New Model to Replace Community Based Flexible Supports

REQUEST FOR INFORMATION (RFI)New Model to replace Community Based Flexible SupportsCOMMBUYS # BD-17-1022-DMH08-8210B-16243THE DEPARTMENT OF MENTAL HEALTHResponses are due by:June 2, 2017Contact Information: Jerome Collins Assistant Director of Contract Administration[email protected]RFI - New Model to replace Community Based Flexible Supports 1 THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF MENTAL HEALTHRequest for Information New Model to replace Community Based Flexible SupportsJune 2, 2017I. INTRODUCTION DMH is developing a new Service Model (“New Model”) to replace its primary adult community-based service, Community Based Flexible Supports (CBFS). The New Model is a residential and community treatment service providing enhanced clinical and rehabilitative services focused on building and sustaining engagement to promote individual recovery, achievement of personal goals and successful completion of the service. Residential and community treatment occurs in all housing settings, including group living environments, other provider managed settings and independent situations. The New Model will align with MassHealth’s Behavioral Health Community Partner program (BH CP) and with all available employment services, including those provided by DMH Clubhouse providers and the Massachusetts Rehabilitation Commission (MRC), to leverage existing resources, improve coordination of care and avoid duplication of services. MassHealth, as part of its 1115 demonstration, is advancing accountable care to emphasize value in care delivery and to better meet members’ needs through more integrated and coordinated care. The BH CP is a key element of this effort. The goal of the BH CP program is to support and coordinate services across the continuum of care for members with high behavioral health needs, including Serious Mental Illness (SMI) and/or Substance Use Disorders (SUD). BH CPs will partner with Accountable Care Organizations (ACOs) and Managed Care Organizations (MCOs) to facilitate integration of members’ care, including medical, behavioral health (BH), social, long term services and supports (LTSS), and other needs. BH CPs will also collaborate with members’ clinicians and other providers, such as DMH’s New Model, to promote collaborative, comprehensive and holistic care. MassHealth’s restructuring to accountable and outcome-based care has led to a service delivery model change across many of the Commonwealth’s health and human services programs and a decision to incorporate this focus into the New Model. DMH and MassHealth will establish clear roles and accountability between BH CPs and the New Model. This past winter, DMH conducted a series of stakeholder engagement sessions with various stakeholders involved in CBFS to gather input for the purposes of informing the design of the New Model. This RFI seeks input from those who are interested in commenting on key components of the New Model. Questions of specific interest to DMH can be found in Section III of this RFI. Please answer any or all questions.II. OVERVIEW OF NEW MODEL RFI - New Model to replace Community Based Flexible Supports 2 The New Model will provide focused clinical and rehabilitative interventions and peer and family support to individuals residing in all housing settings, including supervised residential treatment settings as well as supported and independent settings. Specialty residential treatment services (e.g. medically intensive, clinically intensive) will be included in some of the anticipated contracts procured under the New Model. Services will be delivered by an integrated team, based on a standard staffing model, to promote engagement, provide continuity of relationships, and establish clinical accountability. In addition to the clinical and rehabilitative interventions, providers will be responsible for operating a range of housing options (supervised residential treatment settings, also known as group living environments, supported living arrangements, etc). Care coordination functions will be delivered by BH CPs, One Care Health Homes and DMH Case Management to provide for the continuity of the care coordination relationship during and beyond the individual’s participation in the New Model. Providers of the New Model will collaborate with these care coordination entities to conduct assessments and treatment planning; promote community tenure; provide “critical time interventions” during and after hospitalizations, arrests and Emergency Department visits; and provide rehabilitative interventions that support health and wellness. Similarly, DMH will leverage a range of employment services, including DMH Clubhouse and MRC services, to provide job placement and support for individuals participating in the New Model. Providers of the New Model will deliver an essential piece of the employment experience in building interest to work through engagement strategies, incorporating employment goals into an