Common use of Treatment Initiation and Engagement Clause in Contracts

Treatment Initiation and Engagement. At least 85% of beneficiaries have a second treatment visit within 14 days of assessment [initiation] • Of those initiating treatment, at least 75% will have two treatment visits within the next 30 days [engagement] • There are no inequities in treatment initiation and engagement when stratified by race/ethnicity and gender identity Transitions Between Levels of Care Appropriate Care Coordinators/clinicians from both the discharging and admitting provider agencies shall be responsible to facilitate the transition between levels of care, including assisting in scheduling an intake appointment, ensuring a minimal delay between discharge and admission at the next level of care, providing transportation as needed, and documenting all information in Xxxxx’x Electronic Health Record. Performance Standard: • Transitions between levels of care shall occur within five (5) and no later than 10 business days from the time of re-assessment indicating the need for a different level of care. • There are no inequities in transitions between levels of care when stratified by race/ethnicity and gender identity Care Coordination and Linkage with Ancillary Services The Contractor shall ensure 42 CFR Part 2 compliant releases are in place in order to coordinate care. The Contractor shall screen for and link clients with mental and physical health, as indicated. Contractors will implement procedures to ensure clients are provided contact information for their assigned Care Coordinator(s) and document in the client record. Performance Standard: • There is documentation of physical health and mental health screening in 100% of beneficiary records • At least 80% of beneficiaries have 42 CFR compliant releases in place to coordinate care with physical health providers • At least 70% of beneficiary records have documentation of coordination with physical health • At least 80% of beneficiaries engaged for at least 30 days will have an assigned Primary Care Provider • At least 80% of beneficiaries who screen positive for mental health disorders have 42 CFR compliant releases in place to coordinate care with mental health providers • At least 70% of beneficiary records for individuals who screen positive for mental health disorders have documentation of coordination with mental health (e.g. referral for mental health assessment or consultation with existing providers). • At least 85% of beneficiaries will contact information for a designated contact responsible for coordinating the beneficiary’s care Medications for Addiction Treatment Contractors will either directly offer or have an effective referral mechanism to the most clinically appropriate MAT services for beneficiaries with SUD diagnoses that are treatable with medications or biological products. An effective referral mechanism/process is defined as facilitating access to MAT off-site for beneficiaries while they are receiving services if not provided on-site. Providing a beneficiary the contact information for a treatment program is insufficient. Contractor staff will regularly communicate with physicians of beneficiaries who are prescribed these medications unless the beneficiary refuses to consent a 42 CFR, Part 2 compliant release of information for this purpose. Performance Standard: • At least 80% of beneficiary records for individuals receiving Medication Assisted Treatment for substance use disorders will have 42 CFR compliant releases in place to coordinate care • At least 80% of beneficiaries with a primary opioid or alcohol use disorder will be linked to an MAT assessment and/or MAT services Culturally Responsive Services Contractors are responsible to provide culturally responsive services. Contractors must ensure: • Policies, procedures, and practices are consistent with the principles outlined and are embedded in the organizational structure, as well as being upheld in day-to- day operations. • Translation and oral interpreter services must be available for beneficiaries, as needed and at no cost to the beneficiary. • Each program reviews monthly performance data (automated reports sent from Xxxxx’x Electronic Health Record monthly) and identifies and implements at least one performance improvement initiative annually to address to any inequities noted either in the monthly dashboard or Treatment Perceptions Survey data. Performance Standard: • 100% of beneficiaries that speak a threshold language are provided services in their preferred language. • At least 80% of beneficiaries completing the Treatment Perceptions Survey reported being satisfied (3.5+ out of 5.0) with cultural sensitivity of services. • 100% of contractors will implement at least one performance improvement initiative annually related to reducing inequities by race/ethnicity or gender identity. • 100% of contractors are in compliance with the CLAS standards. Delivery of Individualized and Quality Care Beneficiary Satisfaction: DMC-ODS Providers shall participate in the annual statewide Treatment Perceptions Survey (administration period to be determined by DHCS). Upon review of Provider-specific results, Contractor shall select a minimum of one quality improvement initiative to implement annually. ASAM Level of Care: The assessed and actual level of care (and justification if the levels differ) shall be recorded in Xxxxx’x Electronic Health Record with seven (7) days of the assessment. Performance Standards: • At least 80% of beneficiaries will report an overall satisfaction score of at least 3.5 or higher on the Treatment Perceptions Survey • Overall satisfaction scores are balanced when stratified by race/ethnicity and gender identity • At least 80% of beneficiaries completing the Treatment Perceptions Survey reported that they were involved in choosing their own treatment goals (overall score of 3.5+ out of 5.0) • Contractor will implement with fidelity at least two approved EBPs • 100% of beneficiaries participated in an assessment using ASAM dimensions and are provided with a recommendation regarding ASAM level of care • At least 70% of beneficiaries admitted to treatment do so at the ASAM level of care recommended by their ASAM assessment • At least 80% of beneficiaries are re-assessed within 90 days of the initial assessment Outcomes In order to assess whether beneficiaries: 1) Reduce substance abuse or achieve a substance-free life; 2) Maximize multiple aspects of life functioning; 3) Prevent or reduce the frequency and severity of relapse; and 4) Improve overall quality of life, the following indicators that will be evaluated and measured include, but are not limited to: • Engagement in the first 30 days of treatment (at least two treatment sessions within 30 days after initiating treatment) • Reduction in substance use • Reduction in criminal activity or violations of probation/parole and days in custody • Increase in employment or employment (and/or educational) skills • Increases in family reunification • Increase engagement in social supports • Maintenance of stable living environments and reduction in homelessness • Improvement in mental and physical health status • Beneficiary satisfaction These metrics will be analyzed by program and at a minimum, stratified by race/ethnicity and gender identity