1.01Introduction and Program Description
The Department of Health and Social Services (DHSS), Division of Behavioral Health (DBH) and Finance and Management Services, Facilities Section is requesting proposals from eligible applicants to provide Chronic Inebriate Anti-Recidivism Treatment Program -Permanent Supportive Housing Program (PSH) services for the State of Alaska in FY2015 through FY2017. Services are sought for the Municipality of Anchorage. Program Services are authorized under 7 AAC 78 Grant Programs, AS 47.30.520-620 Community Mental Health Services act, AS 47.376 Uniform Alcoholism and Intoxication Treatment Act, AS 47.30.655-915 Alaska Civil Commitment Statutes, and AS 47.30.011-061 Alaska Mental Health Trust Authority and Chapter 18, SLA 14, Page, 53, Line 27. 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 Request for Proposals.
Structure of this RFP
In this Request for Proposals (RFP), the DBH Treatment & Recovery Section is splitting funds into two categories, Category A and Category B. It is DBH’s intention to fund one program in each Category. These two programs will serve distinct populations in order to meet the varying intensity of behavioral health needs of the chronically homeless population in the Anchorage area. Applicants will submit a proposal to one of the following categories of Permanent Supportive Housing (PSH): Category A. Assertive Community Treatment (ACT) for chronically homeless individuals with severe and persistent mental illness, OR Category B. Intensive Case Management (ICM) for chronically homeless individuals with primary diagnosis of substance abuse
Please review the Category listed on the solicitation carefully, as responding to the incorrect Category may result in not being funded. It is up to the applicant to submit a proposal to the correct Category solicitation as described below. Applicants can only apply for ONE funding Category:
This solicitation is currently making a total of $3,760,000 in capital funds available for Chronic Inebriate Anti-Recidivism Treatment Program – Permanent Supportive Housing Program; $1,885,000 for Category A-ACT, and $1,875,000 for Category B-ICM. (Successful Category A- ACT applicants may be eligible to receive additional FY16-17 non-competitive operating grant awards in the amount of $2,215,000. Therefore, through the two fund sources, the total amount available for 2.5 years of program operations total $4,100,000 in grant funds.)
The Department of Health and Social Services has identified several challenges including the development of quality local Psychiatric Emergency Services throughout the state and alternatives to hospitalization. Alaska Psychiatric Institute (API), the only state-owned psychiatric hospital, has only 50 acute adult beds and often operates at capacity. In addition, there is a statewide shortage of residential supportive housing that can accommodate people with behavioral health issues too severe to be managed in a standard assisted living home but who do not require hospitalization. Individuals exiting correctional facilities or involved with the Court System lack housing with support services to prevent repeated episodes of homelessness and institutionalization. In addition, those experiencing chronic homelessness often do not have access to the appropriate services and supports necessary to aid in their recovery.
The Division of Behavioral Health is committed to building a behavioral health system that treats clients through traditional clinic-based services as well as other service delivery models. This solicitation will fund increased availability of intensive community-based services that use multi-disciplinary and person-centered teams for homeless individuals. Stable housing is a critical component in the recovery process for individuals with serious mental illness and co-occurring substance abuse disorders. Without having access to the right housing and support services, many of those in the behavioral health population will experience severe health outcomes and high mortality rates. Supportive housing integrates individuals into the community in the least restrictive setting possible and promotes self-sufficiency. Types of supportive housing can range on a continuum that includes intensive models with a medical component (i.e. Assertive Community Treatment), high intensity community based services (i.e. Intensive Case Management), or low intensity community based services (i.e. standard outpatient). The programs funded through this solicitation will serve to re-balance the housing and services continuum toward less acute care. Access to integrated community-based services paired with housing will decrease the impact of homelessness on the community and individuals.
Permanent Supportive Housing (PSH) is an Evidence-Based Practice (EBP) characterized by availability of recovery-oriented services in integrated community settings coupled with safe and affordable housing. In line with federal efforts to re-structure services to better meet the housing and related needs of consumers, the Division of Behavioral Health is supporting the creation of additional Permanent Supportive Housing in Alaska targeted at individuals who are chronically homeless with behavioral health needs.
- PSH is not time-limited and is a crucial resource for many people with psychiatric disabilities, experiencing homelessness, living in unnecessary restricted and segregated settings, at risk of losing housing, or re-entering the community from institutional settings.
- Research around supportive housing indicates this intervention is a solution for a subset of the homeless population with significant healthcare needs.
