Mergers and Acquisitions

Mergers and Acquisitions Q: Can agencies or CABHAs without a credentialed site in the Alliance Network collaborate or merge with another provider that has a credentialed site in the Alliance catchment area? For collaborations, can providers share a credentialed site for storage of records? Will the collaborating agencies still be able to bill separately, or will they be required to merge legally under one name, NPI, and Medicaid number? A: We will accept responses from providers who are contemplating mergers or acquisitions, but collaborations or MOAs will not suffice. Respondents must be able to provide all services required by the RFP through a single legal entity that is able to fulfill the requirements of the RFP. Alliance will not recognize collaborations for the purpose of these RFPs but will consider merger plans. Providers cannot share a credentialed site for administration, storage of records or service delivery. Any subcontracts must be approved by Alliance in accordance with Medicaid contract requirements. Q: What does Alliance consider to be a merger? A: This refers to plans to acquire another agency or for two agencies to join to form a new legal entity. The acquiring agency must have a credentialed site within the Alliance catchment area. If two agencies decide to merge, at least one agency must have a credentialed site within the Alliance catchment area. The agency with a credentialed site is responsible for submitting the RFP response. Q: If we are planning to merge with another agency, what information should we provide? A: Respondents should submit an implementation plan for merger that includes concrete timelines, with various merger tasks along that timeline for which the provider maintains accountability. Merger implementation plans must be approved by Alliance and the merged entity must meet all RFP requirements. Mergers or acquisitions should be completed by March 31, 2014 to meet consumer transition needs. The merger implementation plan will need to indicate whether one agency is acquiring another or if a third, new company, is being formed. Agencies should be prepared to respond to questions from Alliance about merger plans. Q: Does Alliance prefer collaborations between providers for regional purposes to cover all four counties? A: We have no preference that providers be able to serve multiple counties or that providers establish agreements to cover all counties. The purpose of this RFP is to ensure that all services are of high quality and being delivered in accordance with service definition requirements. Q: We currently have a credentialed site here in Durham. Can we provide services to the other 3 counties without setting up a physical site? A: IIH and CST providers with a credentialed site within the Alliance catchment area may provide services to consumers throughout the catchment area if able to meet supervision, records and other requirements of the service definition. Outpatient services must be available within the county where services are being provided. Because SAIOP must be operated from a licensed and credentialed site, these services are site-specific and can be provided only from the site location. Q: If we are not expanding or merging, what should we include in the implementation plan? A: There is no need to submit an implementation plan if you have no plans for merger or expansion. However, if you are able to accept additional referrals that may be generated by this RFP (for example, if existing providers 1

do not respond or do not meet RFP requirements), please submit a timeline by which you can accept new referrals. Q: Is it possible to push back the due date of the RFP s due to possible mergers with agencies in order to meet needs in community? A: We cannot push back the due date. If providers are in the process of a full merger then Alliance will need the plan and timeline for that. CABHA Q: If I am not awarded a contract and this service is part of my CABHA continuum, will this impact my ability to remain a CABHA? What is the implication of not being selected? Could not being awarded an RFP affect our CABHA status in other catchment areas? A: Your CABHA status will be affected if you no longer meet the continuum requirements for CABHA, and this may affect your CABHA status in other catchment areas. Q: If you lose CABHA status, could you be awarded an RFP for only one CABHA service when you do not offer another required CABHA service? A: You must retain CABHA status in order to be awarded an RFP for a CABHA offered service. Q: Please elaborate on the duties of the medical director and the decision made regarding the requirement for the Medical Director to be contracted for 10 hours. What if the psychiatrist is more involved in the actual oversight of our program than the Medical Director? A: N.C. Session Law 2012-171 requires each CABHA to have a Medical Director who provides medical, clinical and quality management oversight of the agency s CABHA services. This function cannot be delegated to a psychiatrist who is not the Medical Director. Alliance believes that performance of this function requires a minimum of 10 hours per week devoted to medical, clinical and quality management oversight, separate and apart from medication management or service delivery. In your proposal, please describe the involvement of your Medical Director and any clinical staff who are involved in the oversight and supervision of your program. Q: Is it required that the medical director be a psychiatrist? A: It is not required, but we expect the individual to have a background and expertise relevant to the clinical focus of the program. We are adhering to the CABHA expectations. Q: Will there continue to be CABHA monitoring in the future or just Gold Star Monitoring? A: We are still waiting on clarification from the state about CABHA monitoring. Alliance will adhere to Gold Star Monitoring as required by the State. If State requirements change, providers will be notified via the weekly Alliance Provider update. Q: How many RFPs will be awarded? General questions about RFP process A: Alliance is not looking for a specific number. We are looking for high quality providers implementing the service definition as it is written. 2

