North Sound Mental Health Administration by WQ64Ogg

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									                      North Sound Mental Health Administration RFQ
                          Questions and Answers regarding the RFQ
                                      February 21, 2007
                             Updates and Clarifications to the RFQ
                                  Change in Implementation Schedule
As announced at the Bidder’s Conference Meeting, the implementation of the new contracts will be
October 1, 2007 and not July 1, 2007 as stated in the RFQ. The Mental Health Division has notified the
RSNs that they will be bridging the current contracts until September 30, 2007 and new contracts will
begin October 1, 2007. NSMHA has changed this date on our RFQ on the website in the following
locations: page 9, page 15 at top of page, page 20 Section 4.2, Page 22 Section 5.2, Page 24 Section 6.1,
Page 28 Section 8.2, and Page 30 Section 9.3.

                             NSMHA 2007 Payment/Fee Schedule
The following fee schedule represents the rates for services that will be paid on a fee-for-service basis.
Once we receive the final applications we will re-examine our fee schedule to determine whether
adjustments are needed. Rates for the services that will be paid on a capacity basis will be developed after
the applications are submitted, using data from the budgets in Section IV of the applications.
       NSMHA 2007 Fee Schedule Analysis
                                              Final (In,               Out-Of-
                                                 Out       In-Clinic    Clinic
                                              Combo)         Final      Final          Final Comment
       Fully Loaded Cost per Clinical Hour (Individual Services)
       Psychiatrists/MDs                        $340.64     $341.00    $341.00   No Add-On for Prescribers
       Nurse Practitioner/Physician Asst        $225.87     $226.00    $226.00   No Add-On for Prescribers
       Registered Nurse/LPN                     $147.37     $137.00    $206.00   50% Add-on Effective Rate
       PhD and Masters-Level Providers          $126.64     $118.00    $177.00   50% Add-on Effective Rate
       Bachelor's, AA Level Clinician           $105.54      $98.00    $148.00   51% Add-on Effective Rate
       Peer Counselor                            $68.25      $64.00     $96.00   50% Add-on Effective Rate

       Fully Loaded Cost per Hour for Group Services
       Psychiatrists/MDs                         $85.16      $85.25     $85.25   25% of the Individual Rate
       Nurse Practitioner/Physician Asst         $56.47      $56.50     $56.50   25% of the Individual Rate
       Registered Nurse/LPN                      $36.84      $34.25     $51.50   25% of the Individual Rate
       PhD and Masters-Level Providers           $31.66      $29.50     $44.25   25% of the Individual Rate
       Bachelor's, AA Level Clinician            $26.38      $24.50     $37.00   25% of the Individual Rate
       Peer Counselor                            $17.06      $16.00     $24.00   25% of the Individual Rate

The fee-for-service rates will be paid based on the clinician type, the amount of time spent, whether the
service was provided in the clinic or in the community, and whether the service was an individual or
group-type service. The template for the rate schedule was developed during the design process and
populated with actual historical NSMHA provider data from 2004 that was supplied to the actuaries for
the 2005 Washington State MHD actuarial study. Additional work was completed by NSMHA to adjust
the data for inflation; provide an additional 15% adjustment upwards for PhD/Masters and Bachelors/AA
clinicians due to wages that were below the statewide average for those positions; and set productivity rates
and overhead levels that appeared reasonable for a system moving to fee-for-service. Fees were adjusted
to provide an approximate 50% add-on for community-based services. Group services are scheduled to
be paid at 25% of the individual rate, which addresses average group size and additional charting time.
The full fee schedule template is attached to this Q&A document as Attachment 1.
                                            Format of RFQ
The RFQ responses must be single-sided.
                                     Page 1 of 13
The questions and answers below are from the North Sound Mental Health Administration’s Bidders’
Conference on February 9, 2007 and from questions directly submitted to North Sound Mental Health
Administration (NSMHA). NSMHA recommends that bidders read all of the questions and answers
for the answers may be more complete or even changed in some ways from the Bidders’ Conference.
Questions from the Bidders Conference are addressed first and then the questions directly submitted to
NSMHA outside of the Bidders’ Conference are addressed starting on page XXX.