individual’s treatment plan, coordinating with employment service providers and providing rehabilitation interventions that support individuals as they prepare for, seek and maintain employment. A. Integrated Team Model The New Model is anchored by a standard team model designed to ensure early and sustained engagement. The integrated team will ensure that the full complement of services is available to all individuals and the team will continue to serve individuals as they move between settings (e.g. supervised residential treatment and independent settings). A Licensed Practioner of the Healing Arts (LPHA) is responsible for leading assessment and treatment planning activities and ensuring that interventions are delivered in accordance with the treatment plan. It is expected that the LPHA will be an active member of the team, delivering services to individuals in the community and providing clinical oversight through modeling and supervision. Additional roles on the team include substance abuse counselor, housing specialist, direct care staff and peer support. Peer support is inclusive of Certified Peer Specialists, Recovery Coaches, and Family Partners. Oversight for clinical accountability in the New Model is provided by a Program Director (team leader), Assistant Program Director and consultation through RNs and a Psychiatrist. To provide adequate support to staff and clinical accountability, providers of the New Model must ensure that supervision is available both within the team and as a discipline- specific activity as needed. In addition, all staff activities must be consistent with staff qualifications, credentials, job description and roles. The number of teams that a contract will have will be dependent of the size of the contract.Residential and community treatment services in the New Model will include: • EngagementRFI - New Model to replace Community Based Flexible Supports 3 • Clinical and Rehabilitative Interventions, including Critical Time Interventions • Peer Support and Recovery Coaching • Family Engagement and Support • Addiction Treatment • Medication Administration • Coordination and Communication Across Systems (Healthcare, Employment and Housing) Several of these components are described in greater detail below. B. Clinical and Rehabilitative Interventions Clinical and rehabilitative interventions will continue to be the core services of the New Model. The New Model considers engagement strategies and critical time interventions during care transitions to be essential rehabilitative interventions. The provider must ensure that clinical and rehabilitative interventions are delivered flexibly to address individual recovery goals and are continuously changed to address barriers that are preventing an individual’s progress. Rehabilitative goals and interventions are developed with the goal of defining what is needed for individuals to achieve their recovery goals and successfully complete the service. The provider will be expected to provide the necessary support and training for individuals to self-administer and monitor their own medication whenever possible and to provide Medication Administration Program (MAP) services to individuals who require that level of intervention regardless of living arrangement.C. Coordination Activities A major goal of the shifting healthcare landscape in Massachusetts is to strengthen linkages between health care providers, including behavioral health (BH) providers, to support members with high behavioral health needs and to help these members navigate the system of behavioral health care in the Commonwealth. This has led to the creation of Behavioral Health Community Partners (BH CPs). The goal of the BH CPs is to support and coordinate services across the continuum of care of members with high behavioral health needs, including Serious Mental Illness and/or Substance Use Disorders. BH CPs will partner with Accountable Care Organizations (ACOs) and Managed Care Organizations (MCOs) to facilitate integration of members’ care, including medical, behavioral health (including the New Model and other DMH services), social, long term services and supports (LTSS), and other needs. DMH will ensure that each individual in the New Model will receive care coordination through BH CP, OneCare and/or DMH Case Management. The care coordination entity is responsible for coordinating care between an individual’s service providers and for identifying and bridging gaps in the individual’s health care delivery experience. New Model providers must collaborate with the care coordination entity in: 1. Assessing needs that the New Model will address; 2. Coordinating treatment interventions when both entities have a role in supporting the individual’s service need, and; RFI - New Model to replace Community Based Flexible Supports 4 3. When the New Model identifies a need that requires an additional provider or resource. The following table provides examples of activities that the New Model provider and BH CP