SECTION 1 &nbs= p; REQUEST FOR RESPONSE (RFR) SUMMARY

1.1 Issui= ng Entity/Contact Person and RFR Distribution=

Issuing Entity: &nbs= p; ___________ Area of the Department of Mental Health

RFR = File Title: __________= ____ Area Community Based Flexible Supports Request for Response

RFR File Number: &nbs= p; 2010-____-3054-01

Contact Person: ________________= _______

Addr= ess: = &= nbsp; De= partment of Mental Health

____________ Area Office

______________________

_____________________

Fax = #: &= nbsp; &nbs= p; ___________________________

E-Mail Address: ______________________= _____

This RFR has been distributed electronically using the Commonwealth of Mas= sachusetts Procurement Access and Solicitation (Comm-PAS= S) system. Comm-PASS is the official system of record for all procurement information.&nb= sp; It is publicly accessible at no charge at www.comm-pass.com. All records on Comm-PASS consist of multiple tabs, or pages. For = example, Solicitation records contain Summary, Rules, Issuer(s), Intent or Forms &am= p; Terms and Specifications, and Other Information tabs. Each tab may contain data and/or f= ile attachments provided by DMH. = All are incorporated into this RFR.

It is the responsibility of= every bidder to check Comm-PASS for any addenda or modifications to a solicitation for which they intend to respond. The Commonwealth and its subdivisions accept no liability and will provide no accommodation to bidders that submit a response based upon an out-of-date solicitation document. Potential bidders are advised to check the “last change” field on the summary page of solicitations to which they intend to respond = to ensure they have the most recent solicitation files.

The bidder may not alter the RFR or its components except for those portions intended to collect the bidder’s response (= cost pages, etc.). Modifications t= o the body of the RFR, specifications, terms and conditions, or any other documen= ts that would change the intent of this RFR are prohibited. Any modifications other than where= the bidder is prompted for a response will disqualify the response.<= /span>

For more information about Comm-PASS see the Operational Services Division RFR Required Specifications that are included under the “Forms & Terms” tab of the Comm-PASS file of this RFR.

1.2 &nbs= p; Description and Purpose of Procurement

The Massachusetts Department of Mental Health (DMH), through this RFR, is seeking to procure Community Based Flexible Supports (CBFS) for the ___________Area. The Area anticipates awarding one = contract for each of the client populations described in the Contract Descriptions attached to this RFR for a total of ____ (--) contracts. (See also Subsection 1.10 f= or more information on the different contracts that may be awarded under this RFR.)

CBFS is a new activity cod= e for DMH. CBFS contractors are responsible for providing rehabilitation, support, supervision, and housing/room and board where needed to a defined set of DMH adult clients in the Area. Housing/room and bo= ard may only be provided by CBFS contractors to clients receiving rehabilitatio= n in accordance with the clients’ Individualized Action Plans (see Subsections 3.4 and 3.5) unless approved by the Area Director in writing. CBFS is designed to increase clien= ts’ capacity for independent living and their recovery from mental illness. It is the role of CBFS contractors to individualize = the delivery of services in partnership with each client. A contractor is required to adjust the mix and intensity of CBFS provided to individual clients to meet their changing needs and goals as they move toward recovery and to coordinate CBFS with the cl= ients’ other DMH services and, to the extent feasible non-DMH services.=

The CBFS activity code rep= laces in full the following existing DMH adult activity codes: 3049 Adult Residen= tial Services; 3059 Community Rehabilitative Support (CRS); and 3013 Rehabilitat= ive Treatment in the Community (RTC). The descriptions for these existing codes are attached to this RFR as Appendix = F.

CBFS contractors must be abl= e to provide the full array of CBFS directly or through subcontracts, affiliate agreements or other arrangements approved by the applicable DMH Area Office= . The role of DMH, relative to CBFS, = will be to award contracts, determine individuals eligibility for DMH continuing care services, refer clients, monitor client outcomes and activities, engag= e in collaborative risk management with clients and contractors, perform utiliza= tion review and contract management activities, conduct audits, and reimburse contractors for services rendered.

1.3 Acqui= sition Method

__X___ Fee For Service = ______ Other (Specify):

1.4 Singl= e or Multiple Contractors

____ Single Contractor &n= bsp; __ = X___ Multiple Contractors

1.5 Use o= f Procurement

____ Open for use under separate contract execution

____ Open to all eligible public entities

____ Restricted to use by defined entities only:___________________________=

_X_ Restricted to use by issuing e= ntity only

1.6 Expec= ted Duration of Contract (Initial Duration and Any Options to Renew)

Initial Duration: up to __5__ y= ear(s)

Renewal Options: up to __3__ op= tions for up to __1__ year ea= ch option

(DMH reserves the right to exercise more than one option at any given time).

Any contract award made as a result of this RFR and all contract renewals are subject to appropriations and contractor performance on an on-going basis. =

1.7 Bidde= rs’ Conference

A bidders’ conference ____ WILL NOT be offe= red.

A bidders’ conference __X= __ WILL be offered.

Date: January 8, 2009<= /p>

Time: 10:00 – 11:30 AM<= /span>

Location: Hoagland-Pincus Con= ference Center

= University of Massachusetts Medical School

Address: 222 Maple Avenue, Shrewsbur= y, MA

1.8 Writt= en Inquires

There ____WILL NOT be an opportunity for written questions.

There __X__WILL be an opportu= nity for written questions. Questi= ons may be submitted to the Contact Person named in Subsection 1.1 by mail, fax= , or e-mail. To be considered, que= stions must be submitted by 4 p.m. EST on= January 13, 2009. DMH will review questions rece= ived before the deadline and, at its discretion, prepare written answers to questions of general interest. Written answers, if any, will be posted on Comm-PASS as indicated in Subsection 1.9. DMH is not bo= und by any oral comments or representations made by the Contact Person and/or any other employee of DMH.

