Fund Balance RFP
July 27, 2012
Could there be a Tribal carve out for our catchment area so we would be able to serve Native Americans in
Snohomish and other counties where needed?
o NSMHA would welcome a proposal from a Tribe or a coalition of Tribes.
What is the degree of flexibility NSMHA would have in entertaining proposals outside of the stated structure?
o Other proposals addressing the intent and goals will be considered equally with the specific program
What is the total dollar amount of the fund balance overall?
o Approximately 4.9M, the split of Medicaid to State funding isn’t clear at this juncture, however we
anticipate more Medicaid than State funding.
Isn’t there 2 million dollars of this already committed to housing?
o Yes; 2M is set aside for the five counties for housing along with approximately $500,000 for upgrades to
the Triage Facilities. This housing and triage facility funding has now been separated from the $4.9
million dollars available in this RFP.
What is the breakdown of Medicaid and State funding for the 5 million?
o We are not definite at this juncture as to the exact split of funding. We do know there will be a
preponderance of Medicaid funding.
Where it notes contractor must be in good standing with NSMHA; does that limit it to existing contractors?
o No, it does not.
Regarding EMR is there thought to NSMHA contracting for that and then having that provided to all agencies?
Or does each agency need to submit a proposal on this?
o There will be no contract with an entity to provide this for the agencies. Each agency has unique needs,
so they should research the many offerings and pick the best fit for their agency needs.
Do you need a proposal from every agency on this then?
o Each proposal submitted would need to address the business needs of the agency involved.
If a proposal is submitted that is not one of the five types of pilots listed on page 3 does the proposal still
need to indicate its relationship to the four areas of need listed on that same page?
On the emergency medication assessment how rapid of access are you looking at?
o Propose what you think would be necessary; we want to divert people from going to Emergency
Departments or unnecessary psychiatric hospitalizations so rapidness is of importance; perhaps next day
access. Creative approaches are welcome.
For the inpatient 7 day follow up on page 18 part D it states each discharge that is seen within the 7 days a fee
would be paid and if not a penalty fee would be charged; is that correct?
Yes, that is correct.
o Is that for Inpatient units that are physically located in the north sound region?
That has not been determined; but does not include WSH.
o So it does not include WSH, but does include every other inpatient psychiatric bed?
o And that Includes free standing E&Ts, like Kitsap for example?
We would like to include all E&T facilities that are utilized by those Medicaid eligible.
Should a separate letter of intent be submitted for each service program area an agency intends to apply for?
o No, just one letter of intent will satisfy.
On page 12 under geriatric assessment team Part C # 3 it states the referral will be through the access line not
the crisis line; is this correct?
o Access line is correct; we want it similar to the King County model which is not a 24-7 program; it is to
work with older adults in their homes or AFHs, possibly nursing homes.
If an agency intends to apply for more than one service program area under item C, should a separate
application be prepared for each item C area or should the agency prepare one application that encompasses
each service area applied for under item C?
o It would be one application and if you apply for more than one program area, then you will have a
separate proposal for each program area.
On page 9 under Mental Health Service Qualifications, item xxi. says to provide at least one written reference
from an allied service provider, should more than one letter be obtained if more than one service program
area is being applied for?
o If you are applying for more than one specific program area it would be expected to supply a reference
for each specific program area.
On page 18 D.7 it states an agency will develop working relationships and D.9 states it will be provided to
enrolled and un-enrolled; would we need to negotiate reimbursement with the agency that has this?
o No, these are all Medicaid eligible people.
It says applicants may propose variations as long as the intent and goals are addressed; does the variation
allow for going outside those program requirements?
o You can go outside the program requirement as long as you address the intent and goals.
Do we need a separate budget for each specific program area?
o Yes, you will need a separate budget for each.
On page 18 under item E. 3 it says that the element details of the MOU need to be described. Does NSMHA
want to see a draft of the MOU language in this section or just a description of what would be included in the
o Addressing the elements to be included in the MOU is acceptable.