Bidders Questions: (from Bidders’ Conference)

1.    When are we going to find out what the reimbursement rates will be and what the
reimbursement rates will be for?

The fee schedule presented in updates on page 1 of this document represents the rates for services that
will be paid on a fee-for-service basis. Once the NSMHA receives the final applications, the NSMHA will
re-examine its fee schedule to determine whether adjustments are needed. Rates for the services that will
be paid on a capacity basis will be developed after the applications are submitted, using data from the
budgets in Section IV of the applications. The full fee schedule template is attached to this Q&A
document as Attachment 1.

2.     What would the outpatient rate be? Would it be by CPT code or a differential for
outpatient/in and outpatient/out? Are there amounts for food services?

See the response to question 1, which provides an answer to the first two parts of this question. The
NSMHA is assuming that the food service question relates to services that are capacity-based and as
mentioned above, rates for those services will be set after the applications are received based on the
budgets in Section IV of the applications.

3.      Are you anticipating the rates in the model will be significantly changed from what you
will give us in the final answer?

No. We do not expect a large difference from the design process, but we do anticipate a greater level of
detail that wasn’t nailed down at the design meetings.

4.      After February 16th, will the NSMHA know the number of potential respondents? When
will that information become public information?

This is a public process. Letters of intent will be posted on our website by February 21, 2007.

5.     In expanding the number of providers that you are looking for, have you determined what
percentage you are hoping to increase by?

We have not set any level and we have no preconceived ideas. The NSMHA would like to have a
minimum of two providers in each service area of the Region.

6.     Under the child and youth high intensity treatment services, there is an option to go with
fee for service or capacity funding; if we choose to go to capacity funding do you make the
determination?


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The payment method for this section will be determined by the type of services we end up selecting.
Some types of service do not lend themselves to a fee-for-service payment mechanism, and it may be
appropriate to pay capacity-based for these services. These decisions will be made after the applications
are submitted and evaluated.

7.     High-Intensity treatments ask for evidence-based practices which come with their own
paperwork. Would the RSN accept that evidence-based practices paperwork in substitution of the
regular RSN paperwork or do we do both sets?

Since this is paid for with Medicaid and State funds, NSMHA and our provider contractors are subject to
Medicaid and State WAC requirements, so we have to meet those paperwork requirements. Our goal is to
minimize the amount of paperwork and the time spent on non-clinical activities while complying with all
regulatory requirements. This can be negotiated during the contracting process.

8.    Would the CHAP program be reimbursed on a fee for service basis unless otherwise
suggested by a provider?

This is about High-Intensity Services; CHAP services are not up for bid in this RFQ; the NSMHA
understand that CHAP will be capacity funded.

9.     We provide outpatient mental health services in King County and we currently use a tier
model. Are you using a tier model or are you thinking of using a fee for service model for
outpatient mental health services?

The NSMHA is shifting to a capped fee for service model using a LOCUS/CALOCUS leveling system.
There will be increasing levels service for increasing LOCUS/CALOCUS levels. In RFQ, the NSMHA
has presented general expected ranges of service for each rating level. See page 13 as an example.
Providers do not have to be within all these parameters for hours of service on each individual case, but
the NSMHA will monitor agencies to see if they are on average fitting those parameters. NSMHA will take
action if providers are consistently above or below the projected hours of service.

10.     Would there be an opportunity to serve non-Medicaid clients?

It would be within available resources as NSMHA does have some State only money projected to use for
some non-Medicaid services in our design model. On page 13, there is a breakdown into Medicaid and
non-Medicaid clients and hours.

11.     If you are applying for the child or adult outpatient medication section, do you have to
serve all levels of care?

No, especially if you are providing a specialty service. Make sure in your application that you clearly state
what levels you want to serve.

12.     If you are applying for Section 2, do you have to provide medication services (or all of the
State Plan Modalities of Services) as part of the package?

A provider agency could propose to provide specialized services and may not need to provide the full
range of the State Plan Modalities of services. An agency making such a proposal would need to justify in
their proposal why the consumers they are proposing to serve would not need the full State Modality range


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of services. The agency would also need to propose how they would manage a consumer who might need
services the agency was not providing.

