Opioid Abuse Prevention Pilot Projects

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1 Opioid Abuse Prevention Pilot Projects GRANT REQUEST FOR PROPOSAL (RFP) Minnesota Department of Health PO Box Saint Paul, MN /23/2018 To obtain this information in a different format, call Printed on recycled paper.

2 Table of Contents Opioid Abuse Prevention Pilot Projects... 1 RFP Part General Information Program Description Funding and Project Dates Eligible Applicants Questions and Answers... 4 RFP Part Priorities Eligible Projects Grant Management Responsibilities Grant Provisions Review and Selection Process RFP Part Application Deadline Application Submission Instructions Application Instructions RFP Part 4: Attachments Attachment A: Application Form Attachment B: Application Evaluation Criteria and Score Sheet

3 RFP Part 1 OPIOID ABUSE PREVENTION PILOT PROJECTS GRANT RFP 1.1 General Information Announcement Title: Opioid Abuse Prevention Pilot Projects Minnesota Department of Health (MDH) Program Website: Application Deadline: Monday, February 26, 2018 (physical submission by 4:30 p.m. or electronic submission by 11:59 p.m.) 1.2 Program Description Minnesota Statutes (M.S.) Section 143 of Minnesota Session Law 2017 and M.S and Laws of Minnesota 2017, 1st Special Session, Chapter 6, Article 10, Section 144 direct the commissioner of health to establish opioid abuse prevention pilot projects in geographic areas throughout the state based on the most recently available data on opioid overdose and abuse rates, to reduce opioid abuse through the use of controlled substance care teams and community-wide coordination of abuse-prevention initiatives. 1.3 Funding and Project Dates Funding Approximately $700,000 of state general funds are available for these grants. Up to ten awards may be made, ranging from $50,000 to $150,000. At least one of the awards will be made to one of Minnesota s Tribal Nations or to an agency or organization serving Minnesota s urban American Indians. Funding will be allocated through a competitive process. If selected, you may only incur eligible expenditures when the grant agreement is fully executed and the grant has reached its effective date. Funding may be used for program and personnel costs at the discretion of the applicant in order to achieve grant objectives. Funding Estimate Estimated Amount to Grant $700,000 Estimated Number of Awards 10 Estimated Award Maximum $150,000 Estimated Award Minimum $50,000 Match Requirement There is no match requirement. 3

4 Project Dates OPIOID ABUSE PREVENTION PILOT PROJECTS GRANT RFP The estimated project start date is March 30, The projected end date is February 29, Eligible Applicants Eligible applicants include tribal governments, local units of government, health care providers, health plan companies or other entities. See section 2.2 for a review of mandatory requirements for applicants. Mandatory requirements are essential to the success of the project. Collaboration Multi-organization collaboration is welcomed and encouraged. The state recognizes that prevention will happen only as we work together. 1.5 Questions and Answers Prospective responders who have any questions regarding this request for proposal must submit all questions in writing only to the Injury website: Health.injuryprevention@state.mn.us. In the subject line of the , include this phrase: Opioid Pilot Project RFP Question. All questions received and MDH s answers to those questions and comments will be posted at and can be accessed by navigating to that URL, viewing the right hand navigation bar, and clicking on the subheading entitled Opioid Pilot Project RFP Question Responses. Responses to all questions received by the close of business on Monday, February 19, 2018, will be posted to the above web site by the close of business, Wednesday, February 21, Responses to questions received earlier will be posted by the close of each business day. Other MDH personnel are NOT authorized to discuss this request for proposal with responders before the proposal submission deadline. To ensure the proper and fair evaluation of all applications, other communications regarding this RFP including verbal, telephone, written or internet initiated by or on behalf of any applicant to any employee of the Department, other than questions submitted to as outlined above, are prohibited. Any violation of this prohibition may result in the disqualification of the applicant. 4

