Project Title: Substance Use Disorder (SUD) Continuum Services
Project #: RFPQ-71-2020
Issued by: Multnomah County view agency website
Publish Date: 12/7/2019
Due Date: 2/3/2020 This opportunity has closed.

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Amendments: 1. Amendment 1 corrected the address for the optional prepreposal meeting. 2.  Amendment 2 removed a contact name for Internal County use. 3. Amendment 3 corrected the PDF formatting issue. 4. Amendment 4 added file formats to document descriptions for Buyers Attachment 1. PRE-PROPOSAL CONFERENCE There will be a pre-proposal conference for this Solicitation on December 17, 2019 at 2:00 pm PST at 501 SE Hawthorne Blvd, Portland Oregon 97214 in room 126 on the first floor. Attendance: Optional INSTRUCTIONS: ITEMS TO SUBMIT AS SUPPLIERS ATTACHMENTS FOR THIS RFPQ: Proposal Your Proposal must be a Word or pdf document; computer generated or typewritten, single spaced, space-and-a-half or double spaced, formated for 8.5” x 11” paper. All pages should be numbered. Margins should be at least ½ inch on all sides. Font size can be no smaller than 10 points. Proposals using smaller font sizes or smaller margins may be rejected. The Proposer is required to submit a written narrative for each question asked in the Buyer Attachments 1 - RFPQ Proposal Questions. For Group 2.1 Programmatic Questions and Group 2.2, Responsible Business Practice Questions submit response as a complete proposal response and upload as a "Supplier Attachment" in the Sourcing Event. Proposers must respond to all the questions listed in the Buyer Attachments 1 - RFPQ Proposal Questions. The format for each question response should be as follows: the group number, question number and title (example: Group 2.1.1 Organization Philosophy and Capacity) and then provide their written response. Proposer should not restate the entire evaluation criteria with its response. If Proposer has a formal partnership such as MOUs, QSOAs or letters of commitment, etc., upload as a Supplier Attachment in the Sourcing Event. This document does not count towards the page limits and should be labeled as Appendix 1. IMPORTANT GUIDANCE REGARDING PROPOSER RESPONSES Medicaid expansion greatly impacted the system of care for SUD services in Multnomah County. As such, answers should focus on current and proposed service delivery for SUD and problem gambling treatment and recovery support services, not on the history of the organization. Proposal page limit is 12 pages. This equates to not more than 6 sheets of paper that are printed on each side, or 12 pages printed on only one side. We recommend that you not use cover sheets or any extra materials as these will count as pages. Excess pages will be removed and will not be evaluated. After uploading the proposal, Proposers must check the “Yes” button for each question in the Questions section of the RFPQ. SERVICE DESCRIPTION, FUNDING AND CONTRACTING INFORMATION PURPOSE AND OVERVIEW The Multnomah County Department of Health, Mental Health and Addiction Services Division (MHASD) is seeking proposers from whom it may purchase Adult and Youth Outpatient and Residential Substance Use Disorder (SUD) Services, and Integrated Outpatient Adult Problem Gambling Treatment Services. SUD Services are intended to assist Multnomah County residents whose household income is at or below 200% of the Federal Poverty Guidelines, and who do not have a covered benefit for SUD treatment or recovery support. In order to contract with MHASD, proposers must be certified by the Oregon Health Authority (OHA) to provide SUD Treatment, and be able to bill treatment services to Oregon Health Plan (OHP). Certified agencies that are not currently able to bill Oregon Health Plan may qualify under this procurement, but will need to address their plan to meet the requirement by time of contracting in their response. Recovery Support Services provided by peer-run agencies that do not provide SUD treatment will be procured in fiscal-year 20/21. Eligibility: In order to meet the minimum qualifications for this RFPQ, at the time of contracting proposers must be: Substance Use Disorder treatment agencies certified for Behavioral Health Treatment Services with the Oregon Health Authority (OHA), in accordance with Oregon Administrative Rules (OAR): 309-008-0100 through 309-008-1600. MHASD will purchase services in the following service areas: SUD treatment services, including Assessment, Withdrawal Management, Residential, Intensive Outpatient, and Outpatient operating as a continuum of care modeled after the American Society of Addiction Medicine (ASAM) Criteria. Medication Supported Recovery (MSR) Integrated Problem Gambling Treatment Services Peer Services Supportive Housing Services Case Management and Outreach Services INTRODUCTION AND PROGRAM HISTORY MHASD is a part of the Health Department. Through our staff and our contracted providers, we deliver recovery-based mental health and addiction services to Multnomah County's adults, children, and families. The system of care we maintain is funded by the state of Oregon, Multnomah County, Federal Medicaid money and other grants. MHASD offers specific 'safety net' services to protect the most vulnerable members of our community. These services include SUD treatment to uninsured and under-insured community members, problem gambling treatment, and a wide range of recovery support that is not a covered benefit under the Oregon Health Plan, including; peer mentoring, supportive housing, case management, outreach, and individual assistance. MHASD is looking to expand access to care, especially to culturally-specific communities, and improve health outcomes by procuring a wide range of treatment and recovery support services. GOALS, VALUES AND OTHER IMPORTANT CONSIDERATIONS The primary underlying goals of MHASD’s treatment programs are to promote individual recovery and resiliency, and to improve health outcomes for individuals with substance use and gambling disorders. Treatment services include several key elements: Evidence-based and builds on known best practices. At the same time, providers are encouraged to engage in innovation guided by strong program delivery and outcomes (fidelity). Collaboration across the treatment community to assure cultural responsivity and smooth access and transition across levels of care between addictions treatment providers and MHASD. A potential source of referrals is the MHASD Addiction Benefit Coordination Team (ABC). Culturally Responsive and Culturally Specific service provision: to develop interventions and approaches that recognize and incorporate the practices, values, beliefs and experiences of specific cultures is essential to engagement and retention. Strengths based models help individuals to see their possibilities. While learning new behaviors is emphasized in the literature, believing that those behaviors are meaningful is also important. Trauma Informed: As the majority of the individuals have histories of trauma, it is essential that the provider have clarity on how this impacts the individual, and how they have developed a model of care that recognizes and makes room for trauma. This should impact the provider’s policies and practices, treatment approach, as well as how they recognize and attend to their own staff. Well integrated within the broader Recovery Oriented System of Care (ROSC). Increasing coordination with other systems of care including mental health, primary care, homeless services, criminal justice and domestic violence. Harm Reduction: MHASD supports a harm reduction approach rather than strict abstinence, recognizing that recovery is a process. The primary goal is to engage individuals in treatment and recovery support and to continue progressing towards their goals. DESCRIPTION OF SYSTEM WIDE VALUES/APPROACH The following approaches to service delivery will be utilized: Recovery Oriented System of Care (ROSC) This procurement seeks to provide SUD recovery services modeled after ROSC approach, which is a best practice approach. ROSC provides individualized treatment services, a continuum of care, coordination of services, and peer-delivered services with an