- Supportive housing has been used as a tool to increase access to care, improve health, and lower health care costs for people who face some of the most significant barriers to housing and health care.
- Stably housed individuals are less likely to draw on expensive public services; they are less likely to end up in homeless shelters, emergency rooms, or jails.
- In recovery, individuals have the opportunity to live close to their families and friends, to live more independently, to engage in productive employment, and to participate in community life.
In an effort to blend and braid state funding, Category A- ACT program funded through this solicitation may receive both state capital and operating funding to finance treatment services. (Successful Category A- ACT applicants may be eligible to receive additional FY16-17 non-competitive operating grant awards to further leverage the capital grant fund offered in this RFP. Through the blending of funding and targeted Evidence-Based Practices for services, DBH anticipates a strategic impact on the most vulnerable of the homeless population.) Successful applicants will provide coordinated care through brokered and non-brokered access to a full range of wrap-around services. Successful applicants will be required to perform a vulnerability assessment to determine the highest needs individuals to be served through this grant and ensure these individuals are receiving the appropriate housing model.
The applicant must be an Alaskan non-profit organization, a municipality, or a Federally recognized tribal entity.
Total Funding Available
$3,760,000 capital funding (FY15-FY17)
Services are sought for the Municipality of Anchorage.
Required Target Populations
Category A- Assertive Community Treatment: chronically homeless individuals with severe and persistent mental illness, high rate of functional impairment, recent history of interaction with criminal justice system or high use of psychiatric emergency services
Category B- Intensive Case Management: chronically homeless individuals with primary diagnosis of substance abuse, chronic public inebriate, high use of Anchorage Safety Center
The applicant must assist clients to access the essential services described below:
Employment support services/job skills training
Substance abuse treatment and coordination
Mental health treatment and coordination
Housing stability services
Intervention with support networks
Referral to primary care services
Activities of daily living services and training
Medication management and monitoring
Detoxification services; relapse prevention and recovery planning
Illness management and recovery skills
The applicant must work with DBH to obtain data described in the RFP
The applicant must provide a plan that reflects understanding of the program goals and service standards
The applicant must form a community stakeholder group involving critical community members to guide development of the project
1.02Program Goals and Anticipated Outcomes
The proposals and required logic model must demonstrate a thorough understanding of the grant program goals and outcomes anticipated by the DBH. Proposed projects must meet or exceed anticipated minimums described in this RFP. Proposals must include a description of proposed activities that support the goals and outcomes which will be accomplished using a Housing First philosophy and the Substance Abuse and Mental Health Services Administration's (SAMHSA’s) Permanent Supportive Housing Evidence Based Practice.
Program Model and Philosophy:
Permanent Supportive Housing Program Model: Supportive housing combines affordable housing with support services to promote recovery and self-sufficiency. Support services include a focus on how to assist the individual to maintain long-term independent housing and to use stable housing as a platform for individual health, recovery, and personal growth. Lease agreements comply with landlord-tenant act and do not contain any clauses that are not present in lease agreements for individuals without a disability. Rent is affordable; the tenant pays no more than 30% of their income towards rent. Key principles include choice of housing, separation of housing and services, and community integration. Services are voluntary, individualized, and flexible.
Housing First Program Philosophy: In the Housing First philosophy pioneered by Dr. Tsemberis, consumers have a choice in the housing and services they receive and are served in a consumer-directed service approach that supports clients in pursuing their own goals by providing them housing first. There are no pre-tenancy conditions of sobriety or engagement in treatment before a person is placed in permanent housing. Housing First follows a harm reduction model with respect and compassion shown to each client in support of their recovery, and a commitment to serving the client long-term. An important element of this model is housing choice, where client’s preferences are honored as to which neighborhood they would like to reside in. Services and housing are separated, therefore the housing unit is not owned by the service provider and engagement in services is not a requirement of tenancy. Clients must agree to two program requirements: payment of rent and agree to at least weekly visits.
Service Categories for This Solicitation:
Supportive housing services under the Permanent Supportive Housing program model fall into two Service Categories based on level of service intensity: Assertive Community Treatment or Intensive Case Management.
Permanent Supportive Housing
Assertive Community Treatment Intensive Case Management
Category A- Assertive Community Treatment: Assertive Community Treatment (ACT) is a service delivery model that has been identified by the Substance Abuse and Mental Health Services Administration as an evidence‐based practice that consistently demonstrates positive outcomes and is considered by experts as an essential treatment option.