Q: Will providers who responded to the Cumberland RFI expressing an interest in one of these services be able to apply if we are not currently providing the service? A: We had an overwhelming response to the Cumberland RFI. Most of the responses were seeking to provide services for which Alliance has sufficient capacity: http://www.alliancebhc.org/cumberland-county-providers Providers that responded to the Cumberland RFI but do not have a credentialed site in the Alliance catchment area at this time are not eligible for this RFP. Q: Is it possible to be considered for one RFP and not be considered for another RFP? A: Yes. Each RFP is separate and independent of the others. Q: Does the opportunity for Q & A close on 10/11? A: Yes, questions closed 10/11/13. Q: I notice that the actual RFP does not explicitly state that you must have a credentialed site in the Alliance area to respond to the RFP but your website does. A: We have amended the RFPs to include the clarification that providers must have a credentialed site in the Alliance catchment area in order to submit a RFP response. Q: If we are not awarded a contract from Alliance, would other MCOs see this as negative? A: Non-selection for the RFP is not an adverse action. Q: If awarded can the provider expand? A: If awarded and the expansion plan is approved, then yes. Q: Will selected providers be awarded a contract (that stipulates the number of youth to be served, total contract amount, etc.) or will providers simply be authorized to provide services? A: Selected providers will be awarded a fee for service contract for Medicaid that will utilize a standard template. Q: Is there a minimum and/or targeted capacity that Alliance is looking for providers to serve (i.e. 3 teams, 5 teams, etc.)? A: Alliance has no minimum expectations for number of teams. We want providers to have a high quality team and sufficient number served to be financially viable. Q: MH/SA diagnosis DSM 5 does not go into effect until October 2014 according to APA. Please clarify the reference to DSM-5. A: Continue to use DSM-IV-TR for now. Alliance has not asked providers yet to begin using DSM 5. Clinical criteria in the RFP are about diagnosis, not billing. Q: If selected through the RFP, can agencies add more credentialed sites? A: Respondents that would like to expand services to additional sites should so indicate in their proposal and provide detailed information in the implementation plan. 3

Q: Will Alliance make an exception for providers who have offered the service covered by the RFP for less than a year due to the length of time to complete the endorsement/credentialing process? A: Alliance will make an exception if the provider submitted an endorsement application prior to July 31, 2012 and is currently contracted to provide the service covered by the RFP or if the provider was contracted to provide the service covered by the RFP on February 1, 2013 (the start-date of Alliance Waiver operations). Q: My agency has a valid contract with Alliance for some of the RFP services but we are not currently providing the services in the Alliance catchment. We were actively in process of setting up two sites in the catchment area to begin providing the services. The RFP states that the respondents have to be currently providing services in the Alliance catchment area. Is there any opportunity for us in this RFP process? A: No, respondents must be currently providing the service covered by the RFP through a credentialed site within the Alliance catchment area. Providers should not be setting up sites in the Alliance catchment area without prior approval from Alliance as the network is currently closed. Q: What is the expected referral volume if a provider responds to the RFP? A: We are looking for providers to be flexible to take on additional referrals in the event that other providers cannot. At this time we cannot provide an expected referral volume. Q: What is the current # of individuals served per county by funding service? Medicaid versus state funded by county? A: Alliance will post a response to this question separately on the website at a later date. Q: Will Alliance be accepting new applications for IPRS Funding? A: We will consider state funding at a later date for providers who are selected through these RFPs. Providers who are not selected for these RFPs will not be eligible for state funded service contracts for these services after June 30, 2013. Q: Please provide more information about the evaluation of RFP responses? Will we be given our scoring if we are invited for an interview? A: We will review first for minimal compliance, followed by a desk review of written responses and interviews of providers whose proposals meet the desk review requirements as described in the RFPs. Desk review scores will not be shared during the selection process. Q: The RFP notes that Alliance reserves the right to reject any proposal for any reason. Will Alliance articulate the reasons for rejection of proposals? A: If the agency is rejected, we will disclose the reason to the respondent. Q: Will there be an appeal process if the proposal is rejected? A: There is no formal appeal process, but Alliance will offer the opportunity for a meeting with the CEO/ Area Director or her designee to discuss the basis for the non-selection. 4