Except as set forth in 5.6.2.h (Qu= alification), telephone calls will NOT be accepted regarding this RFR.<= /b>

=

=

1.9       Procu= rement Time Table

RFR Release Date:            &n= bsp;            = ;            &n= bsp;     December 18, 2008

Statewide Bidders’ Conference:        &= nbsp;           &nbs= p;            &= nbsp; January 8, 2009

Written Inquiries Due:        &= nbsp;           &nbs= p;            &= nbsp;     January 13, 2009, 4:00 pm EST

Anticipated Answers to Written Inqui= ries Posted

&n= bsp; on Comm-PASS         &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;        January 20, 2009

Response(s) Due:         &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;       February 27, 2009, 4:00 pm EST

    Send responses to the Contact Person at the

    address specified in Subsection 1.1

Review of Responses and Contract Negotiations=         &= nbsp; March 2 – April 3, 2009

Anticipated Award Announcement                &= nbsp;           &nbs= p;   April 6, 2009
Contract Start Date:        &= nbsp;           &nbs= p;             &= nbsp;           &nbs= p;   July 1, 2009

1.10     Anticipated Expenditures, Funding or Compensation for Expected Duration

__X__ Contract(s) will have a Maximum Obligation Amount.

_____ Contract will NOT have a Maxim= um Obligation Amount (Rate Contract).

_____ Subject to Quotes by Pre-Qualified List of Contractors.

The estimated annualized maximum obligation amounts for the different contracts that may be awarded under this RFR are as follows:

Co= ntract Description

Es= timated Annualized Maximum Obligati= on Amount

Appendix 1

$=

Appendix 2

$=

Appendix 3

$=

Appendix 4

$=

Fe= deral funds __X__ MAY be used to fund part/all of Contract(s)

Fe= deral funds ____ WILL NOT be used to fund part/all of Contract(s)

DMH reserves the right at any time to change the maximum obligation of any cont= ract awarded under this RFR and/or to award subsequent or additional contracts to other bidders when DMH considers it necessary or appropriate. Examples of when this may be neces= sary or appropriate include, but are not limited to, (a) the early termination or non-renewal of another contract, (b) an increase in the need for services a= nd in availability of funding; and (c) a programmatic decision to reallocate f= unds due to the under-utilization of services in other existing contracts.<= /o:p>

1.11     RFR Forms & <= /span>Definitions

All forms and terms included under the "For= ms & Terms" tab of the Comm-PASS file of this RFR are expressly incorporated herein by reference and made a part of this RFR. These forms and terms include, but= are not limited to, the following:

·      = Operational Serv= ices Division RFR Required Specifications. The “Required for POS Only” provisions contained in these Specifications are applicable to = this RFR and the contracts to be awarded as a result of the RFR.<= /span>

·      = Commonwealth Ter= ms and Conditions for Human and Social Services

&middo= t;      = Commonwealth of Mass= achusetts Standard Contract Form and Instruct= ions

·        DMH Additional Contract Terms and Conditions

·        List of Permitted Response Attachments =

·        POS Attachments 3 – 6=

·        UFR Titles

·        Affirmative Market Program Plan Form

·        Authorized Signatory Listing    &n= bsp;

·        Authorization for Electronic Funds Payment  &nb= sp;

·        RFR Evaluation Tool

·        MA Form W-9

·        WTO Government Procurement Agreement Link

·        RFR Cover Sheet<= /p>
·        DMH CBFS Business Associate Terms and Conditions

·        Staffing Chart

1.12     Definition of Ter= ms

Affirmative Market Program Plan (A= MPP): Specifies how a contractor will utilize and/or mentor M/WBEs under = the contract awarded as a result of this RFR.=

Area Director: The senior DMH administration official in a DMH Area.=

Culturally and Linguistically Competent Services: S= ervices that demonstrate an integration and transformation of knowledge, informatio= n, and data about individuals and groups of people into specific clinical standards, skills, service approaches, techniques, and marketing services t= hat match the culture and language of the individual receiving services so that there is an increase in the quality and appropriateness of health and behavioral care and outcomes.

<= /span>

Day: A c= alendar day including weekends and holidays.

Disenrollment: Whe= n a client stops receiving CBFS services from a CBFS contractor as specified in Subsection 3.18.

DMH Area: The geographic subdivision within the state that is responsible for providing access to comprehensive mental health services for individuals within its boundaries. There are six (6)= DMH Areas. Each Area is administered by an Ar= ea Director who is supported by an Area Office. Areas are further divided into “Sites” that are managed by Site Directors at Site Offices.

DMH Client: An individual who has been determined to be eligible for DMH continuing care services according to clinical and need-for-services criteria contained in = 104 Code of Massachusetts Regulations (CMR) 29.04 and is receiving at least one= DMH funded service.

Enrollment: A D= MH client who has been referred to and screened by a CBFS contractor (Subsecti= on 3.2) and who has not been disenrolled pursuant to Subsection 3.18.

<= /span>

Evidence Based Practices: Approaches to prevention or treatments that are based in theory and have undergone scientific evaluation. "Evidence-based" stands in contrast to approaches that are based on tradition, convention, belief, or anecdotal evidence.

<= /span>

Full-Time Equivalent (FTE):= Forty (40) hours a week defines a full time employee.

Lega= lly Authorized Representative (LAR): The L= AR is a guardian or other fiduciary granted applicable authority by a court of competent jurisdiction. It al= so includes a Health Care Agent who is authorized to make health care decisions under a valid Health Care Proxy.

Lice= nsed Practitioner of the Healing Arts (LPHA): A= practitioner who has the authority within the scope of his or her practice under State l= aw to recommend Rehabilitative Services when, in his or her judgment, the provision of medical or remedial services would promote maximum reduction of physical or mental disability and restore a DMH client to his or her best possible functional level. The following is a list of LPHAs currently recognized under state law:

a.   Physicians licensed pursuant to the requireme= nts of M.G.L. c.112 §§ 2, 9, and 9B, which authorizes the person to engage in the practice of medicine (243 CMR 2.00).=

b.   Registered Nurses licensed pursuant to M.G.L. c.112 (244 CMR 3.00).

c.   Psychologists licensed pursuant to M.G.L. c.1= 12 (251 CMR 1.00-4.00).

d.   Licensed Independent Clinical Social Workers, Licensed Certified Social Workers and Licensed Social Workers licensed pursuant to M.G.L. c.112 (258 CMR 12.00).

e.   Reg= istered Occupational Therapists licensed pursuant to = M.G.L. c.112 (259 CMR 3.00).

f.    Licensed Rehabilitation Counselors lice= nsed pursuant to M.G.L. c.112 (262 CMR 4.00.)

g.   Licensed Mental Health Counselors licensed pursuant to M.G.L. c.112 (262 CMR 2.00.)

h.=    Other persons who = become licensed in a mental health related discipline or profession in accordance = with state law and regulations and subject to the approval of the Commissioner of DMH.