- ACT consists of a multidisciplinary team who work together to provide the majority of treatment, rehabilitation, and support services participants need to achieve their goals.
- ACT services are individually tailored through relationship building, individualized assessment and planning, and active involvement with participants to enable each to find and live in their own residence, to find and maintain work in community jobs, to better manage symptoms, to achieve individual goals, and to maintain optimism and recover.
- The ACT team is mobile, 24/7, and delivers services in community locations rather than expecting the participant to come to the program. Seventy-five percent (75%) or more of the services are provided outside of program offices in locations that are comfortable and convenient for participants.
- Caseloads do not exceed 1:10 and the entire team will serve 100 clients.
- The individuals served have severe and persistent mental illness that are complex, have devastating effects on functioning, and, because of the limitations of traditional mental health services, may have gone without appropriate services.
Category B- Intensive Case Management: Intensive Case Management (ICM) is a service-delivery model in which case managers, working in teams, provide intensive outreach and engagement, coordinate with other service providers, and develop strong therapeutic relationships to assist recipients get access to needed services.
- ICM supports recipients through the use of a team for the coordination of services to meet a recipient’s behavioral health treatment, occupational, housing and other needs, thereby enabling them to live in the least restrictive environment possible and increasing adaptive capabilities.
- Case managers fulfill a vital function for recipients by working with them to realize personal recovery goals.
- ICM is more than a brokerage function. It is an intensive service model that is flexible as recipient needs change and cross service settings.
- The intensive case management team composition must include staff with competencies specifically needed to assist with the special needs of the population.
- Caseloads do not exceed 1:15-20 and the entire team will serve 50 clients.
- For the purposes of this RFP, individuals served by this model are those with primary substance abuse diagnoses and are chronic users of the Anchorage Safety Center for public intoxication.
The program goals in this solicitation include a focus on community input and alleviating neighborhood impact through decreased homelessness and emergency service usage. To ensure community involvement, a stakeholder group will be formed for each Category to ensure responsive services are prioritized to the target population. Grantees will be required to form a community stakeholder group to guide development of the project.
- Category A- ACT: the stakeholder group will function as a referral committee and will include representation from state and local government, the criminal justice and courts system, and local consumer and emergency response groups. This referral committee will serve to prioritize services to high risk individuals identified as frequent users of the emergency services system (and meet eligibility criteria for ACT services).
- Category B- ICM: the stakeholder group will function as a steering committee will include leadership representation from the local homeless coalition, Municipality of Anchorage Department of Health & Human Services, local interested community council(s), representatives from the business community, and consumer and emergency response provider groups. This steering committee will allow for community input into program implementation, responsiveness, and feedback on neighborhood impact of the services.
Primary Program Outcomes:
The anticipated primary outcomes of these Permanent Supportive Housing programs include housing stability and decreased acute/correctional care.
- Housing stability will be measured through housing tenure (length of stay in permanent supportive housing) and housing status at discharge.
- Use of acute/correctional care will be measured through reduced recidivism, defined as: the number/days a recipient returns to corrections or an acute care setting during the program and 1 year post-discharge.
Proposals must include a description of proposed activities that support the goals and outcomes to be employed in the project. Proposed activities must match those summarized in the Logic Model. The applicant must also include a timeline for implementation in their proposal.
Applicants agree to comply with all of the following additional program requirements and service standards, see attached Interim Program Standards for Intensive Case Management (ICM) and Assertive Community Treatment (ACT), incorporated herein by reference. Applicants must describe how they will use the Housing First philosophy to guide this project and be operationalized in the community (above and beyond information provided in the RFP).
Proposals submitted in response to this RFP must contain a detailed plan for services in FY15 and should include a brief outline of services planned in subsequent years according to the two phases described below. This includes submitting a budget for FY15 of the grant in GEMS and attaching a proposed budget for FY16 and FY17. If available, funding in the subsequent year(s) will require submission and approval of documents needed to update service plans, evaluation measures and budgets.
The applicant will use a standardized form in the GEMS portal to complete a grant application.
For this project, applicants should plan two phases to allow time for program development and community outreach prior to delivery of services. The two phases are described below. Applicants are required to describe in their proposal how they plan to carry out these two phases as well as how they will incorporate DBH feedback and stakeholder input into program operations.
Phase 1: Development & Community Outreach
1a. Capacity Building/Staff Training
During the development phase, successful applicants will formalize their internal program development and planning to include staffing and training in Permanent Supportive Housing and the corresponding service delivery model (ICM or ACT).