Q: What are some of the reasons a company may not be selected? A: Some of the reasons include poor clinical performance, not in good standing with Alliance, other LME/MCOs or the State, financial difficulties and lack of expertise in or fidelity to service definition and evidence-based practices. Q: When will the selection be announced? When will providers be notified that they were not chosen? A: All decisions regarding the outcome of the RFPs require approval by the Alliance Board. Providers will be notified after the Alliance Board meeting at which RFP selection is approved. We are planning around our Board s availability and expect to present recommendations to the Board in January. We will post additional updates on the Alliance web page. Q: If we are awarded the contract, how long does it last? A: All contracts are good for one year. Contract renewal will be based on performance. Q: What is the process if your agency is not selected for this process? A: We intend to offer short-term contract extensions to providers that respond to the RFP in order to assist with transition of consumers from agencies that are not selected. We will work with non-selected agencies to coordinate transition plans. Respondents should include in their proposal their capacity to take on additional consumers that may be transitioning from non-selected providers. Q: If we do not have a credentialed site in the Alliance catchment area and are serving Alliance consumers, do we have to submit a response to continue providing this service? A: No. We will continue to contract with providers who are serving Alliance consumers who reside outside of the Alliance catchment area through our Out of Network process. We will respond to requests as needed. Q: Is Alliance considered a LME or MCO for appeal purposes? A: Alliance is a multi-county LME/MCO as that term is defined at N.C. Gen. Stat. 122C-3(20c) [N.C. Session Law 2013-85]. Q: Several sections of the RFP request evidence from respondents. What type of evidence will Alliance accept? A: Evidence may include but is not limited to written policies/procedures, protocols, job descriptions, QI plans, training certificates etc. This information may be included in the appendix of your response. Section 10 (Attachments) of the RFP proposal, as noted in the section list in Content of the Proposal, provides an opportunity for respondents to submit additional documentation. It is up to each respondent to submit sufficient information within the context of the submission as well as supporting attachments to demonstrate they meet the RFP requirements. Q: When you talk about expansion of services, you are only talking about the services for which RFPs have been issued no other services, right? A: Yes, expansion plans should include only the services that are within the scope of the RFP. Expansion of services should be included in the implementation plan if this is something the provider is planning on doing. Adding site(s) during the RFP process will be considered if the expansion proposal is approved. Alliance understands that additional licensure may be required and will work with providers wishing to add a site during this process. 5

Q: Where Alliance is asking for numbers served, data, etc., do you want our information for only the Alliance area? A: We would like to see all of your data if it involves a model that you are interested in bringing to your local program. We would like to see QI plans, description of how you collect your data, what evidence-based practices you use, evidence of trainings, work with special populations and how your model of care is targeted towards the population. Data should include Alliance data specifically but in subsequent information can include data across the state regarding this service. Q: Please explain the minimum requirement for respondents to provide outpatient therapy, since this is not a CABHA requirement. A: We are looking for providers that offer a full continuum within the Alliance catchment area and are not limited in their service array. We are particularly interested in any innovative and/or specialty programming around outpatient services, such as open access, DBT, etc. Respondents should include a summary of your current outpatient services as well as any plans to add outpatient services to your service array. This information should be included in your implementation plan. Q: Please explain Alliance s preference for organizations that offer employee benefits. A: We are looking for organizations that have the ability to recruit and retain qualified staff and maintain a stable workforce. This is a preference but not a requirement for respondents. Q: Will the gold star monitoring have an impact on the selection process? A: Gold Star is still in process and we are waiting for further guidance from the State. If your agency has undergone a Gold Star review, we will consider the results in the selection process. Q: Are provider cultural competency requirements included in the RFP? A: Yes, it is important to identify your cultural competency plan in your response. Submission Requirements Q: Is there a limit on the number of pages you can submit or length of sections? A: We do not have any specific page or word limits for the RFP or its sections. Respondents are encouraged to present information concisely but with sufficient detail to respond to all elements of the RFP. Q: Regarding the proposal, if our agency provides more than one of the services, do we need to submit a separate plan for each service or can they be all in one? A: Yes, you must submit a separate response to each RFP. Q: If we are applying for 3 different RFP s, do we need to submit 3 separate applications? A: Yes. You will need to submit 3 separate responses. Q: Within each proposal, for each question in the scope of work, are you asking us to answer ONLY within the context of that service or across services. Some questions are clear and seem to apply only to the specific service. A: We prefer information about both, although our primary objective is to understand the agency s service delivery associated with the scope of the RFP. 6