Training Applicable staff are required to participate in the following training: • DMC-ODS Training (within 30 days of hire and at least annually) • Compliance, Information Privacy and Security – Including 42CFR Part 2 and HIPAA/Law & Ethics (Within 30 days of hire and at least annually) • ASAM E-modules 1 and 2 (Prior to Conducting Assessments) • Cultural Humility (At least four hours annually) o One Cultural Humility training (annually) o Once LGBTQ+ training (annually) o One Working with Interpreters training (Bi-annually) • Oath of Confidentiality (Review and sign at hire and annually thereafter) • At least five hours of continuing education in addiction medicine annually for LPHA staff, including Medical Director • Xxxxx’x Electronic Health Record and CalOMS Treatment (Prior to Use of Marin Electronic Health Record and thereafter as needed) • CalMHSA CalAIM Trainings – Including documentation requirements, CPT code training, EHR and other applicable trainings (within 30 days of hire) • Naloxone Training – Ensure at least one staff member, at all times, on the premises who knows the location of naloxone or other FDA- approved opioid antagonist medication, and who has been trained in its administration. Contractors shall maintain training logs for all staff, including maintaining pertinent evidence of training completion in personnel files. Contractors shall also submit evidence of training during the November and May Training and Staff Certification Log submission periods, or at additional times upon request. Digital Accessibility Vendor shall ensure that all digital content and deliverables comply with World Wide Web Consortium's (W3C) Web Content Accessibility Guidelines (WCAG), 2.1, level AA or most recent version. Vendor is responsible for addressing accessibility problems in any implementation, configuration, or documentation delivered or performed by Vendor, and in any software, documents, videos, and/or trainings given and published by Vendor and delivered under this contract. Applicable laws include but are not limited to Americans with Disabilities Act, 21st Century Communications and Video Accessibility Act (CVAA) and California Government Code Sections 7405 and 11135. Contract Changes If significant changes are expected, you must submit a request in writing to the contract manager. You must receive written approval prior to any changes being implemented and/or reimbursed. Significant changes include, but are not limited to: Scope of Work • Proposing to add or remove a service modality and/or CPT/HCPCS code • Proposing to transfer substantive programmatic work to a subcontractor • Proposing to add or remove rendering provider types • Demand for Marin Medi-Cal beneficiaries exceed contracted capacity Budget • Proposing to increase or decrease FTE • Proposing to increase the contract maximum Contractor shall also report any other key changes per the timelines and processes outlined in applicable Policies and Procedures,(xxx.XxxxxXXXX.xxx), Contract Exhibit I and Practice Guidelines (xxx.XxxxxXXXX.xxx), including, but not limited to: 1) Staff Updates; 2) Facility alterations/renovations; 3) Unusual occurrences or incidents; 4) Reduction in DMC services; and 5) Not accepting beneficiaries or 90% capacity (facility at capacity). One-Time Electronic Health Record (EHR) Documentation Adoption Incentive Payments One-Time Electronic Health Record (EHR) Documentation Adoption Incentive Payments are a one-time incentive provided to Contractor for utilizing the Marin County instance of SmartCare as their EHR for Marin County Beneficiaries and having their rendering providers/clinicians document into SmartCare in accordance with the Documentation Standards outlined in Exhibit I and the Clinical Documentation Guide. This will enable better care coordination between the county and the provider. Contracted agencies that have their staff only enter the service level billing and state reporting data will not qualify for this incentive. Document Title Due Date Where Submitted Submission Format Not Accepting New Beneficiaries By 9am each day that the program is not accepting new beneficiaries BHRS Access and Contract Manager E-mail Reached 90% of treatment capacity Within seven days (and via XXXXX by the 10th of the month) County AOD Administrator and XXXXXxxxxxxxx@xxxx.xxx E-mail EHR (CalOMS) - Client-specific data - DMC Billing - ASAM, Timely Access Data, etc. Progress notes for routine services within 3 calendar days; Other client-specific data should occur within 7 days of event Marin Electronic Health Record Technical Assistance: XXXXXXXXxxxxxx@XxxxxXxxxxx.xxx CalMHSA Help Desk Contract Manager Electronic Submission Adult Drug Court Weekly Progress Reports By 12 noon every Thursday ADC Coordinator (Xxxxxxx Xxxxx) xxxxxxx@xxxxxxxxxxx.xxx and ADC Recovery Coach Encrypted E- mail Staff Update Form/ Provider Update Prior to or within 24 hours of the staff change [e.g. new or separating staff, role change] Existing Users: XXXXXXXXxxxxxx@xxxxxxxxxxx.xxx New Users: TBD E-mail Monthly Provider Check and attestation By the 10th of the month BHRS Office – Administrative Services Associate E-mail All Billing Invoices and Supporting Documentation By the 10th of the month EHR and BHRS Office (as applicable) Electronic Submission Drug and Alcohol Treatment Access Report (XXXXX) By the 10th of the month State DHCS Electronic Submission Resubmission of Denied DMC Claims By the 20th of the month following notice of denial Marin Electronic Health Record Electronic Submission NOABD Log and Issued NOABDs By the 10th of the month BHRS Office – Administrative Services Associate E-Mail Provider Self Audit Projected January 2024 BHRS Office – Contract Manager Electronic Submission Annual Report Projected June 30, 2024 BHRS Office – Quality Management. Copy to Contract Manager E-mail or Hard Copy Provider Cost Reports To Be Determined Marin HHS - Fiscal TBD

Treatment Initiation and Engagement. At least 85% of beneficiaries have a second treatment visit within 14 days of assessment [initiation] • Of those initiating treatment, at least 75% will have two treatment visits within the next 30 days [engagement] • There are no inequities in treatment initiation and engagement when stratified by race/ethnicity and gender identity Transitions Between Levels of Care Appropriate Care CoordinatorsCase managers/clinicians from both the discharging and admitting provider agencies shall be responsible to facilitate the transition between levels of care, including assisting in scheduling an intake appointment, ensuring a minimal delay between discharge and admission at the next level of care, providing transportation as needed, and documenting all information in Xxxxx’x Electronic Health RecordMarin WITS. Performance Standard: • Transitions between levels of care shall occur within five (5) and no later than 10 business days from the time of re-assessment indicating the need for a different level of care. • At least 80% of beneficiaries receive a follow-up contact within seven (7) days of discharge from Residential treatment or Residential Withdrawal Management. • There are no inequities in transitions between levels of care when stratified by race/ethnicity and gender identity Care Coordination and Linkage with Ancillary Services The Contractor shall ensure 42 CFR Part 2 