BRIAN SANDOVAL JULIE KOTCHEVAR, Ph.D. Governor Administrator Ihsan Azzam, PhD, MD RICHARD WHITLEY, MS Chief Medical Officer Director DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC AND BEHAVIORAL HEALTH Bureau of Behavioral Health Wellness and Prevention 4126 Technology Way, Suite 200 Carson City, Nevada 89706 Telephone (775) 684-4200 • Fax (775) 687-7570 http://dpbh.nv.gov Request for Applications (RFA) For Assertive Community Treatment Teams: (ACT) Release Date: July 31, 2018 Questions to be Submitted: On or before August 9, 2018, 5:00 p.m. PST Must be submitted to: [email protected] with RFA Assertive Community Treatment in the subject line of the email. Technical Assistance Webinar: August 14, 2018 at 10:00 a.m. PST Join from PC, Mac, Linux, iOS or Android: https://zoom.us/j/427831163 Or iPhone one-tap : US: +16699006833,,427831163# or +16468769923,,427831163# Or Telephone: Dial(for higher quality, dial a number based on your current location): US: +1 669 900 6833 or +1 646 876 9923 Meeting ID: 427 831 163 International numbers available: https://zoom.us/u/etbxea5Oa Deadline for Application Submission: August 21, 2018 by noon For additional information, please contact: [email protected] Assertive Community Treatment Teams RFA 1 | P a g e Funding Opportunity Title: Assertive Community Treatment Teams (ACT) Funding Opportunity Number: NV ACT - 01 Due Date for Applications: August 21, 2018 by noon Anticipated Total Funding Available: $1,800,000 Estimated Number of Award(s): Up to 6 awards Estimated Award Amount: $350,000 / applicant organization Cost Sharing/Match Required: None Project Period: Upon approval through September 30, 2019 Eligible Applicants: Indian Health Centers Federally Qualified Health Centers (FQHC) SAPTA Certified Providers Medicaid Enrolled Behavioral Health Providers (Clinical or treatment-based services must be provided by applicants that are existing Medicaid providers) Successful awardees MUST attend the MANDATORY AWARDEE MEETING: September 14, 2018 - Kickoff Meeting (specific location TBD) Assertive Community Treatment Teams RFA 2 | P a g e Request for Application (RFA) Timeline NOTE: These dates represent a tentative schedule of events. The State reserves the right to modify these dates at any time, with appropriate notice to prospective applicants. TASK DUE DATE & TIME SAPTA distributes the Request for Application Guidance with July 31, 2018 all submission forms Q&A Written Questions due to SAPTA August 9, 2018 by 5:00 August 14, 2018 (10:00am – 11:00am) Join from PC, Mac, Linux, iOS or Android: https://zoom.us/j/427831163 Or iPhone one-tap : US: +16699006833,,427831163# or +16468769923,,427831163# Informational Webinar to address questions Or Telephone: Dial(for higher quality, dial a number based on your current location): US: +1 669 900 6833 or +1 646 876 9923 Meeting ID: 427 831 163 International numbers available: https://zoom.us/u/etbxea5Oa Deadline for submission of applications August 21, 2018 by noon Technical Review of Applications August 21-22, 2018 SAPTA will notify organizations that have discrepancies within their application. August 23, 2017 Evaluation Period: Content review of applications August 23-28, 2018 Interviews with Applicants August 30, 2018 Funding Decisions Announced – SAPTA will notify September 4, 2018 organizations via e-mail to the listed Project Director Successful awardees MUST attend the MANDATORY September 14, 2018 AWARDEE MEETING: Kickoff Meeting Completion of subgrant awards for selected awardees September 30, 2018 Grant Award Commencement of Project – Pending approved Upon Execution of Award SAMHSA grant award and receipt of Notice of Award October 2018 Assertive Community Treatment Teams RFA 3 | P a g e Table of Contents Request for Application (RFA) Timeline ........................................................................................................ 3 ACT Model Implementation Timeline ........................................................................................................... 6 ACT Teams ..................................................................................................................................................... 7 Staffing .............................................................................................................................................................................. 7 Staffing Definitions ................................................................................................................................ 7 Staff Training ..................................................................................................................................................................... 8 Services to be Provided by ACT Team ............................................................................................................................. 8 Service Definitions ................................................................................................................................ 9 Safety Plan ...................................................................................................................................................................... 10 Cultural Competence ..................................................................................................................................................... 10 Care Coordination with other Agencies ........................................................................................................................ 10 Admission and Discharge Criteria .................................................................................................................................. 10 ASAM Admission Criteria .................................................................................................................... 10 ACT Discharge Criteria ........................................................................................................................ 11 Ongoing Program Evaluation ......................................................................................................................................... 12 Program Funding ......................................................................................................................................... 13 Allowable Activities ............................................................................................................................. 13 Non-Allowable Activities ..................................................................................................................... 14 Technical Requirements.............................................................................................................................. 14 Division Certification Process through SAPTA ............................................................................................ 14 Medicaid Enrollment Requirements and Division Funding Eligible Requirements .................................... 14 Submission of Proposals ............................................................................................................................. 15 Required Format: Each proposal submitted must contain the following sections: ........................... 16 Application Evaluation Criteria ................................................................................................................... 17 APPENDICES ................................................................................................................................................ 18 Application Submittal Package ................................................................................................................... 18 APPENDIX A ................................................................................................................................................. 19 COVER PAGE ................................................................................................................................................................... 19 APPENDIX B ................................................................................................................................................. 20 AGENCY PROFILE INSTRUCTIONS .................................................................................................................................. 20 AGENCY PROFILE ............................................................................................................................................................ 21 ADDITIONAL FACILITY LOCATIONS................................................................................................................................. 22 CONTACT INFORMATION ............................................................................................................................................... 23 APPENDIX C ................................................................................................................................................. 24 Narrative ......................................................................................................................................................................... 24 Assertive Community Treatment Teams RFA 4 | P a g e Organizational Strength and Description (up to 25 points, no more than 2 pages) ................................................... 24 Collaborative Partnerships (up to 15 points no more than 2 pages)..........................................................................