Q: Per the submission requirements (page 3 of RFP), providers must submit the proposal contents according to the outline specified. Does this mean that the proposal should respond to each bullet item in the order they are listed, or can the order be modified as long as all bullet points are covered within the text of the specific section (e.g. Clinical Programming and Response to Scope of Work)? A: Respondents may submit information in any order within a section as long as all bullets within each section are covered and content is organized in a manner that enables the reader to identify specific content areas. Q: If we are given an opportunity to interview for more than one of the RFP services, will there be separate interviews? A: Yes. We have different people on panels for different services. Some of the same questions may be omitted during subsequent interviews if they were fully answered in the initial interview. Q: Can we respond to some of the questions by providing our policies and procedures? A: You may respond by providing your policies and procedures as an attachment but you must identify that as your response within the body of the submission, i.e. (see [name of procedure] and page/ section if applicable). If they are in a different font or layout than the RFP requests, they will still be accepted. This is true also for any brochures that you may submit. Q: What do we indicate if the statement does not apply to the agency? For example, Section 4 asks respondents to identify any legal actions in which our organization is a party, including all federal, state and administrative actions. A: If an area does not apply or there is no information to report for a given area, please provide sufficient information to confirm that the area is not applicable or the reasons that no information is available. For example, note that our organization has had no legal actions rather than leaving blank or writing n/a. Q: For providers serving multiple counties in Alliance s catchment area, do we submit one RFP application? A: Yes, providers should submit one application per service. Q: For respondents providing services at multiple locations within Alliance s catchment area, will multiple RFPs need to be submitted? A: No, a single RFP response should be submitted for each service the agency proposes to deliver. Separate RFP responses are not necessary for each site location, but the response should include all information about the site locations from which the respondent proposes to deliver the service. Q: Where will the Q&A document and other materials be posted? A: All RFP materials, including the Q&A documents, will be posted on the Alliance webpage where the current RFP information is located. Q: Is the attestation letter the same as a cover letter, and is there an expected format? A: The attestation letter is the same as a cover letter but must include all required elements as described in the RFP. There is no expected format but we may post a sample on the website. 7

Organizational Background Q: When asked to identify other LMEs/MCOs with which we have a contract, is this referring solely to our program in the Alliance catchment area or to all of the services provided by our organization regardless of location? A: All publicly-funded MH/IDD/SA services regardless of location. Q: How much evidence is Alliance looking for to show a continuum of care has been established within our agency? A: Minimum of program description, organizational chart, staffing pattern and job descriptions and any other information you wish to submit. Q: On page 7 of the RFP, in Section 2., Organizational Background, the 6 th bullet states Attach a copy of your current organizational chart; indicate names and numbers of FTEs per title. Should providers include their operations in the Alliance catchment area or statewide? All services or IIHS only? A: Provide information about all sites in the Alliance catchment area, your corporate site, and any other agency resources that support the services covered by the RFP. Q: On page 7 of the RFP, in Section 2., Organizational Background, the 9 th bullet states Identify your current service location(s) with the physical address and services offered at each site. Also identify the types of funding in the contracts. Should providers include their operations in the Alliance catchment area or statewide? All services or only the service covered by the specific RFP? A: Please include a description of services provided within the Alliance catchment area as well as an overview of overview of services provided throughout the state. We are interested particularly interested in your service continuum associated with the scope of the RFP, but would like to understand your broader array of services across the state as well. Clinical Programming Q: Please clarify "clinical profiles". Is this by service type or service type and diagnosis? Also, is this agency wide or specific to Alliance clients? A: We are primarily interested in diagnostic and demographic profiles of consumers currently served in the programs covered by this RFP, but providers are welcome to submit additional information about the scope of services and experience of the broader agency. Q: How do you demonstrate partnerships with stakeholders in the community? A: Please include a description of any formal or informal partnerships, agreements or relationships with stakeholders in your narrative, and include a point of contact with the stakeholder organization. We are not asking for letters of support. We may want to check with them as references. Q: If you serve a special population would you include it in your customer satisfaction area? A: Yes, this should be included in program narrative as well as Section #10 of response. Q: Should providers give details on their step down process of consumers in the RFP? A: Yes. 8

