PIONEER CENTER NORTH PIONEER CENTER EAST Substance Use Disorder (SUD) Residential Adult Long Term Care Statement of Work

Transcription

1 PIONEER CENTER NORTH PIONEER CENTER EAST Substance Use Disorder (SUD) Residential Adult Long Term Care Statement of Work I. WORK STATEMENT The Contractor shall provide SUD residential treatment in the form of Adult Long Term Care (LTC) services designed from a recovery and resiliency perspective that will enable residents to live in the community with minimal dependence on public safety and acute care resources. II. PROGRAM DESCRIPTION A. Eligibility 1. Persons eligible for SUD residential placement are adult North Sound Behavioral Health Organization region and King County residents who meet access to care criteria for SUD as well as specific ASAM placement criteria. Individuals meeting these criteria will have demonstrated need for intensive services to facilitate recovery. 2. The North Sound region includes the counties of Island, San Juan, Skagit, Snohomish, and Whatcom. B. Program-Specific Requirements 1. Residential Admissions: a. North Sound BHO and King County BHO are each responsible for the authorization of North Sound regional residents into SUD residential services. Individuals must meet the following criteria to be eligible for this level of care i. DSM 5 criteria for Substance Abuse Disorder; ii. The specific ASAM criteria for placement; and iii. The individual s needs cannot be more appropriately met by any other formal or informal system or support. b. The Contractor shall be an active participant in the following authorization processes as determined by the client s Home BHO (individual s BHO of residence). i. The initial authorization for North Sound regional residents for residential. ii. services shall be procured by the community-based assessor after verifying bed availability with Contractor. iii. The community assessor shall complete the authorization request and submit electronically to North Sound BHO. iv. North Sound BHO shall review the initial authorization request and determine authorization status, and confirm service placement level. Page 1 of 9

2 v. North Sound BHO shall respond to the community-based assessor within three working days of the receipt of the authorization request. vi. The community-based assessor shall provide documentation of authorization from North Sound BHO to the Contractor, in addition to the assessment and other referral materials needed for placement and successful course of treatment. vii. The community assessor shall be responsible for arranging the individual s transportation to the facility and ensure necessary processes and documents are completed and communicated to the residential facility. viii. The Contractor shall confirm the individual s admission into the facility on the scheduled admit day and update North Sound BHO IS. ix. A person shall not be placed in the SUD residential services under this contract without the North Sound BHO authorization. x. North Sound BHO shall not reimburse SUD residential services without documented pre-authorization. 2. King County Residents: a. For King County residents, community assessors shall complete the referral information and submit to the King County Care Authorizer (KCCA). b. KCCA shall review the referral packet to ensure that all documents are complete and if necessary - contact community assessor to request missing information within three working days of referral receipt. c. KCCA shall determine authorization status and confirm service placement level. d. KCCA shall assess bed availability of SUD residential facilities and forward referral application packet with confirmation of KC authorization to Contractor. e. The Contractor shall notify KCCA of provider s decision regarding referral application within one business day. f. If referral is accepted by the Contractor, KCCA and Contractor shall confirm authorized initial length of stay, determine admit date and clarify the processes or documents required to ensure a problem-free admission. g. KCCA shall notify community assessor and referred individual regarding individual s acceptance to residential facility and scheduled admit date. h. Community assessor shall be responsible for arranging individual s transportation to facility and ensuring necessary processes/documents are completed and communicated to residential facility. i. KCCA shall confirm individual s admission into facility on the scheduled admit day and update the BHRD Information System (IS). j. A person shall not be placed in the King County s SUD residential services level of care without KC authorization. k. King County shall not reimburse SUD residential services without documented preauthorization. NORTH SOUND BHO-PHS-RESIDENTIAL Page 2 of 9