emphasis on building recovery capital and developing and strengthening a recovery support system within the community. As such, successful proposals will demonstrate a fully integrated approach to assessment, referral, and treatment addressing individual addictions and recovery challenges, as well as physical health, mental health, and basic needs. The goal of this integrated approach is to ensure concurrent referral to and receipt of mental health, physical health, and addictions treatment and recovery support services as necessary. To this end, proposals should address each provider’s capacity to support individuals in the development of Recovery Support Plans and provide or connect individuals to a wide range of recovery supports, such as housing assistance, peer delivered services and other non-treatment services to promote the continuation of the recovery process. Treatment Services are tailored to each individual’s level of clinical severity and function and are designed to help the individual achieve changes in their addictive behaviors. Treatment must address major lifestyle, attitudinal, and behavioral issues that have the potential to undermine the goals of treatment or to impair the individual’s ability to cope with major life tasks without the addictive use of alcohol, tobacco, drugs, or problem gambling. While abstinence is the ultimate goal of any substance abuse treatment system, harm reduction is an important part of addressing the practical realities of an individual’s needs. The incorporation of harm reduction strategies is an important step in expanding the recognized continuum of approaches that support movement toward wellness. Providers of substance abuse services should work collaboratively with other agencies to create a system of comprehensive services that include harm reduction strategies. Comprehensive services may be achieved by expanding service options within existing programs, through collaboration with other service agencies, or by creating new services to address specific needs. Through understanding and acknowledgement of the strengths and limitations of different program approaches, each program can be strengthened, and can more effectively serve the unique needs of individuals. In a comprehensive system of substance abuse services, programs should: Deliver care in a culturally-responsive, nonjudgmental manner which demonstrates respect for individual dignity, personal strength, and self- determination; Deliver interventions that will reduce the economic, social and physical consequences of substance abuse; Seek creative opportunities and develop new strategies to engage, motivate and intervene with individuals; Decrease the short-and long-term adverse consequences of substance abuse, even for those who continue to use drugs or alcohol; Include strategies that reduce harm for those individuals who are unable or unwilling to stop using, and for their loved ones; Recognize relapse as part of the recovery process not as “failure of treatment”; and Allow full access to substance abuse treatment services for patients prescribed medications for the treatment of medical and psychiatric conditions, including addiction. Trauma Informed Care The Federal Substance Abuse and Mental Health Administration (SAMHSA) has identified six key principles of a trauma-informed approach to behavioral healthcare ( It is critical to promote the linkage to recovery and resilience for those individuals and families impacted by trauma. Services and supports that are trauma-informed build on the best evidence available and consumer and family engagement, empowerment, and collaboration. Safety: Throughout the organization, the staff and the people they serve feel physically and psychologically safe; the physical setting is safe and interpersonal interactions promote a sense of safety. Understanding safety as defined by those served is a high priority. Trustworthiness and Transparency: Organizational operations and decisions are conducted with transparency and with the goal of building and maintaining trust among individuals, family members, staff, and others involved with the organization. Peer Support: Peer support and mutual self-help are key vehicles for establishing safety and hope, building trust, enhancing collaboration, and utilizing their stories and lived experience to promote recovery and healing. Collaboration and Mutuality: Importance is placed on partnering and the leveling of power differences between staff and individuals and among organizational staff from clerical and maintenance personnel, to professional staff to administrators, demonstrating that healing happens in relationships and in the meaningful sharing of power and decision-making. The organization recognizes that everyone has a role to play in a trauma-informed approach. Empowerment, Voice and Choice: Throughout the organization and among the individuals served, individuals’ strengths are recognized, built upon. The organization fosters a belief in the primacy of people served, in resilience, and in the ability of individuals, organizations, and communities to heal and promote recovery from trauma. The organization understands that the experience of trauma may be a unifying aspect in the lives of those who run the organization, who provide the services, and/or who come to the organization for assistance and support. As such, operations, workforce development and services are organized to foster empowerment for staff and individuals alike. Organizations understand the importance of power differentials and ways in which individuals, historically, have been diminished in voice and choice and are often recipients of coercive treatment. individuals are supported in shared decision-making, choice, and goal setting to determine the plan of action they need to heal and move forward. They are supported in cultivating self-advocacy skills. Staff are facilitators of recovery rather than controllers of recovery. Staff are empowered to do their work as well as possible by adequate organizational support. This is a parallel process as staff need to feel safe, as much as people receiving services. Culture, Historical and Gender Issues: The organization actively moves past cultural stereotypes and biases(e.g. based on race, ethnicity, sexual orientation, age, religion, gender-identity, geography, etc.); offers access to gender-responsive services; leverages the healing value of traditional cultural connections; incorporates policies, protocols, and processes that are responsive to the racial, ethnic and cultural needs of individuals served; and recognizes and addresses historical trauma. Culturally Responsive and Culturally Specific Services MHASD has also identified that throughout Multnomah County, Specific Population Groups have been historically underserved. While people of all backgrounds are typically welcome in most treatment programs, culturally-specific services have been less readily available. These populations include cultural groups (specifically African Americans, Latino, Slavic, Native Americans, and other immigrant groups), language specific groups (particularly Spanish, is currently lacking in residential treatment), LGBTQ+, Older Adults, and Persons with Disabilities. Proposers are also encouraged to submit collaborative proposals with community-based partners that offer Recovery Support Services and/or address service gaps for specific populations. MHASDs is using definitions of Culturally Responsive and Culturally Specific services developed through a collaborative County-wide work group, led by the Multnomah County Chief Operating Officer and the Director of the Office of Diversity and Equity. These definitions realize the county stated belief that: culturally responsive and culturally specific services eliminate structural barriers and provide a sense of safety and belonging which will lead to better outcomes. Culturally Responsive: Culturally responsive services are general services that have been adapted to honor and align with the beliefs, practices, culture and linguistic needs of diverse consumer / individual populations and communities whose members identify as having particular cultural