Q: For customer satisfaction, should the provider attach actual surveys or a summary of collected surveys? A: A summary will suffice, but Alliance reserves the right to request a copy of actual surveys and results during the interview process. Q: To provide evidence of the outcome data for the recent two years that is relevant to our organization, can this be done in a case study? If not can you elaborate on what information you would like presented for that section A: We prefer aggregate outcome data that demonstrates your understanding of the impact of your services on consumers served. If your agency does not have this data available, please describe your plans for collection of outcomes data. Q: Please clarify the expectation regarding Motivational Interviewing that Clinical Staff must be proficient in Motivational Interviewing and must have received training from a MINT-certified trainer have achieved MINT or other recognized certification. Do the staff all have to be MINT certified or just the trainer offering the MI training? A: The RFPs should have stated that staff must be trained by a MINT Certified trainer (staff are not required to be MINT certified themselves although this is preferred). We have clarified this requirement in the amended RFPs. Q: Are we to submit our template job descriptions for all related clinical positions, OR are we to submit actual signed job descriptions for existing staff? A: Template job descriptions. Q: Page 7 Section 3 Clinical Programming and Response to the Scope of Work clarification needed for the implementation plan is this specific to expansion or merging? Mergers and acquisitions need to be included as well as expansion. A: Implementation plan for site expansion, addition of outpatient services, transition of consumers from other providers, and any mergers, acquisitions or other changes of ownership. Q: On page 7 of the RFP, in Section 3., Clinical Programming and Response to Scope of Work, the 2 nd bullet states Describe the payor mix of clients currently served. Should we respond for operations in the Alliance catchment area or statewide? A: We are primarily interested in the payor (Medicaid, State funds, grants, private insurance, etc.) mix of consumers served in the Alliance catchment area. Q: Could you elaborate on what you are specifically looking for when asking about the demographics of the clients served? A: Please provide descriptive aggregate information about the background of your consumers such as age, sex, race, ethnicity, etc. Q: Please clarify what is meant by experience working with the criminal justice system. A: For consumers who have involvement with the criminal justice system, we expect providers to have an awareness of this system and to take actions to communicate and coordinate care when appropriate. 9

Q: What is meant by models of service delivery, evidence-based models? A: See further discussion of this question in the SAIOP section. Q: Is there a certain date that trainings, specifically MI and CBT should have been obtained by? In the State Funded Enhanced Mental health and Substance Abuse Services Manual, it states that it should have been obtained by June 30, 2011. If it was received before that date, is it a valid training? A: Training provided prior to June 30, 2011 would still be considered valid. Further information is available at: http://www.ncdhhs.gov/mhddsas/implementationupdates/update075/attachmentbiihtraininggrid6-23-10.pdf http://www.ncdhhs.gov/mhddsas/implementationupdates/archive/2010/update073/attachmentccsttrainingg rid5-17-10.pdf Q: For medication management and psychiatric services, can a psychiatric physician s assistant provide those services? A: Yes, a PA can provide medication management and psychiatric services under the supervision of a psychiatrist. Q: In terms of seeking safety and matrix model, would you want them targeted towards the populations they were meant? A: Yes. Q: Page 8 bullet #4, current processes for fidelity do you want our fidelity data as evidence? Do you want the actual outcomes or do we show you how we measure fidelity? A: We want to know how you measure, gather, and respond to data regarding model fidelity. Alliance reserves the right to request supporting evidence of fidelity or other documentation during the interview process. Q: Should we include our forms to measure fidelity? A: This is not a requirement, but providers are encouraged to submit all information that will provide details about the agency s capacity to measure fidelity. Q: Last bullet on Page 8, example of consumer outcome data sample of outcome data what are we looking for? Are we looking for aggregate data? A: We are not interested in the line by line consumer information. We want to know how you know whether you are making an impact and what you do with that data. Q: In the clinical supervision section, are you looking for the clinical supervision plan in general or for all staff? A: Please describe your clinical supervision plan in the narrative, including how your agency provides ongoing supervision and oversight. Keep in mind that CABHAs are required to have a Medical Director who provides medical, clinical and quality management oversight of the agency s CABHA services. Alliance reserves the right to request a copy of your plan or individual staff supervision plans during the interview process. 10

