1.01Introduction and Program Description
The Department of Health and Social Services (DHSS or Department), Division of Behavioral Health (DBH), is requesting proposals from eligible applicants to provide State Opioid Response: Medication Assisted Treatment Expansion services for the State of Alaska in FY2020 through FY2021. Program Services are authorized under 7 AAC 78 Grant Programs. Additional governing statutes are AS 47.30.520-.620 Community Mental Health Services Act; AS 47.30.655-.915 Alaska Civil Commitment Statutes; 7 AAC 70 Behavioral Health Services; 7AAC 135 Medicaid Coverage for Behavioral Health Services; and AS 47.37 Uniform Alcoholism and Intoxication Treatment Act; 7 AAC 10.930 Request for a Variance. State of Alaska statutes and regulations are accessible at http://www.law.state.ak.us/doclibrary/doclib.html or through the contact person identified on the cover page of this Request for Proposals (RFP).
Applicants must be actively engaging in the process to become a certified Opioid Treatment Program (OTP) with the Substance Abuse Mental Health Services Administration (SAMHSA) as defined by 42 CFR Part 8.11 (located here) in order to be eligible to apply.
The OTP will offer methadone treatment along with comprehensive addiction services in the Kenai Peninsula Borough to increase access to medication assisted treatment (MAT) for adults and adolescents (ages 16-18) with opioid use disorder (OUD) and those who are at risk of OUD.
The grantee is required to utilize an adaptation of Vermont's proven Hub and Spoke service delivery. They will provide services to clients through Medicaid, insurance or self-pay/ sliding scale. The grantee must be appropriately staffed with medical professionals who can provide medical intakes and conduct admissions into OTP services. The grantee must have a care coordinator to ensure that there is coordination between the behavioral health agency and the OTP, and that the individual is seamlessly linked to the “spokes,” which may be a long term prescriber and recovery support services such as housing, peer support, employment, etc.; and that the individual is transitioning between levels of care as needed (moving into the “hub” for more intensive services if needed at any point). Current research indicates that when individuals with opioid use disorder have immediate access to medications they are more likely to engage in treatment services. Grantees will ensure immediate access (1-2 days) to appropriate medications. The agencies will provide access to all of the FDA approved medications for the treatment of opioid use disorders (buprenorphine, methadone, and naltrexone). The appropriate medications must be identified by addiction specialists trained in addiction medicine in partnership with the individual service recipient and selected based on the evidence base that determines which medications are more appropriate for individuals according to the severity of their use, history of use, and other biopsychosocial factors. It is expected that clients will be provided with evidence based individual and group treatment. Additionally the grantee will offer support to clients, as needed, including housing vouchers and transportation vouchers to access treatment and support for the medication costs. Each grantee will be required to either develop peer support services for the clients served or to provide access to peer support activities within the community for the clients served.
1.02Program Goals and Anticipated Outcomes
The proposed project must demonstrate a thorough understanding and support 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: Become established as an Opioid Treatment Program (OTP), also known as a methadone clinic. Applicants must submit a narrative as part of their application to provide a status regarding which of the steps below have been completed and which are currently in progress.
Requirements to become an established OTP:
- SAMHSA form SMA-162- OTP applicants must complete this form in order to obtain Provisional Certification. The form can be found at http://dpt2.samhsa.gov/sma162/. Additional information can be found at http://www.samhsa.gov/medication-assisted-treatment/opioid-treatment-programs
- Drug Enforcement Administration (DEA)- applicants must contact the regional DEA office for a list of DEA requirements. Applicants may fill out the DEA application form online: https://apps.deadiversion.usdoj.gov/webforms/jsp/regapps/common/newAppLogin.jsp
- Accreditation- applicants must agree to apply for accreditation by one of the SAMHSA approved OTP accrediting bodies. http://www.samhsa.gov/medication-assisted-treatment/opioid-treatment-accrediting-bodies/approved. OTP applicants must attach the "early application letter" from the accrediting body you have applied for to SAMHSA Form SMA-162.
Goal 2: Increase the number of admissions for medication assisted treatment.
Objective 2: Successful applicants will be required to demonstrate an increase in individuals being admitted for OUD services as verified in the AKAIMS electronic record.
Goal 3: Projects will demonstrate a decrease in illicit opioid drug use and prescription opioids used in a non-prescribed manner at 6 month follow-up with the enrolled clients. Grantees will participate in the biannual data collection required.
Objective 3: Grantees will be required to report urinalysis screening results to AKAIMS. The data entered will demonstrate decrease in illicit opioid drug use.
The anticipated outcomes related to the above goals and objectives include:
- An increase in admissions for medication assisted treatment
- A decrease in illicit opioid drug use and prescription opioid use in a non-prescribed manner.
