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 residential Substance Use Disorder (SUD) Withdrawal Management services in Alaska that are in alignment with the American Society on Addiction Medicine’s (ASAM) standards for withdrawal management. 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. 37 Uniform Alcoholism and Intoxication Treatment Act, 7 AAC 70 Behavioral Health Services, 7 AAC 135 Medicaid Coverage Behavioral Health Services, 7 AAC 138 115 Substance Use Disorder Waiver Services, 7 AAC 139 1115 Behavioral Health Waiver Services, and 7 AAC 160 Medicaid Program: General Provisions. Access State of Alaska statutes and regulations at Department of Law document library or through the contact identified on the cover of this Request For Proposal (RFP).
DBH receives multiple phone calls from individuals seeking withdrawal management services (WM) for themselves or their loved ones or acquaintances, primarily for alcohol and/or opiates. These calls are usually made when someone has “hit bottom” and is desperate for immediate help. Ambulatory Withdrawal Management is not sufficient in these circumstances; the individuals need 24-hour monitoring involving trained medical staff, whether it be in a medically monitored or clinically managed WM program. If they are unable to access this level of care, most individuals return to their alcohol and/or drug use or go to the hospital emergency department.
There are currently only a few residential WM programs in the State of Alaska. Some of these programs are consistently at full capacity and have a wait list. Since, as aforementioned, most of these individuals cannot wait for a bed to become available, they either return to substance use or show up at the emergency department. This RFP is in response to the urgent need for more residential WM programs and/or an expansion of the number of WM beds in existing programs. There will be up to two awards granted.
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.
- Providing timely, accessible care
- Providing effective care as indicated by program outcomes
- Utilization of Evidence-Based Practices
- Provision of culturally and linguistically appropriate services
- Provision of trauma-informed services
- Promotion of recovery, resilience, and community integration
Projects must meet or exceed anticipated minimum outcomes described in this RFP.
1.03Program Services/Activities
Responses to this solicitation can be for one of two levels of withdrawal management: Level 3.7-WM or level 3.2-WM. Each of these levels of withdrawal management must align with the standards contained in The ASAM Criteria 3 (American Society of Addiction Medicine, Third Edition).
The goals of these WM programs are to assist adults to safely withdraw (formerly “detox”) from alcohol and/or other drugs as these individuals are often frequent users of Emergency Medical Services (EMS), Public Safety services, the Emergency Rooms (ER) of acute care hospitals or inpatient psychiatric care services. Outcomes will demonstrate a reduction in the use of these expensive services as well as a reduction in deaths and continued substance misuse. In addition, these WM programs are expected to refer these individuals to continuing care during or upon completion of these WM services.
NOTE: DBH funded programs providing SUD services are required to comply with Substance Abuse Block Grant (SABG) Requirements and these can be found in Attachment A- DBH Behavioral Health Provider Standards and Administrative Manual for SUD Services.
Medically Monitored Inpatient Withdrawal Management (WM) Facilities (ASAM Level 3.7-WM). This level of care provides for 24-hour evaluation and withdrawal management in a permanent facility with inpatient beds. Services are delivered by medical and nursing professionals under a defined set of physician-monitored procedures or clinical protocols.
Clinically Managed Residential Withdrawal Management Facilities (ASAM Level 3.2-WM) This level of care is sometimes referred to as “social detox”. It is an organized service that may be delivered by appropriately trained staff who provide 24-hour supervision, observation, and support for patients who are intoxicated or experiencing withdrawal. This level is characterized by its emphasis upon peer and social support rather than medical and nursing care, however medical evaluation and consultation must be available 24 hours a day as needed.
Both levels of Withdrawal Management must provide the following services:
- Availability of specialized clinical consultation and supervision for biomedical, emotional, behavioral, and cognitive problems.
- Availability of medical nursing care and observation as warranted based on clinical judgement.
- Direct affiliation with other levels of care
- Ability to conduct or arrange for appropriate laboratory and toxicology tests.
- A physical examination done by a Physician, Physician Assistant or Nurse Practitioner within 24 hours of admission and appropriate laboratory and toxicology tests.
- An addiction-focused history and sufficient biopsychosocial assessment to determine the level of care in which the patient should be placed and for the individualized care plan.
- An individualized treatment plan with goals and objectives and recommended actions to meet those objectives.
- Daily assessment of patient progress through withdrawal management and any treatment changes.
Required Documentation must include:
- Alaska Automated Information Management System (AKAIMS) Minimal Data Set.
- Progress notes that clearly reflect implementation of the treatment plan and the patient ’s response to treatment, as well as subsequent amendments to the plan.
- Withdrawal rating scale (i.e. CIWA/COWS) tables and flow sheets (which may include tabulation of vital signs) are to be used as needed.
Applicants will upload a timeline for the initiation of services and project activities. The start date for this project is July 1, 2022.
Proposals must describe the ways in which the project aligns with program intent as well as identifying the ASAM level of service to be provided. The response will identify agency resources available to the project; describe project activities; and clearly state the project’s anticipated goals, outputs, and outcomes.
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:
Department Priorities
- Health & Wellness Across the Life Span
Department Core Services
1.1 Protect and Promote the Health of Alaskans
Department Objectives
1.2 Decrease Substance Use and Dependency
Performance Measures
- Efficiency: Maintain a bed utilization rate of at least 75%
- Effectiveness: Meet or exceed the state average for program completion rates as documented in AKAIMS (to include Satisfactory Completion, Referral to another program with satisfactory progress, and Transferred to another facility for health reasons)
- Effectiveness: Percent of individuals referred to SUD treatment upon discharge
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. The applicant's evaluation plan must include indicators and data gathering strategies that will be used.
Required grant 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.
- AKAIMS Minimal Data Set (MDS) is required of all applicants. See Attachment B for a comprehensive description of AKAIMS Minimal Data Set requirements.
Applicants must affirmatively agree to comply with the requirements of the AKAIMS Minimal Data Set (Attachment B).
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 are individuals with substance use disorders and co-occurring substance use and mental health disorders.
Service Areas and Communities: The service areas and communities requested for the services solicited are Statewide, however communities with the greatest need for these services will be prioritized.
1.06Program Funding
Funds available for this program are anticipated to total $1,600,000 in Federal American Rescue Plan Act (ARPA) funds for the grant duration. Funds available for this program statewide total $800,000 per fiscal year. Up to two grants will be awarded.
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 the first fiscal year of the project. 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. Funds are to be used for administrative costs and service delivery, including supplies and equipment. Expenditures for construction and building repairs are not allowable.
The proposed budget will 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. If an agency has never entered into a federally approved Indirect Cost Rate Agreement or no longer has a federally approved agreement in place, the recently updated Federal Uniform Guidance 2 CFR 200 now allows that agency to budget the 10% De Minimis.
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.