or linguistic affiliations by virtue of their place of birth, ancestry or ethnic origin, religion, preferred language or language spoken at home. Culturally responsive services also refer to services provided in a way that is culturally responsive to the varied and intersecting “biological, social and cultural categories such as gender identity, class, ability, sexual orientation, religion, caste, and other axes of identity.” Culturally responsive organizations typically refer to organizations that possess the knowledge and capacity to respond to the issues of diverse, multicultural communities at multiple intervention points. Culturally responsive organizations affirmatively adopt and integrate the cultural and social norms and practices of the communities they serve. These agencies seek to comprehensively address internal power and privilege dynamics throughout their service delivery, personnel practices and leadership structure. Culturally Specific: Culturally specific services are services provided for specific populations based on their particular needs, where the majority of members/individuals are reflective of that community, and use language, structures and settings familiar to the culture of the target population to create an environment of belonging and safety in which services are delivered. Culturally specific organizations typically refer to organizations with a majority of members/individuals from a particular community. Culturally specific organizations also have a culturally focused organizational identity and environment, a positive track record of successful community engagement, and recognition from the community served as advancing the best interests of that community. TARGET POPULATION SERVED Substance Use Disorder Target Population The target population is Multnomah County residents with Substance Use Disorder whose income is at or below 200 percent of the current Federal Poverty Guidelines and who are uninsured or under-uninsured, or who do not have a covered benefit for Treatment, Outreach, Case Management or Recovery Support Services (including housing). Funds provided through this contract may not be used to deliver covered Services to any Individual enrolled in the Oregon Health Plan. For the current Federal Poverty Guidelines, please see: Priority populations for admission to SUD treatment are: Individuals who are pregnant and using intravenously Individuals who are pregnant Individuals who are using intravenously Women with dependent children Individuals referred by the State Department of Human Services, Child Welfare, and Drug Courts Individuals living with HIV/AIDS Under-represented individuals (eg: Individuals of Color, LGBTQ+, Differently Abled, etc Gambling Disorder Target Population The target population is individuals who gamble in Oregon, their family members and others impacted by their gambling behavior. There are no income or geographic restrictions, though there is a variance process to treat individuals who do not live in Oregon. Family members may engage in counseling services regardless of the engagement of the individual with disordered gambling. FUNDING MHASD has budgeted approximately $9,922,697 annually, a mix of federal, state and local funding for services. The current allocation policy provides for a base allocation plus additional funds allocated on a formula basis. The formula directs funds to service areas with greater needs, taking into account multiple factors such as: Culturally-specific services, Geographic location of services, Services accessibility, Availability of recovery support and/or peer-delivered service, Availability of Medication Supported Recovery (MSR) Service authorization to individuals based on risk Commitment to trauma-informed approaches Funding of the work described in this RFPQ is not guaranteed. Fluctuations in funding from  year to year should be expected. The County cannot assure that any particular level of work will be provided and the contract will permit the County to add or remove work as necessary depending on availability of funding. If during the term of any Contract subsequent to this RFPQ, Contractor delivers less than the anticipated level of service upon which payments were calculated, the County may unilaterally reduce the amount of the remaining payments for that service. SCOPE OF SERVICES In partnership with treatment providers, MHASD continuum of services for all eligible individuals modeled after the ASAM Criteria. The ASAM Criteria is the most widely used and comprehensive set of guidelines for placement, continued stay and the transfer and discharge of individuals with addiction and co-occurring conditions. MHASD will also continue to fund housing, outreach, and recovery supports that are not covered benefits under the affordable care act.  Residential and Outpatient SUD Treatment Services As licensed treatment providers, applicants shall comply with the following: Oregon Administrative Rules: Applicable Oregon Health Authority rules and regulations pertaining to Behavioral Health Services and the 2019-21 Intergovernmental Agreement for the Financing of Community Mental Health, Substance Use Disorders, and Problem Gambling, available on the MHASD provider resource website: ASAM Level of Care Treatment Services: Consistent with the ASAM Criteria, MHASD SUD treatment system will be guided by a set of foundational principles and best practices that represent a shift in how SUD treatment individuals are assessed, treated, and supported in their recovery. Multi-dimensional assessment using the ASAM Criteria: Diagnosis alone is not sufficient justification for entering a certain modality or intensity of treatment; individual assessment will support treatment that is holistic and able to meet the multiple and changing needs of an individual across all six dimensions. Broad and flexible continuum of care: Levels of care will represent intensities of services along the continuum of treatment; reflect the varying severity of illness treated and the intensity of service required. The intensity of treatment is split into “levels of care”, and each of the levels connect to each other, acting more like “benchmarks” along a single continuum. Individuals can move between levels, or benchmarks along the continuum, depending on their unique needs and response to treatment. The ASAM Criteria uses separate criteria and levels of benchmarks for adult individuals and adolescent individuals due to the different states of emotional, mental, physical, and social development adolescents may be in. Treatment referral system: Referrals to a specific level of care will be based on a careful and comprehensive assessment of individual needs across six dimensions with the primary goal of placing individuals in the most appropriate level of care. The preferable level of care will be the least intensive, while still meeting treatment objectives and providing safety and security for the individual. The levels of care are ranked under the ASAM Criteria and represent benchmarks or points along the continuum of treatment services that can be accessed depending on an individual's needs and responses to treatment. That is, an individual may begin at one level of care but transition up or down to another level of care. Treatment providers will be required to have the capacity to transition individuals across the treatment continuum either in-house or through formal partnerships with other providers along the continuum (written, approved MOUs). This also includes partnering with service providers and systems both inside and outside the treatment continuum, including mental health, primary care, Opiod Treatment Programs (OTP) and MSR providers, and the criminal and juvenile justice systems. Tailored treatment system: The treatment system will be tailored to the needs of each participant, guided by individualized treatment plans and developed in consultation with individuals through the formation of therapeutic alliances. The goal of interventions and treatment will determine the methods, intensity, frequency and types of services provided. Decisions about individual discharge from a level of care or a transfer to