Projects must meet or exceed anticipated minimum outcomes described in this RFP.
Applicants will upload a detailed plan for services for March 1, 2020 through July 1, 2020. Proposals must describe the ways in which the project aligns with program intent. The submitted project proposal must identify agency resources available to the project, describe project activities, and clearly state the project's anticipated goals, outputs and outcomes.
Applicants must provide an implementation timeline and corresponding narrative that explains the agencies' current status in the process for applying to become a certified OTP. In addition to this, the applicant must describe the facility and infrastructure that is already in place to support the addition of these services.
Requirements for operation of the grant funded Opioid Treatment Program:
- Applicants must comply with all state regulations. http://dhss.alaska.gov/dbh/Documents/OTP-Regulations.pdf
- Applicants must have a valid drug room license from the Board of Pharmacy under 12 AAC 52.800(a) as per 7 AAC 70.125(a)(5).
- Programs must be appropriately staffed with medical professionals who can provide medical intakes and conduct admissions into OTP services. (See federal guidelines for information about staffing requirements for OTP services.)
- Programs must have a medical director: a licensed physician that provides clinic oversight, medical evaluations as part of the intake process and the ordering of methadone for patients enrolled in the OTP.
- Nurse Practitioners and Physician Assistants under the supervision of the medical director could potentially order, administer and dispense medication at the OTP, so as long as an exemption request is submitted and approved by both the State Opioid Treatment Authority and the SAMHSA. These approved waivers under 42 CFR 8.11(h) contribute toward increasing access to OTP's since there is a limited number of medical physicians available for this service.
- OTP's are required to provide structured, observed daily dosing until patient achieves stability and moves through phases of their recovery when they can earn take-home privileges. Individuals must meet certain criteria in order to be eligible for treatment in an OTP and generally adolescents (individuals younger than 18) do not meet criteria except for in instances when the individual adolescent has two documented attempts at detoxification within a 12 month period.
Applicants must review the above requirements and ensure that the identified applications are completed and submitted to the SAMHSA and the DEA. Grant funds are to be used toward developing the program for start-up costs including supplies and personnel. It is expected that the infrastructure needed (i.e. facility) already exists and this program will be an enhancement to an existing operation.
The grantees will provide OTP services in a community where OTP services in the Kenai Peninsula Borough. The agency will serve as the “Hub” and utilize a version of the Vermont Hub and Spoke method of MAT. Alaska’s system is comprised of a different payment structure and types of services than that of Vermont, so it is not possible to fully replicate the Vermont Hub and Spoke. However, it is possible to implement a service delivery method that has an emphasis on stabilizing individuals in one setting and referring them out to “spokes” for less intensive services when appropriate. Proposals must have a strong emphasis on the care coordination operation in this service delivery model to ensure timely access, and supported transitions to ancillary services and levels of care.
In general the “hub” is responsible for the following:
- Provide comprehensive assessments and treatment protocols;
- Initiate MAT and provide care for initial stabilization period;
- Coordinate referral and transition to ongoing care (“spoke”);
- Provide specialty addictions consultation and support to ongoing care; and
- Provide ongoing coordination for clinically complex clients.
The “spoke” is the ongoing care system comprised of a prescriber and collaborating health and addictions professionals who:
- Monitor adherence to treatment;
- Coordinate access to recovery supports; and
- Provide counseling contingency management and case management services.
Spokes can be outpatient substance use disorder treatment providers, primary care providers, federally qualified health centers, community behavioral health centers, or independent psychiatrists.
All applicants agree to comply with the following program requirements and service standards.
- Service Delivery: Applicants must develop a treatment program and protocols for MAT which includes collaboration with a MAT prescriber, the use of medications in combination with counseling and behavioral health therapies, and providing a whole-patient approach to the treatment of substance use disorders. Applicants must describe their treatment program, which must include all of the following:
- Outreach and engagement strategies for MAT with diverse populations at risk of OUD, including veterans and pregnant women.
- Immediate access to medications upon brief screening to verify eligibility criteria are met. Access must be within 1-2 days of initial contact (initial contact means first encounter such as when client calls asking for assistance or shows up at the agency for help).
- Identify screening and assessment protocols for immediate access and for co-occurring disorders.
- Identify service delivery sources to meet the treatment needs of clients presenting with complex problems (co-occurring mental health, trauma, and/or chronic pain).
- Peer and other recovery support services will be implemented to improve access and retention in MAT.
- Tobacco cessation integration in the program for MAT participants.
- Participate in monthly teleconference meetings with DBH program manager and other MAT and opioid treatment programs.
- Participate in yearly onsite review with DBH program manager.