- Permanent Supportive Housing is a model that involves community-based practice and is not “business as usual”. Successful applicants are asked to describe in this phase how they will modify agency operations by moving direct care staff into the community and out of the clinic setting.
- Grantees will work with Program Managers during the initial team start-up period to include collaboration on program development.
- Category A- ACT: specific technical assistance from a national expert and start-up training will be provided by DBH and participation is required to ensure high fidelity to the model.
1b. Creation of Evaluation Plan
Successful applicants will work with their DBH Program Manager to create and agree upon a data collection and evaluation plan within 90 days of acceptance of award. Post-award, DBH will work with successful applicants to provide resources for a third-party evaluator.
- It is DBH’s intent to use data collected from this demonstration program to inform future State efforts around comprehensive community-based programs that include a focus on housing.
- Data collection and performance reporting is critical to measure and report success of the project.
- DBH recognizes the impact to providers and clients on data collection and will work collaboratively with the successful applicant to minimize this impact.
1c. Community Outreach:
Successful applications will also conduct outreach to appropriate entities in the homeless and emergency service provider network as detailed below.
- Category A- ACT: a referral committee will be formed during this phase consisting of a representative group such as: the Division of Behavioral Health, Department of Corrections, Department of Labor, the Alaska Mental Health Trust Authority, psychiatric emergency services (such as hospitals, Designated Evaluation & Treatment centers (DET), and Alaska Psychiatric Institute), consumer advocacy groups, the tribal system, homeless and emergency services system, SAMHSA Projects for Assistance to Transition from Homelessness (PATH) homeless outreach provider, and the larger community. This group will also function over time as the referral committee to refer individuals into the ACT team. The grantee will have final right of refusal on acceptance of referrals. DBH partner with successful applicant to coordinate this referral committee as a shared responsibility.
- Category B- ICM: a steering committee will be formed during this phase. The steering committee will include leadership representation from the designated HUD Continuum of Care (CoC), Municipality of Anchorage Department of Health program and the Anchorage Safety Center, local interested community council(s), representatives from the business community, faith-based providers (emergency cold-weather response system), and emergency response providers. The steering committee will allow for input into the program design and operations and allow feedback for neighborhood impact that speaks to the effectiveness of the program. To target specific individuals, the applicant will need strong partnership with the Municipality of Anchorage to identify top users of the Anchorage Safety Center to be paired with housing and services.
For the purposes of referral and coordination of care, proper Release of Information (ROI)’s or Business Associate Agreements must be in place with appropriate entities that provide services to the target population. This will ensure collaboration and partnership between providers and non-duplicative services.
Phase 2: Client Outreach & Service Delivery
During the client outreach and enrollment phase, successful grantees will conduct active outreach to chronically homeless individuals to engage, assess, and prioritize the target population. It is DBH’s intention that services are delivered as soon as possible and individuals are quickly assessed, prioritized, and placed into housing. Program standards will assist to guide the number of new clients per month to be added to the team in order to maintain fidelity and decrease staff turnover. Regular meetings of the stakeholder group will be established on an agreed-upon schedule.
Comprehensive services will be offered to the client based on self-identified goals through individualized service planning. Services are flexible and change over time. For this RFP, applicants should detail how they will ensure the following services are available to the target population:
- Assertive outreach and engagement
- Initial goal-setting and assessment of service needs
- Linkage to affordable housing/rental subsidies
- Housing stability services (detailed below)
- Intervention with support networks
- Referral to primary care services
- Activities of daily living services and training
- Medication management and monitoring
- Entitlements and benefits assistance/counseling
- Money management skills training
- Transportation and accompaniment on appointments
- Detoxification services; relapse prevention and recovery planning
- Substance abuse treatment and coordination
- Mental health treatment and coordination
- Employment support services/job skills training
- Illness management and recovery skills
- Medication prescription and monitoring
- Education and information-sharing groups
- Referrals to legal assistance and other ancillary services
Category A- ACT: ACT services in accordance with detailed Interim Program Standards to include non-brokered service delivery including 24/7 intensive behavioral health services provided by the team, including mobile crisis assessment and intervention.
Category B- ICM: ICM services in accordance with detailed Interim Program Standards to include both brokered and non-brokered service delivery.