The NSMHA would expect agencies to provide medical services or to develop sub-contracts to provide
medication services. NSMHA has concern about splitting the two services apart from a clinical practice
standpoint due to the importance of communication and continuity of care between prescriber and
treating clinician(s).

13.    For outpatient mental health services what other array of services is required?

Please see the following crosswalk of services for Outpatient Mental Health and the other seven Service
Categories.

               Crosswalk between RFQ Service Areas and State Plan Modalities
           The following crosswalk of Service Categories to State Plan Modalities lists the
           types of services that may be provided and billed for each Service Category.
           Further work will occur prior to contracting to finalize what codes should be billed
           for the different programs within a Service Category. For example, NSMHA will
           work with the provider(s) of Integrated Dual Disorder Treatment to decide
           whether those services should be billed with the S9480 Intensive OP Psychiatric Services
           per diem code or the per visit/per minute CPT and HCPC codes.

              Service Category                           State Plan Modalities
            Outpatient and             Brief Intervention Treatment
             Medication Services        Crisis Services
                                        Family Treatment
                                        Group Treatment
                                        Individual Treatment Services
                                        Intake
                                        Interpreter Services
                                        Medication Management
                                        Medication Monitoring
                                        Peer Support
                                        Psychological Assessment
                                        Rehabilitation Case Management
                                        Special Population Evaluation
                                        Supported Employment
                                        Therapeutic Psychoeducation
            Integrated Dual          High Intensity Treatment
             Disorder Treatment        Or a combination of the following:
                                      Brief Intervention Treatment
                                      Crisis Services
                                      Family Treatment
                                      Group Treatment
                                      Individual Treatment Services
                                      Intake
                                      Interpreter Services
                                      Medication Management

                                         Page 4 of 13
   Service Category                             State Plan Modalities
                            Medication Monitoring
                            Peer Support
                            Psychological Assessment
                            Rehabilitation Case Management
                            Special Population Evaluation
                            Supported Employment
                            Therapeutic Psychoeducation
                            Interpreter Services
 Intensive Outpatient    High Intensity Treatment
  Services – Adults/       Or a combination of the following:
  Older Adults            Crisis Services
                          Family Treatment
                          Group Treatment
                          Individual Treatment Services
                          Interpreter Services
                          Medication Management
                          Medication Monitoring
                          Peer Support
                          Psychological Assessment
                          Rehabilitation Case Management
                          Special Population Evaluation
                          Supported Employment
                          Therapeutic Psychoeducation
 Mental Health           Mental Health Services in a Residential Setting
  Services in a            (Note: Further discussion is needed regarding which of the
  Residential Setting      following codes can also be used for this Service Category.)
                          Crisis Services
                          Day Support
                          Family Treatment
                          Group
                          Interpreter Services
                          Med Management
                          Med Monitoring
                          Peer Support
                          Psych Assessment
                          Special Population Evaluation
                          Stabilization
                          Supported Employment
                          Therapeutic Psychoeducation
 High Intensity          High Intensity Treatment
  Treatment Services -     Or a combination of the following:
  Child/Youth             Crisis Services
                          Family Treatment
                          Group Treatment
                          Individual Treatment Services
                          Interpreter Services
                          Medication Management
                          Medication Monitoring

                             Page 5 of 13
               Service Category                             State Plan Modalities
                                         Peer Support
                                         Psychological Assessment
                                         Rehabilitation Case Management
                                         Special Population Evaluation
                                         Therapeutic Psychoeducation
            Supported                   Supported Employmentt
             Employment                  Crisis Services
                                         Family Treatment
                                         Group Treatment
                                         Individual Treatment Services
                                         Interpreter Services
                                         Medication Management
                                         Medication Monitoring
                                         Peer Support
                                         Psychological Assessment
                                         Rehabilitation Case Management
                                         Special Population Evaluation
                                         Therapeutic Psychoeducation
                                         Interpreter Services
            Clubhouse                 Mental Health Clubhouse
                                       Interpreter Services
            Drop-In/Peer Support      Interpreter Services
                                       Peer Support

14.    Under data management and data processing, what sort of IS reporting will be required?

If a provider has an information system that can submit data directly to us in the required format, it is our
intention that NSMHA have the capability to accept IS Data in the specified format directly by October 1,
2007. Sound Data Systems currently is submitting information for providers and presumably will be
available to other agencies. There would be a charge for the Sound Data Services.

