in a Massachusetts Emergency Department (ED) or statewide behavioral health crisis intervention system, and who requires inpatient psychiatric, or community based acute treatment level of care.

Programs of All-inclusive Care for the Elderly (PACE): the Programs of All-inclusive Care for the Elderly (PACE), as described in 42 CFR 460 and 130 CMR 519.007(C): Program of All-inclusive Care for the Elderly (PACE).

Project Managers: individuals from EOHHS and Bidder identified and designated as Project Managers shall perform project management on behalf of EOHHS and Bidder under the agreement.

Request for Responses or RFR: shall refer to this RFR (document number 22EHSBHTRPSRFR) procurement specification and referenced documents.

Requirements: the technical and functional requirements for the BH TRP incorporated into in Section 3 of this RFR.

Response or Bid: any information submitted by the Bidder in response to the Requirements outlined in this RFR, including any clarifying information provided by the Bidder if requested by EOHHS.

Services: shall mean the activities engaged in by Bidder for the purpose of fulfilling its obligations under the terms of this RFR, which may or may not result in the creation of a Deliverable.

Software-as-a-Service (SaaS): a component of cloud computing, software licensing and delivery model in which software is licensed on a subscription basis and is centrally hosted.

Solution Architect: individual from the Bidder that is responsible for the design and development of the applications or services.

Statement of Work or SOW: a contract resulting from this procurement governing the design, development, implementation, maintenance and support of the BH TRP. A template SOW is attached hereto as Attachment 1.

Task: a material activity engaged in by Bidder for the purpose of fulfilling its obligations to EOHHS under the terms of this RFR, which may or may not result in the creation of a Deliverable.

Vendor or Selected Bidder or Contractor: Bidder who is selected and executes a contract or agreement under this RFR.

1.3 General Procurement Requirements

EOHHS is issuing this RFR in accordance with the provisions of 801 CMR 21.00 which governs the procurement of services by state agencies and requires a competitive procurement process, including the issuance of an RFR, for acquisitions of commodities and services. For reference see https://www.mass.gov/files/documents/2017/11/07/801cmr21.pdf.

Words used in this RFR shall have the meanings defined in 801 CMR 21.00. Unless otherwise specified in this RFR, all communications, responses, and documentation must be in English, all measurements must be provided in feet, inches, and pounds and all cost proposals or figures in U.S. currency.

This Request for Response (“RFR”) does not commit the Commonwealth of Massachusetts (“Commonwealth”) to enter into a Statement of Work or to pay any costs incurred in the preparation of the Bidder's Quote or contract for products or services.

EOHHS reserves the right to accept or reject any and all proposals received as a result of this RFR, and to contract for some, all or none of the products and services as a result of this RFR. EOHHS further reserves the right to negotiate with any or all qualified Bidders and to cancel in part or in its entirety this RFR if it is in the best interest of EOHHS or the Commonwealth of Massachusetts to do so.

EOHHS reserves the right to amend this RFR at any time prior to the date Responses are due. Any such amendment shall be posted to the Commonwealth’s procurement website, COMMBUYS, at www.commbuys.com. Bidders are reminded to check the COMMBUYS site regularly, as postings to this site shall be the sole method used for notification of changes as well as for any clarifications of the RFR that EOHHS might issue.

All Responses and related documents submitted in response to this RFR become public records and are subject to the Massachusetts Public Records law, M.G.L. c.66, §10 and M.G.L. c.4 §7, subsection 26. Any statements in submitted Responses that are inconsistent with these statutes shall be disregarded.

All Response submissions, regardless of whether a contract is awarded to a particular Bidder, become the property of EOHHS. EOHHS shall not return to Bidders any proposals or materials they submit in response to this RFR.

The Selected Bidder shall sign the Commonwealth’s Standard Contract Form to which the Statement of Work (SOW) will be attached and that incorporates this RFR as well as the Selected Bidder's Response. A template SOW is included as Attachment 1 to this RFR, however this SOW is a representative form only and the terms are subject to change depending upon the scope of work and selected application. The order of precedence of contract documents comprising the agreement between EOHHS and the Selected Bidder shall be as follows: (1) the Commonwealth Terms and Conditions for Information Technology Contracts; (2) the Commonwealth’s Standard Contract Form; (3) this RFR; (4) the Data Management and Confidentiality Agreement (DMCA); (5) the SOW; (6) any other terms negotiated by the parties including any Task Orders or Change Orders; (7) any documentation submitted by the Selected Bidder in connection with a presentation, request for a technical correction, clarification or BAFO, and the Selected Bidder’s response thereto; and (8) Selected Bidder’s Response to the RFR.