In addition to standard behavioral health treatment services, successful applicants should detail how they plan to provide the following services focused on finding and maintaining housing:
A. Pre-tenancy supports
a. Housing search; assistance with rental application and connection to rental subsidy or provide bridge rental subsidy through grant
b. Orientation to housing and services, review of lease program policies
c. Assistance with rental interview/facilitation of housing unit inspection
B. Move-in supports
a. Assistance with move-in/lease-up (purchasing/acquiring bed, kitchen supplies, household furniture, assistance with security deposit)
b. Physically assisting with move-in; meeting property manager/neighbors
C. Ongoing housing stability services
a. Assisting clients to integrate into neighborhood/community; family reunification and social support network
b. Tenant rights education; periodic meetings with property manager to proactively address tenancy issues
c. Training in cooking/meals preparation, personal hygiene, housing keeping and apartment safety, use of mass transit/public transportation, financial management
d. Emergent visits to client/tenant for psychological/emotional support and resolution of household emergencies (eviction prevention/mediation activities)
A key provision of Permanent Supportive Housing is the separation of housing and services so that housing is not used as a tool of coercion; in some cases this is not possible so recommendations are that if both housing and services are operated by one agency, different staff members administer the two components. A major goal of Permanent Supportive Housing is to integrate people fully into the community. Behavioral Health Treatment grantees are expected to participate in systems-level change through a comprehensive approach to ending chronic homelessness for the most vulnerable persons in Anchorage.
Category A-ACT: Due to the expectation the target population will experience social determinants of health-harming legal needs, such as fair housing and wrongfully denied benefits, applicants are asked to partner with a statewide legal service advocacy organization to provide civil legal assistance. A part-time civil attorney will provide a full specturm of interventions that address the legal needs for individuals to include: training of ACT team members to recognize the legal needs and triage, consultations, and legal representation to ACT participants.
If the applicant is chosen to be funded as a grantee by the Division of Behavioral Health, the expectations and requirements for FY15 are summarized as follows:
Requirements for FY15 below:
• Program development, including capacity building and staff trainings to ensure high fidelity practice
• Create and agree upon evaluation plan for program data collection and reporting (within 90 days of acceptance of award)
• Community outreach and formation of stakeholder advisory group
• By the end of FY15, active outreach to high risk individuals to engage, assess, and prioritize the target population by June 30, 2015
• By the end of FY15, implement a full range of identified services using Housing First model
• By the end of FY15, evaluate and report on program effectiveness by June 30, 2015
1.04Program Evaluation Requirements and Reporting
The proposal must contain an evaluation plan with stated performance measures the applicant will use to evaluate the progress of the grant project toward achieving the program goals and desired outcomes.
Logic Model Development and Updates: An evaluation plan must be created using the Logic Model format and instructions attached to this RFP (see Criteria and the Logic Model Resource Guide in the Attachment section). The Logic Model must include goal(s), outcomes, outputs, resources and activities applicable to the proposed project and compliant with program intent. 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 desired outcomes and must be supported by the applicant’s Logic Model.
Logic Model training may be available from DHSS, please check the website at http://www.hss.state.ak.us/grantees/default.htm for scheduled trainings.
As part of the continuing work to identify outcomes for success and improve services, grant programs will be required to align with DHSS’s priorities and core services, detailed below. This RFP is in alignment with the following DBH Core Service: Develop and maintain a stable, accessible, and sustainable system of behavioral healthcare for Alaskans in partnership with providers and communities.
DHSS Priority 1. Health & Wellness Across the Life Span:
DHSS Core Services 1.1: Protect and Promote the Health of Alaskans
Objective 1.1.3: Decrease substance abuse and dependency
Goal 1: Through supportive housing services and supports, individuals with substance addictions will have access to treatment as well as post-discharge support. These wrap-around supports will increase rates of success for treatment completion and decrease post-discharge relapse.
Performance measure (effectiveness): Percent of Alaskans discharged from substance abuse treatment services that successfully completed treatment.
DHSS Core Services 1.2: Provide quality of life in a safe living environment for Alaskans
Objective 1.2.4: Increase the number of Alaskans with behavioral health issues who report improvement in key life domains.
Goal 2: Enhance community capacity to deliver supportive housing services and provide alternatives to hospitalizations through a coordinated service program for homeless at-risk adults. Currently, DHSS is faced with challenges to providing alternatives to hospitalization and high rates of recidivism; supportive housing is an effective intervention that has is a proven solution to these challenges and supporting individuals in their recovery.
Performance measure (efficiency): Percent of behavioral health recipients who re-admit to API within 30 days of discharge.
Performance measure (effectiveness): Percent of behavioral health recipients who report improvement in quality of life.