another level of care will be based on how the treatment and duration both resolves an individual’s presenting challenges and impacts an individual's prognosis for long-term recovery. Treatment services are expected to stabilize an individual’s condition and promote wellness and recovery. Individuals struggling with treatment should receive enhanced efforts to engage and treat, not termination. Interdisciplinary team approach to individual care: Treatment professionals will be required to collaborate with physicians, mental health clinicians, peers and peer supports, and other persons important to an individual’s recovery. All treatment providers will be required to collaborate and coordinate treatment care with primary care, behavioral health clinics and other service providers such as housing, educational and vocational providers. Integration of Peers within multi-disciplinary teams: Peer support offers individuals significant interpersonal relationships and a shared sense of community that facilitates the process of healing. At its best, a peer relationship can facilitate and enhance an individual's wellness and recovery. It also can provide increased meaning and purpose in the life of Peers. Peers are colleagues who have experienced behavioral health and addiction challenges bringing their empathy and empowerment to the recovery process. Development of a robust array of individual supports and services: Outpatient treatment services include the integration of outreach, case management (CM) and recovery services (RS) as medically indicated. Outreach will identify potential individuals. CM will proactively link individuals with necessary ancillary services to ensure treatment success. RS services, including aftercare and supportive or Alcohol Drug Free Housing (ADFC) housing, will support an individual’s role to succeed in recovery, emphasizing their health and teaching them to use effective self-management support strategies that prevent relapse. CM and RS may also include linkages to and coordination with Medication Supported Recovery (MSR) services to evaluate, administer, adjust and monitor individual medication support services. All treatment services are required to be offered consistent with a Harm Reduction Philosophy of Service. ASAM Level of Care Service Components & Requirements (Levels 1.0-3.7): The following is a summary of ASAM level of care treatment service components and requirements excerpted from The ASAM Criteria, Treatment Criteria for Addictive, Substance-Related and Co-Occurring Conditions (American Society of Addictive Medicine, Third Edition, 2013). Applicants must demonstrate capacity to meet all ASAM level of care components and requirements in their proposals. Level 1 – Outpatient Substance Use Disorder Services Requirements: Outpatient Services are benchmarked at the lower end of the ASAM treatment continuum and include organized outpatient treatment services which can be delivered in a variety of settings such as addiction programs, behavioral health homes and clinics. Services are provided less than 9 hours per week for adults and less than 6 hours per week for adolescents. In Level 1 programs, a multi-disciplinary team provides services. Members of the team may include addiction, mental health treatment, Peers, and general health care personnel, including addiction credentialed physicians. The team provides professionally directed screening, evaluation, treatment and ongoing recovery and disease management services. Level 2.1 – Intensive Outpatient Substance Use Disorder Services Requirements: Intensive Outpatient Services offer a higher intensity of outpatient services with the goal of stepping individuals down to Level 1 Outpatient Services or discharge. A minimum of 9 hours of structured programming per week is provided. Although programming consists primarily of counseling and education about addiction-related problems, providers must demonstrate capacity to provide all required Level 2.1 service components. Individual psychiatric and medical service needs are provided through consultation and closely coordinated referrals, as indicated and through appropriate release of information (ROI) agreements, formal MOUs or Qualified Service Organization Agreements (QSOA). Applicants must demonstrate on-site capacity or formal partnerships with mental health and healthcare providers to meet the needs of individuals with co-occurring mental disorders. Evidence of formal partnerships may include fully executed, written MOUs, QSOAs, letters of commitment, etc. with these service providers identifying the specific roles and responsibilities of each partner; supporting evidence should be included as attachments in the proposal appendix. Level 3 – Residential Substance Use Disorder Services Requirements: Adult Substance Use Disorder Residential Treatment Services (A&D 61) are Services delivered to individuals18 years of age or older who are unable to live independently in the community; cannot maintain even a short period of abstinence from substance abuse; are in need of 24-hour supervision, treatment, and care; and meet the treatment placement criteria indicated in the American Society of Addiction Medicine (ASAM) Level 3.1 – 3.7. Individualized services provide 24-hour structure and a supportive living environment. Services facilitate an individual’s ability to acquire basic living skills, application of recovery skills, relapse prevention, and emotional coping strategies. They promote personal responsibility and reintegration into the workforce, education and family life. Medication Supported Recovery (MSR) MHASD supports expanded access to Medication Supported Recovery (MSR) services and requires greater management of patient compliance with medication to support the goals of improved patient outcomes, a better patient experience and reduced healthcare costs. Providers must demonstrate MSR capacity within their organization or linkages to MSR services through: Assessment of every individual for MSR services using the ASAM criteria; Procedures and protocols in place to provide MSR onsite or care coordination and linkage of MSR services; Case management practices and process to support regular communication, consultation, and coordination between SUD treatment staff and physicians of patients that are prescribed medications (MSR); and Practices and process to prescribe, monitor, adjust, and manage MSR for patients as medically necessary. This includes linkages to OTP for methadone services. MSR medications may include the following: buprenorphine, naloxone, acamprosate, naltrexone, and disulfiram. Agencies providing MSR are classified as either Opioid Treatment Programs or Office Based Opioid Treatment programs: Opioid Treatment Programs (OTP): Opioid (Narcotic) Treatment Program means an outpatient clinic licensed by State and federal (CSAT, DEA) agencies to provide narcotic replacement therapy directed at stabilization and rehabilitation of persons who are opiate-addicted and have a substance use diagnosis. In addition to methadone, Opioid Treatment Programs will be required to offer and prescribe medications to beneficiaries covered under the OHP formulary, including buprenorphine, disulfiram, naltrexone, acamprosate, and naloxone. Opioid Treatment Programs use a multi-disciplinary team approach to treatment that includes, at a minimum, physicians, nurses, licensed or certified addiction counselors, and mental health therapists who provide individual-centered, recovery- oriented individualized treatment, case management, and health education. Services such as dosing, level of care, length of services, and frequency of visits are tailored to the needs of individuals, through federally-mandated program components include regularly scheduled psychosocial treatment sessions, random urine drug tests, and scheduled medication visits within a program structure. Opioid Treatment Programs must meet federal admission, discharge, and continued service criteria under 42 CFR 8.12 and Oregon law. Office Based Opioid Treatment (OBOT): In an effort to expand access to MSR, outpatient and residential behavioral health programs may provide Office Based Opioid Treatment (OBOT) without being licensed by State and federal agencies (CSAT, DEA). Providers are responsible for ensuring that there is a prescribing practitioner on staff who maintains DEA Registration, meets the requirements for DATA Waived Physicians (DWPs), and is prescribing within all applicable state and federal regulations. Contracted OBOT providers may prescribe Suboxone, buprenorphine, and naltrexone (Vivitrol), but may not contract with Multnomah County to prescribe Methadone, which is limited to agencies licensed as Opiate Treatment Providers. More information on the DEA waiver requirements and prescribing guidelines can be found on the SAMHSA website: Integrated Outpatient Problem Gambling Treatment In an effort to expand access to Problem Gambling Treatment, MHASD is considering contracting services to agencies who are also contracted to provide SUD treatment services. Unlike other services funded through this procurement, problem gambling treatment does not have insurance billing, residency, or income requirements. There is no additional licensing requirement from OHA, though OHA may perform additional site monitoring. Services must be delivered in accordance with OAR 309-019-0170. Outpatient problem gambling treatment services provide problem gambling assessment, treatment, and rehabilitation services, delivered on an outpatient basis or intensive outpatient basis to individuals and those in relationships with Individuals with gambling related problems who are not in need of 24-hour supervision for effective treatment. Outpatient services must include regularly scheduled face-to-face or non-face-to-face therapeutic sessions or services, in response to crisis for the Individual, and may include individual, group, couple, and family counseling, and programming must include targeted outreach and inreach: Outreach: Individual-finding/referral pathway development and maintenance; Treatment-specific outreach is targeted outreach for which the primary purpose is to get disordered and problem gamblers and, if appropriate, their family members into treatment through screening, identification and referrals from entities such as social service, allied health, behavioral health and criminal justice organizations. In-reach: Treatment-specific efforts that engage, educate and assist behavioral health programs and/or SUD’s treatment programs within County or subcontractors with screening, identification and referral to A&D 81 Services. Services are to be made available to any Oregon resident with a Gambling Disorder or diagnosis of relational problem as defined below. Services to out-of-state residents are permissible if the presenting Gambling Disorder or relational problem diagnoses are reported as primarily related to an Oregon Lottery product. Providers must request a waiver, to provide Services to out of state residents, using the Out of State Variance Form. Contractor will provide Problem Gambling Treatment Services utilizing the current American Society of Addiction Medicine (ASAM) Criteria to ensure appropriate level of care placement, and the current Diagnostic Statistical Manual (DSM)-5 to determine Gambling Disorder diagnosis. An Individual must have one of the diagnoses listed below in order to obtain services; the diagnosis must be primary or secondary: A diagnosis of Gambling Disorder, defined as an individual with persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting one or more diagnostic criteria of the most current version of the Diagnostic and Statistical Manual for Mental Disorders; or A diagnosis of relationship distress with spouse or intimate partner; a diagnosis of relational problems or problems related to psychosocial circumstances; or diagnosis of stressful life events affecting family and household, as listed within the most current version of the International Classification of Disease (ICD), as it relates to problem gambling. Peer Services Peer Support Services are provided when necessary and are not indicated for all individuals who succeed in treatment. It is anticipated, however, that most individuals might benefit from PeerSupport Services. Applicants must demonstrate capacity within their proposals to connect individuals to peer services, ideally by integrating peer services into their treatment programs at all ASAM levels of care. For the purposes of this procurement, MHASD is defining "Peers" as: Certified Recovery Mentor (CRM) requires an AMH approved addiction training program (peer delivered services), certified by the Mental Health and Addictions Certification Board of Oregon. Peer Support Specialist (PSS) is defined by in OAR 410-180-0305 as an individual providing services to another individual who shares a similar life experience with the Peers (addiction to addiction, mental health condition to mental health condition, family member of an individual with a mental health condition to family member(s) of an individual with a mental health condition. A peer support specialist shall be: A self-identified individual currently or formerly receiving addictions or mental health services;  A self-identified individual in recovery from an addiction; A self-identified individual in recovery from problem gambling. Peer services must at a minimum include all of the following: Peer Services: Peers identify as having the lived experience of being  in recovery.  As such, they actively work to reduce stigma and inspire others in their process of recovery. They uphold the values of recovery and resiliency, and serve as role models for wellness, responsibility, and empowerment. Throughout all interactions, peers communicate warmth, empathy, and non-judgment. While precise job descriptions vary across agencies, peer support specialists focus heavily on the identification of strengths, skill building, effective symptom management, and goal setting among those with whom they work. In addition, they often provide outreach, advocacy, social and logistical support, and education. While the role of a Peer will vary based on the level of care and individual needs, Peers engage in the following activities: Provide Support and Advocacy: Peers work with individuals to connect them to resources in the community including how to independently identify needs and access resources. As integrated members of the treatment team, Peers also advocate for individuals in treatment settings and within the community. Role Model Recovery: Peers have a wealth of experience navigating their own recovery journeys. By sharing their stories and modeling healthy, effective decision-making in peer relationships, they can inspire individuals to do the same. Facilitate Positive Change: The spirit of recovery and resilience is grounded in hope and optimism. Peers work to motivate individuals through positive means, highlighting strengths and resources. Peer support specialists can facilitate change through goal setting, education, and skills building.  Education and Job Skills: linkages to life skills, employment services, job training and education services; Family Support: linkages to childcare, parent education, child development support services and family/marriage education; and Ancillary Services: linkages to housing assistance, transportation, case management, and individual services coordination. Supportive Housing For this RFPQ, supportive housing is defined as  a transitional  or permanent housing model that meets guidelines for alcohol-and-drug free housing (ADFC) for individuals in a verifiable program of recovery. Program participants are connected to Peers who provide recovery focused activities and supports in maintaining recovery and achieving employment, income, and stable housing. Peers and/or case managers assist individuals in navigating Multnomah County’s continuum of care, and ensure individuals have access to other physical and behavioral health care services. SAMHSA has defined best practices and suggested guidelines for recovery housing that can be found at In order to contract with MHASD, housing services must be directly managed by the qualified provider, through either leases or ownership of the property, and must include in-house recovery support. Supportive housing services cannot be subcontracted to other providers, though treatment services can be provided either in-house or through partnerships with other agencies.  