The order of precedence above is nonnegotiable. Bidders that do not agree with this order of precedence should not respond to this RFR. If there are conflicting provisions among the documents that make up the agreement, the order of precedence as listed above shall apply. The provisions of the Commonwealth Terms and Conditions for Information Technology Contracts, the Commonwealth Standard Contract Form and the Statement of Work are mandatory and non-negotiable.

As set forth in the template SOW, the Selected Bidder, prior to commencing work, shall:

a) Ensure that all staff assigned to the project comply with the Intellectual Property and Work Effort Agreement for Vendor's Employees, Contractors and Consultants and Agents terms as set forth in the SOW; and

b) Agree to and ensure all staff abide by the “Data Management and Confidentiality Agreement” (DMCA) included herein as Exhibit B to RFR Attachment 1 (the template SOW) (this document is not to be submitted with the Bidder's Response to this RFR).

This RFR seeks services to implement, maintain, and support a BH Treatment and Referral Platform (BH TRP) for participant organizations. The Requirements are set forth in Section 3.

It is anticipated that the SOW resulting from this RFR will be funded, in whole or in part, using federal assistance provided to the Commonwealth of Massachusetts by the U.S. Department of the Treasury under Section 9901 of the American Rescue Plan Act of 2021 (“ARPA”), which established the Coronavirus State Fiscal Recovery Fund (“FRF”). In accordance with Section 9901 of ARPA, the U.S. Department of the Treasury’s regulations implementing the FRF (31 CFR Part 35), the Award Terms and Conditions,[footnoteRef:2] and the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, 2 C.F.R. Part 200, the terms and conditions set forth on Attachment A to the SOW (“ARPA FRF Terms and Conditions”) will apply to the Selected Bidder in connection with its performance of the SOW. [2: The Award Terms and Conditions are available at the U.S. Treasury’s website at https://home.treasury.gov/system/files/136/Financial-Assistance-Agreement-States-and-Territories.pdf]

In addition to the other certifications contained or referenced in this RFR, by submitting a Response, the Bidder certifies that: 1) it has reviewed the ARPA FRF Terms and Conditions; and 2) if the Bidder is selected to enter into a SOW as result of this RFR, the Bidder will be bound by and comply with the ARPA FRF Terms and Conditions and will execute and comply with any amendment to the SOW deemed necessary or appropriate by EOHHS to comply with ARPA, 31 CFR Part 35, the Award Terms and Conditions, 2 C.F.R. Part 200, or U.S. Treasury guidance regarding FRF-related compliance.

Bidders are prohibited from communicating directly with any employee or contractor of the Commonwealth concerning this RFR except as specified in Section 4.1.1, and no other individual Commonwealth employee or representative is authorized to provide any information or respond to any question or inquiry concerning this RFR, for any purpose.

All Responses shall be submitted in accordance with the bid process specified in Section 4. Responses must provide a complete solution to the Requirements, in accordance with Section 4, with all costs included. Any exceptions must be specifically addressed in the Bidder’s Response.

Acquisition method: Fixed price.

Single or multiple vendor(s): Single.

Use of Procurement by single or multiple agencies: The BH TRP, and this procurement or any resulting contract(s) will be used by other EOHHS agencies as appropriate and should be of a scalable nature to allow multiple agencies to participate at the discretion of the Commonwealth.

Anticipated Payment Structure: see Section 1.4.

1.4 Payment

For implementation, payment will be on a fixed price basis with payment based on the proposed Detailed Project schedule and Deliverables list requested in Section 4.3.2.4, less a 10% reserve to be paid at the conclusion of a successful 90-day warranty period. EOHHS anticipates payment will cover the platform implementation and training, as set forth in Section 3.3 of this RFR and including the first-year licensing, reporting, and support fees for the identified participant organizations.