may conduct. These examples are illustrative and are not intended to represent definitive actions that will be provided.Example New Model Activities BH CP Activities Person is  Perform critical time intervention  Participate in discharge planning admitted into an and participate in discharge  Revise crisis/treatment plans inpatient planning  Perform medication psychiatric unit  Participate in revision of crisis/ reconciliation with outpatient treatment plans providers and New Model and  Provide transportation home, if communicate discharge plan needed  Ensure person engages in follow-  Receive mediation reconciliation up appointments and information from BH CP communicate relevant  Provide interventions to support information to all providers person’s transition to home, such  Provide face-to-face encounter as filling prescriptions, sorting within three days of discharge mail, purchasing food, reconnecting with social supports.  Inform BH CP of any changes that need to be communicated to other providers Person is newly  Participate in revision of treatment  Revise treatment plan diagnosed with plan  Communicate treatment diabetes  Provide interventions to support recommendations to all providers purchasing and preparing foods  Ensure person engages in follow- consistent with dietary up appointments recommendation  Connect individuals to additional  Inform BH CP of person’s services, such as diabetes response to interventions, such as education group, specialists decision to not follow recommended diet E. Utilization Review Process DMH anticipates that the New Model design, including the emphasis on engagement strategies, rehabilitative interventions and clinical accountability, will help individuals achieve treatment goals and prepare for successful completion of the New Model. The care coordination entity will ensure that there is continuity of care and sufficient transition when a person achieves treatment goals and no longer needs the service. DMH will develop a comprehensive utilization review strategy to ensure New Model service providers are sufficiently engaging individuals in the service, that services align with individuals’ needs, and to identify individuals who can transition to other services. Enrollment inRFI - New Model to replace Community Based Flexible Supports 5 the New Model and in group living environments will be the responsibility of DMH. DMH also intends to focus utilization review activity on group living environments to monitor the individual’s continued need of these service and efficient use of this limited resource. In addition, DMH and MassHealth will develop operational guidelines addressing collaboration between New Model service providers and care coordination entities, including assessment and treatment planning, critical time interventions and data exchange.F. Additional Resources For additional information pertaining to proposed model changes, the stakeholder engagement process, and stakeholder meeting materials, please reference the site below: http://www.mass.gov/eohhs/gov/departments/dmh/cbfs-stakeholder-engagement.htmlIII. QUESTIONS DMH is seeking feedback on the following areas of the proposed New Model. Respondents are not required to respond to all questions. Brevity should be considered when contemplating a response; please do not provide a response that exceeds 5 pages. Bulleted lists and short paragraphs are both appropriate response formats.Integrated Team Model: Given that the integrated team will ensure that the full complement of services are available to all individuals and that the team will continue to serve individuals as they move between settings: 1. What is the best structure for the integrated team to deliver interventions, provide clinical accountability and maintain continuity throughout duration of service? 2. How should this team model be adjusted to support clients living on their own in the community?3. What impact does size of contract and level of resources (i.e. number of supervised residential treatment settings) have on how integrated team(s) is structured? What should DMH consider in developing a standard team model? 4. What standards does DMH need to consider to safeguard and support peer roles on the Integrated Team, including job functions and supervision? Assessment and Treatment Planning: If a client is engaged with a BH CP prior to enrolling in the New Model, the BH-CP will have conducted an assessment for the client. 1. Should the service providers of the New Model do an independent assessment for the client, or could there be coordination between the providers and BH CPs during this process? RFI - New Model to replace Community Based Flexible Supports 6 2. Are there any components of the BH CP’s assessment that could contribute to the Provider of the New Model’s assessment and creation of the treatment plan? If so, is there a timeline after which components of the BH CP’s assessment should no longer be considered? 