Habitability standards can be found at Supportive housing can be a step-down program for individuals exiting detox or residential treatment, or an alternative to residential treatment for individuals connected to outpatient, intensive outpatient treatment or a recovery program. Referrals can come from internal agency programs, coordination with other providers, Multnomah County Addictions Benefit Coordination, or self-referral. The goal for all targeted individuals receiving these services is to complete SUD treatment, develop natural community supports and meaningful connections to a recovery community, obtain employment or benefits income, secure stable housing, and maintain long-term recovery. These services incorporate the values of a Recovery Oriented System of Care and reflects the value of peer delivered, recovery oriented, community support services. Supportive Housing Staffing Requirements: Staffing for Supportive Housing programming is not dictated by Oregon Administrative rules, and may vary from model to model. Peers provide oversight at each house, including during evenings and on weekends, skill building groups and recovery support and engagement in recovery services.  The Peers will assist residents in maintaining treatment engagement and recovery, achieving self-sufficiency including longer-term housing, and, if appropriate, family reunification. Case Managers are available and provide oversight and assistance to the treatment team, Peers, and parole officers where applicable. Housing Specialist and Employment Specialist are available to provide for smooth transition and referral to permanent housing and employment. Case Management Services and Outreach Services Case management services are considered effective and proactive when they directly link patients to needed services and supports ” that ensure patients are connected and stay connected to mental health, primary care, and other needed services through closely coordinated referrals by counselors. Applicants must integrate case management services into their treatment programs at all ASAM Levels of Care for individuals who need case management. Goals of case management services include: Addressing the comprehensive needs of program participants including medical, psychosocial, behavioral, and spiritual needs; Partnering with individuals to problem-solve and explore treatment options; Improving coordination of care and communication among members of the care planning team; Promoting patient self-advocacy, self-care, and self-determination; Integrating Peers within treatment planning to share their knowledge, advocate for and support patients; Proactively ensuring that transitions to other levels of care are effective, safe, timely and complete (“warm hand-offs)”; Improving individual safety and satisfaction; and Helping individuals reach their optimal level of health, well-being and recovery. Outreach Services provide support and services to populations who might not otherwise have access to those services. A key component of outreach is the mobility of the provider. In other words, the provider is meeting individuals at their respective locations. In addition to delivering services, outreach has an educational role, to raise the awareness of existing services and provide a safe path for the client to meet more sophisticated needs. Outreach strategies include: Research the communities and organizations identified for outreach prior to engagement Limit or eliminate the use of acronyms when speaking to communities and/or organizations Highlight words/terms that will capture the attention of the targeted audience in flyers & pamphlets Be present when you are present Make yourself available Be able to answer the “What’s in it for Them” question for the individual community and/or organization Employ active listening skills when doing outreach Become familiar with interviewing techniques and even stages of change Use available technology Be a walking resource Carry snacks when possible FISCAL, PROGRAM, AND REPORTING REQUIREMENTS Basic Regulatory Compliance Neither the entity, nor any staff to be assigned to the program which is the subject of this request, shall have been disqualified to provide services which are funded by any Federal or State healthcare program. To be eligible to contract with the County an individual or entity must not be listed on the current Cumulative Sanction List of the Office of the Inspector General (U.S. Department of Health and Human Services) or the General Services Administration’s list of parties excluded from federal programs. The County will not contract with any individual or entity found to be on any of these lists. The County will verify at the time of contracting the entity is not on this list.  The entity is responsible in ensuring their staff which is subject to this request is not listed on any of these lists. The County plans to use the following links to identify individuals and entities that are not eligible to contract with the County: and Oregon Health Authority Suspension Search Database. Each proposer should verify that it is not on any list prior to preparing a proposal to submit in response to this solicitation. Correction of any errors found on any sanction list is the sole responsibility of the proposer and must be made prior to the day the proposal is submitted. The County requires all potential proposers (individuals or entities) to self-disclose any pending charges or convictions for violation of criminal law and/or any sanction or disciplinary action by any federal or state law enforcement, regulatory or licensing agency or licensing body, including exclusion from Medicare and Medicaid programs. During the term of the contract between a selected applicant (the contracting entity or individual) and the County, and in accordance with law, if the contracting entity or individual becomes an ineligible person, the contractor shall be removed from any responsibility and/or involvement with County contracted obligations related to any direct or indirect federal or state health care programs and any other federal and state funds. An ineligible person is defined as any individual or entity who is currently excluded, suspended, debarred or otherwise ineligible to participate in the federal healthcare programs; or has been convicted of a criminal offense related to the provision of health care items or services and has not been reinstated into the federal health care programs after a period of exclusion, suspension, debarment, or ineligibility. The County does not require, and neither encourages or discourages the use of lobbyists or other consultants for the purpose of securing business. All federal, state and local individual confidentiality requirements must be adhered to by SUD treatment providers. Proposers must have policies, practices, and workforce training in place that are consistent with and in full compliance with confidentiality requirements. This includes ensuring individuals have signed a consent for a 42 CFR, Part 2 compliant release of information to allow for the sharing of individual information for the purpose of multi-disciplinary treatment planning, treatment, medication management, mental health monitoring and management, medical monitoring and management, and transitions to other levels of care or treatment program discharge. One of the key tenets of providing better care to individuals is a referral system that is efficient and effective. Too many individuals are lost due to a poor referral system. Proposers must show how they will ensure timely access to treatment, including any strategies to quickly engage new referrals and follow up with those individuals who are difficult to engage. Proposers should describe their ability to successfully transition individuals to other ASAM levels of care either within their own organization, or to another program within the provider network. All treatment providers are expected to proactively engage individuals in all aspects of their care from intake