15.     The letter of intent has a grid that we are suppose to put checks in the various boxes for
type of service and geographic region. Do we need to check all boxes that we intend to serve with
our letter of intent or can we choose or add different ones in our proposals?

Check all you are considering when you submit your letter of intent and then in your proposal you may
delete some of those choices.

16.    For mental health treatment in a residential setting, the services have been reported as per
diem in the past; and the services are defined as hours in the RFQ. Is it your intent that all those
services will be reported to you as hours instead of per diem?

Yes, the NSMHA intends to collect the underlying service modalities in minutes for mental health
treatment in a residential setting, but will pay on a per diem basis. NSMHA will report to the State on a
per diem services basis.



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17.    I am not talking about room and board, I am talking about mental health services in a
residential setting, about the overlay of services how will those be paid?

Payment is listed as bed capacity. NSMHA will want to clarify this issue with applicants applying for
Residential Services.

18.     On page 8, items 4 and 5 are combined and defined as client hours. Did you arrive at the
number of hours by dividing that by the dollar amount in the model?
The NSMHA used model based on estimated number of clients (233) time the estimate number of hours
per client (70) times the estimated average cost per hour ($132). This can be found in Section 9.d. of the
budget. The NSMHA is contracting on a fee for service basis for Section 4 services and a budget or
capacity basis for Section 5 services. This is why we are asking for cost information in the RFQ for
Residential Services.

19.     So it has to do with submitting a budget rather than proposing a certain number of hours
of service?

That is correct for Section 5. Mental Health Services in a Residential Setting.

20.     Once you select the providers, how long is the contract for?

The Contract would go through June 30 2009. We have changed the start date because the Mental Health
Division notified us their new contract will not be ready until September 30th. The NSMHA will do a
bridge contract from July 1st to October 1st with our current contractors. This new contract will run from
October 1, 2007 – June 30. 2009.

21.     Will the North Sound RSN be affected by any changes that happen to Provider One?

The NSMHA does not yet know if Provider One will be rolled into mental health. When it happens we
will make the changes.

22.     Will that change this contract?

NSMHA thinks it would only change the contract in the sense of how you report.

23.   Regarding the matrix of the service areas and the boxes to check, do we need to show how
the modalities will be provided by geographic region?

Correct. You need to show how you will coordinate service and it must be provided if medically necessary.

24.    Are we indicating where the services will be physically housed or for specialized services
do we indicate the services are available for clients coming from other areas?

NSMHA will expect and require that services would meet the travel parameters in the mental health
contract. The State time and distances parameters for access to services are the maximum allowable and
certainly not convenient for consumers or conducive to positive outcomes. Preference will be given to
services that are located more conveniently to consumers’ homes and communities.

25.     So we would indicate where we are willing to serve people who are living in those areas
outside of where the service is geographically housed?

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Correct. The State’s time and distances parameters for access to services are the maximum allowable and
certainly not convenient for consumers or conducive to positive outcomes. Preference will be given to
services that are located more conveniently to consumers’ homes and communities.

26.     Is it correct that we are starting October 1st and that we are maintaining the status quo
until then?

That is correct; we will offer a bridge contract extending the current contracts with our current providers
to September 30, 2007.

27.    There are two areas, integrated dual disorder treatments and high-intensity treatment
services; what services are you including in those two groups?

These sections are looking for evidence-based practices, so refer to the attachments for expectations. The
NSMHA believes these services are a mixture of the State modalities. See Attachment 2.

28.     What is being included or excluded from those groups? Do you see the 16 modalities
falling exclusively in one or the other of this mix of services that is on this grid?

The grid has been updated in this document. See Question 13 above.

29.   Do you anticipate clients receiving services from more than one provider such as
medication services from one provider and clubhouse services from a different provider?

Yes, this is anticipated. The primary provider would be paid for services provided by that agency and the
provider of clubhouse services would also be paid. The primary provider would be responsible for
directing treatment so the other providers would need to be on the treatment plan; this funding system
allows clients to go to more than one provider.