3 3. Continuing Stay Criteria: a. Continued stay assessments are person-centered based upon the resident s individual treatment needs and progress in residential treatment. b. Continued stay eligibility criteria are as follows: i. The resident meets the ASAM placement criteria for the requested residential service level. ii. The resident has demonstrated progress toward achieving treatment goals during the initial authorization period. iii. The resident s needs cannot be more appropriately met by any other formal or informal system or support. c. The Contractor shall request a continuation of an individual s stay by completing and forwarding the required written documentation to the resident s Home BHO no later than five working days before expiration of initial authorization. Failure to provide complete information within this timeline may result in a rejection of the continuing stay request. i. The required written documentation includes: a) Updated ASAM evaluation; b) Requested number of days for continuing stay; and c) Brief description of resident s progress on ISP goals and reason for continued stay including projected treatment goals. d. The Home BHO shall make a decision on the continuing stay request and notify the Contractor of the disposition within two working days of receiving the continuing stay request submittal. i. If it is determined that the resident does not meet continuing stay eligibility criteria, the Contractor, resident and/or resident s family (if legal guardian) may appeal the disposition. e. North Sound BHO shall not reimburse for SUD residential services beyond the initial authorization period without North Sound BHO documented approval of continuing stay request 4. Priority Populations a. Per the Substance Abuse Block Grant (SABG) requirements, North Sound BHO, King County BHO and the Contractor shall prioritize treatment admissions according to the following priority categories: i. Women who are pregnant and injecting drugs; ii. Women who are pregnant with SUDs; and iii. Individuals who are injecting drugs. NORTH SOUND BHO-PHS-RESIDENTIAL Page 3 of 9

4 b. Washington state and North Sound BHO defined priority populations: i. First priority: Parenting women; ii. All other populations are prioritized as follows: iii. Postpartum (up to one year, regardless of pregnancy outcome); iv. Parenting individuals involved with Child Protective Services; v. Offenders (as defined in RCW 70.96A.350); vi. Other Medicaid Individuals; and vii. Individuals referred by Screening, Brief Intervention, Referral and Treatment (SBIRT) Programs. 5. Access to Services. The Contractor shall provide access to services as follows: a. Opiate Substitution Clients: The Contractor shall accept and make the necessary adjustments to continue treatment for any clinically-appropriate client actively taking an opiate substitution medication. b. The Contractor shall not have policies or procedures in place that deny treatment services to any individual solely on the basis that the client is taking prescribed medication. However, the Contractor reserves the right to deny admission to any individual when the Contractor determines that the individual is beyond the scope of the Contractor's ability to safely or adequately treat. c. Nicotine: The Contractor shall ensure that access to treatment services is not denied solely on the basis that a client is using over the counter nicotine cessation medications or actively participating in a Nicotine Replacement Therapy regimen. d. Ensure that treatment services are not denied to any individual solely on the basis of that individual's drug(s) of choice. 6. Treatment Goals: a. The Contractor shall provide services according to need, and to each resident and his or her family or support system, in order to help the individual achieve recovery and resiliency through mutually negotiated goals of treatment. b. The Contractor shall ensure residents have a voice in developing their Individual Service Plan (ISP) including their crisis plan and advance directives. c. The Contractor shall ensure significant others, as identified by the client, are involved in the service plan development and implementation. d. The Contractor shall ensure treatment goals are written in the words of the client. e. The Contractor shall ensure documentation related to progress toward treatment goals includes the client s views on his or her progress. 7. The Contractor shall provide each patient the necessary personal items; i.e., soap, toothbrush, toothpaste, and sanitary items from the funds included in the daily bed rate. NORTH SOUND BHO-PHS-RESIDENTIAL Page 4 of 9

5 8. Planned Leave: a. The Contractor shall allow a resident to leave the facility for the purposes of obtaining medical treatment not available at the center, conducting personal business, visiting with family members or significant others and for other reasons that may be beneficial to the patient's treatment program. The placing outpatient treatment program shall be informed of the need for a planned leave. b. If a resident shall be absent from the Contractor s facility on approved planned leave for more than 72 hours, the following applies: i. Residential staff must notify the resident s Home BHO and indicate the total number of days the resident will be absent and the reason for the absence. ii. Notification for planned absence shall occur prior to leave. iii. Staff shall complete and submit Residential Absence Authorization form electronically. iv. The Home BHO will review the planned leave request, determine if the SUD residential bed should remain open for the resident and, if so approve payment for the bed days. The North Sound BHO will forward a copy of the approved absence authorization to the Contractor within three business days. v. All planned leaves must be consistent with the resident s Individual Service Plan (ISP). c. Residential staff shall be responsible for providing ongoing case management at all times during a resident s planned leave, including crisis intervention and stabilization, until the individual has returned to the residential bed. d. Residential staff shall be responsible for linking the resident to appropriate services if the resident will not be returning to facility, developed in collaboration with the community assessor or outpatient treatment facility that made the bed placement and initial authorization. 9. Unplanned Leave: a. The Contractor may maintain a benefit for 24 hours without requesting Home BHO authorization for a resident s unplanned, voluntary exit should the individual s return remain a possibility. i. The termination date is the date of exit if the person does not return to the program. b. If the Contractor wants to maintain the benefit beyond 24 hours following a resident s unplanned, voluntary exit from the program, the following applies: i. Residential staff shall complete and submit to the Home BHO the Residential Absence Authorization form documenting the total number of days requested and reason(s) for the request. NORTH SOUND BHO-PHS-RESIDENTIAL Page 5 of 9