M/WBE: A Minority Owned Business or a Woman Owned Business certified as su= ch by the State Office of Minority and Woman Business Assistance (SOMWBA). For a list of M/WBEs, go t= o: http:= //www.somwba.state.ma.us/BusinessDirectory/BusinessDirectory.aspx.<= o:p>

&nb= sp;

Person Centered Planni= ng: A process in which a client’s strengths, experiences, culture, values, preferences, needs, hopes and life goals guide the type, intensity,= and duration of the services provided.

Recovery: The process by which people are able to live, work, learn, and participate fully in their communities. For some individuals, recovery is t= he ability to live a fulfilling and productive life despite a disability. For others, recovery implies the reduction or complete remission of symptoms. President's New Freedom Commission Report<= span style=3D'mso-bookmark:_Toc212644603'>

<= /span>

Resilience: The personal and community qualities that enable individuals to rebound from adversity, trauma, tragedy, threats, or other stresses – and to go on with life with a sense of mastery, competence, and hope. President's New Freedom Commission = Report

<= /span>

Strength= -Based: An approach to service delivery that utilizes a client= 217;s existing competencies and abilities to guide and implement the client’= ;s Individualized Action Plan. S= trengths are maximized and used in areas where the client wants help in reaching his= /her goal. This approach is suppor= ted by a framework of hope, healing, and empowerment.

1.13   &nb= sp; Bidder Communications=

Bidders are prohibited from communicating directly with a= ny employee of DMH regarding this RFR, except as specified in this RFR; and no other individual Commonwealth employee or representative is authorized to provide any information or respond to any question or inquiry concerning th= is RFR. Bidders may contact the Contact Pe= rson for this RFR (Subsection 1.1) if this RFR is incomplete or the bidder is ha= ving trouble obtaining any required attachments electronically through Comm-PASS= .

1.14     Publ= ic Records

1.15=      Reasonable Accomm= odation

Bidders with disabilities that seek reasonable accommodation, which may include the receipt of RFR information in an alternative format, must communicate such requests in writing to the Contac= t Person identified in Subsection 1.1. Requests for accommodation will be addressed on a case-by-case basis. The request must state that it is based on a disability and specific= ally identify the accommodation desired. Although DMH will make all reasonable efforts to accommodate the requests of bidders with disabilities, DMH reserves the right to reject unreasonable requests.

=

1.16     Minimum Bid Duration

Pursuant to M.G.L. c.106, §2-205, bidders’ responses/bids submitted in response to this RFR must remain in effect for = 90 days from the date of submission.<= u>

SECTION 2    PR= OCUREMENT OVERVIEW

2.1  &= nbsp;    DMH Mis= sion Statement

=

= An organization awarded a contract as a result of this RFR will be responsible= for ensuring that the mission and values of DMH= , and when applicable DMH policies, directives, procedures and initiatives, are integrated and adhered to in all contract activities and by all staff members. DMH’s vision a= nd mission statements are as follows:

V= ision

Mental health is an essential part of health care. The Massachusetts Depar= tment of Mental Health, as the State Mental Health Authority, promotes mental hea= lth through early intervention, treatment, education, policy, and regulation so that all residents of the Commonwealth may live full and productive lives.<= o:p>

<= o:p>

Mission Statement

The Department of Mental Health, as the State Me= ntal Health Authority, assures and provides access to services and supports to m= eet the mental health needs of individuals of all ages, enabling them to live, = work, and participate in their communities. The Department establishes standards to ensure effective and cultura= lly competent care to promote recovery. The DMH sets policy, promotes self determination, protects human rig= hts and supports mental health training and research. This critical mission is accomplis= hed by working in partnership with other state agencies, individuals, families, providers, and communities.

DMH has an overall goal of promoting Recovery and Resiliency through Partn= ership. This goal is fostered by the princ= iples of: meaningful client and family involvement; self- and family-direction; dignity and respect; culturally and linguistically competent care; eliminat= ion of disparities; use of evidence-based practices; and operational efficienci= es.

2.2&= nbsp;           &nbs= p; CBFS Service Description

DMH provides services to adults with serious and persistent mental illness to f= acilitate and support their maximal integration in the community. This is accomplished by providing services that are responsive to the preferences and needs of individuals and their families and focused on rehabilitation and recovery.

Mental illness affects thousands of individuals of= all ages, ethnicities, gender, and social backgrounds including subpopulations = such as transitional age youths, elders, homeless individuals, parents with ment= al illness, individuals who are deaf and hard of hearing, individuals with substance use disorders, and individuals with co-morbidity.

Recent data from Massachusetts and other states show th= at those with psychiatric disabilities die from treatable medical illnesses at rates that are significantly higher than those in the general population, d= ying up to 25 years earlier from cardiovascular disease, respiratory illness, and lung cancer. (National Association of State Mental Health Program Directors: October 2006). Additional noteworthy data regarding individuals with serious mental illness include:

·      = 75% are tobacco-dependent compared to about 22% of the general population.

·      = 70% have a chronic health problem, most prevalent is pulmonary disease.

·      = 42% have a chronic health problem severe enough to limit functioning.

·      = Individuals with depression or bipolar disorder are twice= as likely to be obese as the general population; with schizophrenia the likeli= hood is three times greater.

·      = 34% have hypertension.

·      = 13% of schizophrenic adults in their 50s have also been diagnosed as diabetic as compared to 8% of 50 year olds in the general population.

CBFS is the cornerstone of DMH’s community mental health system for adults. Through the procureme= nt of CBFS, DMH intends to continue the transformation of its adult community bas= ed system of care into one that embraces the values of recovery and resiliency with emphasis on rehabilitation and person-centered care. The flexible nature of CBFS is consistent with these values and allows for services to be offered in a man= ner that cultivates resiliency and recognizes, encourages, nurtures, and suppor= ts each client’s path to recovery.