compliant releases are in place in order to coordinate care. The Contractor shall screen for and link clients with mental and physical health, as indicated. Contractors will implement procedures to ensure clients are provided contact information for their assigned Care Coordinator(s) and document in the client record. Performance Standard: • There is documentation of physical health and mental health screening in 100% of beneficiary records • At least 80% of beneficiaries have 42 CFR compliant releases in place to coordinate care with physical health providers • At least 70% of beneficiary records have documentation of coordination with physical health • At least 80% of beneficiaries engaged for at least 30 days will have an assigned Primary Care Provider • At least 80% of beneficiaries who screen positive for mental health disorders have 42 CFR compliant releases in place to coordinate care with mental health providers • At least 70% of beneficiary records for individuals who screen positive for mental health disorders have documentation of coordination with mental health (e.g. referral for mental health assessment or consultation with existing providers). • At least 85% of beneficiaries will contact information for a designated contact responsible for coordinating the beneficiary’s care Medications for Addiction Medication Assisted Treatment Contractors will either directly offer or have an effective referral mechanism to the most clinically appropriate MAT services procedures for linkage/integration for beneficiaries with SUD diagnoses that are treatable with medications or biological products. An effective referral mechanism/process is defined as facilitating access to MAT off-site requiring medication assisted treatment for beneficiaries while they are receiving services if not provided on-site. Providing a beneficiary the contact information for a treatment program is insufficientsubstance use disorders. Contractor staff will regularly communicate with physicians of beneficiaries who are prescribed these medications unless the beneficiary refuses to consent a 42 CFR, Part 2 compliant release of information for this purpose. Performance Standard: • At least 80% of beneficiary records for individuals receiving Medication Assisted Treatment for substance use disorders will have 42 CFR compliant releases in place to coordinate care • At least 80% of beneficiaries with a primary opioid or alcohol use disorder will be linked to an MAT assessment and/or MAT services Culturally Responsive Services Contractors are responsible to provide culturally responsive services. Contractors must ensure: • Policies, procedures, and practices are consistent with the principles outlined and are embedded in the organizational structure, as well as being upheld in day-to- day operations. • Translation and oral interpreter services must be available for beneficiaries, as needed and at no cost to the beneficiary. • Each program reviews monthly performance data (automated reports sent from Xxxxx’x Electronic Health Record Marin WITS monthly) and identifies and implements at least one performance improvement initiative annually to address to any inequities noted either in the monthly dashboard or Treatment Perceptions Survey data. Performance Standard: • 100% of beneficiaries that speak a threshold language are provided services in their preferred language. • At least 80% of beneficiaries completing the Treatment Perceptions Survey reported being satisfied (3.5+ out of 5.0) with cultural sensitivity of services. • 100% of contractors will implement at least one performance improvement initiative annually related to reducing inequities by race/ethnicity or gender identity. • 100% of contractors are in compliance with the CLAS standards. Delivery of Individualized and Quality Care Beneficiary Satisfaction: DMC-ODS Providers (serving adults 18+) shall participate in the annual statewide Treatment Perceptions Survey (administration period to be determined by DHCS). Upon review of Provider-specific results, Contractor shall select a minimum of one quality improvement initiative to implement annually. Evidence-Based Practices (EBPs): Contractors will implement—and assess fidelity to—at the least two of the following EBPs per service modality: Motivational Interviewing, Cognitive-Behavioral Therapy, Relapse Prevention, Trauma-Informed Treatment and Psycho-Education. ASAM Level of Care: All beneficiaries participate in an assessment using ASAM dimensions. The assessed and actual level of care (and justification if the levels differ) shall be recorded in Xxxxx’x Electronic Health Record Marin WITS with seven (7) days of the assessment. Performance Standards: • At least 80% of beneficiaries will report an overall satisfaction score of at least 3.5 or higher on the Treatment Perceptions Survey • Overall satisfaction scores are balanced when stratified by race/ethnicity and gender identity • At least 80% of beneficiaries completing the Treatment Perceptions Survey reported that they were involved in choosing their own treatment goals (overall score of 3.5+ out of 5.0) • Contractor will implement with fidelity at least two approved EBPs • 100% of beneficiaries participated in an assessment using ASAM dimensions and are provided with a recommendation regarding ASAM level of care • At least 70% of beneficiaries admitted to treatment do so at the ASAM level of care recommended by their ASAM assessment • At least 80% of beneficiaries are re-assessed within 90 days of the initial assessment Client Outcomes In order to assess whether beneficiaries: 1) Reduce substance abuse or achieve a substance-free life; 2) Maximize multiple aspects of life functioning; 3) Prevent or reduce the frequency and severity of relapse; and 4) Improve overall quality of life, the following indicators that will be evaluated and measured include, but are not limited to: • Engagement in the first 30 days of treatment (at least two treatment sessions within 30 days after initiating treatment) • Reduction in substance use • Reduction in criminal activity or violations of probation/parole and days in custody • Increase in employment or employment (and/or educational) skills • Increases in family reunification • Increase engagement in social supports • Maintenance of stable living environments and reduction in homelessness • Improvement in mental and physical health status • Beneficiary satisfaction These metrics will be analyzed by program and at a minimum, stratified by race/ethnicity and gender identity Training Applicable staff are required to participate in the following training: • Cultural Competency (At least four hours annually) • Oath of Confidentiality (Review and sign at hire and annually thereafter) • DMC-ODS Training Training, including Documentation Standards (within 30 days of hire and at At least annually) • Compliance, Information Privacy and & Security – - Including 42CFR 42 CFR Part 2 and HIPAA/Law & and Ethics (Within 30 days of hire and at At least annually) • ASAM E-modules 1 and 2 (Prior to Conducting Assessments) • Cultural Humility CPR and First Aid (At least four hours annually) o One Cultural Humility training (annually) o Once LGBTQ+ training (annually) o One Working with Interpreters training (Bi-annuallyWM Staff - As outlined in Standards) • Oath Marin WITS and CalOMS