EXHIBIT A - 1 SUBSTANCE ABUSE TREATMENT SERVICES PENAL CODE 1000 DRUG DIVERSION PROGRAM

EXHIBIT A - 1 SUBSTANCE ABUSE TREATMENT SERVICES PENAL CODE 1000 DRUG DIVERSION PROGRAM I. BACKGROUND Kern County spans 8,161 square miles in the central valley of California. The County is divided into eleven (11) Geographic Service Areas for serving mental health and substance abuse clients. This RFP targets the citizens in Geographical Service Area (GSA) 3, which encompasses the towns of Taft, McKittrick, Tupman, Maricopa, and Fellows in the southwest region of the county. The population of Taft, the largest town in GSA 3, was 9,027 at the 2010 census. The Kern County Mental Health Department s administration office is located in Bakersfield, the county seat, in the central region. The Department operates under the directorship of Mr. Bill Walker, LMFT, and is governed by the five (5) members of the Kern County Board of Supervisors. The Department strives to promote its mission statement Working together to achieve hope, healing, and a meaningful life in the community. The Department consists of various Systems of Care to serve specific client populations. The Substance Use Disorders System of Care primarily serves adults with substance use disorders; however, many of the clients have a co-occurring mental health and substance abuse diagnosis. The Kern County Mental Health Department ensures the citizens of Kern County who are afflicted with substance use disorders are provided with services and resources necessary for their treatment and recovery. The Department utilizes the services of contracted providers for direct client substance abuse treatment services in most geographic areas throughout the County. The contractor shall provide Level 3 outpatient substance abuse treatment services as described in Section V included herein in detail. The number of treatment slots will be negotiated between the Department and the service provider during the contract negotiation process. The County currently contracts for forty-six (46) treatment slots in GSA 3 to serve ninety-two (92) individuals during the term of the one-year agreement. The turnover rate for Level 3 substance abuse clients is two (2) times per year. Proposals must include a plan for ensuring all operational requirements, including but not limited to, hiring and training staff, securing a service delivery site, purchasing equipment, and obtaining licenses, certifications and insurance, are in place to provide direct clients beginning July 1, 2015. For new treatment providers, this plan will be referred to as a transition plan. Plans are to include milestones events to substantiate adherence to the start date. Proposals must also include a statement stating whether the proposer agrees with the County s Master Terms and Conditions. Once a formal agreement between the County of Kern and the contractor has been finalized, the contractor shall become a member of the network of providers of the Kern County Mental Health Substance Use Disorders System of Care, a continuum of care that includes prevention, outpatient, and residential programs, as well as Sober Living Environments and advance treatment services. 1

Proposers are encouraged to visit the Mental Health Department s website at http://www.co.kern.ca.us/artman2/kcmh/publish for news and information on the services offered. II. DESIRED OBJECTIVES The desired objectives of this project are to increase the level of sobriety and to reduce the level of relapse and recidivism among the clients served. The Department will use data reports to monitor the performance of the contracted provider on a monthly basis to ensure the services being delivered will promote the objectives. The following key elements are instrumental in a service provider s ability to meet the stated objectives: A. Maintaining a reasonable wait time to admission to a treatment provider. B. Maintaining a low number of client no-shows to intake appointments and counseling. C. If a problem related to access, no-shows and/or retention is identified, the provider will be expected to identify and implement steps to accomplish the following: Reduce the clients wait time to admission to a treatment program; Reduce the number of client no-shows to intake appointments and counseling sessions; Increase the number of client admissions to treatment; and Increase the clients length of stay in treatment programs. The contracted agency will provide services that: A. Will utilize evidence-based, research-based, or promising programs; B. Will be cost effective in terms of numbers of clients served; C. Will be integrated with other supportive services available throughout Kern County, as demonstrated by an understanding of available community resources and partnerships with local agencies; and D. Will be accessible to the clients, and barriers such as transportation, language, cultural diversity, ability to pay, etc., are factored into the service delivery model. III. ESTIMATED VALUE/COST The Kern County Mental Health Department allocated $170,877 for outpatient drug-free services in GSA 3 for the term July 1, 2014 through June 30, 2015. It is anticipated the funding for fiscal year 2015-16 will be at the same level. The Department will negotiate the actual funding amounts for services with the contractor prior to executing the agreement. The proposer must include a line-item budget in the proposal, which should include, at a minimum, the following items: 1. Salaries and benefits based on proposed staffing pattern 2

