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 Mobile Outreach services for the State of Alaska in a partial year FY2023. Program Services are authorized under 7 AAC 78 Grant Programs. Additional governing statutes are AS 47.30.520-620 Community Mental Health Services Act, 7 AAC 70 Behavioral Health Services, 7 AAC 135 Medicaid Coverage for Behavioral Health Services, AS 47.37 Uniform Alcoholism and Intoxication Treatment Act, AS 47.30.655-.915 Alaska Civil Commitment Statutes, 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. State of Alaska statutes and regulations are accessible at the Department of Law Document Library or through the contact person identified on the cover page of this Request for Proposals (RFP).
In the proposed State Fiscal Year 2023 budget the Department of Health and Social Services will be reorganized into two distinct executive branch Departments: the Department of Health and the Department of Family and Community Services. This re-organization will be effective July 1, 2022 which is the first day of State Fiscal Year 2023.
The Division of Behavioral Health recognizes the need to support agencies in the early development of standing up mobile crisis outreach response services particularly in small communities. Many of the larger hub communities have funding mechanisms and resources in place to support the development of services along the crisis services continuum, however smaller communities require resources in the purchasing of vehicles, telehealth, and other equipment to develop mobile crisis outreach response services. This request for proposal is for up to two grant awards that will fund mobile crisis outreach projects statewide with a service location in an area with a population of less than 30,000 as defined solely by the 2021 Population Estimates by borough, Census Area and Economic Region listed at the Department of Labor Workforce Development website.
Currently psychiatric emergencies are responded to by roughly 33 providers across the State who receive grant funding to work in tandem with local hospitals, law enforcement, and court systems to address the behavioral health crises. These providers report they are often understaffed, and their services are utilized heavily within their respective communities. The collaboration between the hospitals, law enforcement, and court system is sometimes strained due to staff turnover, workforce shortages, and limited knowledge about local and statewide resources. With the implementation of the 1115 Medicaid Waiver Demonstration project, crisis stabilization services were added to the Behavioral Health Continuum services including mobile crisis outreach. It is essential that mobile crisis outreach programs work with local law enforcement, first responders, and psychiatric emergency service providers as well as other community behavioral health providers.
Mobile Crisis Outreach Response services are essential to the crisis continuum in mitigating the severity and escalation of behavioral health related crises. As a result of the COVID-19 pandemic, individuals are experiencing more behavioral health related conditions to varying degrees, some of which require crisis intervention. Deploying crisis mobile outreach response teams replaces the over reliance of emergency departments and higher acute psychiatric settings in a system where there is already significant strain on capacity due to COVID. Behavioral health crises can be responded to appropriately and at times more effectively by professionals on a mobile crisis response team than in other medical settings. The goal is for the team to stabilize the crisis and to link the individual to the appropriate level of care including outpatient services for continued support and treatment if indicated.
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 goal of mobile crisis response is to provide triage/screening, including explicit screening for suicidality; assessment, de-escalation/resolution including a warm hand off if needed to facility-based care. Anticipated outcomes include diversion from unnecessary law enforcement involvement, emergency department use and hospitalization, increased linkage to outpatient services, and crisis planning and follow up to prevent future crisis situations.
Projects must meet or exceed anticipated minimum outcomes described in this RFP.
1.03Program Services/Activities
Applicants must describe the proposed activities that support the goals and anticipated outcomes to be employed in the project. Review DHSS grant regulation 7 AAC 78.160. for allowable costs and restrictions.
Applicants must submit a description of staffing patterns that include identification of the credentials of staff responsible for/overseeing and providing the MOCR. Staffing patterns and credentials must meet the requirements in the Alaska Administrative Services Standards Manual (Attachments #1 and #2).
Applicants must identify and describe their mobile response program team type as either: 1.) Urban or 2.) Rural and Frontier.
Programs will be available 24/7, make available psychiatric consultation, and provide rapid face-to-face response as follows:
- Urban teams on average must respond to client within an hour.
- Rural and Frontier teams are not required to respond within an hour but must document efforts taken with respect to a rapid face to face response.