In addition to Service Specifications (Section 3= ) and Service Standards (Appendix A,) each CBFS contractor must fully integrate into its service delivery structure the following:

·        Assessments, treatment planning, and service delivery are done in collaboration with cli= ents, utilizing a person-centered planning process.

·      = A trauma informed approach to treatment planning and serv= ice delivery. Effective trauma in= formed care includes an understanding of a client’s symptoms in the context = of the client’s life experiences and history, social identity, and cultu= re.

·        Growth and recovery involve taking reasonable risk and that clients must be supported through that process.

·      = Services are individualized and provided, to the extent feasible, in the least restricti= ve clinically appropriate setting using the least intrusive interventions.

·      = Services ar= e age and developmentally appropriate, including services for transitional age yo= uth and elders.

·      = Culturally = and linguistically competent services, including assessment and treatment plann= ing (Subsection 1.12) that are sensitive and responsive to cultural, ethnic, linguistic, sexual orientation, gender differences, parental status, and ot= her individual needs of the clients.

·      = Culture of = wellness is promoted by facilitating access to needed medical and dental services. <= o:p>

·      = Peer-to-peer services and peer-to-peer education is embraced and cultivated.<= /span>

·      = Working relationships with other relevant community organizations and natural suppo= rts to help facilitate clients leading full lives in the community with the support networks of their choosing.

·      = The princip= les of the Individual Placement and Support (IPS) model to support clients interes= ted in maintaining or obtaining employment.&nb= sp; Becker, D.R. and Drake, R.E. (1993) Awaking Life: The Individual Placement and Support (IPS) Program<= /u>, N.H.: New Hampshire-Dartmouth Psychiatric Research Center.

·      = Evidenced b= ased practices and best practices when appropriate.

As described in detail in Section 3, CBFS encomp= asses four key service components: Rehabilitation, Supervision, Support, and Hous= ing/Room and Board. Housing/Room and Board may only be provided by CBFS contractors to clients receiving rehabilitation in accordance with the clients’ Individualized Action Plans unless approved by the Area Director in writing= . In addition, CBFS contractors= are responsible for: client screenings and enrollment; assessments and integrat= ed treatment planning; quality and utilization management; data collection and reporting; service documentation and discharge planning.<= /p>

Each CBFS contractor must have the capacity to p= rovide, directly or through subcontracts, the full array of CBFS components and ser= vice specifications. A CBFS contra= ctor will be responsible for a client population that includes individuals who need intensive services as well as those who require less intensive supports. A contractor is required to adjust= the mix and intensity of CBFS provided to each client to meet each client’s changing needs and goals as the client moves toward recovery. The individual clients served will change as new clients enter the service system and current clients achieve their recovery goals and are discharged or otherwise leave the applicable service area or DMH.

Each CBFS contractor has the responsibility and = the authority for making decisions about utilization, resource allocations and service delivery. Such decisi= ons are not subject to prior approval by DMH.&= nbsp; DMH will measure performance through client and administrative outco= mes and through quality and utilization review. DMH will also be responsible for contract monitoring and auditing. DMH will work collaboratively with the contractor to manage high risk clients. (See Subsection 3.13)

CBFS contractors will be compensated for services rendered on a unit rate basis, as described in Section 4.=

2.3<= span style=3D'mso-tab-count:1'>       CBFS Procurement Goals

DMH has two sets of overarching goals for the CB= FS procurement.

2.3.= 1    Service Delivery Goals.= The focus of CBFS service delivery is on rehabilitative interventions that facilitate recovery and achieve the following outcomes for the clients being served:

·      = Safe, stable housing

·      = Full participation in the community

·      = Self manage= ment

·      = Self determination and empowerment

·      = Wellness and improved physical health

·      = Independent employment

2.3.= 2    Administrative Goals. To maximize the effectiveness of available resources this procurement= is designed to achieve the following system outcomes:

·      = Administrative efficiencies

·      = The payment of a fair price for the services contractors provide

·      = Enhancement of DMH’s ability to collect Federal Financial Participation (FFP) for the rehabilitation services rendered

·      = Contractors’ maximize third party payments (e.g., food stamps, housing subsidies) an= d use of generic services (e.g., Visiting Nurses Association Home Health agencies= , Massachusetts Rehabilitation Commission)

·      = An efficient system of care that is supported by meaningf= ul utilization management and financial oversight

·      = An integrated and flexible system of care that is dr= iven by clinical, rehabilitative, and recovery expertise

·      = Reduced number of group living situations, as appropriate  &nbs= p;

SECTION 3  &nbs= p; SERVICE SPECIFICATIONS<= o:p>

CBFS contractors must provide Rehabilitation, Su= pport, Supervision, Housing/Room and Board to their assigned clients as needed to facilitate each client’s recovery in a safe and clinically appropriate manner. Key features of CBFS are: person-centered planning, flexibility, movement towar= ds independence and community integration, and service coordination across the continuum of services needed by the clients served. CBFS is provided in accordance wit= h each client’s Individualized Action Plan (Subsection 3.4). The service components and other s= ervice features are described in this Section 3.

3.1<= span style=3D'mso-bookmark:_Toc212959788'>       Referral to CBFS

DMH is responsible for determining eligibility for DMH continuing care services and for referring DMH clients to a specific CBFS contractor. Referrals are made by the applicab= le DMH Area Office and/or Site Office. Referral information includes materials gathered through the eligibi= lity determination process, as appropriate; as well as documents that identify t= he reasons for the referral. The= CBFS contractor must accept all referrals within its negotiated capacity = (for capacity see Subsection 5.7.1).&nbs= p; DMH only pays for CBFS rendered to DMH clients who have been referre= d to a CBFS contractor by DMH.

=

3.2<= span style=3D'mso-tab-count:1'>       Screening and Enrollment

=

A Lic= ensed Practitioner of the Healing Arts as defined by Subsection 1.12 must meet and screen each= DMH client who is referred to a CBFS contractor within 72 hours, including holi= days and weekends, of the referral. The purpose of the screening is to determine if any immediate interventions are needed to maintain the client’s health and safety until a full Indivi= dualized Action Plan (IAP) is completed. If urgent needs are identified, the clinician and client must develop and implement a critical needs plan. Upon completion of the screening, the client will be considered enrolled into CBFS. The screening and the critical nee= ds plan and the documentation of such must meet DMH CBFS Standard I.A (Appendix A). Within one (1) business d= ay of a DMH client being enrolled into CBFS, the CBFS contractor must notify the applicable DMH Site Office in accordance with the procedures established by= the Site Office. Upon notificatio= n, the enrollment information will be entered by DMH into DMH’s Mental Health Information System (MHIS) to facilitate payment to the CBFS contractor. See Section 4 for more information on payments to CBFS contractors.