2. Services and supplies, including operating expenses 3. Capital expenditures IV. BUSINESS AND/OR WORK ENVIRONMENT The service provider s programs and activities shall maintain a drug and alcohol-free environment at all times. A. Operational requirements 1. Contractor shall take steps necessary to maintain California Department of Health Care Services (DHCS) certifications and/or licensure of the site(s) at which services are provided or may be provided. 2. Contractor shall advise the County Alcohol and Drug Administrator of any potential or planned changes to service locations within seven (7) calendar days of becoming aware of the planned change. 3. All of Contractor s sites where Drug Medi-Cal services are provided must be certified in accordance with Medi-Cal regulations and the Americans with Disabilities Act (ADA). Official fire clearance must take place prior to service provision. If a site is not Medi-Cal certified, or if the renewal is delinquent, the Department will not bill Medi-Cal, or forward payments to Contractor, until site certification is obtained. B. Hours of Service 1. Contractor shall provide services at times that meet the needs of the individuals served, and specific regulations and requirements of specific funding sources. This may include evenings and weekends. 2. Contractor shall post, in English and Spanish, available business hours and how to access urgent services after regular business hours. 3. Contractor shall be aware that some funding sources in this Agreement may require specific hours of operation to include evenings and/or weekends, and programs must adhere to those requirements. C. Timeframe for delivery of services Direct client services shall begin on July 1, 2015. The term of the Agreement for Professional Services will be from July 1, 2015 through June 30, 2016. The Agreement will be subject to renewal, based upon satisfactory performance and mutual agreement, for up to four (4) consecutive fiscal years. D. Information Technology Infrastructure 1. Electronic Medical Record Contractor shall participate in Information Technology System (ITS), including, but not limited to, Department s Electronic Medical Record (EMR), currently Cerner/Anasazi. Contractor shall report to County all programs, Individuals Served, staff and other data and information about Contractor s services as required by Director, or Director s designee. Information to be entered into the EMR shall include, but is not limited to: 3

Client Index Card, Client Assignment, Demographic Information, UMDAP/Financial Review, Third-Party Insurance, Diagnostic Review, Consent to Treat, Release of Information Authorizations, Psychiatric Evaluation, and Psychiatric Visit. Client data should only be entered into the EMR, if the client has requested services. 2. Contractor shall maintain sufficient computer hardware and software to ensure that service data is entered into the County s computer system within forty-eight (48) hours of the date the service was provided. 3. Contractors must request a Virtual Private Network ( VPN ) number to access County databases. V. DESCRIPTION AND SCOPE OF WORK SUBSTANCE ABUSE TREATMENT The following is a specific outline of the Description and Scope of Work that will be required. The client populations to be served in GSA 3 are: A. California Work Opportunity and Responsibilities to Kids (CalWORKs): CalWORKs clients are identified as having substance abuse issues that present barriers to employment and participating in Welfare to Work activities. B. Drug/Medi-Cal: A program to fund medically necessary alcohol and drug treatment services for indigent and low-income beneficiaries meeting eligibility requirements, including limited income and resources. C. Assembly Bill 109 Public Safety Realignment Act: Clients are identified as non-serious offenders, non-sex offenders, and non-felons who face early release from the state prison system and are placed under County supervision, primarily through the Probation Department. The contractor shall provide Level 3 outpatient substance abuse treatment services in accordance with the following standards. Level 3 in Eligible Outlying Clinics (outside of metropolitan Bakersfield) Eligible clinics are those who use the Matrix Model for integration of services to clients assigned to Level 3 by the Department s Gate Team and who are providing services outside the metropolitan Bakersfield area. A. Eligibility: Individuals seeking substance abuse treatment services from participating clinics in outlying areas must meet eligibility requirements for outpatient treatment Level 3 and be referred by the Kern County Mental Health Gate Team. B. Duration: Six (6) months. Clients eligible for Level 3 shall receive treatment consisting of four (4) months of Matrix Early Recovery (ER) and Relapse Prevention (RP), followed by two (2) months of Social Support (SS). 4