For software licensing and maintenance and support services, payment will be annually, on a fixed price basis. It is expected that organizations participating on the platform will pay their respective, ongoing licensing, maintenance and support fees. The Bidder will be responsible for establishing, updating and managing contractual arrangements with the organizations participating on the platform and should be capable of contracting with and billing the participant organizations directly.

Invoices shall be paid according to the Commonwealth's bill paying terms (See: Commonwealth of Massachusetts, Office of the Comptroller, Bill Paying Policy and General Payment Policies, last revised May 19, 2011). Bidders must provide hourly rate information for Key Personnel and additional personnel as set forth in the Cost Response Sheet.

1.5 Anticipated Term of Statement of Work

The SOW that may result from this RFR shall have an initial term of two (2) years and may be extended for an additional eight (8) years, in any time increment, at the discretion of EOHHS.

1.6 Changes in Requirements/Additional Requirements

EOHHS shall have the option, at its sole discretion, to modify, increase, reduce or terminate any requirement or activity related to the SOW resulting from this RFR whenever, in the judgment of EOHHS, the goals of the project have been modified or altered in a way that necessitates such changes.

EOHHS may determine that additional work products or new initiatives are necessary to accomplish the objectives of this RFR, or that certain items are not required or shall be substantially modified. The Selected Bidder and EOHHS may negotiate Change Orders to the SOW that are in the best interest of the Commonwealth. If additional funds become available, EOHHS reserves the right to increase the maximum obligation under this RFR subject to available funding, satisfactory contract performance, and service needs.

EOHHS shall provide prior written notice of any necessary or desired Change Orders or additional work products or new initiatives to the Selected Bidder, and the parties shall negotiate the effect of such changes in Requirements on the schedule and payment terms. No compensation shall be owed, nor credits given, until the parties reach agreement on the Change Order. Such Change Order, when approved, shall detail the changes, including tasks and deliverables if applicable; the cost impact (if any); and the timeline impact (if any). Any Change Order(s) must be executed as a written amendment to the SOW as described in Section 8 of the template SOW attached hereto as Attachment 1.

SECTION 2. BIDDER QUALIFICATIONS

2.1 Firm Qualifications

Bidders shall provide personnel with significant project management experience to drive development and implementation towards completion under tight timelines as well as manage operations once implemented. Prior knowledge of the healthcare data exchange and management solutions including relevant federal and state privacy and security laws and regulations, in addition to experience working with Software-as-a-Service (SaaS) solutions is mandatory. Bidders shall provide further information regarding its qualifications as set forth in Section 4.3.2 as part of the Programmatic/Technical Response.

2.2 Subcontractors

The use of subcontractors is permitted as set forth in this RFR and the SOW, and Bidder subcontractors shall be subject to the same firm qualifications as the Bidder itself (set forth in Section 2.1). The Selected Bidder shall be fully responsible for the satisfactory performance and adequate oversight of its subcontractors. Subcontractors are required to comply with the same federal and state laws and regulations and applicable Requirements as the Selected Bidder. EOHHS reserves the right to reject any subcontractor the Selected Bidder may propose. Bidder shall provide further information regarding its subcontractor(s) qualifications as set forth in Section 4.3.2 as part of the Programmatic/Technical Response.

2.3 Staff Qualifications

The qualifications of Key Personnel shall be considered in evaluating a Bidder's Response. These individuals may be invited to participate in Bidder interviews as part of the evaluation process.

For this project, the only required Key Personnel are the Bidder Project Manager and the Bidder Solution Architect. Bidders are encouraged to propose additional Key Personnel to demonstrate the strength of their implementation team. All Key Personnel proposed shall be subject to the following restrictions:

· Any changes in Key Personnel during the term of the project shall be approved by EOHHS.

· Replacement Key Personnel shall have comparable training, experience and ability to the person originally proposed for the position.

Assessment criteria for Key Personnel include the following:

· Knowledge and understanding of healthcare data exchange and management solutions;

· Knowledge and understanding of applicable federal and state security and privacy requirements.

· Knowledge and understanding of Massachusetts ADA and Chapter 508 compliance; and

· Familiarity and experience with the successful implementation of a healthcare risk management system.