30.    Since you changed the date on the contract, do you want us to list what our capacity would
be on July 1, 2007 or October 1, 2007?

Yes, change the date to October 1, 2007.

31.    For a client to receive services from more than one provider, is it up to the primary
provider to request authorization for this client to be referred to other providers? What is the
process for getting these further services?

It would not be called an authorization. According to BBA and State contracts, the Health Plan, NSMHA,
authorizes outpatient or inpatient services. In addition, NSMHA will be authorizing access to PACT,
Residential Treatment, Integrated Dual Disorder Treatment, Intensive Outpatient Services for
Adults/Older Adults, and High Intensity Treatment for Children/Youth.

The provider developing the initial treatment plan (the primary provider) must supply the medically
necessary services or arrange for the service through another provider. All services being provided to a
consumer must be on the primary provider’s treatment plan. This will require coordination between
provider agencies serving the same consumer.



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NSMHA will directly pay all contracted agencies for services they provide to consumers. When the new
payment system is fully implemented, NSMHA will be paying agencies based on the client service data
they submit through the Consumer Information System (CIS).

32.    What if a provider denies the service?

The provider agencies do not deny services for they are not doing the authorization. If the NSMHA
denies a service, it is subject to appeal by the consumer or provider. If a provider believes it is not
medically necessary or refuses to provide a service to a consumer, the consumer may file a grievance.

33.    Is the primary provider required to have a sub-contract or inter-agency agreement with all
other providers of services they don’t provide?

No. Care needs to be coordinated; the NSMHA will write a policy on coordination of care between
provider agencies. Providers don’t need subcontracts with each other unless the other provider is not
contracted with North Sound RSN. See response to question 31 for more information pertaining to this
issue.

34.    Crisis services are not in the RFQ, so does that mean children’s crisis services are also
outside of this and would not be part of either high-intensity or the outpatient?

Children’s High Intensity Treatment Services are part of the RFQ, but are not crisis services or involuntary
treatment services. There are children’s crisis services being provided now and those would remain outside
the RFQ. There is a separate budget for those services and they will continue under those contracts and
will not be in the RFQ.

35.    For 24-hr crisis services, we contract with other agencies for our evening and weekend
services. Is this acceptable to the North Sound RSN?

Yes, under the following conditions. Outpatient providers are responsible for crisis services during regular
business hours. The crisis and involuntary commitment teams are separate from this RFQ and are
responsible for crisis services after hours and on weekends. The crisis teams provide back-up during the
day if an outpatient provider cannot respond. The NSMHA contracts separately for the after-hours crisis
services so the providers do not need to subcontract for those services.

36.    Do your clinicians have access to the database to see if one of their patients has been
involved in a crisis over the weekend?

Yes. The VOA crisis team notifies the agencies if one of their patients has been involved with or contacted
the crisis line or entered our crisis system after hours.

37.   Will there be any technical support for bidders beyond the question submissions before
March; such as follow up questions after the answers come out? In other words is there a way to
submit a question after the answers come out?

The answer is no because of the tight timeframes, it creates an unfair situation for all those who have
submitted questions on time.

38.   If a new provider is accepted to your system, will you provide any technical assistance to
them?
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Yes. The NSMHA offers help on our policies and procedures, and on the IS side NSMHA can tell you
data needs and specifications, but you must supply them.

39.    What about support on policies, processes, procedures and requirements?

Yes, NSMHA would provide support on this. There is also a lot of information on our website and we
have monthly quality management meetings and management council meetings with providers to go over
issues and provide training.

40.    On page 33 section 11 under current mental health consumers served, you asked us to
indicate the number of mental health consumers served in the last year according to group and
payment source. Do you only want North Sound consumers or any consumer by any payment
source that’s not Medicaid?

This is to look at the size of your mental health program and the number of patients served by age group
so we’re looking at all patients served not just the North Sound side of this.

41.    So non-Medicaid includes NSMHA State paid as well? (Based on question 40 above)

Medicaid is NSMHA’s and non-Medicaid is all others.

42.    Is this for mental health patients only? (Based on question 40 above)
Correct.

43.    Is there anywhere on the application to indicate the capacity of your organization to
provide services other than mental health services such as co-occurring disorder treatments,
medication, HIV/AIDS?