=

When = a CBFS contractor is unable to screen a client due to circumstances related to the client (e.g., client is not able to make a scheduled appointment within 72 = hours, client is unable to be located, client is resistant to services), the reaso= ns must be documented as well as all attempts to engage the client. If after 7 days of referral, the C= BFS contractor is unable to screen the client, the contractor must notify the D= MH Site Office so next steps can be determined.

3.3       Assessment

Each = newly enrolled CBFS client must be assessed within twenty (20) days of enrollment and, at a minimum, annually thereafter.&nb= sp; CBFS contractors are required to use the Adult Comprehensive Assessm= ent tool developed by the Massachusetts Standardized Documentation Project (MSD= P) and corresponding instructions, which are attached as Appendix B or compara= ble forms and procedures as approved by DMH.&n= bsp; The assessment must also be completed, documented and updated in compliance with DMH CBFS Standard I.B (Appendix A). For clients who will be transition= ed into CBFS from DMH existing service activities see Subsection 3.24.<= o:p>

=

3.4       Individualized Action Plan

  &nbs= p;           =

CBFS contractors must complete an integrated Individualized Action Plan (IAP) for each of its clients within ten (10) days of a client’s assessment bei= ng completed. The IAP is a comprehensive plan for all DMH services received by a client and, if feasib= le, also includes non-DMH services and supports. The IAP planning process is intend= ed to be multidiscipline in nature in that all staff are expected to work in collaboration with the client (e.g., direct care staff, nurse, employment specialist). The CBFS contrac= tor must collaborate with all of the client’s DMH operated or funded service providers and, to the extent feasible, the client’s other service providers. Clients/LARs may i= nvite persons of their choice to be present at meetings regarding the development= of their IAPs. It is DMH’s= intention that clients receiving CBFS will not receive DMH case management services.<= span style=3D'mso-spacerun:yes'> However, in limited situations, wh= en determined necessary by DMH, a CBFS client may receive case management services. If a CBFS client is receiving DMH case management services, the DMH case manager must be includ= ed in the IAP process.

=

In de= veloping IAPs, CBFS contractors are required to use the IAP form developed by the Massachusetts Standardized Documentation Project (MSDP) and corresponding instructions, which are attached as Appendix B or comparable forms and procedures as approved by DMH. In addition, the IAP must be developed, documented and revised in accordance w= ith DMH CBFS Standard I.C (Appendix A). &= nbsp;

=

DMH i= ntends to eliminate the requirement for Program Specific Treatment Plans as set fo= rth in 104 CMR 29.07 and 29.08 and develop regulations for IAPs. CBFS contractors will be obligated= to comply with the IAP regulations once promulgated.

=

3.5       Service Components=

3.5.= 1    Rehabilitation:<= /b> “Medical and remedial services recommende= d by a physician or other Licensed Practitioner of the Healing Arts, within the sc= ope of his practice under state law, for maximum reduction of physical or mental disability and restoration of a recipient to his best possible functional l= evel.” (Title XIX, Social Security Act.) For a service to be considered Rehabilitation, it must meet this definition; be identified as a rehabilitative service in the client’s IAP (see Subsection 3.3) and have a duration for authorized services based on the client’s assessed needs and anticipated progress. Services provided under the Rehabil= itation component include, but are not limited to:

a.   Interventions performed in partnership with the client designed to promote recovery:

      =             &nb= sp;            =             &nb= sp;             i.   &nb= sp;        Manage psychiatric symptoms in community setting: self management plans, crisis management plans, cognitive behavioral therapy plans, dialectic behavioral therapy
      =             &nb= sp;            =             &nb= sp;           ii.   &n= bsp;        Restore or maintain the skills needed to secure and maintain housing in the community

      =             &nb= sp;            =             &nb= sp;          iii.   &= nbsp;        Restore or maintain the skills= needed to maintain a stable home life (e.g. meeting financial obligations related = to home expenses; addressing issues with property owners, utility companies and other parties; maintaining adequate supply of items needed to furnish the h= ome)

      =             &nb= sp;            =             &nb= sp;         iv.   &n= bsp;        Restore or maintain skills nee= ded to access self-help options in the community

      =             &nb= sp;            =             &nb= sp;           v.   &nb= sp;        Restore or maintain the skills needed to utilize various means of transportation

      =             &nb= sp;            =             &nb= sp;         vi.   &n= bsp;        Restore or maintain daily livi= ng skills, including physical health maintenance (e.g. diet, exercise, receivi= ng regular primary medical and dental care), self-care, purchasing and caring for pers= onal items including clothing, etc

      =             &nb= sp;            =             &nb= sp;        vii.   &= nbsp;        Restore or maintain the skills needed to manage money

      =             &nb= sp;            =             &nb= sp;      viii.   =          Restore or maintain the skills needed to manage time, including: scheduling appointments, attending appointments and other events in a timely manner, calling when running late= for or needing to postpone appointments

      =             &nb= sp;            =             &nb= sp;         ix.   &n= bsp;        Restore or maintain the skills needed to take medications as prescribed

b.      Pre-vocational related services that are not job specific, that assist clients to restore or maintain and utilize the skills necessary to undertake employment

c.       Informal supportive counseling= and problem solving

d.      Social and recreational skill training to improve communication skills, encourage clients to utilize recreation and leisure resources, and facilitate appropriate interpersonal behavior

e.      Face-to-face crisis interventi= on to aid the client in managing a crisis, and intensive short-term interventi= ons to stabilize behavior

f.        Telephone outreach to perform = a brief assessment of client well being, including extent of presence of symptoms, = and to prompt the client to follow treatment regimen, including taking medicati= ons and engaging in other therapeutic or rehabilitative activities

g.      Medication training that focus= es on the role and effects of medication in treating symptoms of mental illnes= s to include, but not be limited to, collaborating with prescribers to achieve t= he fewest number of medications at the lowest effective doses