SECTION 3. PROGRAM REQUIREMENTS

This project will include several main tasks:

· Provision, customization, and configuration of software to implement the functionality required to implement the statewide Behavioral Health Treatment and Referral Platform

· Hosting and Operations of that software on a SaaS basis, including provision of a 24x7 helpdesk to address user questions and to enable emergency user authorization

· Implementation services at the various institutions and state agencies including technical integration, training, and support

3.1 Software capabilities

3.1.1 Program scope & capability requirements

EOHHS wishes to solicit competitive responses for a Behavioral Health Treatment and Referral Platform that will support automation of the ED BH screening, evaluation, and referral process, enable the electronic transmission of standardized admissions information, and create a real-time, transparent view of patients who require inpatient psychiatric treatment or community based acute treatment for participant organizations.

The platform will provide methods whereby acute care hospitals can communicate about patients who are in the emergency department awaiting inpatient psychiatric admission or community based acute treatment, including exchange of indicators automatically through HL7 interfaces with each Massachusetts hospital via Admissions, Discharge, Transfer (ADT) feeds. As automation may not be available for all facilities, the Selected Bidder will need to provide a secure and efficient way for users to log in to the platform and input the necessary information to support psychiatric boarding workflows.

The platform shall enable access to participant organizations real-time data on emergency department boarding, including length of wait, primary reason for wait, level of care required, type of insurance coverage and available data on patient age, race, ethnicity, preferred spoken language, disability, sex, sexual orientation, and gender identity (RELD/SSOGI). Additionally, the platform shall include single-sign-on (SSO) integration capability for a future, real-time behavioral health bed search solution that categorizes beds by care level, licensing authority, age restrictions and geographic location. All data collection, creation, receipt, storage, transmission and sharing on the platform shall be compliant with applicable state and federal privacy and security laws. Information used and shared shall be limited to those minimally necessary to achieve the objectives described herein.

An example data partner access and flow sheet are depicted below. This represents nominal data flows and data access needs across the participant organizations. EOHHS expects this model to be qualified and refined with stakeholder input on requirements and capabilities as part of the RFR evaluation and the Selected Bidder engagement process.

Graphic: Example Data Flow and Access

The Selected Bidder shall implement a solution with the following minimum required capabilities:

3.1.1.1 Patient Dashboard & Electronic Waitlist

a. Enable all parties, including MassHealth and DMH, as well as hospitals, insurance carriers, MassHealth MCEs and PACE, access to custom-configured dashboards on patient activity according to those identified as waiting in an ED, seeking inpatient psychiatric care and/or community based acute treatment.

b. Dashboards and data availability must be compliant with applicable state and federal privacy laws. This includes ensuring the end user view allows for appropriate protections and firewalls to limit personal health information for only those entities with necessary and allowable access to such data.

c. Dashboards will be made available to acute care hospitals, community-based crisis intervention teams and associated crisis stabilization units, psychiatric units in acute care hospitals and standalone inpatient psychiatric hospital facilities, carriers, MassHealth, MassHealth MCEs, PACE organizations and state agencies indicating the queue of patients/members who are currently waiting in an ED, seeking inpatient psychiatric treatment. The breadth of this list will depend on the entity viewing it: hospital EDs and community-based crisis intervention teams will see patients in their own facility/patients they are doing bed searches for, carriers, MassHealth, MassHealth MCEs and PACE organizations will see their members, and inpatient psychiatric facilities and DMH will see defined information for all patients in need of an inpatient placement and/or community based acute treatment.

d. ED Dashboards for patients awaiting inpatient psychiatric care and/or community based acute treatment will include patient information regarding demographic data, encounter information, contact information, boarding facility, insurance/MassHealth information and length of stay (LOS) while waiting in the hospital ED, primary and secondary diagnosis, barriers to placement, and placement status updates. ED Dashboards for patients awaiting inpatient psychiatric care must have the ability to update these data fields in real time, connecting to the electronic health record(s) and auto-populating from that source as much as possible.

e. The ED Dashboard will allow applicable and relevant participant organizations to maintain an active queue management for patients who are awaiting inpatient psychiatric treatment and/or community based acute treatment.

