City of Austin Health and Human Services Department

City of Austin Health and Human Services Department

REQUEST FOR APPLICATIONS

COVER SHEET

Issued:

Tuesday, July 30, 2013

/ Description:
2013-001 Permanent Supportive Housing Assertive Community Treatment Services Request for Application
MANDATORY
Pre-Application Date Conference and Time:
Thursday, August 8, 2013
3:00 P.M.
Note: Attendance is required. / Pre-Application Conference Location:
City of Austin Health & Human Services Campus
7201 Levander Loop, Building E
Austin, Texas
Request for Explanations or Clarifications in Writing Only
Deadline: Tuesday, August 13, 2013. No later than 3:00 p.m.
E-mail:
Responses to written questions will be posted on: http://www.austintexas.gov/department/health
Applications Due No Later Than:
12:00 P.M., Monday, August 19th, 2013
NOTICE: Late applications will not be accepted
RFA Authorized Contact Person:
Natasha Ponczek
Homeless Services Coordinator
Phone: (512) 972-5027
E-mail: / Deliver Completed Application prior to Due Date and Time to:
City of Austin
Health and Human Services Department
Homeless Services, Attn. Natasha Ponczek
7201 Levander Loop, Building #E
Austin, Texas 78702
(off Airport Road, just north of 183/Montopolis Bridge)

Page 1 of 1

Request for Application # 2013-001 Permanent Supportive Housing Assertive Community Treatment Services

INTRODUCTION

In October 2012 the City of Austin’s Health and Human Services Department (HHSD) submitted an application to Central Health for a new project to be included in the Region 7 Medicaid Waiver Application. Texas Health and Human Services Commission (HHSC) has received federal approval of a waiver that a) allows the state to expand Medicaid managed care while preserving hospital funding; b) provides incentive payments for health care improvements and; c) directs more funding to hospitals that serve large numbers of uninsured patients. There will be two statewide pools worth $29 billion over five years. Funding from the pools will be distributed to hospitals and other providers to support the following objectives:(1) an uncompensated care (UC) pool to reimburse for uncompensated care costs as reported in the annual waiver application/UC cost report; and (2) a Delivery System Reform Incentive Payment (DSRIP) pool to incentivize hospitals and other providers to transform their service delivery practices to improve quality, health status, patient experience, coordination, and cost-effectiveness. DSRIP Pool Payments are incentive payments to hospitals and other providers that develop programs or strategies to enhance access to health care, increase the quality of care, the cost-effectiveness of care provided and the health of the patients and families served.

The City proposed providing an Assertive Community Treatment (ACT) team to individuals (housed through a public or non-profit housing provider) who were chronically homeless and who have tri-morbid conditions, meaning that they have co-occurring psychiatric, substance abuse, and chronic medical conditions and are in need of additional support systems.

Austin City Council passed a resolution in 2010 directing the City Manager to give priority to funding PSH, and to develop a comprehensive, community strategy for the construction and operation of 350 PSH units over the next four years. This Medicaid Waiver project will enhance the City of Austin’s existing PSH strategy (developed in 2010) by providing expanded ACT services to men and women in need of this type of comprehensive care, thus improving their outcomes in permanent housing.

To that end, the City of Austin Health and Human Services Department (City HHSD) seeks applications in response to this Request for Application (RFA) from qualified social service providers (Applicants).

The successful Applicant:

·  Will provide Assertive Community Treatment (ACT) services to residents in Housing First (HF) permanent supportive housing (PSH), which may include case management, mental health, substance abuse, housing search and placement, or other services to help maintain housing.

·  Will work with clients who are eligible for funding through a short-term, HF, rental assistance pilot project through the City of Austin, contingent on funding availability. The objective of the rental assistance pilot is to design a replicable model that can lead to future HF opportunities. The multi-agency project approach is demonstrated in Exhibit A.

·  Will provide services to the target population specified in this RFA which includes individuals who are chronically homeless and who are frequent users of emergency departments and ambulance services.

·  Is well-versed in providing supportive services to this population.

·  Can demonstrate understanding of and success of using a HF model.

·  Has experience in assisting this population in securing benefits and income, including SOAR, or similarly trained staff members.

·  Collaborates and/or applies for funding with other service providers when necessary to provide a broad range of services appropriate for this population.

·  Addresses the strategies identified in the City of Austin PSH Strategy (September 30, 2010).

·  Applies for the full amount available - $250,000 per year.

·  Will implement the program(s) proposed within thirty (30) days of contract execution.