3.5.= 2  &nbs= p; Support: Any of the activities listed above= for Rehabilitation could be support activities if they are performed on behalf = of clients but do not meet the definition of Rehabilitation. Other examples of activities constituting Support include, but are not limited to, the following:

a.      Participation in case conferen= ces; providing family consultations; functioning as a liaison with community resources; providing consultations with state and community agencies; devel= oping Individualized Action Plan

b.   Provision of reasonable furni= shings and equipment to help maintain community tenancy

c.   Educational support; which may include assessing the effects mental illness has had on an individual’s ability to achieve educational goa= ls within a normal timeframe

d.   Wellness promotion and support of the management of medical conditions.

e.   Assistance and support to access other services as needed such as:
·  &n= bsp;     psychiatric and medical

·  &n= bsp;     entitlements and benefits=

·  &n= bsp;     generic education and employme= nt services

f.        Support in exploring housing options and assistance with housing applications and housing search

g.      Assistance in maintaining community tenancy

h.&n= bsp;     Assistance with management of client funds including serving as representative payee

i.&n= bsp;       Assistance with obtaining acce= ss to, or providing, transportation

j.&n= bsp;       Assista= nce with obtaining and maintaining employment

k.&n= bsp;     Assistance with organizing pil= lbox or blister packs, creating schedule for self administration and adhering to schedule

l.&n= bsp;       Delivery of pre-packed medicat= ions

m.&n= bsp;   Telephone contact and conferen= cing with pharmacies, primary care clinicians, hospitals, service programs and significant members of a client’s social network regarding medication regimes, side effects and desired effects of medication
n.&n= bsp;     Preparation of correspondence = when medical documentation is needed for collateral services to a client

o.      Client and family training abo= ut mental illness, the treatment of mental illness, the effects of mental illn= ess on family members and resources available to family members

3.5.3        Supervision: Activities performed by staff to help maintain a safe environment for clients. Example= s of activities constituting Supervision include, but are not limited to, the following:

a.   Provide varying levels of sta= ff supervision in a setting where the client is living

b.      Promote safety within the livi= ng environment and the community

c.       Provide ongoing monitoring of = the client’s symptoms and response to treatment

d.      Provide assistance with taking medications as needed

e.      Monitor compliance and accuracy when assisting clients with medication

3.5.4    Housin= g/Room and Board. = Housing/Room and Board where needed may only be provided by CBFS contractors to clients receiving Rehabilitation in accorda= nce with the client’s Individualized Action Plan unless approved by the A= rea Director in writing. Housing/= Room and Board is typically provided in group living situations for clients who = are unable to maintain community placement without intensive and consistent supervision and structure.

Housing/Room and Board is the provision of sleeping accommodations to clients together w= ith food and/or meals. If this definition is met, the following costs may be subsidized with contract fund= s: rent or mortgage payments (interest only and not principal), insurance, real estate taxes; utilities, food and maintenance costs. Cost for capital improvement is not considered an allowable expense. Housing provided to clients pursuant to the Housing First Model for engagement purposes will be considered housing done in support of Rehabilit= ation for purposes of this Subsection 3.5.4. If a CBFS contractor provides Housi= ng/Room and Board, it must collect client contributions for such in accordance with= DMH regulation and policy and 808 CMR 1:00. In addition, the CBFS contractor is required to provide handicapped accessible housing to clients if need is identified in the applicable Contr= act Description Appendix and/or as negotiated with DMH.

DMH intends to revise its community licensing standards set forth in 104 CMR 28.00. It is anticipated DMH = will require physical site licensure only when the contractor leases or has a di= rect or indirect ownership interest in the property occupied by the client (s= ee 104 CMR 28.15 (7)(a) and (b)). If licensure is applicable, the physical site will need to meet the current requirements of Subpart B of 104 CMR 28.00, with the exception of 28.15(5). Appropriate staffin= g for any residential site will need to be agreed upon by DMH and the applicable contractor based on client need and service model. Documentation requirements previou= sly reviewed as part of licensing will be incorporated into DMH’s contract and utilization review processes.

3.6  &= nbsp;    DMH Affiliated Housing<= span style=3D'text-shadow:none'>

DMH has had a long and successful history levera= ging affordable housing resources for its clients, usually in the form of housing grants from federal, state, and local housing agencies. DMH services have been used to sup= port clients living in the housing developed through such grants to maintain sta= ble tenancies. In many instances,= the value of these supportive services has been used to meet local matching requireme= nts required by many federal housing programs.

Based on these commitments and the long-term benefit to DMH clients, DMH has the responsibility and interest to ensure that these identified housing resourc= es are utilized to their fullest extent. This responsibility has been established and documented generally through one of four ways. Fir= st, DMH may have a direct ownership interest in the residential property. Second, housing may have been deve= loped by third parties using capital financing and rent subsidy programs that restrict occupancy to DMH clients referred to by DMH. Third, access to housing may have b= een accomplished through rental subsidy programs exclusively available to DMH clients referred by DMH. Four= th, DMH may have written agreements with certain housing providers that give the DMH the exclusive right to refer clients for tenancy in specified housing units.

Included in the attached Contract Descriptions A= ppendices is a listing of the DMH affiliated housing leveraged by DMH as described ab= ove and which is currently available to the client population to be served under th= e applicable CBFS contract. It is DMH̵= 7;s intent/expectation that these DMH affiliated housing resources identified in the Contract Description Appendices will be utilized by the CBFS contractor= s to the extent possible permitted by the applicable owners. This will require contractors to negotiate with the owners and may require the contractor to enter into gran= t, contract and/or other such administrative as well as reporting arrangements with sta= te, local, federal, or private housing entities sponsoring the leveraged housing programs. As necessary and appropriate DMH will work with CBFS contractors to facilitate the creation = of these arrangements and agreements, in order that the housing can continue t= o be available to DMH.

In addition, DMH intends to continue its strategy for leveraging external hous= ing resources on behalf of clients. In recent years, DMH has focused its leveraging strategy on creating a supply = of affordable apartments that provide clients with more independent supported living opportunities under their own leases. DMH expects CBFS contractors to collaborate with respective Area Offices in implementing this strategy.