6 ii. The Home BHO will review the authorization request and notify the residential facility of the disposition. iii. The Home BHO will authorize a benefit for maximum of 72 hours from the date of the resident s unplanned, voluntary exit from the program. 10. Termination and Discharge: a. SUD residential benefit will terminate under the following circumstances: i. The Home BHO authorization period expires; ii. The resident permanently exits the program prior to the expiration date of the authorization period; iii. The resident dies; iv. The resident gains enough resources during the benefit to be treated as a private-pay client; or v. Contractor discharges resident to ensure the safety of other residents and staff. b. A terminated benefit is payable to the date of termination. i. For the required terminations above, the date of the termination is the date of the event, unless otherwise specified. ii. When a required termination is not submitted or is submitted with an incorrect effective date, payment for the benefit beyond the correct effective date may be recouped by the Home BHO. 11. Clinical Records and Documentation: The Contractor shall ensure that residential facility staff maintains clinical records and documentation that meet the following standards: a. An ISP is developed within five days of placement that includes the following: i. Personalized to the individual's unique treatment needs. ii. Initiated with at least one goal identified by the individual during the initial assessment or at the first service session following the assessment. iii. Includes individual needs identified in the diagnostic and periodic reviews, addressing: a) All substance use needing treatment, including tobacco, if necessary; b) Patient bio-psychosocial problems; c) Treatment goals; d) Estimated dates or conditions for completion of each treatment goal; and e) Approaches to resolve the problem. iv. Documents approval by a chemical dependency professional (CDP) if the staff member developing the plan is not a CDP. NORTH SOUND BHO-PHS-RESIDENTIAL Page 6 of 9

7 v. Documents that the plan was updated to reflect any changes in the individual's treatment needs, status, and progress towards goals, or as requested by the individual. vi. Demonstrates the resident s participation in the development of the plan and that plan was mutually agreed upon with copy provided to resident. vii. Be strengths-based. viii. Contains measurable goals or objectives or both. b. Progress notes are documented in a timely manner and before any subsequent scheduled appointments of the same type of service session or group type occur or documentation as to why this did not occur. c. Progress notes include the date, time, duration participant names, and a brief summary of the session and the name of the staff person who provided it. d. Progress notes document: 12. Services: i. Significant changes in the resident s clinical and health status; ii. Coordination and communication with outside providers; iii. Medical appointments; and iv. Family contacts. a. Services shall be provided according to all of the following values: i. Cultural, linguistic and disability competent; ii. Oriented toward promoting recovery and resiliency; iii. Appropriate to the age and developmental stage of the resident; and iv. Preference for the most independent living setting. b. The Contractor shall provide adult SUD residential services within the identified levels of care as defined in the WAC B and as described by ASAM. Services shall be provided in accordance with the Department of Health regulations as stated in WAC or its successor for a Residential Treatment Facilities (RTF). c. Long-Term Care Residential (LTC) services are licensed, facility based services that provide for the care and treatment of persons with diagnosed SUDs and impaired self-maintenance capabilities. Services include a concentrated program of SUD treatment, individual and group counseling, education, vocational guidance counseling, personal care services and related activities including room and board in a twenty-four-hour-a-day, supervised facility in accordance with WAC B The service as describes satisfies the level of intensity in ASAM Level 3.3. An agency providing LTC services must: i. Provide each resident a minimum of two hours each week of individual or group counseling. ii. Provide each resident a minimum of two hours each week of education regarding alcohol, other drugs, and other addictions. NORTH SOUND BHO-PHS-RESIDENTIAL Page 7 of 9