Q: Evidence-based model does not meet the staffing expectations in the service definition. Do we have any flexibility to alter? A: Yes please describe your current practices and alignment with evidence-based practices. Legal and Compliance Q: When asked to provide details of any site location or office closures that resulted in the termination of services within the last 2 years, is this any location/office anywhere (including other LME/MCO regions) or just in the Alliance region? A: Please provide details associated with any closures at any location within the state. Q: When asked to identify Plans of Correction within the last 6 months, is this specific to our program in the Alliance catchment area or to all of the services provided by our organization regardless of location? A: This question applies to all services within the state. Q: Given the federal government shutdown (IRS), are we taking that into account for our good standing letters from the IRS? A: The shutdown ended effective 10/17/2013 and the IRS does not provide good standing letters. The purpose of this section is for respondents to fully and completely disclose any sanctions. The failure to disclose a sanction may result in rejection of your response. Q: In reference to good standing, what proof is required for agencies other than Alliance? A: Respondents may contact other LME/MCOs to request letters of good standing. If not available by the time of submission, Alliance will contact other LME/MCOs to obtain this information. Q: Do recoupments on Gold Star monitoring count as a sanction? A: Yes. Q: Should we disclose voluntary repayment? A: Yes, all overpayments should be disclosed but may not be a bar to selection. We are looking for a history and demonstration of repayment. Financial Q: In the Financial Information section of the RFP, you are requesting copies of our most recent audit report, audited financial statements and management letter. Can agencies that are not required to have an audited financial statement submit alternative documentation? A: If not required to complete an annual audit, a compilation or review completed by a CPA firm will be accepted. If an annual audit is required, you must submit copies of the audited financial statements. Q: In the financial portion, what is a management letter? A: A management letter is issued by audit firms with the audited financial statements. It covers deficiencies noted in the audit and general internal control suggestions. 11

Q: Would the providing agency be able to conduct their own internal audit for the requested information, or does the providing agency have to have a professional book keeper come in and complete the audit for the review? A: Alliance prefers at a minimum a review by an outside CPA but will accept internal statements. However, any concerns may require a follow up letter from a CPA review. Q: What evidence are you looking for that providers have clean claims? A: This information will be reviewed by Alliance staff. Providers do not need to submit evidence of clean claims. Q: Page 2 minimum requirements, do the applications need to provide their data or will Alliance use its own source regarding clean claims and administrative denials? A: Alliance will use our own sources. Q: If you provide services that are paid for by other payers such as grants, private insurance in addition to Medicaid, how does Alliance look at this? A: Alliance supports companies seeking other methods of financial stability. This language is included in our contracts. Q: What are the metrics/ measurements that you will be using to determine fiscal viability? A: Alliance will consider assets, liabilities, and cash on hand, and will thoroughly review the audited financial statements. If there are concerns about payments expected from other LME/MCOs or NCTracks, they should be identified as receivables and respondents may submit a statement of explanation. Alliance reserves the right to contact other LME/MCOs or the State for additional information if necessary. Technological Capability Q: What information is needed to demonstrate that we have the "ability to create and test electronic 5010 compliant 837 Professional and Institutional claims and send via secure FTP to Alliance Behavioral Healthcare"? A: This was a miscommunication. Providers may submit claims via 837 or manually via the AlphaMCS provider portal. Q: We need more details as to what exactly is being requested. Is it as simple as the agency stating they use Alliance approved software? A: Providers must demonstrate that they can successfully submit electronic claims. If they work with an outside vendor, they must include details about the vendor s capabilities. Providers are not required to submit claims via 837. Q: What is the difference between filing an 837 and filing through the Alpha system? A: The Alpha portal requires manual entry of claims, and the 837 is a batch process. Q: What is needed to file 837 claims? A: Information is available on Alliance s website at: http://www.alliancebhc.org/providers/finance-and-claimsforms 12