3.7<= span style=3D'mso-tab-count:1'>       Co-oc= curring Mental Illness and Substance Disorders

CBFS contractors must have the capacity to provide or arrange for:

·        Engagement = - interventions that are designed to facilitate the individual’s ability and motivati= on to initiate and maintain participation in dual diagnosis treatment services= ,

·        Relapse prevention

·        Use of self= -help groups such as AA, NA, Al-Anon

·        Peer counse= ling

CBFS contractors may address the needs of its clients through collaboration, coordination consultation and linkage to providers with specialized knowled= ge of alcohol and drug services.

In providing CBFS services, the contractor must recognize that some clients ma= y be actively using substances, that relapse is part of recovery, that safety remains a priority and that the sobriety of other clients may be jeopardize= d. The contractor must have protocols= that address:

·        Substance u= se

·        The handlin= g of illicit and/or licit drugs brought to a service site by a client including actions that are to be taken by the contractor when a client is using subst= ances onsite

·        Relapse pre= vention with procedures on how to handle relapse including time away from a group setting

3.8  &= nbsp;    Individual Placement & Support

CBFS contractors mu= st provide Individual Placement and Support (IPS) for clients participating in or seek= ing vocational activities. This m= odel must be embedded into all aspects of the contractor’s service model.<= span style=3D'mso-spacerun:yes'> The key principles of the IPS mode= l are: (a) participation is based on client choice; (b) no one is excluded who wan= ts to participate; (c) supported employment is integrated with treatment, (d) employment specialists collaborate with clinicians to ensure that employmen= t is part of the IAP; (e) job search starts as soon as a client expresses intere= st in working; (f) follow-along supports are continuous as long as the client wants the assistance; (g) client preferences are important; and (h) benefits counseling is part of the employment decision-making process. A CBFS contractor must have the ca= pacity to provide or arrange for the provision of vocational services that assist clients with job placement and support.&nb= sp;

In addition, CBFS contractors must establish, maintain, and utilize relationsh= ips with employment related services including but not limited to the following: Massachusetts Rehabilitation Commission (MRC), Career Centers, job training programs, Clubhouses, local colleges and universities, and disability services. <= /p>

3.9  &= nbsp;    Peer Support

The CBFS contractors must ensure that clients have access= to peer support services either directly or through subcontract. Peer support services are activiti= es performed by individuals with lived experience whose knowledge about mental illness comes from the experience of being diagnosed and treated for his/her own mental illness, including co-occurring disorders. These activities include, but are = not limited to, the following:

a.      Provide advocacy, support, and educa= tion during intake and transition processes across the spectrum of services and transit= ion to independence

b.      Serve as team members and assist the clients to communicate the goals of their personal recovery action plans to treatment teams

c.      = Provide information and training on = recovery tools and techniques, self management strategies, and when desired, assistance in developing a self management pl= an. (e.g., Wellness Recovery Action Plan)

d.      Support the development of self-advo= cacy skills

e.      Facilitate linkage to community serv= ices and networks

f.      = Provide training and consultation to CBFS contractor staff to facilitate understand= ing clients’ perspectives

The amount of access to information = and involvement of peers providing supports must be determined by each DMH clie= nt individually.

3.10=      Notes<= /span>=

CBFS contractors must regularly document a DMH client’s progress towards the attainment of IAP goals and objectives. Progress notes ar= e to be used to inform the IAP process. DMH requires the contractor to use the Progress Note forms and corresponding instructions developed by the Massachusetts Standardized Documentation Project (MSDP), which are attached as Appendix B, or comparab= le forms and procedures as approved by DMH.&n= bsp; When using the MSDP progress note forms the contractor must, at a minimum, use the monthly note form and otherwise comply with current or fut= ure Medicaid Rehab Option requirements. Other MSDP notes may be used at the contractor’s discretion. In addition, the contractor must maintain other notes regarding the client’s life events. Progress Notes and other notes mus= t meet DMH CBFS Standard I.D (Appendix A).

3.11     Client Record & Documentation

In delivering the CBFS service components, a CBFS contractor must maintain sufficient documentation to meet medical records s= tandards, Medicaid Rehabilitation Option (Rehab Option) and contract billing requirem= ents. The tools and forms developed by t= he Massachusetts Standardized Documentation Project (MSDP) currently meet generally acceptable medical records documentation standards. (See Subsections 3.3, 3.4, 3.10) Use of these forms is also sufficient to meet t= he requirements of Rehab Option. Documentation will need to be modif= ied should standards or Rehab Option requirements change. Client records and documentation mu= st meet DMH Standards I.E (Appendix A).

=

It is anticipated that the requirements set forth in Subpart A of 104 CMR 28.00 (28.02-28.12) will be incorporated into DMH’s contract and utilization review processes, not as part of licensing. CBFS contractors must comply with = these regulations and any subsequent changes made to these regulations. (See Subsection 3.5.4 regarding licensing changes.)

CBFS contractors must maintain a central CBFS fi= le for each client containing all screenings, assessments, IAPs, and notes whether provided directly by the contractor or subcontractor.

3.12     Crisis Management

CBFS contractors must have and implement written= protocols for developing crisis management plans for each of their CBFS clients. Crisis management plans must be developed through a collaborative process with the clients/LARs and, to the extent possible and authorized, individuals of the clients’ choosing,= the clients’ other DMH service providers, applicable Emergency Service providers, and insurers as appropriate.&nb= sp; Crisis management plans must be developed and maintained in accordan= ce with DMH CBFS Standard VI (Appendix A).

As part of the above described protocol, or as a separate protocol, CBFS contractors must have procedures to respond to clients in crisis 24 ho= urs a day, 7 days a week. The pro= tocol must provide for CBFS staff availability 24 hours a day, 7 days a week and include provisions for the appropriate staff training thereby reducing the = use of Emergency Service Program level of care.=

CBFS contractors must have the capability to inc= rease and change interventions in a timely manner in response to changes in client’s needs. This in= cludes providing additional staff time with the client in the community, increasing client contacts (face-to-face or by phone), and, when indicated, relocating= the client to a community-based staffed facility and/or a crisis stabilization = bed (via the Emergency Service provider.)