DHSS Priority 2. Health Care Access, Delivery, & Value
DHSS Core Services 2.1: Manage health care coverage for Alaskans in need.
Objective 2.2.1: Improve access to health care.
Goal 3: Decrease neighborhood and individual health and safety impacts from chronically homeless adults. Health outcomes of chronic homelessness include increased rates of chronic disease and high morbidity. By increasing community capacity to deliver effective and integrated care interventions to this population, communities and individuals will see increased health outcomes. Through the targeted use of comprehensive wrap-around services and stable housing, individuals will have access to appropriate healthcare they were unable to get while homeless, thereby decreasing number of preventable hospitalizations and higher Medicaid costs.
Performance measure (population health indicator): Number of preventable hospitalizations based on Agency for Health Care Research and Quality (Healthy Alaskans 2020, LHI22)
Performance measure (effectiveness): Percent of the estimated need for behavioral health services that are met through community based services (*separated into SUD, SMI & SED Met Need).
Performance measure (efficiency): Medicaid cost per recipient.
For more information about the Department of Health and Social Services priorities click on the link to view the document: http://dhss.alaska.gov/Documents/Pdfs/PABS.pdf
To view the December 2013 Streamline newsletter regarding the FY2015 Performance Measures Update click the link to view the document: http://dhss.alaska.gov/Commissioner/Grantees/Documents/Streamline/2013-07.pdf.
Other program evaluation requirements will include a focus on fidelity and outcome tracking. This data collection is important for future expansion of Permanent Supportive Housing (PSH) services statewide. Successful applicants will be expected to work with their DBH Program Manager once awarded on an evaluation plan with stated performance measures the applicant will use to evaluate the progress of the grant project toward achieving the program goals and desired outcomes. Applicants are required to submit a draft evaluation plan based on the contents of this RFP (see below sample under Grant Reporting). Post award, DBH will work with successfull applicants to provide resources of a third-party evaluator.
• Fidelity: DBH will assist in monitoring fidelity to the SAMHSA Permanent Supportive Housing models, as well as monitoring the services according to the attached Assertive Community Treatment and Intensive Case Management Interim Program Standards. The fidelity monitoring will be used as a tool to create recommendations around quality assurance and to inform development of future program standards and ACT certification for ACT expansion in Alaska. DBH will monitor adherence to the Housing First model to ensure that housing services are offered with no preconditions of treatment compliance.
• Length of stay and recidivism: DBH will monitor primary outcomes through quarterly reporting to include at a minimum: housing tenure (length of stay in permanent supportive housing), housing status at discharge, recidivism (defined as: the number/days a recipient returns to corrections or an acute care setting during the program and 1 year post-discharge).
• Behavioral/treatment outcomes: Grantees will provide DBH with results of initial and periodically administered Client Status Review (CSR) for DBH analysis of treatment outcomes. Grantees clinical team reviews progress and data for each recipient at least weekly, and adjusts treatment as indicated. Summary data will be included in treatment plans and will be used to inform treatment plan changes. Clinical staff will develop quarterly and annual reports for DBH/DHSS clinical and management review, relying on grantee/AKAIMS reports and other on-site monitoring activities. Quarterly reports to include but not limited to the identified outcomes listed in the logic model and evaluation plan.
To be agreed upon in the evaluation plan, attached is an example of items to be potentially evaluated to ensure the program is operating as intended and build the groundwork for future expansion of similar services. The agreed-upon evaluation plan will be used to create the required quarterly report, assessed during on-site reviews as noted above, as well as in fidelity reviews or evaluations conducted by DBH or third-parties. Please include in your application a logic model and first draft evaluation plan for review on the example attached in the Attachment section.
The grantee will be required to complete the following reporting for this grant in GEMS:
1) Cumulative Fiscal Report (overall grant and match expenditures are reported quarterly by a budget line item);
2) Grantees will be required to evaluate and submit quarterly activity reports;
Grantees will comply with all required reporting, to include specialized Permanent Supportive Housing report including but not limited to outcomes listed in this RFP and/or agreed upon in the evaluation plan.
1.05Target Population and Service Area
Proposals 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 document.
Target Population: The target population for this program and services requested in this solicitation is as follows. Permanent Supportive Housing services will be prioritized to individuals:
A. Who are chronically homeless, (the individual has had four (4) episodes of homelessness in the last three (3) years or has been continuously homeless for a year or more);
B. The individual must be at or below 50% Area Median Income;
C. Priority will be given to individuals with a history of hospitalizations and law enforcement contacts; and
D. Grantees will be required to use a screening tool to prioritize based on vulnerability (such as Level of Care Utilization System (LOCUS) or Vulnerability Index Service Prioritization Decision Assistance Tool (VI-SPAT)).