5 RFP Part Priorities Health Equity Priorities OPIOID ABUSE PREVENTION PILOT PROJECTS GRANT RFP It is the policy of the State of Minnesota to ensure fairness, precision, equity and consistency in competitive grant awards. This includes implementing diversity and inclusion in grant making. The Policy on Rating Criteria for Competitive Grant Review establishes the expectation that grant programs intentionally identify how the grant serves diverse populations, especially populations experiencing inequities and/or disparities. Each pilot project must have goals to: (1) reduce emergency room and other health care provider visits resulting from opioid use or abuse, and reduce rates of opioid addiction in the community; (2) establish multidisciplinary controlled substance care teams that may consist of physicians, pharmacists, social workers, nurse care coordinators, and mental health professionals; (3) deliver health care services and care coordination, through controlled substance care teams, to reduce the inappropriate use of opioids by patients and rates of opioid addiction; (4) address any unmet social service needs that create barriers to managing pain effectively and obtaining optimal health outcomes; (5) provide prescriber and dispenser education and assistance to reduce the inappropriate prescribing and dispensing of opioids; (6) promote the adoption of best practices related to opioid disposal and reducing opportunities for illegal access to opioids; and (7) engage partners outside of the health care system, including schools, law enforcement, and social services, to address root causes of opioid abuse and addiction at the community level. This grant will serve Tribal Nations, communities and populations most at risk of drug overdose in Minnesota. Grant outcomes and performance measures will include: changes in the number of opioid prescriptions, the number of emergency room visits related to opioid use and other health care provider visits resulting from opioid use or abuse, changes in rates of opioid addiction in the community, and a strengthened community system to respond to and to prevent drug overdose. The strength of community system measure will be developed, tested and revised by the funded pilot prevention projects. The MDH has contracted with Catholic Health Initiatives (CHI) St. Gabriel s Health Care in Little Falls, MN to conduct evaluation and report results to the chairs and ranking minority members of the legislative committees with jurisdiction over health and human services policy and finance and public safety by December 15,

6 6 OPIOID ABUSE PREVENTION PILOT PROJECTS GRANT RFP 2.2 Eligible Projects Mandatory requirements. Each pilot project must address each of the seven goals described in Section 2.1 (above). Each pilot program must also: Name a physician/prescriber as the program champion for the organization; this champion will also serve as the subject matter expert for prescribers; Agree for at least one prescriber (either with or in collaboration with the organization) to become licensed by the Drug Enforcement Agency (DEA) to prescribe Suboxone and learn to implement a medication assisted treatment (MAT) program; Dedicate the time and resources necessary to support an active multi-disciplinary care team; Seek medical home certification (if not already so certified); Collect measurement and outcome data including: o A registry or panel of patients with chronic opioid prescriptions; o Baseline and tapers; o Payor mix data; o Referrals to community resources and to behavioral/mental health treatment facilities; o Community engagement and participation; o Opioid prescriptions filled from at least one local pharmacy; o Heroin and prescription drug overdoses (fatal and nonfatal) in county/service area; and o Minutes from meetings of a community task force that holds regularly scheduled meetings. Funding may be used for program and personnel costs at the discretion of the applicant in order to achieve grant objectives. Ineligible Expenses Ineligible expenses include but are not limited to: Fundraising Taxes, except sales tax on goods and services Lobbyists, political contributions

7 Bad debts, late payment feeds, finance charges, or contingency funds New construction 2.3 Grant Management Responsibilities Grant Agreement Each awardee must formally enter into a grant agreement. The grant agreement will address the conditions of the award, including implementation for the project. Once the grant agreement is signed, the grantee is expected to read and comply with all conditions of the grant agreement. No work on grant activities can begin until a fully executed grant agreement is in place. Each grantee must formally enter into a grant agreement. The grant agreement will address the conditions of the award, including implementation for the project. Once the grant agreement is signed, the grantee is expected to read and comply with all conditions of the grant agreement. No work on grant activities can begin until a fully executed grant agreement is in place. The funded applicant will be legally responsible for assuring implementation of the work plan and compliance with all applicable state requirements including worker s compensation insurance, nondiscrimination, data privacy, budget compliance, and reporting. Accountability and Reporting Requirements It is the policy of the State of Minnesota to monitor progress on state grants by requiring grantees to submit written progress reports at least annually until all grant funds have been expended and all of the terms in the grant agreement have been met. For the purposes of these grant agreements, the reporting schedule will be: June 30, 2018 September 30, 2018 December 31, 2018 March 31, 2019 June 30, 2019 September 30, 2019 December 31, 2019 February 29, 2020 Grant Monitoring Minn. Stat. 16B.97 and Policy on Grant Monitoring require the following: 7