The awarded contract will start September 30, 2013 through September 29, 2014, with two one-year renewal options and be authorized by the Austin City Council.

Permanent Supportive Housing Strategy Background

The City is engaging in the present PSH strategy as part of an intentional effort to redesign the delivery of homeless services to explicitly achieve the goal of markedly reducing long-term homelessness in Austin.

Although PSH is a resource-intensive intervention, the high public costs of homelessness mean that it costs essentially the same amount of money to house someone in stable, supportive housing as it does to leave that person homeless and stuck in the revolving door of high-cost crisis care and emergency housing.

For the purposes of this RFA, the City of Austin’s definition of PSH is[1]:

·  Rental housing that is targeted to long-term homeless;

·  Lease based, non-time limited;

·  Deeply affordable and targeted to households earning 30% Area Median Income with multiple barriers to housing stability;

·  Housing with coordinated, comprehensive, voluntary services;

·  Housing that enables tenants to live independently and participate in community life.

1115 Medicaid Waiver Assertive Community Treatment (ACT) Model

The Assertive Community Treatment (ACT) model utilizes a multi-disciplinary team, which can consist of, but is not limited to, outreach team members, registered nurses, case managers, psychologists or psychiatrists, and/or a primary care physician. Broadly speaking, the goal of this HF ACT program is for participants to achieve housing stability, connect to a medical home, and ultimately live healthy, happy lives. Other goals include avoiding hospital inpatient re-admissions, averting involvement in the criminal justice system, promoting wellness and medication adherence, and ultimately, substance abuse recovery.”[2] Milestones for this project are outlined below.

Participants will be connected with a medical home and provided respite care if necessary. Treatment is an important component of the ACT model, and includes psychopharmacologic treatment, including new atypical antipsychotic and antidepressant medications, individual supportive therapy, mobile crisis intervention, and substance abuse treatment, and group therapy (for participants with a dual diagnosis of substance abuse and mental illness).[3] Another critical component is rehabilitation, such as behavior oriented skill teaching (supportive and cognitive-behavioral therapy) and support for resuming education and employment.[4] Due to the vulnerable nature of these participants, these services are available 24/7/365. [5]

solicitation

2013-001 Permanent Supportive Housing Assertive Community Treatment Services

TABLE OF CONTENTS

Section Title

N/A Cover Sheet, iNTRODUCTION and Table of Contents

n/a Scope of work

100 Standard PurchasING Definitions (not included-see note below*)

200 Solicitation Instructions

300 Standard PurchasING Terms and Conditions (not included-see note below*)

400 NOT APPLICABLE

500 Work Statement Format, Evaluation Factors, Budget Documents

600 Application Preparation Instructions

Attachment A OVERVIEW OF FUNDING PARTNERSHIP WITH CITY OF AUSTIN HHSD 1115 MEDICAID WAIVER PROGRAM

ATTACHMENT b INsurance requirements

ATTACHMENT c pROPOSAL pACKAGE dOCUMENTS (sECTIONS 800, 805, & 810)

*Note: Sections 100 and 300 are on the Internet at the Vendor Connection under Standard Bid Documents tab at the bottom of the page.

http://www.austintexas.gov/department/standard-bid-documents, but are not included with this application. Refer to the “Standard Solicitation Documents for Purchases” selections. When reading, substitute the words “applicant” and “application” for “proposer” and “proposal.” Do not use the addresses or phone numbers from the Internet documents. Use the addresses and phone numbers within this document. If you do not have Internet access, it is available at the Austin Public Libraries, or you can obtain the paper documents from the Health and Human Services Department (contact information below.)

Natasha Ponczek at or 512-972-5027 located at Health and Human Services Department, 7201 Levander Loop, Building #E, Austin, Texas 78702.

Page 5 of 5

Request for Application # 2012-002

Permanent Supportive Housing Act Team Services

SCOPE OF WORK

1.  PRINCIPAL OBJECTIVE

The principal objective of this solicitation is to provide Assertive Community Treatment (ACT) services to individuals in HP PSH units in order for formerly homeless residents to maintain housing.

The applicant should demonstrate its ability to assist formerly homeless clients who are hard to serve and to offer services based on the HF Strategy (refer to City of Austin PSH Strategy dated September 30th, 2010 for more information on HF http://www.ci.austin.tx.us/housing/downloads/csh_austin_psh_strategy_%20092710.pdf).