C. Minimum Services Provided: 1. A minimum of one (1) individual session for assessment and treatment planning; 2. Individual counseling sessions no less often than once per month; 3. Group counseling sessions at a rate of three (3) per week for two (2) months followed by two (2) per week for the next two (2) months; 4. A minimum of one (1) individual session at discharge for the purpose of discharge planning; 5. Months one (1) and two (2) shall consist of one (1) ER group and two (2) RP groups weekly; 6. Months three (3) and four (4) shall consist of two (2) RP groups, or one (1) RP and one (1) Family Education group per week; 7. Months five (5) and six (6) shall consist of two (2) months of one (1) SS group weekly with one (1) individual discharge planning session per month; 8. Attendance at a minimum of twelve (12) self-help meetings; and 9. Drug testing at the client s expense. D. Treatment Goals: At the end of treatment, the client should demonstrate an understanding of factors that have contributed to his or her drug and/or alcohol use; an ability to deal with daily stressors without the use of drugs and/or alcohol; engagement and participation in fulfilling activities that support recovery; and a commitment to abstinence. E. Clinical Components for Treatment: i. Assessment; ii. Treatment Planning; iii. Individual Counseling; iv. Group Counseling; v. Discharge Planning; and vi. HIV Early Intervention Services F. Other Treatment-Related Services 1. Drug Testing as a usual clinical procedure; 2. Referral Assistance to community resources; 3. Advanced Treatment conducted in a peer group setting; and 4. Self-Help Meetings consisting of twelve (12) meetings during the course of the program. G. Other Services Proposers are encouraged to refer to pages XX through XX in the Sample Agreement incorporated herein for elaboration of the services outlined in this Exhibit A. 5

VI. DESCRIPTION AND SCOPE OF WORK PENAL CODE 1000 DRUG DIVERSION A. Purpose Penal Code (PC) 1000, known as Deferred Entry of Judgment, is a drug diversion program. PC 1000 permits first-time drug offenders with no prior criminal record to participate in a four (4) month, weekly class instead of face incarceration. Once the client successfully completes the class, goes a total of eighteen (18) months without a criminal arrest or conviction, and pays the fee, the case against the client can be dismissed by the court. The charge against the client must not involve the sale of drugs. These standards provide the minimum requirements and procedures for the successful operation and completion of the PC 1000 program. B. Drug Diversion Program Goals 1. Increase clients' understanding of the addiction process and the negative impacts associated with the abuse of drugs and alcohol; 2. Create positive changes in clients' attitudes and behaviors that will lead to a reduction in drug and alcohol abuse; 3. Improve clients' social and personal coping skills and create an environment for change in which responsible decision-making and viable lifestyle alternatives are acceptable; and 4. Assist and encourage clients to explore healthy lifestyles that promote responsible use of alcohol and the non-use of illicit drugs. C. Drug Diversion Program Eligibility When a defendant is found eligible for drug diversion through the court process, the court may suspend criminal proceedings and refer the subject to a County-certified or approved PC 1000 Drug Diversion program. Defendants are eligible if all the following requirements are met: 1. There are no convictions for a prior offense involving controlled substances; 2. The current charge does not involve a crime of violence or threatened violence; 3. There is no evidence of a violation relating to narcotics or other restricted drugs other than a violation of the section listed in PC 1000(a). 4. There is no record of probation or parole being revoked; 5. There is no record of participation in a diversion program within the last five (5) years; and 6. There is no felony conviction within the last five (5) years. 6

D. PC 1000 Drug Diversion Program Provider Responsibilities 1. Operate and maintain program services in compliance with the standards. 2. Ensure fiscal integrity and maintain program costs within the client fee system. 3. Hire, train and retain qualified staff to process enrollments, collect fees, conduct court liaison activities, provide required client services, and perform daily operational activities. 4. Provide the County Alcohol and Drug Program Administrator or designee, access to all program and financial records to conduct program monitoring and evaluation. Access shall not conflict with any local, state or federal confidentiality regulations. 5. Accept all referrals from the courts and Probation Department, except in cases in which the safety of the program staff or other clients may be in jeopardy. 6. Provide timely, factual reports to the Probation Department on client s status, according to the designated requirements. 7. Maintain a County approved annual program expenditure and revenue budget. 8. Develop and implement ongoing quality control procedures to ensure that program resources are maximized and that client and support services comply with these Standards. 9. Provide a payment schedule for those who need financial assistance. 10. Maintain data collection according to County requirements. 11. Post the name and telephone number of the County Alcohol and Drug Program Administrator. E. PC 1000 Drug Diversion Certification Requirements 1. County shall develop and implement a program certification process based on these standards. 2. All certified PC 1000 programs shall be certified for a period of three (3) years, unless the program fails to meet these standards, and certification is revoked. 3. Only agencies with concurrent certification to provide outpatient drug-free counseling from the California Department of Health Care Services are eligible to receive certification as PC 1000 Drug Diversion Program providers. 4. Only those service agencies selected and approved by the Kern County Mental Health Substance Use Disorders System of Care shall be certified as PC 1000 providers. 7