3.1.1.2 Platform for Admission Packet Preparation and Submission

a. Admission Packets, inclusive of minimum programmatic data to be determined by the State as set forth in EPIA 3.0 protocol, will be compiled through electronic health record data or uploads and made available for access by hospitals EDs, inpatient psychiatric hospitals, community-based crisis intervention teams, carriers, MassHealth and its MCEs, PACE organizations and DMH within a portal. (See RFR Attachment 3). Admission Packets will only be accessible by those who have the appropriate authorization to view such information under applicable privacy law including HIPAA.

b. In the case of inpatient psychiatric units in acute care hospitals and freestanding psychiatric facilities, Vendor will create and utilize a Patient Waitlist, consisting of a to-be-defined set of minimal patient data, which must be clicked by the organization, as detailed in paragraph c below, to establish a relationship and allow access to the full Admission Packet.

c. From the platform, inpatient psychiatric units and freestanding psychiatric hospitals can choose to “accept”, “accept for next available bed”, “decline” (with selected reason), or “request more information” on a patient. That status will then be reflected to the waitlist. If additional information is requested, the functionality must exist to send notification to the hospital ED and community-based crisis intervention teams with the requested information and to return the updated Admission Packet to the inpatient psychiatric unit once such information is added by the hospital ED or community-based crisis intervention teams.

3.1.1.3 Length of Stay (LOS) Management

a. Incorporate tools to allow participant organizations visibility on each patient’s length of stay while in the ED for behavioral health reasons. Tools should include the ability to filter patients based on length of stay, and other demographic fields. This allows care managers, social workers, ED managers, carriers, MassHealth and its MCEs, PACE organizations and state agencies to identify patients who need additional resources or assistance at a certain threshold in time during the ED stay.

3.1.1.4 ED Boarding Notifications

a. Notification functionality will allow identified participant organizations to receive notifications to designated personnel when patients are first arriving in the hospital ED seeking inpatient psychiatric care and/or community based acute treatment and when they pass a certain LOS threshold. This workflow alerts staff of potential cases where internal or external barriers are preventing admission to the appropriate setting. Notification requirements to carriers, MassHealth and its MCEs, PACE organizations and DMH will be optimized by automating any LOS threshold criteria.

a. Platform should support care coordination and transitions of care by enabling electronic routing of discharge information and any uploaded required forms from the hospital ED, community-based crisis intervention teams or inpatient psychiatric facility. Care team members can/will be alerted as patients transition through the continuum of care.

3.1.1.6 Reporting and Analytics

Certain users, including hospital users, insurance carrier users, MassHealth and its MCEs, PACE organizations and state users, shall have access to real time detail reports listing appropriate subsets or all of the patients awaiting placement. These reports must have the ability to be sorted and filtered by factors such as current location, age, LOS, diagnosis, placement barriers as defined by the behavioral health crisis intervention providers or other applicable participant organization(s) or as defined on the Admission Packet records.

a. Provide recurring reports on general boarding statistics, trend analysis on LOS and the indicators contributing to it, and active lists of patients currently waiting in hospital EDs for behavioral health reasons. Such reports must have the capability to stratify by age, length of stay, diagnoses, barriers to placement, boarding facility, and be able to add additional variables as the need arises.

b. Provide a real time view of current patients waiting in hospital EDs for behavioral health reasons that can be downloaded by users for further evaluation. In addition, data must be tabulated into standard reports that may include data regarding current and/or past patients boarding. The Contractor must be available to edit existing reports or create new reports expeditiously.

c. All data reporting and analytics should be configurable and easily customized by specific users based on their needs. Custom reporting should be delivered on scheduled intervals or on demand when a user would require such.

d. Provide authorized access to all data, including administrative data, to MassHealth, DMH, DCF, DYS, DDS, or other state agency and to allow export to appropriate data warehouses or data lakes.