3.13  =    Risk Management

Accepting risk is a fundamental dimension of supporting persons in their recovery. CBFS contract= ors must have a risk management protocol(s) which is consistent with DMH Area r= isk management protocols. DMH and= CBFS contractors must work collaboratively on risk management activities. Contractors must participate in Ar= ea risk management activities and attend meetings as required.

3.14     Third Party Billing

CBFS contractors are responsible for billing third parties as applicable for services delivered to clients other than those specified in Subsection 3.5.= 1. Contractors must maximize third party offsets (e.g= ., food stamps, housing subsidies) and the use of generic services (e.g., Visi= ting Nurses Association, Home Health Care agencies, Massachusetts Rehabilitation Commission) when available.

3.15     Quality Managemen= t (QM) and Performance Outcomes

3.15.1 Quality Management Structure. DMH expect= s CBFS contractors to maintain internal quality and utilization management systems= and to engage in activities to ensure the safety, quality and effectiveness of = the services they provide through systematic performance improvement. Performance improvement is a conti= nuous process that involves measuring, assessing, and improving systems and outcomes. An important aspect= of performance improvement is reducing the likelihood and recurrence of adverse events and/or outcomes. =

CBFS contractors must = have in place mechanisms to gather and evaluate data regarding the quality of programmatic and administrative operations. This generally involves identifying certain crucial measures indicating performance, collecting and analyzing relevant data, and incorporating the analysis into the design of the service through ongoing planning and monitoring.

Specifically, CBFS contractors must collect and analyze d= ata to:

a.      Measure individual client outcomes to inform the IAP proc= ess

b.      Determine efficient use of programmatic resources

c.       Monitor effectiveness of services, particularly those foc= used on rehabilitation

d.      Inform workforce development including: staff recruitment, retention, training, supervision, and staff competencies<= /span>

e.      Identify needs to modify delivery of services for individ= ual clients

f.        Establish and monitor performance benchmarks and goals

g.      Inform quality management and improvement activities=

CBFS contractors must = also participate in quality improvement activities as required by DMH and to col= lect and analyze data to assist in facilitating such activities.

QM functions and responsibilities must be assigned to individuals with the appropriate skill= set to oversee and implement organization-wide quality activities that apply to= all clinical and non-clinical aspects of a contractor’s service delivery system.

In addition= , CBFS contractors must have a process to review client records for monitoring compliance with the specifications of the RFR and DMH and contractors’ policies and procedures. The review must a= lso monitor clients’ utilization of CBFS and the appropriateness of servi= ces. CBFS contractors must submit their= process for client record review and annually submit a summary of the record review= s to DMH.

CBFS contractors must conduct an annual evaluation of their QM program. Also contractors must submit data = from quality reviews and QM initiatives to DMH annually.

CBFS contractors must incorporate clients and family memb= ers into their QM structure.

3.15= .2 Performance Outcomes, Performance Measures, Reporting.= DMH will establish state= wide performance outcomes and measures upon which all CBFS contractors will be required to report. Upon cont= ract award, a contractor must collaborate with DMH to:

a.   Develop specific outcome measures that will be used to determine achievement of the goals set forth in Subsection 2.3.1. This will include: defining terms, establishing numerators and denominators, determining the frequency of data collection, and identifying the applicable measurement tools.

b.   Establish specific performance targets during the first year of the contract. During the first six months of the contract baseline data will be collected and used to set the performance targets.

c.   Establish a pre-determined minimum data set that will be required to be submitted to = DMH at set intervals which will include, but not be limited to, demographic information and service utilization data.

Further, DMH may require CBFS contractors to rep= ort outcomes using a tool selected by DMH.

Below are examples of potential performance outc= omes related to service delivery and administrative goals:

·        Increase in= the percentage of clients who move to a less restrictive living arrangement

·        Increase in= the percentage of clients who achieve their individualized discharge criteria a= nd are discharged from CBFS in accordance with their discharge plan=

·        Increase in= the amount of third party revenues collected (e.g., food stamps, fuel assistanc= e, community nursing services)

·        Increase community tenure (e.g., reduction in psychiatric hospitalizations, number of hospital days, jail stays)

·        Increase in= the percentage of clients who are non-smokers

·        Increase in= the percentage of clients who participate in wellness and fitness activities

·        Increase in= the percentage of clients who are employed

·        Increase participation in self help groups for addictions

·      = Increase in= the percentage of clients who report satisfaction with their level of participa= tion in their treatment planning.

3.15.3 Aud= its. DMH may at any time, but at a minimum yearly, audit a contractor’s performance, including compliance with t= he requirements of this RFR. As part of such audits, DMH will review client record and billing documentation, including Rehab Option requirements and other information the contractor is required = to maintain and/or develop as part of its contract. Changes in the services to be deli= vered under the contract may be made as a result of these audits.

3.15.4 Cli= ent Satisfaction Survey. <= /b>DMH intend= s to retain the services of a third party to assess client satisfaction with CBF= S. CBFS contractors must participate = and cooperate with DMH and the selected third party responsible for administering the survey. CBFS contractors are prohibited from retaliating against clients who participate in the survey.<= span style=3D'mso-spacerun:yes'> Findings from the survey will be u= sed to inform quality improvement activities and will not be used to penalize CBFS contractors.

3.16=      Contingency Payme= nts

CB= FS contractors may provide funds for incidental expenses to assist the DMH cli= ents they serve to remain in the community.&nbs= p; This may include, but is not limited to, payments for one-time rent expenses and for basic furnishings. The CBFS contractor must follow guidelines set forth in the DMH Contingency Fund Procedures. = (See Appendix D)

3.17 Meetings with DMH=

= ;

A CBFS contractor must participate in regular and ad hoc meetings with DMH. These meetings will be on topics including but not limited to: =

·      = Individual = client care;

·      = Quality improvement; and

·      = Contract compliance.

At a minimum, a contractor will be required to m= eet with DMH bi-annually to review the success of services purchased pursuant to this RFR. The review will be = based upon

Co= ntract Description	Es= timated Annualized Maximum Obligati= on Amount
Appendix 1	$=
Appendix 2	$=
Appendix 3	$=
Appendix 4	$=