Category A- ACT: ACT services are limited to individuals with a severe and persistent mental illness. Priority will be given to individuals with diagnosis of schizophrenia, other psychotic disorders (e.g. schizoaffective disorder) and bipolar disorder. The individual must experience significant functional impairments due to mental illness, continuous high service needs, and are individuals who demonstrate or have demonstrated a medical necessity for inpatient psychiatric hospitalization.
Category B- ICM: ICM services are limited to individuals with primary substance use disorder and have been identified as a top user of the Anchorage Safety Center (ASC) for public intoxication. (In 2013, the top 50 users of the public intoxication safety service represented 23% of all ASC intakes).
Service Areas and Communities: The service areas and communities requested in this solicitation include the Anchorage Municipality area.
This RFP is for a 2.5 -year period, beginning mid-year FY2015, January 1, 2015, through June 30, 2017. At the discretion of the Department of Health and Social Services, an operating program funded under this RFP for FY 2015 may be considered for continued funding in subsequent program years, FY 2016 through FY 2017. The decision to continue funding for the subsequent years of the 2.5-year grant cycle is based on the following general conditions:
a. DHSS’s judgment that there is a continued need for the grant project service;
b. the grantee’s satisfactory performance during the previous grant year;
c. the availability of sufficient grant program funds, and whether continuation of the financing is consistent with public health and welfare; and
d. the ability of the grantee and the DHSS to agree on any adjustments in payments or service.
Match Requirements: The budget must include matching funds to equal no less than 10% 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.
Funds available for this program are anticipated to total $3,760,000 for the duration of the project. The intent of this RFP is to fund two distinct program operations targeted to the Anchorage area for 2.5 years of program operations. Individual grant proposal budgets may not exceed dollar amounts for each Category listed below (it is up to the applicant to submit a proposal to the correct solicitation. Please review the Category listed on the solicitation carefully. Responding to the incorrect solicitation may result in not being funded):
- Category A- Assertive Community Treatment (ACT): ACT team can request up to a total of $1,885,000 from this capital solicitation to fund an ACT team for the 2.5 year duration. Successful applicants of this program may be eligible to receive additional FY16-17 non-competitive operating grant awards in the amount of $2,215,000. Therefore, through the two fund sources the total amount available for 2.5 years of program operations totals $4,100,000 in grant funds. Where realistic, DBH operating funds will be utilized before capital funds (through this appropriation) are expended. The amount is based on an initial estimated case rate of $18,000 per person served, with the understanding that start-up operational funding will be needed until the team is fully staffed, serving 90-100 clients and able to bill other income sources for services. Grant funds will be decreased over time as programs build capacity to bill Medicaid for eligible services.
a. FY15 operations: $900,000 grant funds (based on expectation of minimal Medicaid income and 6 months of operations)
b. FY16 operations: $1,700,000 grant funds (based on expectation to increase Medicaid billing and a full year of operations)
c. FY17 operations: $1,500,000 grant funds (based on expectation to increase Medicaid billing and a full year of operations).
- Category B- Intensive Case Management (ICM) team can request up to a total of $1,875,000 from this capital solicitation to fund an ICM team for 2.5 years of operations. This amount is based on an approximate case rate of $15,000 per person served to fund both non-brokered and contracted services to the 50 clients served by the team. The total grant funds in this category for 2.5 years of operations totals $1,875,000. (Medicaid billings have not been considered a major fund source due to this population’s unlikelihood of being considered Medicaid-eligible.)
a. FY15 operations: $375,000 (based on expectations of minimal Medicaid income and 6 months of operations)
b. FY16 operations: $750,000 (based on expectations of minimal Medicaid income and a full year of operations)
c. FY17 operations: $750,000 (based on expectation of minimal Medicaid income and a full year of operations).
Where appropriate, grantees will be expected to utilize the funds in this grant or other relevant sources (such as Medicaid, Individual Services Agreements (ISA), Section 8 Housing Choice Voucher Program, Special Needs Housing Grant, HUD Continuum of Care subsidy and service programs, local funding, private donations, etc. to ensure that the target population has access to all necessary services and supports to ensure housing stability. To ensure affordable housing is available for program participants, DBH will prioritize allocation of DHSS rental subsidy vouchers to individuals receiving comprehensive services through this RFP. (The DHSS/AHFC “Moving Home Voucher Program” will serve up to 150 individuals statewide with targeted rental assistance to individuals who are Alaska Mental Health Trust Beneficiaries and are chronically homeless. Vouchers are allocated through an application process through DBH).