Treatment (Prior to Use of Confidentiality (Review Marin WITS and sign at hire and annually thereafterthereafter as needed) • At least five hours of continuing education in addiction medicine annually for LPHA staff, ; including the Medical Director • Xxxxx’x Electronic Health Record (At least annually) Authorization Process – Initial Authorization Requests for initial authorization are to be submitted to BHRS Access on the Treatment Authorization Request (TAR) - Initial Authorization’ form at least 24 hours ASAM/DHCS Levels 3.1, 3.3 and CalOMS Treatment (Prior 3.5 before the scheduled admission date. A copy of the ASAM Continuum or County- provided ASAM assessment tool shall be attached to Use of Marin Electronic Health Record and thereafter as needed) • CalMHSA CalAIM Trainings – Including documentation requirements, CPT code training, EHR and other applicable trainings (within the TAR. Initial authorizations can be granted for up to 30 days for youth and up to 45 days for adults. An approved authorization allows for a client to be admitted to treatment within seven (7) calendar days of hirethe approval date. Admissions later than seven (7) • Naloxone Training – Ensure at least one staff member, at all times, calendar days from the authorization date will be considered on a case-by-case basis and will require written approval by the County. Continuing and Extension Authorizations Requests for continuing and extension authorizations are to be submitted to BHRS Access on the premises who knows the location of naloxone or other FDA- approved opioid antagonist medication, and who has been trained in its administration. Contractors shall maintain training logs for all staff, including maintaining pertinent evidence of training completion in personnel files. Contractors shall also submit evidence of training during the November and May Training and Staff Certification Log submission periods, or at additional times upon request. Digital Accessibility Vendor shall ensure that all digital content and deliverables comply with World Wide Web Consortium's ‘TAR – Continuing Authorization’ form seven (W3C7) Web Content Accessibility Guidelines (WCAG), 2.1, level AA or most recent version. Vendor is responsible for addressing accessibility problems in any implementation, configuration, or documentation delivered or performed by Vendor, and in any software, documents, videos, and/or trainings given and published by Vendor and delivered under this contract. Applicable laws include but are not limited to Americans with Disabilities Act, 21st Century Communications and Video Accessibility Act (CVAA) and California Government Code Sections 7405 and 11135. Contract Changes If significant changes are expected, you must submit a request in writing calendar days before to the contract managerexpiration date of the current authorization. You A copy of the re-assessment (ASAM Continuum or County-provided ASAM assessment tool) shall be attached to the TAR. Continuation authorizations can be granted for up to 30 days for youth and up to 45 days for adults. Extension authorizations can be granted for up to 30 days for both youth and adults. Clients’ residential length of stay will be based on medical necessity. Additional Information - TARs For a TAR to be considered eligible for authorization, the individual must receive written approval prior to any changes being implemented and/or reimbursed. Significant changes include, but are not limited to: Scope of Work • Proposing to add or remove be a service modality and/or CPT/HCPCS code • Proposing to transfer substantive programmatic work to a subcontractor • Proposing to add or remove rendering provider types • Demand for Marin County Medi-Cal beneficiaries exceed contracted capacity Budget • Proposing to increase beneficiary or decrease FTE • Proposing to increase the contract maximum Contractor shall also report any other key changes per the timelines and processes outlined in applicable Policies and Procedures,(xxx.XxxxxXXXX.xxx), Contract Exhibit I and Practice Guidelines (xxx.XxxxxXXXX.xxx), including, but not limited to: 1) Staff Updates; 2) Facility alterations/renovations; 3) Unusual occurrences or incidents; 4) Reduction in DMC services; and 5) Not accepting beneficiaries or 90% capacity (facility at capacity). One-Time Electronic Health Record (EHR) Documentation Adoption Incentive Payments One-Time Electronic Health Record (EHR) Documentation Adoption Incentive Payments are a one-time incentive provided to Contractor for utilizing the Marin County instance low-income (<138% FPL) uninsured resident, meet medical necessity and the ASAM criteria for the proposed level of SmartCare as their EHR for Marin County Beneficiaries care. Payment and having their rendering providers/clinicians document into SmartCare submission of claims to Medi-Cal are subject to a beneficiary’s eligibility and services being rendered and documented in accordance with the ODS Documentation Standards outlined in Exhibit I Standards, ASAM diagnostic and dimensional criteria and the Clinical Documentation GuideDMC- ODS STCs. This will enable better care coordination between the county and the provider. Contracted agencies that have their staff only enter the service level billing and state reporting data will not qualify for this incentive. Document Title Due Date Where Submitted Submission Format Not Accepting New Beneficiaries By 9am each day that the program is not accepting new beneficiaries If BHRS Access and Contract Manager E-mail Reached 90% of treatment capacity Within seven days (and via XXXXX by the 10th of the month) County AOD Administrator and XXXXXxxxxxxxx@xxxx.xxx E-mail EHR (CalOMS) - Client-specific data - DMC Billing - ASAMresponds to a TAR as “pending”, Timely Access Data, etc. Progress notes for routine services within 3 calendar days; Other client-specific data should occur within 7 days of event Marin Electronic Health Record Technical Assistance: XXXXXXXXxxxxxx@XxxxxXxxxxx.xxx CalMHSA Help Desk Contract Manager Electronic Submission Adult Drug Court Weekly Progress Reports By 12 noon every Thursday ADC Coordinator (Xxxxxxx Xxxxx) xxxxxxx@xxxxxxxxxxx.xxx and ADC Recovery Coach Encrypted E- mail Staff Update Form/ Provider Update Prior to or Contractor shall respond within 24 hours of the staff change [e.g. new or separating staff, role change] Existing Users: XXXXXXXXxxxxxx@xxxxxxxxxxx.xxx New Users: TBD E-mail Monthly Provider Check and attestation By the 10th of the month BHRS Office – Administrative Services Associate E-mail All Billing Invoices and Supporting Documentation By the 10th of the month EHR and BHRS Office (as applicable) Electronic Submission Drug and Alcohol Treatment Access Report (XXXXX) By the 10th of the month State DHCS Electronic Submission Resubmission of Denied DMC Claims By the 20th of the month following notice of denial Marin Electronic Health Record Electronic Submission NOABD Log and Issued NOABDs By the 10th of the month BHRS Office – Administrative Services Associate E-Mail Provider Self Audit Projected January 2024 BHRS Office – Contract Manager Electronic Submission Annual Report Projected June 30, 2024 BHRS Office – Quality Management. Copy to Contract Manager E-mail or Hard Copy Provider Cost Reports To Be Determined Marin HHS - Fiscal TBDrequest for additional information.