For the EHR there is a huge variety; are you looking for something that every agency can use to look at all
agencies and research for all or one agency taking on the role as the caretaker of the system so everyone can
o No, we are not looking at one agency to oversee.
We have researched EHR programs that would be great for large and small programs; do you need someone
to research one for all agencies to get?
o No, we are looking for the agencies to make that determination.
Does NSMHA have a preference of the region adopting a single health record for all or a different platform for
o Each agency is unique and must analyze and find the one that best meets their needs to make that
determination. Each agency can have their own though they must be able to transmit to us and we must
be able to pull from access.
Do the EMR programs need to communicate between agencies?
o This is done between respective agencies not NSMHA. Each agency would need to research this
possibility before they choose.
Regarding the Children’s Mobile Crisis Response System: Are crisis stabilization beds and the use of parent
partners required components of the model, or are those components optional if a different model is
o Providing a suitable alternative to crisis beds could work. The use of Parent Partners is key;
however, we could be flexible about when/how they are used. In the end, we will be looking at
whatever meets the need vs. a specific categorical service.
Are data available regarding the number of youth/families who would be expected to be referred? It seems
that information is needed in putting together a proposal for a “no refusal” system. Alternately, is there a
target funding level for the team?
o Since this is a new program, any data must be taken as rough approximations of the need for this
program. Below is data on the previous high intensity treatment program that was operated in
Snohomish County and projected over the entire region.
Possible Service Expectation of a Child Outreach Program
% of Outreach outreach Intakes per
Population folk Hours Services Services folk month
7.0% 2.0 27.7 27.8 18.2 1.8 0.6
1.4% 0.4 5.6 5.6 3.7 0.4 0.1
10.4% 2.9 41.2 41.3 27.1 2.7 0.9
63.4% 17.8 251.8 252.5 165.8 16.7 5.2
17.9% 5.0 71.0 71.2 46.7 4.7 1.5
100.0% 28.1 397.2 398.4 261.6 26.3 8.3
o On the next page is data on the number of children hospitalized across the Region. It is intended that this
program will provide assessments prior to children being hospitalized and divert these children from being
hospitalized when possible.
Inpatient Discharges per Month ages 0-17
Count of County of
Island Skagit Snohomish Whatcom
Row Labels Region Total
2011-01 1 3 5 3 12
2011-02 1 2 16 5 24
2011-03 3 2 13 3 21
2011-04 5 15 1 1 22
2011-05 4 1 12 3 20
2011-06 4 6 1 2 13
2011-07 2 10 5 17
2011-08 5 6 11
2011-09 4 3 12 2 21
2011-10 2 3 4 4 13
2011-11 3 1 10 2 1 17
2011-12 2 1 10 4 1 18
Grand Total 20 32 119 33 5 209
Average 2.5 2.7 9.9 3.0 1.3 17.4
stdev 1.1 1.4 3.8 1.3 0.4 4.2
2 stdev High 4.74 5.42 17.46 5.70 2.12 25.72
2 stdev low 0.26 - 2.37 0.30 0.38 9.11
o We have not set a target for the level of funding; we are looking for proposals that demonstrate
effectiveness and cost efficiency.
The form doesn’t have a space to indicate what topic or area we intend to submit a proposal. Does one letter
of interest cover us if we intend to submit more than one proposal? Or should we submit separate ones for
each proposal we intend to submit, and name the proposal somewhere on the form?
o One letter of intent is all that is needed regardless of how many specific programs areas are proposed.
We will again be submitting a proposal for the EMR that is a collective proposal on behalf of eight
organizations. While there will be one proposal, I believe it will make the most sense to have separate
contracts between NSMHA and each of the eight agencies, to avoid having funds passed through one of the
eight agencies and therefore be potentially B&O taxable. Do you need separate letters of interest from each
of the eight agencies?
o A letter of intent from each agency would be appropriate in this case. We would also want to see a
separate budget and narrative for each agency.