- Participate in technical assistance as recommended by DBH program manager.
- Participate in the development of the biannual reporting.
- Outreach and Cultural Diversity: The agency hosting the Hub must develop relationships with emergency departments/ first responders for referrals of individuals treated for opioid overdoses. Outreach must take place with homeless shelter providers and psychiatric providers. These sites must also actively coordinate with Department of Corrections and prisoner re-entry programs to link individuals with an OUD who are re-entering the community to treatment and recovery support services. Particular attention will be provided to any individuals leaving incarceration who are already on MAT. Although the VA system provides MAT services to the veteran population, this project will work with local coalitions coordinating services for veterans to make available these MAT services to them as well. This project will also focus on serving pregnant women and providing outreach to service providers providing pre-natal and post-natal care to women and their families.
- Evidence Based Practices: Applicants must describe how they will implement evidence based practices in addition to the Hub and Spoke method of delivering services. Evidence Based Program and Practices applicable to this project include methadone, buprenorphine and or naltrexone in conjunction with substance use disorder treatment utilizing modalities such as cognitive behavioral therapy, trauma informed care, peer support, vocational support, relapse prevention, motivational interviewing, and adolescent community reinforcement approach, among others.
This project will focus on increasing the number of clients receiving MAT services. Education opportunities will be offered by the State and grantees will be required to participate. Grantees are required to have their clinical staff, case managers, and prescribers participate in the DBH Annual MAT conference (expected to take place in Spring 2020 in Anchorage) and other provider education opportunities to increase knowledge, competency, and skills in implementing evidence based treatment and recovery support for individuals with opioid use disorders. It is expected that both the behavioral health staff and the medical professionals implementing these projects will participate in these provider education opportunities and will be required to provide evidence of their participation in their grant reporting.
- Travel: Each grantee will be required to attend and participate in the Annual State of Alaska Medication Assisted Treatment Conference. Grantees must budget for two individuals to attend. This conference will take place in Anchorage in the Spring of FY20.
- Patient to Counselor Ratio: Each applicant must agree in their plan for services to maintain a maximum of 35:1 patient to counselor ratio for all behavioral psychosocial counseling services.
- Target Opioid Use Disorder population: This project will provide treatment services to 15 unduplicated adult clients in Year 1 (FY20). The minimum number of adults an applicant must serve in Year 1 is 10. There is no minimum number of youth that must be served. 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. The plan for services must also include a brief outline for the subsequent year that addresses the following:
- Describe how your program will sustain.
- Describe the outreach plan for referrals.
- Describe the evidence based practices.
- Describe how motivational interviewing will be used and how staff will be trained in this modality
- Describe how individuals’ needs for recovery supports will be evaluated and supported (need for transportation, food, housing, and linkage with appropriate supports).
- Describe how peer support will be integrated into the program
- Describe understanding of opioid use disorder and the potential for recurrences and how a service environment is created where individuals are welcomed and supported when there is a recurrence of their substance use disorder condition.
- Describe how family members will be engaged in the individuals’ treatment. This is a requirement for adolescent programs. Engagement of family members is encouraged in adult programs.
- Describe how your program is meeting the needs of diverse groups and individuals.
- Diversion Control Plan: Applicants must submit a diversion control plan.
- Additional Requirements: Grantees will be required to meet the requirements identified in:
- Attachment 1- Program Service Type #11, pg. 48;
- Attachment 1- All Substance Use Disorder Treatment Types - Excluding Withdrawal Management Services pg. 9; and
- Attachment 2- Federal Guidelines for Opioid Treatment Programs (Medical Units) pg. 12 and pg. 66.
Programs serving youth must also implement a family support and education component based on evidence based practice.
1.04Program Evaluation Requirements and Reporting
Results Based Budgeting Framework
Results based budgeting provides a framework in which allocated resources support, and are justified by, a set of outputs and expected results. Within this framework, actual performance and achieved outcomes are measured by objective performance measures.
Projects are required to align with program objectives expressing Department priorities and core services. Projects will use performance measures to evaluate progress toward meaningful outcomes, and to initiate data collection and reporting consistent with Department priorities.
The Department Priorities, Core Services, Objectives, and Performance Measures of Effectiveness and Efficiency for this program are:
- 1 Health & Wellness Across the Life Span
Department Core Services
- 1.1 Protect and Promote the Health of Alaskans
- 1.1.3 Decrease Substance Abuse and Dependency
- Percent of individuals with reduced illicit drug use enrolled at the 6 month Government Performance Results Act (GPRA) follow-up.
- Cost (grant expenditures) per client served.