8 One monitoring visit during the grant period on all state grants over $50,000 Annual monitoring visits during the grant period on all grants over $250,000 Conducting a financial reconciliation of grantee s expenditures at least once during the grant period on grants over $50,000. For monitoring purposes, all pilot projects with awards over $50,000 will have at least one monitoring visit and financial reconciliation by June 30, Technical Assistance The MDH is substantially interested in the success of and lessons learned from these prevention pilot projects. MDH staff members will provide telephone and consultation, with inperson site visits when possible. The MDH has contracted with CHI St. Gabriel s Health Care in Little Falls, MN to provide hands on consultation and technical assistance with some of the daily program level decisions with which the pilot project teams may be confronted. Complete the application included as Attachment A. The background and context section on page 1 of Attachment A is provided as a model for some of the words and phrases to include in your application. Use the outline on page two to guide your written responses. See Attachment B for scoring. Grant Payments Per State Policy on Grant Payments, reimbursement is the method for making grant payments. All grantee requests for reimbursement must correspond to the approved grant budget. The State shall review each request for reimbursement against the approved grant budget, grant expenditures to-date and the latest grant progress report before approving payment. Grant payments shall not be made on grants with past due progress reports unless MDH has given the grantee a written extension. Invoices should be submitted to the MDH project manager on or before the 15 th of each month for the preceding month s activities and expenses. Review of the invoice and approval for payment will occur within five business days of receipt of invoice. 2.4 Grant Provisions Conflicts of Interest MDH will take steps to prevent individual and organizational conflicts of interest, both in reference to applicants and reviewers per Minn. Stat. 16B.98 and Conflict of Interest Policy for State Grant-Making. Applicants must provide a list of all entities with which it has relationships that create, or appear to create, a conflict of interest with the work contemplated by this RFP. The list must provide the name of the entity, the relationship, and a discussion of the conflict. Submit the list as an attachment to the application. If an applicant does not submit a list of conflicts of interest, MDH will assume that no conflicts of interest exist for that applicant. 8

9 Organizational conflicts of interest occur when: 9 a grantee or applicant is unable or potentially unable to render impartial assistance or advice to the Department due to competing duties or loyalties a grantee s or applicant s objectivity in carrying out the grant is or might be otherwise impaired due to competing duties or loyalties In cases where a conflict of interest is suspected, disclosed, or discovered, the applicants or grantees will be notified and actions may be pursued, including but not limited to disqualification from eligibility for the grant award or termination of the grant agreement. Public Data and Trade Secret Materials All applications submitted in response to this RFP will become property of the State. In accordance with Minnesota Statute Section , all applications and their contents are private or nonpublic until the applications are opened. Once the applications are opened, the name and address of each applicant and the amount requested is public. All other data in an application are private or nonpublic data until completion of the evaluation process, which is defined by statute as when MDH has completed negotiating the grant agreement with the selected applicant. After MDH has completed the evaluation process, all remaining data in the applications are public with the exception of trade secret data as defined and classified in Minn. Stat , Subd. 1(b). A statement by an applicant that the application is copyrighted or otherwise protected does not prevent public access to the application or its contents (Minn. Stat , subd. 3(a)). If an applicant submits any information in an application that it believes to be trade secret information, as defined by Minnesota Statute Section 13.37, the applicant must: Clearly mark all trade secret materials in its application at the time it is submitted; Include a statement attached to its application justifying the trade secret designation for each item; and Defend any action seeking release of the materials it believes to be trade secret, and indemnify and hold harmless MDH and the State of Minnesota, its agents and employees, from any judgments or damages awarded against the State in favor of the party requesting the materials, and any and all costs connected with that defense. This indemnification survives MDH s award of a grant agreement. In submitting an application in response to this RFP, the applicant agrees that this indemnification survives as long as the trade secret materials are in possession of MDH. The State will not consider the prices submitted by the responder to be proprietary or trade secret materials. MDH reserves the right to reject a claim that any particular information in an application is trade secret information if it determines the applicant has not met the burden of establishing that the information constitutes a trade secret. MDH will not consider the budgets submitted by applicants to be proprietary or trade secret materials. Use of generic trade secret language