Q: If you are already billing in the Alpha portal, do you still need to be able file 837 claims? A: No. Q: Under #6 Technology Capabilities, how detailed does this need to be? Will a statement from our IT department work to address this? A: We want to know that you have minimum capabilities to interface with Alliance which includes being able to electronically submit claims and/or enter information into the Alpha portal. References Q: Question related to references how to document this. A: List references including name, title, telephone and email contact information. We do not want to receive letters of reference. Q: What type of references does Alliance want? A: We do not request letters. Please provide contact information for individuals/agencies that are willing to provide a reference for your company. We will be contacting them directly. Q: Will support letters from our partnerships count? A: You are welcome to submit these types of letters with your response. We will also need names, addresses and contact information for individuals that we will call as references. CST - Q&A Q: Is the minimum of 15 consumers served per county or per catchment area? A: It is per Alliance s catchment area per team. Each team must have a minimum of 15 consumers. Q: Is the minimum of 15 consumers served on average a requirement or a preference? A: This is a strong preference. We are looking for financial viability and will be looking at your staffing patterns. If you serve less than 15 consumers and you have a plan for expansion, please address this in your implementation plan. The 15 consumers served is per CST team rather than per agency. Q: All fully licensed staff or provisional? IIH - Q &A A: Our preference is for the Team Leader to be fully licensed. Q: Is this about licensure and not about qualifications? Intensive In-Home is a good place for individuals to hone their skills. A: If you are getting great outcomes, then write that up. We want to see experience and clinical oversight. We are not excluding people. We want to see that you have people that know what they are doing with the population served. 13

Q: Where is there room for preference when we are following the service definition by having provisionally licensed? Why is Alliance showing preference for fully licensed staff? A: We are not going to exclude you. Not having the preferred licensed staff does not go against you. Q: Can we have a caseload greater than 12? Service definition says 8. A: Providers must adhere to the service definition. Q: Staffing ratio we are aware that there are evidence based models that do not fit nicely into the service definition. A: Please let us know how you are implementing that evidence based model within the service definition. SAIOP - Q &A Q: Does Alliance have standardized screening tools that providers are supposed to be using? A: No, we do not currently but may develop them in the future. Tell us what screening tools you are currently using and how effective you think they are. Q: Now that the RFP has been released for SAIOP, does that mean that the current contract we have will not include SAIOP/SACOT in the future? A: Providers currently contracted to provide SAIOP who are not awarded a contract under the RFP process will not have their contracts renewed for SAIOP. The RFP process does not affect SACOT. Q: When the RFP talks about medication management, does it apply specifically to substance abuse medications such as suboxone, methadone, etc. or does it refer to all medications? A: We are looking for the ability for your company to prescribe any type of medication that the consumer may need. We want to know if you have medication management or you have a relationship with another provider who does this for your consumers. Q: What is Alliance considering as evidenced based for SAIOP as Motivational Interviewing (MI) is not supported by the literature as being effective for groups? A: We are following the state service definitions which support MI. We want to see MI trained staff as evidence supports this is helpful in the engagement of consumers individually or in a group. Important for staff to have skill set in MI. Q: Please clarify expectations for an Alliance standardized screening. A: We do not require a specific screening tool, but do expect that the screening tool will be a standardized tool or approach. Q: What is Alliance looking for when it states: partnership with physical health providers and is there a standard format to use for the general health screenings? A: It is our expectation that providers are documenting whether a client currently has a primary care physician and if not, that the provider has made an attempt to link the client with a primary care physician. There is not a standard format to use and it is up to providers how they go about obtaining this information. It can be part of the initial paperwork completed by a client or it can be built into the CCA. 14