Funding Decisions: Funding decisions are based on Proposal Evaluation Committee (PEC) scores, applicant’s thorough understanding of grant requirements, and willingness to align with the Housing First model. Future funding for subsequent years may be determined using a Performance Based-Funding methodology. Continued funding beyond year 2.5 of this grant cycle may be based on each grantee’s progress, outcomes, and overall performance of grant conditions, expectations, deliverables, and availability of grant funding.
- Category A- ACT: due to the unique nature of ACT services and to maintain fidelity to the model, one agency must employ the entire ACT team staffing model. Multi-agency agreements for staffing are not recommended (for example, the psychiatrist must be dedicated to the ACT team and not on contract from another agency).
- Category B- ICM: although the grant award will be made to one grantee, it is expected that one agency will not be able to meet all of the needs of the target population. The successful applicant will submit a proposal that illustrates shared funding through potential subcontracts and Memorandum of Agreements (MOA’s). These should clearly define the role of the ICM agency and the services being performed by the subcontractor(s) within the funding limitations. Subcontracts must be pre-approved by DBH and are subject to 7 AAC 78.180 (Subcontracts). It is up to the successful applicant to define the brokered vs. non-brokered services to create a collaborative model to comprehensively serve this high-needs population. This allows for some program flexibility as the successful applicant can creatively design a program to meet the needs of the target population.
Please note that all successful applicants must attend Change Agent conferences in Anchorage bi-annually. This 3-day meeting provides an opportunity for discussion, learning, networking, and meeting with DBH Program Managers. Attendees should include project lead staff and key stakeholder members.
DBH funding for Permanent Supportive Housing is limited. This project represents culmination of efforts to create more integrated and comprehensive service models for individuals with complex behavioral health needs. Depending on the outcome of this demonstration project, DBH will be pursuing ways to expand these models statewide through support of effective housing program models.
As required by DHSS grant regulations, all applicants must provide verification of matching community resources (cash or in-kind) equal to no less than 10% of the grant award amount. In keeping with the intent of this funding to create community ownership and sustainability of the change efforts being initiated with these grant funds, DBH's intention is to use the 10% match to assist communities in:
1. Diversifying their funding (beyond state grant funds);
2. Utilizing state grant funds to leverage other community, state, federal or foundation funding; and
3. Developing sustainability beyond the life of this 2.5-year grant cycle.
Proposed Budget: The proposal must contain both a detailed and narrative budget for FY15, 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 http://dhss.alaska.gov/fms/grants/Documents/DHSS%20Budget%20Guidelines.pdf. 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.
The proposal must also contain both a detailed and narrative budgets for FY16 AND FY17, 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. Please upload the Fy16 and FY17 budgets as one attachment and use the Excel Spreadsheet provided in the criteria.
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 having current grant agreements with DHSS can review in GEMS the Indirect Cost Rate Agreement information on file. Agencies which do not have current grant agreements with DHSS must upload a copy of the Indirect Cost Rate Agreement in the "Agency Administration" 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 apply to obtain one, and seek Medicaid reimbursement for all eligible services.
It is expected that successful applicants will bill Medicaid and third party insurance for payment to the full extent possible. Successful applicants agree to adhere to all applicable Integrated Behavioral Health Services Regulations. In addition, for applicants who are not current Behavioral Health grantees, enrollment in the Alaska Medicaid program will be required, along with adherence to all regulations applicable to Community Behavioral Health Service Providers receiving money from DHSS,as well as the requirement of obtaining National Accreditation by June 30, 2015. These requirements are outlined in the Integrated Behavioral Health Services Regulations.
The following is a link to the Integrated Behavioral Health Services Regulations: HTTP://DHSS.ALASKA.GOV/DBH/DOCUMENTS/PDF/BEHAVIORAL%20HEALTH%20INTEGRATED%20REGS%2010.1.2011.PDF
The following is a link to the Alaska Medicaid Health Enterprise system: https://medicaidalaska.com/portals/wps/portal/EnterpriseHome
Please submit any questions related to becoming a new Behavioral Health grantee to the Grant Administrator listed on the first page of this solicitation.