F. PC 1000 Drug Diversion Program Services 1. Program Requirements: All PC 1000 providers agree to deliver services as follows: a. 1.0 hour of orientation and enrollment, including a brief substance abuse history, other intake paperwork and a pre-test; b. 18.0 hours of program services, in twelve (12) ninety (90) minute, non-sequential sessions, including: i) 1.5 hours of education on the effects of alcohol; ii) iii) iv) 3.0 hours of education on the attitudes created by drug and alcohol use; 4.5 hours of Skill Number 1, Goal Setting Skills Development Introduction, Practice and Mastery; 4.5 hours of Skill Number 2, Communication Skills Development Introduction, Practice and Mastery; and v) 4.5 hours of Skill Number 3, Coping Skills Development Introduction, Practice and Mastery. c. 12.0 hours of Advanced Peer Support, in twelve (12) sixty (60) minute sessions, held no more than once each week for twelve (12) weeks. d. Monitor the client s compliance with the random drug testing program (including completion of three (3) drug screening tests per client), and reports the screening results to the Probation Department. e. Monitor client attendance at a minimum of twenty-four (24) hours of self-help meetings (self-help meetings must be focused on alcohol and/or drug related issues, such as AA, NA, or CA). f. Any classroom or group discussion other than didactic or lectures may not exceed fifteen (15) persons. g. Offer a payment schedule for those who need financial assistance. h. Provide service delivery that is sensitive to the cultural, linguistic and special needs of clients. 2. Client Enrollment a. Each service provider may enroll only those individuals specifically referred to its program. Transfers among programs will, however, be considered acceptable. b. Clients must be enrolled by the date specified by the court and the Probation Department. 8

c. Program orientation must include and explain: i) Required program services; ii) Requirements for successful program completion; iii) Program rules and regulations; iv) Reasons for dismissal; v) Grievance process; vi) Abstinence policy; vii) Confidentiality policy; and viii) Fees. d. Program must enroll a client by completing: i) A brief substance abuse history; and ii) A client contract, which shall list the services to be provided, all program fees, payment schedule, attendance requirements, other program rules, reasons for dismissal, and grievance procedures. 3. Educational Sessions a) The contract shall be dated and signed by staff and the client. b) Program staff shall give one copy of the completed contract to the client and retain one copy in the case record. a. Programs shall provide no fewer than eighteen (18) hours of drug and alcohol education services during a three (3) month period. b. Educational sessions shall be scheduled to reasonably accommodate day/evening client needs. c. Educational topics listed in paragraph IV, C, 1, b above may be offered in any order, which the program deems appropriate. However, skills development education must be provided in the following sequence: Introduction, Practice and Mastery. d. Educational sessions should employ adult learning theory strategies and methods to promote maximum learning. e. The program shall document attendance and participation at educational sessions in each client s case record. 4. Drug Testing a. Each client will be subject to three (3) random drug tests during the program. a. Each client will be charged a fee of $15.00 for each test, in addition to the program fees. 9

