Request for Proposals (RFP) for Assertive Community Treatment (ACT) in Washington County. Questions and Answers (Updated 7/14/2018)

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1 Request for Proposals (RFP) for Assertive Community Treatment (ACT) in Washington County Questions and Answers (Updated 7/14/2018) 1.) What information can you provide regarding the current number, demographic, and needs of individuals that are currently working with proposed referral sources (operated Targeted Case Management and community hospitals) who are believed to be eligible for ACT services? We anticipate most of our referrals in the early phase will come from long-standing clients served by the Adult Division of Washington County, of those clients they would be persons who have shown a need for a higher level of care but wish to remain in their homes living as independently as possible. Some with a need for medication reminders, others benefiting from a fully integrated team with prescriber on hand, and also those who struggle with symptoms that make maintaining an apartment a significant challenge without intensive supports in place. While we cannot determine the exact number of clients we would refer, we could guess at the high end no more than 45 existing clients who might benefit from transitioning off transitional services onto ACT. This number might be lower if persons wish not to participate in a spend down to be Medicaid eligible. From an ongoing basis, Washington County Adult Mental Health intake team will identify new referrals as well as hospital and other agencies such as health care plans and clinics will be making outside referrals. 2.) Related to Section #5, Service Provider Qualifications, does an agency need to hold a contract with Washington County for ACT and ARMHS services at the time of the RFP submission or simply be able to enter into a contract for the January 1 st, 2019 start date? An agency does not need to hold a contract with Washington County at the time the RFP is submitted but will need to execute a proffered contract prior to the anticipated start date of January 1, DHS does not require an ARMHS certification for ACT providers as ACT has their own certification so this requirement has been removed. 3.) What local hospitals are most likely to become referral sources? Primarily Regions Hospital, but referrals will also come from United Hospital and St. Joseph s Hospital. Occasional referrals are anticipated from other metro area hospitals to include Fairview Riverside/Southdale, Hennepin County Medical Center, Mercy Hospital, and the Anoka Metro Regional Treatment Center when clients are there for a restore to competency program or are treated for more significant symptoms that were not fully managed at the local hospitals. 4.) Is the expectation that a Team Lead and Psychiatrist conduct the screening process jointly for all referrals and is this process one that is done in the presence of the referred individual or

2 something that can be done by a review of documentation, etc. with in-person intake conducted after screening? Yes, the team leader and psychiatrist are responsible to determining eligibility for services based off of records and interview with potential client. The process may be individualized based off of the referral although must include both the team leader and psychiatrist determining medical necessity and the individual to be served in agreement with obtaining services prior to admission. 5.) When will the flexible funds amount be determined and accessed? Flexible funds that could be made available for client use will not exceed $20,000 during calendar year The method of disbursement will depend on the proposals received. 6.) Is the State willing to consider approving a small ACT team as this service is implemented? What is the expected size of this team? The team will be initially certified as a small team (no more than 50 individuals) and as the team grows the team could apply for becoming a medium sized team (no more than 74 individuals) and then to a large team (no more than 100 consumers). DHS has recommended building up the team incrementally over a period of two years at a rate of 3-5 individuals per month. 7.) Is the agency required to have a business address in Washington County? No, but it is highly encouraged and recommended. The ACT team will need to be physically located in a central location of the service area (area with highest anticipated individuals served). An ACT team is expected to flex their services to provide the level of care needed for the individual served which could be multiple times per day. When the team is located further away the travel time enables the team from being able to perform their functions of flexible services. It is also recommended the team be physically located in a centralized easily accessible location so individuals served can come to the office if desired and resources such as employment opportunities and basic living needs are local (i.e. laundry mat, grocery store). If you do not intend on obtaining a physical location in Washington County and will be submitting a proposal, please explain in detail how you would effectively serve individuals in Washington County without a physical location in the county. 8.) Is there flexibility on referral sources as the service is ramping up rather than having all referrals come initially from hospitals/county case managers? There will be flexibility on referral sources as the service is ramping up. We understand that not all referrals for the initial phase of team startup will come from current clients served by case management or local hospitals. However, there is a number of people we currently serve who would benefit from more intensive, more integrated services so they would be

