1.01Introduction and Program Description
The Department of Health and Social Services (DHSS/Department), Division of Behavioral Health, is requesting proposals from eligible applicants to provide Medication Assisted Treatment Expansion Grant services for the State of Alaska in FY2017 thru FY2019. Program Services are authorized under 7 AAC 78 Grant Programs and AS 47.30.520-.620, AS 47.30.655-.915 and AS 47.30.011-.061 Access State of Alaska statutes and regulations at http://www.law.state.ak.us/doclibrary/doclib.html or through the contact person listed on the cover page of this RFP.
The Alaska Medication Assistance Treatment Expansion Capacity Project will address Alaska's opioid epidemic by using the most effective FDA approved medications alongside evidence-based practices. The two communities targeted to receive an award will be Anchorage and Juneau due to their high Opioid Use Dependence (OUD) rates and lack of MAT services. This project expects to increase unduplicated individuals receiving MAT services in Anchorage by approximately 60 for the first year of the project and then 130-150 unduplicated individuals in years' two and three. Unduplicated individuals receiving MAT services in Juneau will be increased by approximately 45 for the first year of the project and then 75-100 unduplicated individuals in years' two and three. This increases Alaska's overall MAT capacity by 250 individuals.
There are three attachments included with this solicitation:
- Program Service Types, specifically Program Service Type 8- All successful grantees will be required to adhere to the requirements laid out in Program Service Type # 8.
- Timeline of Targeted Capacity Expansion- All successful grantees will be required to meet the timeline outlined in the attached Timeline Capacity Expansion document.
- Culturally and Linguistically Appropriate Services (CLAS)- All successful grantees will be required to develop a CLAS plan as a part of the SAMHSA grant requirements. This will be due within the first 45 days of award.
1.02Program Goals and Anticipated Outcomes
The Division of Behavioral Health (DBH) is offering new grant funding to establish or expand Medication Assisted Treatment (MAT) in two communities, which have been identified as high risk due to high incidences of opioid dependency and/or lack of MAT services. MAT Expansion Grants will be funded in Anchorage and Juneau.
The proposed projects must demonstrate a thorough understanding and must be clearly supportive of the grant program goals and outcomes anticipated by the Department. The purpose of this project is outlined in the goals and objectives listed below.
Goal 1: Projects must increase the number of admissions for MAT integrated care/treatment.
Objective 1: Successful applicants will be required to demonstrate an increase in individuals being admitted for MAT services as verified in the AKAIMS electronic record.
Goal 2: Projects must demonstrate a decrease in illicit opioid drug use at 6-month follow-up with the enrolled patients. Projects will participate in the biannual data collection required.
Objective 1: Successful applicants will be required to complete a Client Status Review (CSR) form for each MAT client in AKAIMS electronic record every 90-135 days. This CSR form will collect data demonstrating the decrease in illicit opioid drug use.
Goal 3: Projects must decrease the use of prescription opioids in a non-prescribed manner at 6-month follow-up with the enrolled patients.
Objective 1: Successful applicants will be required to complete a CSR form for each MAT client in AKAIMS electronic record every 90-135 days. This CSR form will collect data demonstrating the decrease in the use of prescription opioids in a non-prescribed manner.
Goal 4: Projects must prioritize a Diversion Control Plan (DCP) in their treatment regimen that will minimize the possibility of the diversion of methadone and buprenorphine.
Objective 1: Projects must provide a DCP that addresses each of the following diversion issues: Staff diversion, Community relations planning, MAT agency security, Medication purchasing, Inventory accountability, Program admission, Observed dosing, Take-home medications, Take-home call back and Urine drug screening.
Anchorage applicants must explain how they will meet the target of 60 unduplicated individuals enrolled and receiving MAT services by the end of the first year and 130-150 in the subsequent years. Juneau applicants must explain how they will meet the target of 45 unduplicated individuals enrolled and receiving MAT services by the end of the first year and 75-100 in subsequent years.
This grant requires the following on-going coaching and mentoring to support newly trained individuals and to embed the chosen Evidence Based Practices (EBP) philosophy more deeply into the culture of the provider's program:
- Participate in annual two day training conference with the Opioid Treatment Work Group with all treatment and clinical staff.
- Participate in all behavioral health and primary care system related groups and the learning community associated with program improvement of these services.
- Participate in development of the bi-annual Performance Assessment of the MAT Prescription Drug and Opioid Addition grant program.
- Participate in Monthly/Quarterly teleconferences with other MAT programs. These teleconferences are a requirement of all Opioid Treatment Programs (OTP) and state funded MAT programs.
1.03Program Services/Activities
Applicants must upload a detailed plan for services in the first year of the grant, and should include a brief outline of services in subsequent years. This includes a budget for year one of the grant only. Funding in the subsequent year(s) will require submission and approval of documents needed to update service plans, evaluation measures and budgets, and is dependent upon availability of funding.