and treatment planning, treatment plan review, to discharge and transitions across levels of care or into the community. SUD Billable Services The purpose of this procurement is for MHASD to purchase services that are not a covered benefit under the Oregon Health Plan or other insurers. Providers will be expected to bill insurance as the primary payer for eligible services. MHASD will reimburse treatment services for uninsured and under-insured individuals who are at or below 200% of Federal poverty guidelines. Examples include: Individuals who are uninsurable; Individuals with Medicare who do not have a covered benefit for SUD services; Individuals who are temporarily uninsured; Individuals with high deductible plans, out-of-network charges, and other associated fees that pose a noted deterrent/barrier to accessing treatment and recovery services. MHASD will also reimburse for billable recovery support services, such as peer mentoring, that are not a covered benefit. All billable services are funded based on a fee-for-service model. All services must be pre-authorized; ongoing services must be re-authorized to ensure that individuals still meet eligibility criteria. MHASD currently uses the billing software Ph Tech/CIM to track allowable encounters. MHASD may require invoices or additional backup to remit payment for allowable encounters. The “Multnomah Other” fee schedule and other resources detailing MHASD’s billable services can be found at Problem Gambling Billable Services Problem Gambling Treatment Services are funded through Oregon State Lottery dollars passed through the State, and do not have income eligibility or insurance restrictions. Gambling treatment funded with State dollars is the primary payer. Treatment services to individuals experiencing problem gambling and their families must be free. Peer mentoring and individual-finding outreach are allowable billable encounters. If MHASD contracts Problem Gambling Services through this procurement, the “Multnomah Other” fee schedule will be updated to include gambling-specific modifiers based on State billing rates available on the Oregon PGS website: Non-Billable Services MHASD also plans to contract for non-billable services, which are not a covered benefit under Oregon Health Plan and are not encounterable in the Multnomah Other fee schedule. These services are typically funded through cost-reimbursement funding models. Cost-reimbursement payments require a monthly invoice demonstrating incurred expenses, and are subject to fiscal review and monitoring. Examples of MHASD-funded non-billable services include: Non-billable Recovery Support Services, such as Peer mentoring for individuals not enrolled in treatment Pre-engagement, outreach and case management services Housing Services, such as supportive housing, Alcohol and Drug Free Housing (ADFC), Family Housing, and short-term housing assistance Residential treatment capacity Culturally-specific programming capacity and expansion Pilot programs or other innovative models to address substance use disorder Multnomah County General Fiscal Requirements As appropriate, Providers will comply with all applicable provisions of the County Financial Assistance Contract (CFAC) between the State of Oregon acting by and through its Department of Human Services and the County. A copy of the most recent CFAC can be obtained at Providers, if a non-profit organization and a subrecipient of federal funds passed through the County, must meet the audit requirements of Universal Guidance “Audits of States, Local Governments, and Non-Profit Organization”, which applies the federal Single Audit Act Amendment of 1996, Public Law 104-156. County shall have the right to withhold from payments due Providers such sums as are necessary in County’s sole opinion to protect County from any loss, damage, or claim, which may result from Provider’s failure to perform in accordance with the terms of the Contract or failure to make proper payment to suppliers or subcontractors. Services will be rendered in a manner that services will be available for the entire contract period. Fiscal Requirements for Cost-Reimbursement Contracts Annual Budget for cost reimbursement services: Due no later than 30 days after contract execution. See link under Fiscal Requirements: Monthly cost-reimbursement invoice: Payment requests are due the 20th calendar day of the month following the month in which expenses were incurred. See link under fiscal requirements: PERFORMANCE MEASURES/PERFORMANCE CONTRACTING Measures and Outcomes Tracking System (MOTS): The data collection system for the Health Systems Division (HSD) is the Measures and Outcomes Tracking System (MOTS). In general, behavioral health providers who are either licensed or have a letter of approval from the State, and receive public funds to provide treatment services are required to report to MOTS. In addition to the general rule above, there are four basic ways to classify who is required to submit data to MOTS: Providers with State contracts that deliver treatment services (this includes Community Mental Health Programs [CMHP], Local Mental Health Authorities [LMHA] and other types of community behavioral health providers); These programs should all have a license or letter of approval from the HSD or AMH; Providers that are subcontractors (can be a subcontractor of a CMHP or other entity that holds a contract with the State, such as Multnomah County MHASD, a Mental Health Organization [MHO], or a Coordinated Care Organization [CCO]); Providers that the State does not contract with but are required to submit data to MOTS by State/Federal statute or rule; These include DUII treatment providers and methadone maintenance providers; and Providers that contract with other governmental agencies (e.g., Oregon Youth Authority [OYA] or the Department of Corrections [DOC] to deliver mental health and/or substance abuse services). Performance Measures: Proposers will demonstrate an ability to meet these goals through gathering and reporting meaningful data: System-wide Performance Measure *Required of all contracted service areas AD Providers Meeting: MHASD contractors will attend monthly billing and provider meetings and participate in systems planning and collaboration. PROGRAM AREA OUTCOMES & OUTPUTS MHASD has the ability to change the outcome measure and outputs from year to year based on community needs and funding. Residential Treatment Successful Discharge: 60% of individuals discharge successfully to another level of care or recovery support/lifestyle. Satisfaction: 85% of individuals are offered satisfaction surveys that address all areas of service. The results of the surveys must be used for quality improvement, and must consider race, ethnicity, and language data in measuring satisfaction. Outpatient Treatment Successful Discharge: 50% of individuals discharge successfully to another level of care or recovery support/lifestyle. Treatment Engagement: 50% individuals engage in treatment, as defined by two or more additional services within 30 days of the initiation visit. Satisfaction: 85% of individuals are offered satisfaction surveys that address all areas of service. The results of the surveys must be used for quality improvement, and must consider race, ethnicity, and language data in measuring satisfaction.   Medication Supported Recovery Retention: 60% of individuals engage for more than 30 continuous days in MSR services. Reduction in opioid use: 95% of individuals show a reduction in opioid use as shown through urinalysis. Case Management (e.g. FIT) Treatment Enrollment: 80% of individuals who have been screened by a FIT CADC enter into any level of care. Supportive Housing Unit Utilization:85% of supportive housing units are utilized Exit Destination:75% of individuals transition to stable housing Outreach and Engagement Outreach: The percentage of individuals who have engaged with an outreach worker who enter treatment. Percentage is based on program population. Contract Monitoring / Program Evaluation Contractors will be expected to cooperate fully with MHASD contract monitoring and program evaluation activities. This includes making available data or information that MHASD deems necessary for those processes. Site Reviews: MHASD staff may schedule on-site visits to review agency compliance with contracts. Site visits are usually scheduled with Contractor, but may be conducted without notice. Training and Technical Assistance: MHASD Staff may offer training, technical assistance and/or assist programs with the design of services.  