Treatment Initiation and Engagement. At least 85% of beneficiaries have a second treatment visit within 14 days of assessment [initiation] • Of those initiating treatment, at least 75% will have two treatment visits within the next 30 days [engagement] • There are no inequities in treatment initiation and engagement when stratified by race/ethnicity and gender identity Transitions Between Levels of Care Appropriate Care CoordinatorsCase managers/clinicians from both the discharging and admitting provider agencies shall be responsible to facilitate the transition between levels of care, including assisting in scheduling an intake appointment, ensuring a minimal delay between discharge and admission at the next level of care, providing transportation as needed, and documenting all information in Xxxxx’x Electronic Health RecordMarin WITS. Performance Standard: • Transitions between levels of care shall occur within five (5) and no later than 10 business days from the time of re-assessment indicating the need for a different level of care. • There are no inequities in transitions between levels of care when stratified by race/ethnicity and gender identity Care Coordination and Linkage with Ancillary Services The Contractor shall ensure 42 CFR Part 2 compliant releases are in place in order to coordinate care. The Contractor shall screen for and link clients with mental and physical health, as indicated. Contractors will implement procedures to ensure clients are provided contact information for their assigned Care Coordinator(s) and document in the client record. Performance Standard: • There is documentation of physical health and mental health screening in 100% of beneficiary records • At least 80% of beneficiaries have 42 CFR compliant releases in place to coordinate care with physical health providers • At least 70% of beneficiary records have documentation of coordination with physical health • At least 80% of beneficiaries engaged for at least 30 days will have an assigned Primary Care Provider • At least 80% of beneficiaries who screen positive for mental health disorders have 42 CFR compliant releases in place to coordinate care with mental health providers • At least 70% of beneficiary records for individuals who screen positive for mental health disorders have documentation of coordination with mental health (e.g. referral for mental health assessment or consultation with existing providers). • At least 85% of beneficiaries will contact information for a designated contact responsible for coordinating the beneficiary’s care Medications for Addiction Treatment Contractors will either directly offer or have an effective referral mechanism to the most clinically appropriate MAT services for beneficiaries with SUD diagnoses that are treatable with medications or biological products. An effective referral mechanism/process is defined as facilitating access to MAT off-site for beneficiaries while they are receiving services if not provided on-site. Providing a beneficiary the contact information for a treatment program is insufficient. Contractor staff will regularly communicate with physicians of beneficiaries who are prescribed these medications unless the beneficiary refuses to consent a 42 CFR, Part 2 compliant release of information for this purpose. Performance Standard: • At least 80% of beneficiary records for individuals receiving Medication Assisted Treatment for substance use disorders will have 42 CFR compliant releases in place to coordinate care • At least 80% of beneficiaries with a primary opioid or alcohol use disorder will be linked to an MAT assessment and/or MAT services Culturally Responsive Services Contractors are responsible to provide culturally responsive services. Contractors must ensure: • Policies, procedures, and practices are consistent with the principles outlined and are embedded in the organizational structure, as well as being upheld in day-to- day operations. • Translation and oral interpreter services must be available for beneficiaries, as needed and at no cost to the beneficiary. • Each program reviews monthly performance data (automated reports sent from Xxxxx’x Electronic Health Record Marin WITS monthly) and identifies and implements at least one performance improvement initiative annually to address to any inequities noted either in the monthly dashboard or Treatment Perceptions Survey data. Performance Standard: • 100% of beneficiaries that speak a threshold language are provided services in their preferred language. • At least 80% of beneficiaries completing the Treatment Perceptions Survey reported being satisfied (3.5+ out of 5.0) with cultural sensitivity of services. • 100% of contractors will implement at least one performance improvement initiative annually related to reducing inequities by race/ethnicity or gender identity. • 100% of contractors are in compliance with the CLAS standards. Delivery of Individualized and Quality Care Beneficiary Satisfaction: DMC-ODS Providers (serving adults 18+) shall participate in the annual statewide Treatment Perceptions Survey (administration period to be determined by DHCS). Upon review of Provider-specific results, Contractor shall select a minimum of one quality improvement initiative to implement annually. Evidence-Based Practices (EBPs): Contractors will implement—and assess fidelity to—at the least two of the following EBPs per service modality: Motivational Interviewing, Cognitive-Behavioral Therapy, Relapse Prevention, Trauma-Informed Treatment and Psycho-Education. ASAM Level of Care: All beneficiaries participate in an assessment using ASAM dimensions. The assessed and actual level of care (and justification if the levels differ) shall be recorded in Xxxxx’x Electronic Health Record Marin WITS with seven (7) days of the assessment. Performance Standards: • At least 80% of beneficiaries will report an overall satisfaction score of at least 3.5 or higher on the Treatment Perceptions Survey • Overall satisfaction scores are balanced when stratified by race/ethnicity and gender identity • At least 80% of beneficiaries completing the Treatment Perceptions Survey reported that they were involved in choosing their own treatment goals (overall score of 3.5+ out of 5.0) • Contractor will implement with fidelity at least two approved EBPs • 100% of beneficiaries participated in an assessment using ASAM dimensions and are provided with a recommendation regarding ASAM level of care • At least 70% of beneficiaries admitted to treatment do so at the ASAM level of care recommended by their ASAM assessment • At least 80% of beneficiaries are re-assessed within 90 days of the initial assessment Client Outcomes In order to assess whether beneficiaries: 1) Reduce substance abuse or achieve a substance-free life; 2) Maximize