The Applicant’s ability to implement the program(s) proposed within thirty (30) days of contract execution is essential. The contract period will be September 30, 2013 through September 29, 2014, with two one-year renewal options. Organizations unable to begin services on or near September 30, 2013 should not submit an application.

2.  TARGET POPULATION

The target population is for this project is single adult men and women who have experienced chronic homelessness, have a physical disability, have severe and persistent mental illness and co-occurring substance abuse, and who have been recently placed in deeply subsidized housing despite significant physical and behavioral health (BH) challenges. All clients must be at or below 30% Area Median Income with multiple barriers to housing stability.

Clients will most likely:

A.  Have experienced long-term homelessness, and be documented high users of emergency departments (ED) and EMS.

B.  Have a chronic physical health condition(s) that is at least episodically disabling.

C.  Have an addictive illness that is at least episodically disabling.

D.  Have severe and persistent mental illness that is at least episodically disabling.

E.  Meet, or have previously met, the definition for chronically homeless as established in the HEARTH Act.

3.  RFA GUIDELINES

Successful applicants will:

A.  Provide intensive ACT Team services that include outreach team members from at least the following positions: Registered nurses, case managers, psychologists or psychiatrists, and/or a primary care physician.

B.  Will work with clients who are eligible for funding through a short-term, HF, rental assistance pilot project through the City of Austin, contingent on funding availability. The objective of the rental assistance pilot is to design a replicable model that can lead to future HF opportunities. The multi-agency project approach is demonstrated in Attachment B.

C.  Promote partnerships across public, private, and nonprofit entities to ensure a coordinated, collaborative strategy.

D.  Provide a scalable model that focuses on achieving early successes and expanding the model for future results.

E.  Provide case management staff ratios of 1:10 or less for individuals. Scoring preference will be given to providers that can demonstrate frequent, voluntary client contact.

F.  Include strategies that address the guiding principles from the City of Austin’s PSH Strategy.

G.  Utilize the definition of PSH. For the purposes of this RFA, the City of Austin’s program definition of PSH is affordable housing linked to a range of support services that enable tenants, especially the homeless, to live independently and participate in community life.

H.  Offer cost-effective solutions that result in the reduction of costs to public systems and leverages existing public and private resources and investments. Potential cost-benefit will be considered in the scoring of potential projects.

I.  Demonstrate evidence of a partnership with housing providers that will provide a well-designed, well-built, well-managed, and safe physical environment for tenants.

J.  Demonstrate a high level of data quality in the Homeless Management Information System (HMIS) for other programs that the agency has provided (see HMIS section below).

K.  Demonstrate that they are able to efficiently and successfully apply for public benefits, such as SSi/SSDI, Veterans Administration, Medicaid, and Medical Assistance Program (MAP), on behalf of their clients, by utilizing SOAR training for their staff or other successfully demonstrated case management model.

L.  Demonstrate an effective outreach model for serving the highest needs clients by partnerships with Emergency Medical Services (EMS) and local hospital emergency departments.

4. PROJECT MILESTONES AND GOALS

The applicant must submit an application that includes the provision of ACT Team services for clients in PSH using strategies listed in this Scope of Work.

Awards will be determined based on the application scores that meet the needs of the target population to maximize efficiency and effectiveness of resource allocation, and that result in the most significant impact on self-sufficiency for targeted clients.

The successful Applicant will be responsible for completing the following milestones outlined in this RFA and reporting to HHSD.

115 Medicaid Waiver Category 2 Milestones:

Process
Year 1: Design community based specialized interventions for target populations.

Year 1: Enroll and serve individuals with targeted complex needs (at least 50% of participants).

Years 1-3: Participate in at least bi‐weekly interactions (meetings, conference calls, or webinars) with other providers and the Regional Health Planning entity (Central Health) to promote collaborative learning around shared or similar projects.

Year 2: Enroll and serve individuals with targeted complex needs (remaining participants).

Improvement

Year 3: Anti‐depressant medication management over six months for Major Depressive Disorder and anti‐depressant medication during acute phase over 12 weeks.

·  Goal: 20% of participants will remain on anti-depressant medication.

1115 Medicaid Waiver Category 3 Milestones:

Process

Year 1: Project planning

Year 1: Establish baseline rates[6]

Year 1: Develop and test data systems[7]

Improvement

Year 2: Reduce Emergency Department visits for target conditions - Behavioral Health/Substance Abuse (15% improvement)

Year 3: Reduce Emergency Department visits for target conditions - Behavioral Health/Substance Abuse (20% improvement)