The applicant must also submit a description of proposed activities that support the goals and outcomes to be employed in the project, and upload a detailed timeline for initiating services and project activities as an attachment to their proposal.
Applicants agree to comply with all of the following program requirements and service standards.
A) Service Delivery: Applicants must develop a treatment program and protocols for MAT which includes the use of medications in combination with counseling and behavioral therapies, providing a whole-patient approach to the treatment of substance use disorders. Applicants must describe their treatment program and protocols including:
1. Outreach and engagement strategies for MAT with diverse population at risk of OUD
2. Assessment crafted specific to OUD (including OUD diagnosis, history of OUD, or high risk relapse)
3. Identify screening and assessment protocols for co-occurring disorders
4. Identify service delivery sources to meet identified co-occurring treatment needs
5. Peer and other recovery support services will be implemented to improve access and retention in MAT
6. Tobacco cessation integration program for MAT participants
B) Diversion Control Plan (DCP): Applicants must describe in detail their DCP including how they will identify and prioritize treatment regimens that are less susceptible to diversion by:
1. A plan to mitigate risk of diversion and ensure appropriate use/dose of medication
2. Develop protocol for using Prescription Drug Monitoring Program (PDMP) for each new patient
C) Evidence-Based Practices:
1. Applicants must explain in detail how they will utilize EBPs. Applicants will use the SAMHSA National Registry of Evidence-Based Programs and practices and the SAMHSA Evidence-Based Practices Web Guide as the foundation of opioid medication and treatment. Evidence-Based Program and Practices include methadone maintenance, other MAT medications such as buprenorphine and naltrexone, integrated mental health and substance use disorder treatment delivered via Dual Recovery Therapy, Critical Time Intervention (CTI) case management, peer support, vocational support, Trauma Informed Care, relapse prevention, motivational interviewing, cognitive behavioral therapy (CBT) among others.
2. Detoxification followed by abstinence has shown little success in reducing illicit opioid use. Applicants must utilize FDA approved medications for OUD. For opioid use disorders, three medications are currently approved by the FDA- Methadone, Buprenorphine/Naloxone (Suboxone), and injectable Naltrexone (Vivitrol). Applicants must describe their medication protocol and must include all of the following:
a. The benefits and risks of each medication their program has chosen to utilize
b. How the medication will be utilized
c. Reasons the particular medication was chosen over another
d. Cost benefits of chosen medication
e. How the medication chosen fits into the overall sustainability of the MAT program
D) Travel: Each successful applicant will be required to attend and participate in all of the following. All applicants must include items 1-3 in their budget:
1. One yearly face to face meeting
2. Yearly onsite review
3. One yearly State of Alaska Opioid Treatment Conference (TBA)
4. Monthly teleconference meetings with Project Manager and other MAT and Opioid Treatment Programs (OTP)
E) Behavioral Health Disparities Impact: Each applicant must develop and submit in their plan for services, a behavioral health disparities impact statement to include the following:
1. Number of individuals to be served during the grant period, and subpopulations (i.e., racial, ethnic, sexual, and gender minority groups)
2. Quality improvement plan for the use of program data on access, use and outcomes to support efforts to decrease the differences in access to, use, and outcomes of service activities
3. Methods for the development of policies and procedures to ensure adherence to their Culturally and Linguistically Appropriate Services (CLAS) plan in Health and Health Care
F) Patient-to-Counselor Ratio: Each applicant must agree in their plan for services to maintain a minimum of 35:1 patient to counselor ratio for all behavioral psychosocial counseling services.
G) Target Opioid Use Dependence (OUD) populations: Each applicant must identify in their plan for services, how they will engage and retain the target OUD populations in the first year of the grant and a brief outline for subsequent years through the following:
- Outreach information about the MAT programs to referral sources such as: Homeless Shelters, Behavioral Health Facilities, other social services organizations, hospitals.
- Use the most highly effective and evidence-based medication assisted treatment.
- Motivational interviewing.
- Evaluate individuals' needs for transportation, food, housing, and connecting with the appropriate resources.
- Using Peer Support.
- Understanding the likelihood of relapse as a part of recovery and being a welcoming environment for individuals to return for services.
- Engaging family members in the individuals' treatment.
- Incorporate culturally appropriate interactions.
1.04Program Evaluation Requirements and Reporting
The applicant must provide an evaluation plan with that addresses the performance measures listed below in the description of Results Based Budgeting, and that the applicant will use to evaluate the progress of the grant project. The applicant's evaluation plan must include indicators and data gathering strategies that will be used to evaluate the progress of the grant project toward achieving the program goals and outcomes.
Results Based Accountability Framework
Grant programs will be required to align with the department’s priorities and core services. Utilizing a results-based budgeting framework, grantees will use performance measures to evaluate progress in order to meet meaningful outcomes and initiate data collection and reporting consistent with department priorities. Below are the Department Priorities, Core Services, Objectives, and Effective and Efficiency Performance Measures for this program.