Q: Please clarify terminology regarding models, evidence based practices, evidence based treatment, screenings, and evaluations. A: SAIOP is considered a treatment modality, program or level of care along a continuum of care with routine outpatient services, SACOT/PHP, residential, etc. It is considered an intensive outpatient treatment modality as part of ASAM Level II services. We are not looking for or endorsing a specific practice model, but want to be sure that the treatment delivered is consistent with best practice and that Evidence Based Models are being utilized. Not all treatment models work with all consumers. Evidenced Based Treatment Models are considered best practices, but not all best practices are considered Evidenced Based Treatment Models. Evidence Based Treatments include but are not limited to CBT, MET, Matrix Model (for cocaine/amphetamines), The Seven Challenges (Youth 13-17), Seeking Safety (PTSD/Trauma & SA), Behavioral Couples Therapy (BCT) etc. SAMHSA has a web based guide to Evidence Based Practice models as well as a National Registry of Evidenced Based Programs & Practices (NREPP). More important than simply listing models, it will be important for providers to demonstrate training and proficiency in using the models and how they are incorporated into programming. Best Practices include a variety of treatment models and would also include things like Pharmacologic management specific to substance abuse, i.e. Buprenorphine, Methadone Maintenance, Naltrexone, Medication management for psychiatric conditions, evaluation and management of co-occurring disorders. Q: As for screenings, why is the CCA and its detailed questions about substance use not sufficient for screenings (or evaluations)? A: A thorough substance abuse assessment that is able to establish the appropriate level of care (ASAM) is sufficient. If a provider is using any screening tools in addition to the CCA, then that should be noted in the RFP response. Q: Please clarify what you mean by capacity to conduct evaluations to determine the need for alternative levels of care. A: The capacity to do evaluations to determine the need for alternative levels of care simply means that a provider is able to establish through the use of a CCA the most appropriate level of care, which may mean that a client needs a level of care currently not offered by that provider. It was not meant to imply that we wanted you to establish the competencies of your clinicians or operational expectations surrounding the availability of your clinicians to do substance abuse evaluations. Q: Does three teams equate to three agencies? MH/SA Supported Employment A: No more than three agencies will be awarded contracts for this RFP. Q: Does this mean three teams per county? A: No, we anticipate awarding contracts for three teams in total for the Alliance catchment area. This is a new service that is supported by a limited State allocation. We will not be able to support more than 3 teams. The intent for next fiscal year is to increase our B3 services, so there may be more of an opportunity to add additional team(s) at that time. Q: If we are currently providing the service and not selected, will we lose our contract? A: Yes. 15

Q: The RFP refers to a DHHS reporting tool? What is this? A: We do not currently have this tool. It is referenced in the state service definition but is not yet available. We will provide more information when available. Q: When will the providers begin in the Spring? A: After the Alliance Board makes the selection of providers, we will work with selected providers to coordinate implementation plans. Q: What is meant by braided funding (page 6 of the RFP)? A: This wording originated in the state service definition, page 8. We expect this to be clarified in stateprovided training. Q: We have done supported employment in other states, is that information applicable? A: Yes. Section 10 is where you can include this additional information. Q: Scope of Work (Section 3) What kind of responses are you looking for and are you expecting coverage of all Alliance counties? A: In terms of where do you want to have this program and who do you think you can serve, note the location(s) that you can serve. This will not be the only opportunity. This is only the beginning. Tell us what you do well. There is no requirement to serve all 4 counties. Q: Page 6 Target Population & Eligibility Who will do the diagnostic to ensure the individual is eligible if the person is not referred by VR? A: This information will be obtained by the Supported Employment provider and is typically available from the treatment provider for each consumer. Q: Data collection? A: We are looking for you to have the capacity to collect the data. Most of this is still in development. Q: Minimum requirement is currently credentialed? A: This means your agency must have a currently credentialed site within the 4 counties, but not specifically for this service. Q: Will Alliance continue to authorize services while the RFP process moves forward? A: Yes. Q: Is there a certain number of people to serve from DOJ within the next year for Alliance? A: No. The goal is to get the service up and running. Q: Will Alliance use the State rate? A: Yes. 16

Q: Will we be capping the hours authorized and will that be in our Benefit Plan? A: Selected vendors will be working with us and the State. There needs to be flexibility and understanding of the uncertainty surrounding this new service definition. Q: For Supported Employment, do you have to have an Alliance contract for that service to apply? A: No, you are not required to have a current contract for Supported Employment in order to apply. You can apply as long as you are a current provider of any service under contract with Alliance and are currently providing at least one service from a credentialed site in the Alliance catchment area. Q: Should a provider respond and get approved for a contract for MH/SA SE/LTVS, can a provider be allowed time to ramp up capacity before services must commence? A: We will work with selected providers to coordinate implementation plans. Q: Can Alliance Behavioral Healthcare identify how many individuals would be served through this RFP? A: The number served will be subject to availability of funding. Q: Under this RFP, how many billable units would there be allowable for work on non-employment-related concerns, such as housing, relapse prevention, social networks and activities, etc.? A: The activities related for this RFP should be related to employment and fall within the service definition. Q: Is there a cap on the level of funding available per provider for IPRS or Medicaid B-3 SE services? A: We have not yet determined funding arrangements and will work with selected vendors to clarify. 17