3 given priority admission. We also understand that in order to maintain high fidelity the team will need to have multiple referral sources with active outreach to all. Once the team is established, priority admission will be given to hospitals and county case managers while still utilizing other referral sources when appropriate. 9.) What are the expected outcomes and reporting metrics? The County and the contracted provider will work collaboratively to develop baseline goals in Outcome measures could include: appropriate benchmarks for the total percent of individuals competitively employed or looking for work; total percent of individuals living in private residence (independent or dependent), total percent of individuals not receiving hospital care due to mental illness or substance abuse; and total percent of individuals having an annual physical charted in the medical profile. Performance measures could include: number of referrals to the team, number of admission to the team, number of discharges from the team, total number served, and number of staff vacancies and length of each vacancy. The team will also need to abide by all MN ACT Statute (256B.0622) including data reporting and completion of the Tool of Measurement for Assertive Community Treatment (TMACT) to maintain their certification. 10.) How will Washington County cover uncompensated care for individuals who have properly authorized but who are uninsured or become uninsured due to falling off of Medical Assistance or PMAP? Washington County will allocate funds to cover a certain number of sessions for eligible individuals who may not be covered by MN Health Care Programs or other third party payers. However, Washington County expects the contracted provider to work with individuals in obtaining and maintaining MN Health Care Program coverage. 11.) When will start up funds be distributed? The contracted provider will be able to invoice for the $53,500 on the first day of billable services. 12.) What factors led to Washington County pursuing an ACT team at this time? We are aware that traditional case management services are not able to provide the intensity and integrated options for individuals who have higher needs where such supports like ACT would have made it possible for persons to live more independently and with greater success in integrated housing options of their choice. Often persons with higher needs resort to enrolling on other programs such as CADI to reside in or moving into GRH funded housing with supports. Now that ACT appears feasible we wish to pursue an RFP to support a number of clients who would benefit from such an integrated model and allow for more client choice and greater independence. Furthermore, the state has a continued interest in developing and supporting ACT services across the state through financial and technical assistance ensuring individuals in need have access to high quality services in all areas.

4 13.) Do all referrals come from WCCS? Can they come to the ACT team directly to increase efficiency and access to service? (Page 6, Program Structure, bullet 2) There will be flexibility on referral sources as the service is ramping up. We understand that not all referrals for the initial phase of team startup will come from current clients served by case management or local hospitals. However, there is a number of people we currently serve who would benefit from more intensive, more integrated services so they would be given priority admission. We also understand that in order to maintain high fidelity the team will need to have multiple referral sources with active outreach to all. Once the team is established, priority admission will be given to hospitals and county case managers while still utilizing other referral sources when appropriate. 14.) Section 7. Of the RFP states that the contracted provider will receive $53,500 in start-up funds from the State. Are there any restrictions or further instructions about that funding? The only restriction would be the team needs to obtain and maintain certification as an Assertive Community Treatment Team in MN through DHS. 15.) Should startup fund expenses be included in the budget forms along with the ongoing operating costs? No, it is not necessary. DHS will not factor in the start-up funds during the rate setting process. 16.) What are the numbers/expectations for service and caseloads? How many individuals is the county anticipating to serve? While we cannot determine the exact number of clients we would refer, we could guess at the high end no more than 45 existing clients who might benefit from transitioning off transitional services onto ACT. This number might be lower if persons wish not to participate in a spend down to be Medicaid eligible. The team will be initially certified as a small team (no more than 50 individuals) and as the team grows the team could apply for becoming a medium sized team (no more than 74 individuals) and then to a large team (no more than 100 consumers). DHS has recommended building up the team incrementally over a period of two years at a rate of 3-5 individuals per month as appropriate. 17.) Would the team need to be physically located in Washington County? No, but it is highly encouraged and recommended. The ACT team will need to be physically located in a central location of the service area (area with highest anticipated individuals served). An ACT team is expected to flex their services to provide the level of care needed for the individual served which could be multiple times per day. When the team is located

5 further away the travel time enables the team from being able to perform their functions of flexible services. It is also recommended the team be physically located in a centralized easily accessible location so individuals served can come to the office if desired and resources such as employment opportunities and basic living needs are local (i.e. laundry mat, grocery store). If you do not intend on obtaining a physical location in Washington County and will be submitting a proposal, please explain in detail how you would effectively serve individuals in Washington County without a physical location in the county. 18.) How will proposals be scored? Proposal scoring will focus on the following areas: capacity to provide ACT services; how evidence-based practices or known best practices are incorporated into ACT program; staffing pattern; description of the model of clinical supervision and level of staff qualifications; description of admission criteria including processes for screening and assessing individuals referred for services; ability to provide individualized services based on diverse needs; most recent TMACT fidelity review and any internal quality improvement plans that were developed in response; description of the ACT program s anticipated outcomes and how they will be monitored and evaluated; and provider has the ability to sustain, evolve, and/or expand program as needed by County and clients. In the event two proposals are scored equally and one of the providers does not currently have an operating ACT team, preference will be given to the established ACT team.