Providers must attend trainings designated as mandatory by MHASD. Evaluations/Program Performance: Program performance will be evaluated through other quality assurance/evaluation processes, which may include but are not limited to: Data/reports; Provider semi-annual narratives and provider self-assessments; Program participant satisfaction surveys and complaint resolution processes; Compliance review for contract standards and performance criteria; Compliance reviews for reporting requirements Referral source satisfaction surveys/community partner surveys; Any State and County collected data or information that reflects service delivery or utilization outcomes; and Review of program and program participant records. Evaluation: Contracts will be performance-based and will include expectations regarding service outcomes. Continuing contracts may be linked to successful attainment of projected service outcomes. Evaluation data may be collected on the following items: Timeliness of first initial individual contact to face-to-face appointment; Timeliness of services for the first dose of MSR services; Timeliness from ASAM assessment to treatment initiation; Reliability and timeliness of data entry; Costs of care; Coordination with physical, mental health and recovery services; Utilization management/appropriate level of care; individual experience; and Cultural competence of services. Fiscal Compliance Reviews: County fiscal compliance reviews may be conducted to ensure that financial records, systems and procedures conform to Generally Accepted Accounting Principles and are in compliance with all County and State audit and accounting requirements. CONTRACT NEGOTIATION Once selected in the allocation process, The County will initiate contract negotiations with the Proposer. Multnomah County may, at its option, elect to negotiate general contract terms and conditions, services, pricing, implementation schedules, and such other terms as the County determines are in the County’s best interest. If negotiations fail to result in a contract, the County reserves the right to terminate the negotiations and initiate contract negotiations with another qualified Proposer(s). This process may continue until a contract agreement is reached. CONTRACT AWARD AND ALLOCATION PROCESS This is a formal, competitive, Request For Programmatic Qualifications (RFPQ) process as provided for under the authority of PUR-1. No contracts will be issued as a result of this RFPQ process. Our intent is to establish pools of qualified vendors who will be eligible for potential contract awards. There is no limit on the number of vendors that may be qualified under this RFPQ process. Multnomah County strongly encourages the participation of Minority-Owned, Women-Owned, and Emerging Small Businesses and Organizations in providing these services. ALLOCATION PROCESS Entirely separate from this qualification process, MHASD will initiate and award requirements contracts to those qualified providers who demonstrate the desired experience, skills, proficiency, and certifications (e.g., OHA Letter of Approval for SUD treatment). MHASD will conduct a rigorous funds allocation process to distribute available funds according to known system requirements and priorities. Allocations will only be made to providers who previously qualified under this RFPQ. The funding allocation process will be a formal one, requiring MHASD to document their findings and determinations in writing that lead to specific funding allocations or to the continuation of funding allocations. Vendors may not protest funding allocation decisions. Funding allocation decisions will be made from an overall County system of care perspective. Since the allocation process considers a variety of factors, funding may go to qualified Proposers who did not earn the highest overall RFPQ qualified score. Therefore, it will be possible to qualify under this RFPQ process and not receive a funding allocation due to resource limitations and other factors. The Department cannot predict a case load for these services and does not guarantee any particular volume of business will be offered to any applicant who qualifies to provide services, nor is there any guarantee that the MHASD will use the services of any applicant who is issued a contract by virtue of this application. After Purchasing provides written solicitation results to all Proposers and with the completion of the separate allocation process by MHASD, MHASD staff will contact the successful and qualified Proposer(s) who will receive an allocation for contract negotiations. The County will be awarding Requirements Contracts for these services. Requirements Contracts do not guarantee any level of funding and funding levels may change from year to year. All Proposers seeking to provide services must submit a proposal and receive a minimum of 70% of the total points possible in order to qualify. The County reserves the right to qualify additional suppliers for these services as it deems necessary. All qualified suppliers will be added to one vendor pool, from which contracts will be awarded through the allocation process. CONTRACT TERM Fixed term.  The contract term shall be five (5) years, with funding added every fiscal year (July 1 - June 30) based on total available funding and service priorities. The effective date of any resulting contracts shall be approximately July 1, 2020, or later if other contractors are qualified after the initial allocation process. The end date shall be June 30, 2025. COMPENSATION AND METHOD OF PAYMENT The Cost Reimbursement payment method reflects a purchase arrangement in which the County pays the provider for budgeted agreed-upon costs that are actually incurred in the delivery of services specified in the contract, up to a stated maximum obligation. Unit Rate (also known as Fee for Service), pricing is based on the delivery of a defined unit of service. The unit of service is defined in the Multnomah Other fee schedule. Capacity, in rare instance MHASD may fund a service based on a flat capacity payment. The primary example of this payment method is for Residential Treatment Capacity, which funds capacity in addition to actual utilization. INSURANCE REQUIREMENTS Exhibit 2, located in the Buyer Attachments page of this sourcing ev


About Multnomah County

Multnomah County cares about equity in purchasing and contracting. We are committed to working with State Certified Firms and encourages Minority, Women and Emerging Small Business (MWESB), Service Disabled Veteran (SDV) firms and Disadvantaged Business Enterprises (DBE) to compete for our contracting opportunities.

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You can find the authoritative listing for procurement opportunities on our Bids and Opportunities webpage,

If your firm is interested in an opportunity posted on our webpage, we'd love to hear from you. Here's how:

  1. First, read over the opportunity description.
  2. Next, go to the Multnomah County Bids and Opportunities page for this specific solicitation:
  3. Please review all of our solicitation documents carefully, to ensure that the opportunity is is a good fit for your firm!
  4. Register for the solicitation here. This will ensure you receive any addenda or updates that we may post from time to time.
  5. That's it! You'll receive an email confirming your interest. If you have questions, please contact the Purchasing Contact assigned to the project, or visit our Contact Us page.

Multnomah County competitively procures materials and services, taking into consideration the best combination of price, quality and service. We look forward to hearing from you. Whether this is your first bid proposal, or you've worked with us before, we look forward to doing business with you.