The NSMHA encourages provider agencies to put these in capabilities of organization in your application
where they will earn you points. There are several places on the application where these capabilities can be
included such as page 15 in section 2, etc.

Bidders Questions: (Directly sent to NSMHA)
44.    In responding to you RFQ, specifically on page 32, question 10.7, regarding lawsuits, we
have the following question: Since we are a part of a much larger organization, do you want us to
take into account involvement of any lawsuit affecting the whole of the larger organization or just
any affecting our region, Snohomish, Whatcom, and Skagit Counties?

Please describe each lawsuit within the North Sound Region or suits outside the North Sound Region that
you believe may affect your operations within the North Sound Region. The description should include
the basis of the suit, current status and the outcome, if a resolution has occurred for the suit.

List any other litigation against your overall organization and NSMHA may request more information
during contract negotiations.

45.   On page 8, top paragraph, there is a reference to “flex funds added to each contract as a
percentage of the contract amount and paid on a cost reimbursement basis.” Could you please

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provide more detail on how this will work, how much these funds will be, and what these funds
can be used for.

The NSMHA will allocate a percentage of the $250,000 in flex funds based on the percentage of funds
contracted to an agency divided by the total funds allocated for all services allocated in this RFQ process.

Flex funds are State Funds set aside to purchase items which assist persons with mental illness in their
recovery and facilitate treatment. Flex funds have been spent in the past on items such as emergency
medications, clothing, emergency food, damage deposits on apartment rentals, emergency housing/motel
rooms, summer camp for a child, guitar lessons, etc.

46.   To clarify what was reported at the bidder’s conference - services/contracts are to start
October 1st, 2007 and not July 1st as stated in the RFQ packet?

Yes, the new contracts will start October 1st, 2007 and not July 1st 2007. See the first paragraph of this
document.

47.    At the bottom of page 16 in the outpatient/medications section is a table, what should be
reported in this table?

Please mark the age group by geographic population that you are proposing to serve. For example, if you
are proposing serving all ages in Whatcom County, you would put an X in all of the service area boxes in
column three. If you were proposing to serve older adults in all of Snohomish County, you would put an
X is the four boxes for older adults for the four sections of Snohomish County and leave the rest of the
chart blank. If you’re proposing to serve Older Adults in parts of Snohomish County you would put an X
in the appropriate box.

48.    If a provider is currently interested in applying in one particular county, for example Skagit
County, and during the contract period the provider wishes to expand its services to another
county in order to meet client needs, can the contract be amended in order to expand the services
to another county?

The RFQ process is designed to allocate the provision of services and available funds across the entire
region. It is recommended that providers apply for the service areas in which they plan to provide
services. The NSMHA is planning on contracting for the next 21 months so providers should plan
accordingly. However, this is a plan and contracts may be adjusted upwards or downwards according to
actual utilization.

49.    If the provider currently applies in one region, for example East Snohomish, and then
wishes to expand to other regions within the same county, is that possible? If so, explain the
process to add a region.

Again, it is recommended that providers apply for the service areas in which they want to provide services.
If the appropriate levels of services are being provided and consumer satisfaction is high, the NSMHA
would probably not consider adding an additional provider to an area. If not enough consumers are being
served or there are problems with the services being provided, NSMHA would solicit proposal for
additional provider agencies to deliver services in an area. NSMHA would go through a planning process
and allocate this additional funding.



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50.    Are all providers in the North Sound Region able to access the crisis team to provide after-
hour crisis services? Is there a cost to the provider requesting crisis services or is it covered by the
NSMHA?

The expectation is that outpatient providers will provide crisis services during business hours to
consumers who are in treatment with them. The crisis services after 5 PM and before 8 AM and on
weekends are provided by the crisis teams under separate contracts. Involuntary Treatment Services are
provided under these separate contracts 24 hours a day, seven days a week. The crisis service teams
provide back-up services if the provider is unable to respond to a crisis during working hours. There is no
additional cost to the outpatient provider for these crisis services.

51.   When services are provided in the community (i.e. client’s home) will there be a
reimbursement rate to cover transportation cost?

There will be an increased hourly fee payment for services provided in the community. See the
fee/payment schedule for services attached to these questions as discussed at the beginning of these
questions.