multiple aspects of life functioning; 3) Prevent or reduce the frequency and severity of relapse; and 4) Improve overall quality of life, the following indicators that will be evaluated and measured include, but are not limited to: • Engagement in the first 30 days of treatment (at least two treatment sessions within 30 days after initiating treatment) • Reduction in substance use • Reduction in criminal activity or violations of probation/parole and days in custody • Increase in employment or employment (and/or educational) skills • Increases in family reunification • Increase engagement in social supports • Maintenance of stable living environments and reduction in homelessness • Improvement in mental and physical health status • Beneficiary satisfaction These metrics will be analyzed by program and at a minimum, stratified by race/ethnicity and gender identity Training Applicable staff are required to participate in the following training: • DMC-ODS Training Training, including Documentation Standards (within 30 days of hire and at At least annually) • Compliance, Information Privacy and & Security – - Including 42CFR 42 CFR Part 2 and HIPAA/Law & and Ethics (Within 30 days of hire and at At least annually) • ASAM E-modules 1 and 2 (Prior to Conducting Assessments) • Cultural Humility Competency (At least four hours annually) o One Cultural Humility training (annually) o Once LGBTQ+ training (annually) o One Working with Interpreters training (Bi-annually) • Oath of Confidentiality (Review and sign at hire and annually thereafter) • At least five hours of continuing education in addiction medicine annually for LPHA staff, including Medical Director staff • Xxxxx’x Electronic Health Record Marin WITS and CalOMS Treatment (Prior to Use of Marin Electronic Health Record WITS and thereafter as needed) • CalMHSA CalAIM Trainings – Including documentation requirementsProgram Licensure, CPT code trainingCertification and Standards Practice Guidelines: Contractor shall comply with the BHRS Clinical and Administrative Practice Guidelines, EHR which are located at xxx.XxxxxXXX.xxx/XXXX. Contractor shall possess valid DHCS Alcohol and other applicable trainings (within 30 days of hire) • Naloxone Training – Ensure at least one staff member, at all times, on the premises who knows the location of naloxone or other FDA- approved opioid antagonist medicationDrug Licensure and Certification, and who has been trained in its administration. Contractors shall maintain training logs DHCS DMC certification for all staff, including maintaining pertinent evidence the contracted level of training completion in personnel files. Contractors shall also submit evidence of training during the November and May Training and Staff Certification Log submission periods, or at additional times upon request. Digital Accessibility Vendor shall ensure that all digital content and deliverables comply with World Wide Web Consortium's (W3C) Web Content Accessibility Guidelines (WCAG), 2.1, level AA or most recent version. Vendor is responsible for addressing accessibility problems in any implementation, configuration, or documentation delivered or performed by Vendor, and in any software, documents, videos, and/or trainings given and published by Vendor and delivered under this contract. Applicable laws include but are not limited to Americans with Disabilities Act, 21st Century Communications and Video Accessibility Act (CVAA) and California Government Code Sections 7405 and 11135. Contract Changes If significant changes are expected, you must submit a request in writing to the contract manager. You must receive written approval prior to any changes being implemented and/or reimbursed. Significant changes include, but are not limited to: Scope of Work • Proposing to add or remove a service modality and/or CPT/HCPCS code • Proposing to transfer substantive programmatic work to a subcontractor • Proposing to add or remove rendering provider types • Demand for Marin Medi-Cal beneficiaries exceed contracted capacity Budget • Proposing to increase or decrease FTE • Proposing to increase the contract maximum Contractor shall also report any other key changes per the timelines and processes outlined in applicable Policies and Procedures,(xxxcare.XxxxxXXXX.xxx), Contract Exhibit I and Practice Guidelines (xxx.XxxxxXXXX.xxx), including, but not limited to: 1) Staff Updates; 2) Facility alterations/renovations; 3) Unusual occurrences or incidents; 4) Reduction in DMC services; and 5) Not accepting beneficiaries or 90% capacity (facility at capacity). One-Time Electronic Health Record (EHR) Documentation Adoption Incentive Payments One-Time Electronic Health Record (EHR) Documentation Adoption Incentive Payments are a one-time incentive provided to Contractor for utilizing the Marin County instance of SmartCare as their EHR for Marin County Beneficiaries and having their rendering providers/clinicians document into SmartCare in accordance with the Documentation Standards outlined in Exhibit I and the Clinical Documentation Guide. This will enable better care coordination between the county and the provider. Contracted agencies that have their staff only enter the service level billing and state reporting data will not qualify for this incentive. Document Title Due Date Where Submitted Submission Format Not Accepting New Beneficiaries By 9am each day that the program is not accepting new beneficiaries BHRS Access and Contract Manager E-mail Reached 90% of treatment capacity Within seven days (and via XXXXX by the 10th of the month) County AOD Administrator and XXXXXxxxxxxxx@xxxx.xxx E-mail EHR (CalOMS) - Client-specific data - DMC Billing - ASAM, Timely Access Data, etc. Progress notes for routine services within 3 calendar days; Other client-specific data should occur within 7 days of event Marin Electronic Health Record Technical Assistance: XXXXXXXXxxxxxx@XxxxxXxxxxx.xxx CalMHSA Help Desk Contract Manager Electronic Submission Adult Drug Court Weekly Progress Reports By 12 noon every Thursday ADC Coordinator (Xxxxxxx Xxxxx) xxxxxxx@xxxxxxxxxxx.xxx and ADC Recovery Coach Encrypted E- mail Staff Update Form/ Provider Update Prior to or within 24 hours of the staff change [e.g. new or separating staff, role change] Existing Users: XXXXXXXXxxxxxx@xxxxxxxxxxx.xxx New Users: TBD E-mail Monthly Provider Check and attestation By the 10th of the month BHRS Office – Administrative Services Associate E-mail All Billing Invoices and Supporting Documentation By the 10th of the month EHR and BHRS Office (as applicable) Electronic Submission Drug and Alcohol Treatment Access Report (XXXXX) By the 10th of the month State DHCS Electronic Submission Resubmission of Denied DMC Claims By the 20th of the month following notice of denial Marin Electronic Health Record Electronic Submission NOABD Log and Issued NOABDs By the 10th of the month BHRS Office – Administrative Services Associate E-Mail Provider Self Audit Projected January 2024 BHRS Office – Contract Manager Electronic Submission Annual Report Projected June 30, 2024 BHRS Office – Quality Management. Copy to Contract Manager E-mail or Hard Copy Provider Cost Reports To Be Determined Marin HHS - Fiscal TBD