3. What else should DMH consider in regard to integrating the New Model and BH CP assessment and treatment planning processes? What value can be achieved from an efficiency perspective and from the perspective of the person served?Model Standards: 1. What standards should DMH consider for the New Model providers to encourage family engagement and the use of other natural supports in a client’s care when desired by the client? 2. What specific considerations should be included when the individual is a parent? What are examples of standards related to the assessment and treatment planning which DMH should contemplate to assess service needs? 3. What standards and supports pertaining to engagement and service delivery should be considered for:  young adults (18-25)?  older adults (60+)?4. What standard should be considered for individuals with high risk needs (e.g. homelessness, criminal justice involvement, substance use, history of aggression, separation from service)?RFI - New Model to replace Community Based Flexible Supports 7 Interrelationships within Healthcare System:1. What guidance would you provide to help DMH ensure that the relationships between the New Model providers and BH CPs are as seamless as possible? Please consider the following scenarios: Provider and the Provider and the Scenarios: BH CP are the same agency BH CP are separate agencies When a client is leaving the hospital, or other institution During the engagement process When there are changes in the treatment plan2. What efficiencies can be gained through information sharing between BH CPs and the New Model providers? What are the major barriers? Utilization Review and Measurement: 1. DMH is considering requiring that individuals be reauthorized for the NewModel by DMH when their length of participation in the service and/or stay in a group living environment extends beyond a certain point of time to determine if a change to service is needed. When do you think reauthorization should be done? What standards should be implemented for this? Is there another process that could be used to review situations where individuals are not making progress towards their treatment goals? 2. DMH is considering the use of a tool to guide service delivery recommendations and utilization review activities. Please comment on the following tools, weighing the pros and cons of each, particularly pertaining to the collection and utility of the data. . a. The Assertive Community Treatment Transition Readiness Scale (ATR)Milestones of Recovery (MORS) b. Arizona Self-Sufficiency Matrix c. Others, please specifyRFI - New Model to replace Community Based Flexible Supports 8 IV. RFI SCHEDULE Date Event May 12, 2017 RFI published in COMMBUYS May 19, 2017 Questions About the RFI May 26, 2017 (estimated) Response to Questions about the RFI June 2, 2017 by Noon RFI Submission DeadlineV. HOW TO SUBMIT A RESPONSE AND SUBMISSION FORMAT. a.1.A. COMMBUYS Responses to this RFI must be submitted by the date and time specified in Section IV. Respondents must submit their response though COMMBUYS. If Bidder has any issues with responding through COMMBUYS, it should contact the COMMBUYS Help Desk at [email protected] or call during normal business hours (8AM – 5PM Monday – Friday) at 1-888-627-8283 or 617-720-3197. Useful Links:  Job aid on how to submit a quote: www.mass.gov/anf/docs/osd/commbuys/create-quote-in- commbuys.pdf  Webcast: How to Locate and Respond to a Bid in CommBuys, will familiarize bidders with COMMBUYS terminology, basic navigation, and provide guidance for locating bid opportunities in COMMBUYS and submitting an online quote. a.1.B. Response Instructions and Format. Respondents are invited to respond to any or all of the requests for Information set forth in Section III of this RFI; please respond to as many as you feel appropriate. If responding to more than one request, the responses must be in chronological order (based on the order of the requests) and for each response provided, the applicable request number and header must be inserted before the response (e.g., Integrated Care 1). The response header and number should be in bold. In addition the Respondents must include a completed cover sheet (see Section VI.C., below). The cover sheet and response must be typed using 12 pt. font. . Brevity should be considered when contemplating a response; please do not provide a response that exceeds 5 pages. Bulleted lists and short paragraphs are both appropriate response formats. a.1.C. Response Cover Sheet. In responding to this RFI, the response coversheet must be used. The RFI cover sheet is included in the RFI COMMBUYS file. RFI - New Model to replace Community Based Flexible Supports 9 VI. GENERAL INFORMATION a.1.A. COMMBUYS Please note that this RFI is issued solely for the purpose of obtaining information. Nothing in this RFI shall be interpreted as a commitment on the part of DMH to procure or enter a contract with any respondent. This RFI will be distributed electronically by posting it on COMMBUYS. COMMBUYS offers an optional, value-added