Proposals must include a description of how the following programs and services will be provided within the mobile outreach crisis response program:
- Triage and assessment services
- Crisis assessment including causes leading to the crisis, safety and risk considerations, recent behavioral health treatment, medications, and medical issues. Includes specific screening for suicide
- Crisis intervention and stabilization services including de-escalation, crisis planning such as the creation of a safety plan
- Referral and linkage with appropriate community services and resources, including law enforcement and first responders
- Linkage to medication services as needed through collaboration with qualified providers
- Mediation services as appropriate
- Skills training designed to minimize future crisis situations
- The crisis mobile team has training in trauma informed care, de-escalation & in harm reduction strategies, including opioid overdose response. MOCR must be equipped with naloxone.
- Provide follow up with a client after a response within 48 hours to ensure support, safety, and confirm linkage with any referrals. This may be satisfied through a phone call with a client.
- As the State of Alaska continues to develop the crisis care continuum, the applicant will coordinate with the Alaska Crisis Call Center, Careline, to develop a communication pathway that ensures that referrals will be accepted for mobile crisis outreach services when a caller meets the criteria for those services.
When appropriate provide MOCR services to the family or support system in support of an individual who is experiencing a behavioral health crisis.
- Deploy peer specialists in the provision of mobile outreach response and follow up in 48 hours
- Medication services
- Referral and linkage to appropriate services
Applicants must upload a timeline for the initiation of services and project activities. The timeline must identify a project start date of July 1, 2022 with service delivery beginning no later than August 1, 2022.
Applicant proposals must describe the ways in which the project aligns with program intent. The submitted project proposal will identify agency resources available to the project; describe project activities; and clearly state the project’s anticipated goals, outputs, and outcomes.
Applicants agree to comply with the following additional program requirements and service standards.
MOCR services are to be provided in accordance with the Alaska Administrative Service Standard Manuals and in alignment with national best practices; see The SAMHSA Essential Expectations for Crisis Services and the National Guidelines for Behavioral Health Crisis Best Practice Tool Kit.
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
- 1 Health & Wellness Across the Life Span
Department Core Services
- 1.1 Protect and Promote the Health of Alaskans
Performance Measures
1. Efficiency Measure- Average response time to initial call out
Data Collection: Start time when call is received and end time when the agency arrives to scene as documented in miscellaneous note.
Collection Method: AKAIMS
2. Efficiency Measure- Average after action client follow up
Data Collection: Follow up with clients is required within 48 hours after crisis is resolved. The follow up time is measured by the number of hours between end time of initial encounter and the start time of follow up encounter within 48 hours divided by total number of clients served.
Collection Method: Quarterly Reports
3. Effectiveness Measure- Percentage of mobile crisis responses resolved in the community
Data Collection: # of encounters that were resolved without having to transfer to higher level of care including 23-hour observation.
Collection Method: Quarterly Reports
4. Effectiveness Measure- Percentage of calls responded to within 2 hours.
Data Collection: Start time when call is received and time when the agency arrives to scene as documented in miscellaneous note.
Collection Method: Quarterly Reports
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.)
Grant Reporting
Required reporting will include:
- Cumulative Fiscal Report (overall grant and match expenditures are reported quarterly by budget line item);
- Quarterly Narrative program report
- Minimal Data Set in AKAIMS
- 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).
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 services for this solicitation are individuals including both youth and adults (all ages) experiencing mental health and or substance use related crises.
Service Areas and Communities: The service area for this solicitation is statewide for areas with a population of less than 30,000 as defined solely by the 2021 Population Estimates by borough, Census Area and Economic Region listed at the Department of Labor Workforce Development website.
1.06Program Funding
Estimated funding for the FY23 partial year duration (7/1/2022-3/14/2023) is $450,000 for 1 substance use disorder (SUD) program, and $350,000 for 1 Behavioral Health program. This RFP will fund a total of 2 applicants.
Total funding for the duration of this project is estimated to be $800,000 of Federal Funds. This grant program is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) Block Grant COVID 19 Supplemental Substance Abuse.
Match Requirement: The budget must include matching funds equal to 25% 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 both a detailed and narrative budget for 8.5 months, for startup costs and operation 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 budget should include start-up and operating costs. Review DHSS grant regulation 7 AAC 78.160 for allowable costs and restrictions. Startup costs should be entered in “600 Other Costs” category of the budget detail and narrative section. Grantee's will require pre-approval from DHSS prior to spending grant funds for associated startup costs. The budget is for the partial FY23 July 1, 2022 through March 14, 2023. The federal funding source ends 3/14/23.
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.