Treatment Initiation and Engagement. At least 85% of beneficiaries have a second treatment visit within 14 days of assessment [initiation] • Of those initiating treatment, at least 75% will have two treatment visits within the next 30 days [engagement] • There are no inequities in treatment initiation and engagement when stratified by race/ethnicity and gender identity Transitions Between Levels of Care Appropriate Care Coordinators/clinicians from both the discharging and admitting provider agencies shall be responsible to facilitate the transition between levels of care, including assisting in scheduling an intake appointment, ensuring a minimal delay between discharge and admission at the next level of care, providing transportation as needed, and documenting all information in Xxxxx’x Electronic Health RecordMarin WITS. Performance Standard: • Transitions between levels of care shall occur within five (5) and no later than 10 business days from the time of re-assessment indicating the need for a different level of care. • There are no inequities in transitions between levels of care when stratified by race/ethnicity and gender identity Care Coordination and Linkage with Ancillary Services The Contractor shall ensure 42 CFR Part 2 compliant releases are in place in order to coordinate care. The Contractor shall screen for and link clients with mental and physical health, as indicated. Contractors will implement procedures to ensure clients are provided contact information for their assigned Care Coordinator(s) and document in the client record. Performance Standard: • There is documentation of physical health and mental health screening in 100% of beneficiary records • At least 80% of beneficiaries have 42 CFR compliant releases in place to coordinate care with physical health providers • At least 70% of beneficiary records have documentation of coordination with physical health • At least 80% of beneficiaries engaged for at least 30 days will have an assigned Primary Care Provider • At least 80% of beneficiaries who screen positive for mental health disorders have 42 CFR compliant releases in place to coordinate care with mental health providers • At least 70% of beneficiary records for individuals who screen positive for mental health disorders have documentation of coordination with mental health (e.g. referral for mental health assessment or consultation with existing providers). • At least 85% of beneficiaries will contact information for a designated contact responsible for coordinating the beneficiary’s care Medications for Addiction Treatment Contractors will either directly offer or have an effective referral mechanism to the most clinically appropriate MAT services for beneficiaries with SUD diagnoses that are treatable with medications or biological products. An effective referral mechanism/process is defined as facilitating access to MAT off-site for beneficiaries while they are receiving services if not provided on-site. Providing a beneficiary the contact information for a treatment program is insufficient. Contractor staff will regularly communicate with physicians of beneficiaries who are prescribed these medications unless the beneficiary refuses to consent a 42 CFR, Part 2 compliant release of information for this purpose. Performance Standard: • At least 80% of beneficiary records for individuals receiving Medication Assisted Treatment for substance use disorders will have 42 CFR compliant releases in place to coordinate care • At least 80% of beneficiaries with a primary opioid or alcohol use disorder will be linked to an MAT assessment and/or MAT services Culturally Responsive Services Contractors are responsible to provide culturally responsive services. Contractors must ensure: • Policies, procedures, and practices are consistent with the principles outlined and are embedded in the organizational structure, as well as being upheld in day-to- day operations. • Translation and oral interpreter services must be available for beneficiaries, as needed and at no cost to the beneficiary. • Each program reviews monthly performance data (automated reports sent from Xxxxx’x Electronic Health Record monthly) and identifies and implements at least one performance improvement initiative annually to address to any inequities noted either in the monthly dashboard or Treatment Perceptions Survey data. Performance Standard: • 100% of beneficiaries that speak a threshold language are provided services in their preferred language. • At least 80% of beneficiaries completing the Treatment Perceptions Survey reported being satisfied (3.5+ out of 5.0) with cultural sensitivity of services. • 100% of contractors will implement at least one performance improvement initiative annually related to reducing inequities by race/ethnicity or gender identity. • 100% of contractors are in compliance with the CLAS standards. Delivery of Individualized and Quality Care Beneficiary Satisfaction: DMC-ODS Providers shall participate in the annual statewide Treatment Perceptions Survey (administration period to be determined by DHCS). Upon review of Provider-specific results, Contractor shall select a minimum of one quality improvement initiative to implement annually. ASAM Level of Care: The assessed and actual level of care (and justification if the levels differ) shall be recorded in Xxxxx’x Electronic Health Record with seven (7) days of the assessment. Performance Standards: • At least 80% of beneficiaries will report an overall satisfaction score of at least 3.5 or higher on the Treatment Perceptions Survey • Overall satisfaction scores are balanced when stratified by race/ethnicity and gender identity • At least 80% of beneficiaries completing the Treatment Perceptions Survey reported that they were involved in choosing their own treatment goals (overall score of 3.5+ out of 5.0) • Contractor will implement with fidelity at least two approved EBPs • 100% of beneficiaries participated in an assessment using ASAM dimensions and are provided with a recommendation regarding ASAM level of care • At least 70% of beneficiaries admitted to treatment do so at the ASAM level of care recommended by their ASAM assessment • At least 80% of beneficiaries are re-assessed within 90 days of the initial assessment Outcomes In order to assess whether beneficiaries: 1) Reduce substance abuse or achieve a substance-free life; 