b. A suspicious test result may be considered dirty and may be grounds for discharge from the program. c. A client may be discharged after two suspicious tests. e. All providers will use a laboratory for testing designated by County. 5. Referral to Ancillary Services a. The program may refer clients, based on individual needs, to ancillary services, such as family counseling, residential treatment/recovery services, self-help programs and/or any additional outpatient services. The referral and the reasons for such referral must be documented in the case file. b. Providers must notify the Probation Department of the referral for ancillary services, for follow-up with the client. 6. Client Exit Interview G. Client Records The Client Exit Interview shall include, but not be limited to: a. A post-test, using a county-approved instrument, which measures changes in client attitudes toward the use of drugs and alcohol; b. A final report to the Probation Department, noting final disposition of the client at the completion of his or her diversion program; and c. Completion of client satisfaction survey. 1. Organization and Contents a. The program will establish, for each client, a case folder containing all relevant material and documentation for his or her program. The client record shall include, at a minimum: i) The referral form from the Probation Department; ii) iii) iv) A copy of the signed contract between the client and the program; Copies of the Episode Opening and Registration screens; A copy of the signed Statement of Confidentiality; v) A copy of the signed program rules and regulations; vi) vii) viii) All completed pre- and post-tests, including the attitudinal tests and those for each educational module; The completed brief screening instrument; Signed Consents to Release Information; 10

ix) Documentation of self-help meeting attendance; x) Copies of progress reports to the Probation Department; xi) xii) xiii) xiv) xv) xvi) xvii) xviii) xix) xx) Drug screening test results; Attendance logs; Correspondence; Payment records; Client written notes for each class or session; Requests for leaves of absence; Discharge Summary; Copy of the Certificate of Program Completion; File checklist; and Other miscellaneous information. b. Documentation should be maintained in an electronic medical record health record system whenever applicable. 2. Record Retention The program will maintain client records, including completed copies of all required forms and records for a minimum period of seven (7) years after completion of the program. 3. Confidentiality The program will assure confidentiality of client records and information in accordance with Sections 2.1-2.67 (1); Title 42, Code of Federal Regulations. H. Client Program Fees 1. The program shall charge a fee of $550 for PC 1000 program services, unless the County revises the fee. a. The program may establish an enrollment fee of $70. The balance ($480) is to be collected in installments of $40 per session. b. The client is responsible to pay for his or her own drug screen conducted by the laboratory designated by the County. No more than three (3) tests will be required during the course of the program, unless the Probation Department orders additional testing. c. The program may charge a re-instatement fee of $25. 11

d. The provider will agree to pay County an administrative fee of 5% of gross revenues for County s costs of program certification, administration and ongoing monitoring activities. 2. The client s payment schedule shall be documented in the client contract signed at enrollment. The program shall amend the contract to reflect any subsequent increase or decrease in the assessed program fee or the payment schedule. 3. The program shall refund to the client any program fee paid in advance for a service the program did not provide. 4. The program shall allow the client to pay fees on a schedule other than the one cited above, provided that all fees are paid before the client is deemed to have successfully completed the program. 5. Fee exemptions must be granted in cases of program clients inability to pay. I. PC 1000 Drug Diversion Criteria for Successful Program Completion Minimum requirements and criteria for successful program completion include: 1. Completion of all required program services; 2. Completion of all pre- and post-knowledge tests; and 3. Payment of all fees. VII. DELIVERABLES The effectiveness and productivity of the contractor will be based upon the contractor s ability to successfully treat the number of clients agreed upon through all stages of treatment. Successful program completion involves the following components: A. Attendance: Clients must maintain an attendance rate of eighty-five percent (85%). Consideration for high-risk populations, i.e. co-occurring disorders, high-risk pregnancies, etc., may be given through case conferencing between the referring agency and the treatment provider. B. Abstinence: Clients must have maintained abstinence from drugs and alcohol during the last two (2) months of treatment and advanced treatment, for a total of four (4) months. Abstinence shall be verified by urinalysis and other appropriate testing methods. C. Activity: Clients must demonstrate participation in recovery activities such as employment, training, education, community service, or support groups. D. Medical: 12