3.1.1.7 Visibility to Available System-wide Behavioral Health Treatment Beds

a. Enable Single Sign On (SSO) integration to ensure seamless transition for users into a future bed availability platform of the Commonwealth’s choice to support insight into BH treatment bed availability, at a future date to be determined. Having access to this feature will expedite the placement of boarded patients by giving community-based crisis intervention teams, case management, payer, and state agency staff real-time visibility into where patients can be referred. SSO reduces the burden of users having to manage multiple logins, multifactor authentication, and password management. SSO also provides a streamlined process for organizations to manage account terminations through an integration with their active directory.

b. Enable secure, seamless transition of appropriate patient data to future bed availability platform in real-time, near-real-time, and scheduled batch functionality as per system and use cases.

3.1.2 Technical Requirements

To address the programmatic requirements of Section 3.1.1, EOHHS believes that the technical capabilities listed below are necessary. Bidders are requested to discuss each of these capabilities in their Responses and to explain how these capabilities will be implemented and utilized to address each of the programmatic requirements. In the event that one of more of these capabilities is not required to fulfill the programmatic requirements, please indicate that in the Response.

3.1.2.1 SaaS Solution and Operations

It is envisioned that the solutions represented in the Responses to this RFR will include a set of software operated on a SaaS basis. Please explain the overall operation of the solution, an overview of all data stores, interfaces, and user interfaces. Please explain how the platform will be operated and supported on a SaaS basis and any operational or support SLAs.

3.1.2.2 Data Store

It is envisioned that there will be one or perhaps several data stores to record all data related to all participant organizations in this platform including:

· Patients in the system awaiting behavioral health placement

· Patients previously in the platform over the past rolling number of months to enable historical statistical and trend analysis as well as to enable reporting on repeat episodes of care

· Institutions with EDs that see patients with these needs

· Institutions in which such patients are placed

· Users of the platform, their permissions and institutional affiliation, including ED institutions, BH care facilities, MassHealth Office of Behavioral Health, Massachusetts Department of Mental Health, and any other state agencies and employees Please describe these data stores, their organization, and to the extent known the contents of records pertaining to each element. Please describe how this data is maintained and audited.

3.1.2.3 Data interfaces

It is envisioned that there will be several means of interfaces (HL7, ADT, BAR, FHIR, BAR) with this platform:

· Possible systemic feeds from a primary hospital information system such as EPIC or Cerner into this system

· Possible systemic feeds from specialized emergency department information systems into this system

· Possible system feeds from established event notification systems (ENS) Please explain what interfaces will be available, and describe the content, security, and format of all data that may flow over such interfaces. To the extent that interface development requires a fee, please identify any fee for each system type and each instance of the system type to be assessed.

3.1.2.4 Data output

The following represent some expected data outputs. Please share how each group will be approached.

· Admission Packets: There is requirement for the platform to compile data from the various input sources into Admission Packets. Please discuss how the proposed platform will prepare the Admission Packets, highlighting the source of each data element and demonstrating a thorough understanding of the Admission Packet requirement.

· Reporting: Consistent with requirements outlined above, please describe any reports that the proposed platform will include and how these reports will be generated and delivered to users. Please highlight the source of each data record and element and demonstrate a thorough understanding of the programmatic requirements driving the need for reporting.

· Care Coordination: Please describe the data flows and how care plan documents/records will be generated, viewed, and shared

3.1.2.5 Interactive User Interface system for both input and output

It is envisioned that a web-based graphical user interface (GUI) be in place that will enable role-based permission access to all relevant data including ability for the users to enter or access data necessary for them to accomplish their programmatic tasks. Data access mechanisms should be defined and include the ability to ensure users have proper authorization to access different data sets and the ability to implement permissions for secure data access based on the organization and individual roles. It is also envisioned that the data will be downloadable in a standard format suitable for analysis and reporting. It is desirable that the user interface also include reporting tools.

3.1.2.6 Workflow management

It is envisioned that this platform will incorporate some workflow management capability that will include work queues for each user/institution including notifications in regular email or text indicating that a secure notification is awaiting. Such secure notifications might indicate that escalation times have expired and that the next step in the EPIA escalation process is now due.

Please describe what generic workflow capabilities are included in your platform and the flexibility to establish new workflows and the programmatic process evolves. Please describe workflows the bidder envisions as a way to implement the project requirements, especially the EPIA escalation process.

3.1.2.7 System administration

It is expected that the platform includes technical and user administration capabilities that are configurable at the enterprise and organizational level.