2) Maximize multiple aspects of life functioning; 3) Prevent or reduce the frequency and severity of relapse; and 4) Improve overall quality of life, the following indicators that will be evaluated and measured include, but are not limited to: • Engagement in the first 30 days of treatment (at least two treatment sessions within 30 days after initiating treatment) • Reduction in substance use • Reduction in criminal activity or violations of probation/parole and days in custody • Increase in employment or employment (and/or educational) skills • Increases in family reunification • Increase engagement in social supports • Maintenance of stable living environments and reduction in homelessness • Improvement in mental and physical health status • Beneficiary satisfaction These metrics will be analyzed by program and at a minimum, stratified by race/ethnicity and gender identity Training Applicable staff are required to participate in the following training: • DMC-ODS Training (within 30 days of hire and at least annually) • Compliance, Information Privacy and Security – Including 42CFR Part 2 and HIPAA/Law & Ethics (Within 30 days of hire and at least annually) • ASAM E-modules 1 and 2 (Prior to Conducting Assessments) • Cultural Humility (At least four hours annually) o One Cultural Humility training (annually) o Once LGBTQ+ training (annually) o One Working with Interpreters training (Bi-annually) • Oath of Confidentiality (Review and sign at hire and annually thereafter) • At least five hours of continuing education in addiction medicine annually for LPHA staff, including Medical Director • Xxxxx’x Electronic Health Record and CalOMS Treatment (Prior to Use of Marin Electronic Health Record and thereafter as needed) • CalMHSA CalAIM Trainings – Including documentation requirements, CPT code training, EHR and other applicable trainings (within 30 days of hire) • Naloxone Training – Ensure at least one staff member, at all times, on the premises who knows the location of naloxone or other FDA- approved opioid antagonist medication, and who has been trained in its administration. Contractors shall maintain training logs for all staff, including maintaining pertinent evidence of training completion in personnel files. Contractors shall also submit evidence of training during the November and May Training and Staff Certification Log submission periods, or at additional times upon request. Digital Accessibility Vendor shall ensure that all digital content and deliverables comply with World Wide Web Consortium's (W3C) Web Content Accessibility Guidelines (WCAG), 2.1, level AA or most recent version. Vendor is responsible for addressing accessibility problems in any implementation, configuration, or documentation delivered or performed by Vendor, and in any software, documents, videos, and/or trainings given and published by Vendor and delivered under this contract. Applicable laws include but are not limited to Americans with Disabilities Act, 21st Century Communications and Video Accessibility Act (CVAA) and California Government Code Sections 7405 and 11135. Contract Changes If significant changes are expected, you must submit a request in writing to the contract manager. You must receive written approval prior to any changes being implemented and/or reimbursed. Significant changes include, but are not limited to: Scope of Work • Proposing to add or remove a service modality and/or CPT/HCPCS code • Proposing to transfer substantive programmatic work to a subcontractor • Proposing to add or remove rendering provider types • Demand for Marin Medi-Cal beneficiaries exceed contracted capacity Budget • Proposing to increase or decrease FTE • Proposing to increase the contract maximum Contractor shall also report any other key changes per the timelines and processes outlined in applicable Policies and Procedures,(xxx.XxxxxXXXX.xxx), Contract Exhibit I and Practice Guidelines (xxx.XxxxxXXXX.xxx), including, but not limited to: 1) Staff Updates; 2) Facility alterations/renovations; 3) Unusual occurrences or incidents; 4) Reduction in DMC services; and 5) Not accepting beneficiaries or 90% capacity (facility at capacity). One-Time Electronic Health Record (EHR) Documentation Adoption Incentive Payments One-Time Electronic Health Record (EHR) Documentation Adoption Incentive Payments are a one-time incentive provided to Contractor for utilizing the Marin County instance of SmartCare as their EHR for Marin County Beneficiaries and having their rendering providers/clinicians document into SmartCare in accordance with the Documentation Standards outlined in Exhibit I and the Clinical Documentation Guide. This will enable better care coordination between the county and the provider. Contracted agencies that have their staff only enter the service level billing and state reporting data will not qualify for this incentive. Document Title Due Date Where Submitted Submission Format Not Accepting New Beneficiaries By 9am each day that the program is not accepting new beneficiaries BHRS Access and Contract Manager E-mail Reached 90% of treatment capacity Within seven days (and via XXXXX by the 10th of the month) County AOD Administrator and XXXXXxxxxxxxx@xxxx.xxx E-mail EHR (CalOMS) - Client-specific data - DMC Billing - ASAM, Timely Access Data, etc. Progress notes for routine services within 3 calendar days; Other client-specific data should occur within 7 days of event Marin Electronic Health Record Technical Assistance: XXXXXXXXxxxxxx@XxxxxXxxxxx.xxx CalMHSA Help Desk Contract Manager Electronic Submission Adult Drug Court Weekly Progress Reports By 12 noon every Thursday ADC Coordinator (Xxxxxxx Xxxxx) xxxxxxx@xxxxxxxxxxx.xxx and ADC Recovery Coach Encrypted E- mail Staff Update Form/ Provider Update Prior to or within 24 hours of the staff change [e.g. new or separating staff, role change] Existing Users: XXXXXXXXxxxxxx@xxxxxxxxxxx.xxx New Users: TBD E-mail Monthly Provider Check and attestation By the 10th of the month BHRS Office – Administrative Services Associate E-mail All Billing Invoices and Supporting Documentation By the 10th of the month EHR and BHRS Office (as applicable) Electronic Submission Drug and Alcohol Treatment Access Report (XXXXX) By the 10th of the month State DHCS Electronic Submission Resubmission of Denied DMC Claims By the 20th of the month following notice of denial Marin Electronic Health Record Electronic Submission NOABD Log and Issued NOABDs By the 10th of the month BHRS Office – Administrative Services Associate E-Mail Provider Self Audit Projected January 2024 BHRS Office – Contract Manager Electronic Submission Annual Report Projected June 30, 2024 BHRS Office – Quality Management. Copy to Contract Manager E-mail or Hard Copy Provider Cost Reports To Be Determined Marin HHS - Fiscal TBD