automated COMMBUYS Subscription Service on an annual-fee basis. All vendors are responsible for checking COMMBUYS for any addenda or modifications made to the RFI subsequent to the initial posting on COMMBUYS. The Commonwealth and DMH will accept no liability for and will provide no accommodation to vendors who fail to check for amended RFIs or any other procurement opportunities and subsequently submit inadequate or incorrect responses. Individuals are advised to check the Last Changed Date field on the Summary page or the Amendment History within the Other Information tab of the RFI for which they intend to submit a response in order to ensure they have the most recent files.Individuals may not alter (manually or electronically) the RFI language or any of its component files. a.1.B. QUESTIONS CONCERNING THE RFI. The “Bid Q&A” provides the opportunity for respondents to ask written questions and receive written answers from the Department regarding this RFI. All respondents’ questions must be submitted through the Bid Q&A found on COMMBUYS. Questions must be submitted by the date and time specified in Section VI. Below. Questions submitted to the Department after the date and time specified above or by any other medium (including those that are sent by mail, fax, email or voicemail) will not be considered for a response. To reduce the number of redundant or duplicate questions, respondents are asked to review all questions previously submitted to determine whether their question has already been posted.Bidders are responsible for entering content suitable for public viewing, since all of the questions are accessible to the public. Bidders must not include any information that could be considered personal, security sensitive, inflammatory, incorrect, collusory, or otherwise objectionable, including information about the Bidder’s company or other companies. DMH reserves the right to edit or delete any submitted questions that raise any of these issues or that are not in the best interest of the Commonwealth or this Bid. Locating Bid Q&A: Log into COMMBUYS, locate the Bid, acknowledge receipt of the Bid, and scroll down to the bottom of the Bid Header page. The “Bid Q&A” button allows Bidders access to the Bid Q&A page.All responses must include on the first page the official name (if any) of the firm or entity submitting the response. Please consecutively number all pages of the response.RFI - New Model to replace Community Based Flexible Supports 10 C. INFORMATIONAL SESSIONS. There will be no informational sessions associated with this RFI.D. COSTS By submitting a response, respondents agree that any cost incurred in responding to this RFI, or in support of activities associated with this RFI, shall be the sole responsibility of the respondent. DMH shall not be held responsible for any costs incurred by respondents in preparing their respective responses to this RFI. c.1.E. REVIEW RIGHTS Responses to this RFI may be reviewed and evaluated by any person(s) at the discretion of DMH, including independent consultants retained by Department now or in the future. EOHHS reserves the right to accept or reject, in part or in full, any information contained in or submitted in response to this RFI. The RFI is not binding on EOHHS and shall not obligate EOHHS to issue a procurement that incorporates any RFI provisions or responses. Responding to this RFI is entirely voluntary, will in no way affect EOHHS’ consideration of any proposal submitted in response to any subsequent procurement, and will not serve as an advantage or disadvantage to the respondent in the course of any procurement that may be issued. Responses to this RFI become the property of the Commonwealth of Massachusetts and are public records under the Massachusetts Freedom of Information Law, M.G.L. c. 66, § 10 and c. 4, § 7, cl. 26, regarding public access to such documents. However, information provided to EOHHS in response to this RFI and identified by the respondent as trade secrets or commercial or financial information shall be kept confidential and shall be exempt from disclosure as a public record (see M.G.L. c. 4, § 7, cl. 26). This exemption may not apply to information submitted in response to any subsequent procurement. c.1.F. PUBLIC RECORD All responses to this RFI will be public record under the Commonwealth’s Public Records Law, Mass. Gen. L. c. 66, §10, regardless of confidentiality notices set forth on such writings to the contrary. c.1.G. RFI AMENDMENTS DMH reserves the right to amend this RFR at any time. Interested parties are solely responsible for checking COMMBUYS for any addenda or modifications that are subsequently made to this RFI. The Commonwealth and its subdivisions accept no liability and will provide no accommodation to interested parties who fail to check for amended RFIs. RFI - New Model to replace Community Based Flexible Supports 11

New Model to Replace Community Based Flexible Supports

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