The applicant’s proposed evaluation plan will incorporate the performance measures of effectiveness and efficiency identified above. Applicants can propose additional performance measures for evaluating the project’s progress in achieving results supportive of program goals and outcomes.
Required reporting will include:
- Cumulative Fiscal Reports recording overall grant and match expenditures by budget line; and
- Program Reports in the format prescribed by the program which will require information such as:
- The increase in individuals admitted for MAT services as verified by AKAIMS electronic record;
- The decrease in use of prescription opioids in a non-prescribed manner at 6 month follow-up as evidenced by urinalysis testing results entered into the AKAIMS electronic record;
- Coordinate with the AKAIMS team to create specific SOR report(s);
- Number of provider education activities that staff participate in, and which staff are participating; and
- The number of family members engaged and provided in support services.
- AKAIMS minimal data set reporting Treatment Episode Data Set (TEDS); and
This grant requires the recipient to conduct GPRA interviews. This information will be gathered using SAMHSA's Performance Accountability and Reporting System (SPARS); access will be provided upon award. Data will be collected via a face-to-face interview using this tool at three data collection points: intake to services; six months post intake; and at discharge. Recipients will be expected to do a GPRA interview on all clients in their specified unduplicated target number and are also expected to achieve a three-month follow-up rate of 80 percent. GPRA training and technical assistance will be offered to recipients.
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 program’s intended target population identified in this solicitation.
Target Population: The target population for the solicited services is adults and youth (16-18) with opioid use disorder.
Service Areas and Communities: The service areas and communities requested for the services solicited are Kenai Peninsula Borough.
Funds available for this program are anticipated to total $1,000,000 federal funding for the full duration. One project will be awarded in the Kenai Peninsula Borough, $500,000 per fiscal year.
Please Note: Each award will be for a partial year period.
Year 1 (FY20): Grantees will be awarded March 1, 2020 through June 30, 2020
Year 2 (FY21): Grantees will be awarded July 1, 2020 through December 30, 2020, subject to requirements located in section 3.05 of this RFP.
Match Requirement: The budget must include matching funds equal to 25.00% of the proposed DHSS funds. Calculate required match with the following formula.
Total Requested Grant Award x Required Match Percentage = Required Match
Federal grant funds may not be used to match federal funds awarded through this grant program, and State grant funds may not be used to match State funds awarded through this grant program.
Eligible sources of matching funds include:
- Local Cash: local sources, including local tax receipts, municipal revenue sharing, cash donations
- Local In-Kind: donated items of value for which the applicant incurs no cost, including volunteer labor and donations of supplies, equipment, space
- Other Sources: government and non-government grant awards, third party receipts, direct receipts such as gaming or sales of goods
- Grant Income: earnings anticipated as a result of this project proposal receiving award, and Medicaid reimbursements if award of this grant is required for the applicant to bill Medicaid for awarded services
- Medicaid: includes Medicaid which is not Grant Income, as well as other third party receipts)
Proposed Budget: The applicant must submit a budget proposal for March 1, 2020 through June 30, 2020, and include costs to attend the Annual State of Alaska Medication Assisted Treatment Conference anticipated to take place in the spring of FY20. If no costs will be incurred to attend this conference please state this in the Travel narrative.
The proposed budget detail and narrative, (including required match), will support the program’s results based service delivery and staffing requirements stated in this RFP, and be fully compliant with the limitations described in this RFP, and those detailed in 7 AAC 78.160 (Costs). Regulations are provided under the GEMS Documents tab.
Resources specific to budgeting are also available under the GEMS Documents tab. DHSS Grant Budget Preparation Guidelines provide information and guidance about budget lines, cost detail groupings, and narrative requirements. Grantee User Manual Part I provides detailed instructions for entering a budget proposal in the chapter "Responding to a Solicitation."
Other Agency Funding: Prior to submitting a proposal, applicants are required to list all other agency funding received and applied for. This task must be completed by an Agency Power User in the Other Funding section of the Agency Administration tab. This is part of the pre-award risk assessment required under Uniform Guidance 2 CFR 200.
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. The agreement is to be uploaded in the Agency Administration tab. Lapsed agreements can be used if uploaded with the negotiating federal agency’s written approval to continue using the rate until a new agreement is negotiated.
Payment for Services/Grant Income: If applicable to the services proposed in response to this solicitation, awarded grantees will have a Medicaid Provider Number or apply to obtain one, and will make reasonable effort to bill all eligible services to Medicaid and any other available sources of payment before seeking grant support for delivery of the proposed services. DHSS funds are the payer of last resort.
In the applicant’s proposed budget, anticipated receipts and expenditures for all grant income must be evident in the detail and narrative. Fiscal reports for awarded income generating projects will include the receipts and expenditure of all grant income.