Clients must demonstrate a means to obtain treatment for medical or psychiatric conditions that present a risk for relapse. E. Relationships and Support: Clients should be engaged in satisfying and supportive relationships, or have a credible plan for securing them. This may include plans for couples counseling, family of origin issues counseling, domestic violence counseling, anger management classes, parenting classes, etc. These specialty areas may not have been resolved in the course of the substance abuse treatment program. F. Fee Compliance: Clients must be required to meet their financial responsibilities and will not be placed before the court until the Certificate of Completion is delivered. VIII. PROVIDERS LICENSING, CERTIFICATIONS AND QUALIFICATIONS Programs must have knowledge of the State of California s regulations concerning counselor certification requirements, and be able to comply with all aspects of those regulations in the timeframes allowed by law. A. All treatment programs shall employ clinical staff made up of licensed professionals, certified Alcohol and Other Drug (AOD) counselors, and individuals registered with an approved certifying organization to obtain certification as an AOD counselor, known as a registrant. Contractor shall ensure that all staff members have the necessary credentials and expertise to perform assigned tasks, in accordance with the requirements established by the DHCS. B. Every clinician must have a National Provider Identification (hereinafter NPI ) number in order to bill for the services provided. C. Direct service staff must not be on the State or federal lists of providers and individuals who are not eligible for payment of services. D. Proof of licensing for current staff should be included in an agency s proposal. IX. PERFORMANCE STANDARDS AND QUALITY ASSURANCE The following is a general outline of the Performance Standards and Quality Assurance required as part of this proposal. For additional standards, see Section II Objectives. A. Ninety percent (90%) of individuals referred shall be seen for an initial appointment within ten (10) calendar days of the initial request for service. B. Priority for access to treatment must be given to pregnant and/or parenting clients or applicants for treatment in the following order: 1. Pregnant injecting drug users; 2. Pregnant substance abusers; 3. Injecting drug users; and 4. All others. 13

C. The service provider shall collect required data to measure performance and outcomes, and shall participate in evaluation projects when requested by the County. D. Services shall be provided in accordance with cultural competence guidelines: 1. All services shall be delivered in a manner that respects the client s gender, language, ethnicity, spiritual beliefs, sexual orientation, and physical abilities. 2. Clinical program staff shall be required to attend a minimum of twelve (12) hours of cultural competency training annually, beginning with the effective date of this agreement. 3. Staff and volunteers shall represent the ethnic and cultural diversity of the community it serves. This includes whenever possible bilingual staff and volunteers. E. The service provider shall attend mandatory meetings convened by the Kern County Mental Health Department throughout the term of the contract; F. Financial and program records shall be made available to the County for monitoring purposes upon request from County. County will mail a letter to the provider stating the requested information and date(s) of the site monitoring visit at least one (1) month in advance. G. Services shall be performed in a manner to avoid any breaches of confidentiality. Verifiable breaches may impact the provider s opportunity for future agreements with the County. H. Claims for Payment shall be submitted to the Department by the twenty-fifth calendar day of the month following the month of service delivery. X. CONSTRAINTS TO PROPOSER S APPROACH AND METHODOLOGY A. Providers are often faced with the following challenges that restrict or impact the delivery of substance abuse treatment services: 1. Clients not showing for intake appointments; 2. Clients not returning for counseling after completion of assessment process; 3. Clients not attending counseling appointments on a regular basis; and 4. Clients not providing current contact information, including phone numbers. B. Proposers should address these issues in their proposal by discussing innovative approaches to motivate the clients, and to help them overcome personal barriers to receiving treatment. XI. SECURITY REQUIREMENTS The following is a general outline of the Security and Information Technology Requirements required as part of this proposal. A. Protected Health Information is subject to protection under the State and federal laws, including the Health Insurance Portability and Accountability Act of 1996 14

(HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH Act). B. The contractor shall become a Business Associate of the County under the HIPAA and HITECH Act, and shall sign the Business Associate Addendum included in the Agreement for Professional Services. C. All services must be delivered in accordance with the regulations contained in the Code of Federal Regulations Title 42. D. The Kern County Mental Health Department is required to comply with the Information Exchange Agreement between the Social Security Administration and the California Department of Health Care Services (State Agency). Agencies contracting with the County of Kern through its Mental Health Department are expected to adhere to the guidelines stated in the Information Exchange Agreement. XII. SUMMARY OF DESIRED OUTCOME(S) AND DELIVERABLES The desired objectives of this project are to increase the level of sobriety and to reduce the level of relapse and recidivism among the clients served in GSA 3. The effectiveness and productivity of the contractor will be based upon the contractor s ability to successfully treat the number of clients agreed upon through all stages of treatment by implementing innovative and evidence-based service strategies. The provider s performance during the course of the fiscal year may impact the funding level of future agreements. All services must be delivered in accordance with the terms set forth in this Exhibit A-1. Proposers are encouraged to refer to the attached sample Agreement for Professional Services for an in-depth representation of the business-related procedures involved with contracting with the County of Kern through its Mental Health Department. 15