52.    If a provider is currently interested in applying for outpatient and medication services and
during the contract period the provider sees a need to provide additional services, for example
integrated dual disorder treatment, can the provider request an amendment to the contract to add
a new service?

People with co-occurring disorders can be treated under the Outpatient and Medication Service Contract.
The Integrated Dual Disorder Treatment (IDDT) section of the RFQ was added to encourage the
development of at least 100 slots of Integrated Dual Disorder Treatment that meets the SAMSHA IDDT
fidelity standards. If other providers contract for the 100 slots of Integrated Dual Disorder Treatment
funding might not be available for additional IDDT during the contract period. If funding is available,
this could be considered. Changes in funding allocation will go through a planning process.

53.     When providers are bilingual/bicultural clinicians and speak the client’s native language
and the client for example is a monolingual Spanish speaking client, will there be a cultural
differential for providers who are providing the services to the client in their language and not
accessing the funds allocated for interpreter services?

At this time, no additional rate is being considered for bilingual clinicians. The NSMHA has tried to set
rates that are sufficient to cover the costs of employing clinicians with a variety of specialized skills and
abilities.

54.    Will there be a cap for hours assigned to a client and/or is there a cap per locus level? Can
a provider obtain additional service hours for a client who during the course of treatment requires
more hours?

Mental Health consumers need to be given the medically necessary mental health services they need. The
caps on client hours for each level of care are averages. NSMHA anticipates that some individual
consumers will be under the average hours for their level and others will be over. NSMHA will monitor
these averages to manage the funding across all agencies in the Region. If an agency is consistently
providing more hours or fewer hours than the average, the NSMHA will review the situation from both a
quality and financial perspective and take appropriate action.


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55.   After a provider is selected to provide services by the North Sound Mental Health
Administration, will the provider be required to reapply once the contract period expires in June
2009?

The decision will be made by the Board of Directors as to whether and when the NSMHA will issue
another RFQ in the future. If the contracts are working well across the Region and with each provider, the
contracts would most likely be extended. Some level of negotiation seems to occur each contract period
because there are changing requirements and funding levels from MHD or other initiatives or needs from
consumers, MHD and providers.

56.     Are employment services part of the outpatient and medication services given that
clinicians may provide employment services under case management services?

Yes, consumers needing or requesting employment services can be treated under the Outpatient and
Medication Service Contract. The Supported Employment section of the RFQ was added to encourage
the development of at least two Supported Employment Programs that meet the SAMHSA Supported
Employment Program fidelity standards.

57.    Can the Drop-In/Peer Support Service be a part of the outpatient and medication service?

The Drop-In/Peer Support section of the RFQ is designed to fund at least two peer support activities that
may include drop-in centers or other peer-operated and managed services. The Peer Support modality is
a separate and State required modality of service in the other outpatient services. The Drop-in/Peer
Support might be a part of other programming at a CMHA, but it does not have to be operated by a
CMHA as it is funded with State Funds.

58.    Is a first time provider required to complete page 14, section 2.1 of the RFQ?

This page may be blank for a first time provider. If you are already providing service to consumers from
this geographic area you should complete section 2.2 showing the capacity that your agency is proposing to
provide by October 1, 2007.

59.     In “Outpatient and Medication Services”, will NSMHA reimburse any case management
services that are not face to face? Examples might be phone contact directly with a consumer for
clinical purposes, as opposed to logistical issues as scheduling.

Yes, NSMHA will pay the fee schedule rates for the State Approved Modalities of Services. In addition
you should check the provider operations manual for the specific service expectations/requirements of
each modality at www1.dshs.wa.gov/pdf/hrsa/mh/Final_Operations_Manual-revised_013106.pdf

60.    RFQ page 28, Section 8 "Clubhouse", regarding Item 8.6 as worded "Describe how you
have integrated certified peer counselors into your outpatient programs." Did you mean to ask
how we integrate Certified Peer Counselors into our "clubhouse program"? Your question
specifies our "outpatient programs". We would answer the question differently, depending on
whether you intended "Outpatient" or "Clubhouse".

That is an error. It should read, “Describe how you have integrated certified peer counselors into you
Clubhouse program”.



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