Department Priorities
- 1 Health & Wellness Across the Life Span
Department Core Services
- 1.1 Protect and Promote the Health of Alaskans
Department Objectives
- 1.1.3 Decrease substance abuse and dependency
Performance Measures
- Percent of individuals with reduced illicit drug use, enrolled at the six month Government Performance and Results ACT (GPRA) follow-up
- Cost (Grant Expenditures) per client served
Grant Reporting
Required reporting for this grant will include:
1) Cumulative Fiscal Report (overall grant and match expenditures are reported quarterly by budget line item);
2) Program Reports in the format prescribed by the grantor, which will require information such as:
- The increase in individuals being admitted for MAT services as verified in the AKAIMS electronic record
- The decrease in the use of prescription opioids in a non-prescribed manner at 6-month follow-up.
- Diversion Control Plan (DCP) that addresses each of the following diversion issues: Staff diversion, Community relations planning, MAT agency security, Medication purchasing, Inventory accountability, Program admission, Observed dosing, Take-home medications, Take-home call back and Urine drug screening
- Client Status Review (CSR) form for each MAT client in AKAIMS electronic record every 90-135 days. This CSR form will collect data demonstrating the decrease in illicit opioid drug use.
3) FFATA: If funding for this program includes federal funds with reporting requirements that include those imposed under the Federal Funding Accountability and Transparency Act (FFATA), an agency power user must complete a FFATA form in the GEMS Agency Administration tab. Federal reporting requirements are not limited to prime awardees (such as the State) but include awards with federal funds that the State grants out (sub awardee).
4) AKAIMS minimal data set reporting Treatment Episode Data Set (TEDS) and Government Performance and Results Act (GPRA)
1.05Target Population and Service Area
Applicants must clearly describe the population targeted by the project, including the area or communities that will be served. Proposals will be evaluated for compatibility with the intended target population identified in this solicitation.
Target Population: The target population for this program and services requested in this solicitation includes individuals who are struggling with Opioid Use Disorder (OUD) and can establish at least one year of physical dependency and withdrawal symptoms.
Service Areas and Communities: The service areas and communities requested in this solicitation include Juneau and Anchorage.
1.06Program Funding
Funds available for this program are anticipated to total $800,000 per year. Anchorage funding is set at $450,000, with 30% for first year startup costs. Juneau funding is set at $350,000, with 30% for first year startup costs.
Match Requirements: The budget must include matching funds to equal no less than 25% of the proposed project. To calculate proper match use the following formula.
Total Grant Award Amount x Percentage of Match = Total Proposed Match
Restrictions to allowable matching funds are as follows:
1) Federal grant funds may not be used to match federal funds awarded through this grant program.
2) State grant funds may not be used to match funds awarded through this grant program.
3) Grant Income, Medicaid, and other third party receipts may be used as a match.
4) Local match may include in-kind contributions from volunteers, as well as donations of supplies, equipment, and space, and other items of value for which the applicant does not incur a cost.
5) Local cash match may include local tax receipts, municipal revenue sharing, cash donations, and other local sources of cash receipts.)
Proposed Budget: The applicant must submit both a detailed and narrative budget for the first fiscal year of the grant, including any required match, which is fully compliant with the limitations described in 7 AAC 78.160 (Costs), and supports program staffing and service delivery requirements stated in this RFP. The GEMS portal provides applicants instructions and the ability to enter budget details and narrative for the project budget. More detailed instructions can be accessed in the DHSS Budget Guidelines available online at https://gems.dhss.alaska.gov/Home/Documents.
Administrative Costs: In accordance with federal grant restrictions (or program statute or regulation), proposed budgets must limit the total administrative costs to no more than 15% of the total grant award.
Indirect Costs: If the proposed budget includes indirect costs, 7 AAC 78.160(p) requires a copy of the agency's current federally approved Indirect Cost Rate Agreement. Agencies with current DHSS grant agreements can review the Indirect Cost rate Agreement information in GEMS. Agencies without current grant agreements with the Department must upload a copy of the Indirect Cost Rate Agreement in the "Agency Administration" tab of the GEMS portal. Help instructions are available in the portal to upload and review such documents.
Grant Income: Applicants providing Medicaid reimbursable services must also have a Medicaid Provider Number, or enroll as a Medicaid Provider for Behavioral Health Services, and seek Medicaid reimbursement for all eligible services.
In the applicant’s proposed budget, both anticipated receipts and expenditures for all grant income must be clearly evident in both the detailed and narrative budgets and actual receipts and expenditures must be reported on a quarterly basis.
Infrastructure:
Each applicant may use up to 15% of its awarded funds for infrastructure expense necessary for the expansion of MAT services.