8 iii. Provide each resident, during the course of services, with: a) Education on social and coping skills; b) Social and recreational activities; c) Assistance seeking employment, when appropriate; and d) Assistance with re-entry living skills to include seeking and obtaining safe housing; and e) Conduct and document an ISP review at least monthly. 13. SUD Residential Bed Tracker Data: a. The Contractor shall regularly update (preferably once or twice a day) bed census data on SUD Residential Bed Tracker tool to provide accurate and timely information regarding facility s bed availability. III. COMPENSATION The consideration to be paid by North Sound BHO for the work to be provided by Contractor pursuant to this Agreement shall consist of the available amount from primary funding sources. A. Contractor shall submit encounter data through the North Sound BHO web portal which will be converted to an invoice for payment. B. Contractor shall submit encounter data per the MIS web portal instructions. C. Contractor shall be reimbursed as follows: 1. Pioneer North and East Residential services will be reimbursed at $ per bed day. a. The consideration by North Sound BHO to Contractor pursuant to this Agreement shall be paid the daily bed rate times the number of bed days based on data submitted by midnight on the 15 day of the month following the month of service. b. North Sound BHO will process the payment on the first working day following after the 15 day of the month. A budget payment (the last month of service March 31, 2018) will be made in the first month of the contract. c. The budget payment will be reconciled to actual services provided in the month following the last month of the contract April d. Fifty beds will be purchased on a capacity basis In the Pioneer Human Services North Facility. e. A monthly capacity payment will be made each month for based on the number of days in the month times the daily bed rate. Funds for July 1, 2017, through March 31, 2018, following the end of the annual State legislative session, North Sound BHO shall offer an Amendment with the proposed funds for the next fiscal year. If for any reason Contractor does not agree to continue to provide services using the proposed funds, Contractor must provide the appropriate notice to North Sound BHO under the termination requirements of Section E. NORTH SOUND BHO-PHS-RESIDENTIAL Page 8 of 9

9 IV. KING COUNTY COMPENSATION A. Daily bed rate payments will be made retrospectively based upon dates of admission and discharge as authorized by King County and entered into BHRD IS by KCCA and the Residential Census Log SUD Residential Census Report. B. Contractor is responsible for informing King County should actual resident admission or discharge dates differ from those authorized by King County. King County may recoup payments should Contractor fail to notify the County of changes in admission or discharge dates or provide incorrect dates resulting in benefit payment that exceeds the resident s actual length of stay. C. TIC payments shall be made retrospectively based upon number of days and children recorded on Residential Census Log SUD Residential Census Report. Payments shall not exceed 5 days per week. V. KING COUNTY REPORTING REQUIREMENTS A. Monthly Reports 1. The Contractor shall submit to North Sound BHO the monthly Residential Census Log SUD Residential Census Report in an electronic format provided by the County. The Residential Census Log report must be submitted successfully before the BIP will be considered to be complete. 2. The Contractor shall submit the Reimbursement Request Summary in hard copy and an electronic format provided by the County. VI. AUTHORIZATION OF PIGGYBACKING As established in RCW BHOs are authorized to purchase goods and/or services at the same price and under identical terms and conditions where it is lawful and in their best interest to do so. BHOs purchasing based on this language agree that any subsequent agreement shall be accepted at the same terms and conditions as the original. Any liability created by subsequent agreements based upon this document shall be the sole responsibility of the BHO or other entity. Any piggybacking BHO shall create and maintain a bid file, to include copies of the contract documents from the host agency, including but not limited to any Invitation to Bid/Request for Proposals, advertisement, bid tab, awarded vendor s response, website certification, and the contract itself. Any piggybacking BHO shall provide written notice prior to any authorization for residential services to North Sound BHO of their intent to contract based on this authorization in writing to the address below: North Sound BHO 301 Valley Mall Way, Suite 110 Mount Vernon, WA BHOs may purchase based on this agreement for the term of the contract. NORTH SOUND BHO-PHS-RESIDENTIAL Page 9 of 9