10 encompassing substantial portions of the application or simple assertions of trade secret without substantial explanation of the basis for that designation will be insufficient to warrant a trade secret designation. If a grant is awarded to an applicant, MDH may use or disclose the trade secret data to the extent provided by law. Any decision by the State to disclose information determined to be trade secret information will be made consistent with the Minnesota Government Data Practices Act (Minnesota Statutes chapter 13) and other relevant laws and regulations If certain information is found to constitute trade secret information, the remainder of the application will become public; in the event a data request is received for application information, only the trade secret data will be removed and remain nonpublic. Audits Per Minn. Stat. 16B.98 Subdivision 8, the grantee s books, records, documents, and accounting procedures and practices of the grantee or other party that are relevant to the grant or transaction are subject to examination by the granting agency and either the legislative auditor or the state auditor, as appropriate. This requirement will last for a minimum of six years from the grant agreement end date, receipt, and approval of all final reports, or the required period of time to satisfy all state and program retention requirements, whichever is later. Affirmative Action and Non-Discrimination Requirements for all Grantees The grantee agrees not to discriminate against any employee or applicant for employment because of race, color, creed, religion, national origin, sex, marital status, status in regard to public assistance, membership or activity in a local commission, disability, sexual orientation, or age in regard to any position for which the employee or applicant for employment is qualified. Minn. Stat. 363A.02. The grantee agrees to take affirmative steps to employ, advance in employment, upgrade, train, and recruit minority persons, women, and persons with disabilities. The grantee must not discriminate against any employee or applicant for employment because of physical or mental disability in regard to any position for which the employee or applicant for employment is qualified. The grantee agrees to take affirmative action to employ, advance in employment, and otherwise treat qualified disabled persons without discrimination based upon their physical or mental disability in all employment practices such as the following: employment, upgrading, demotion or transfer, recruitment, advertising, layoff or termination, rates of pay or other forms of compensation, and selection for training, including apprenticeship (Minnesota Rules, part ). The grantee agrees to comply with the rules and relevant orders of the Minnesota Department of Human Rights issued pursuant to the Minnesota Human Rights Act. 10

11 2.5 Review and Selection Process Review Process Funding will be allocated through a competitive process. Applications will be reviewed by a committee that may include representatives from state agencies, local public health, emergency services, law enforcement, social service providers, faith community members, health care providers and content and community specialists with regional knowledge. The review committee will evaluate all eligible and complete applications received by the deadline. Further, the review committee will attempt to recognize and neutralize implicit bias in the review and scoring of applications. MDH will review all committee recommendations and is responsible for award decisions. The award decisions of MDH are final and not subject to appeal. Additionally: MDH reserves the right to withhold the distribution of funds in cases where proposals submitted do not meet the necessary criteria. The RFP does not obligate MDH to award a grant agreement or complete the project, and MDH reserves the right to cancel this RFP if it is considered to be in its best interest. MDH reserves the right to waive minor irregularities or request additional information to further clarify or validate information submitted in the application, provided the application, as submitted, substantially complies with the requirements of this RFP. There is, however, no guarantee MDH will look for information or clarification outside of the submitted written application. Therefore, it is important that all applicants ensure that all sections of their application are complete to avoid the possibility of failing an evaluation phase or having their score reduced for lack of information. Selection Criteria and Weight Attachment B is the score sheet for this RFP. Attachment B includes the selection criteria that will be used to score the application along with the weight of each criterion. The review committee will review each applicant on a 1,000-point scale. A standardized scoring system will determine the extent to which applicants meet the selection criteria. The scoring factors and weight on which applications will be judged are based on the degree to which each of the seven required project goals are addressed in the application and are specific, measurable, attainable, realistic and time-framed. These factors will be assessed in the narrative as the applicant describes their prior experience, their capacity to accomplish their work plan, their strength of community partnerships, and their readiness to implement all aspects of the pilot prevention project proposal in partnership with the contracted evaluator. An adequately detailed budget and narrative must be included as part of the application; the budget, however, is not scored. Required project goals: (1) reduce emergency room and other health care provider visits resulting from opioid use or abuse, and reduce rates of opioid addiction in the community (90 points); 11

12 (2) establish multidisciplinary controlled substance care teams that may consist of physicians, pharmacists, social workers, nurse care coordinators, and mental health professionals (90 points); (3) deliver health care services and care coordination, through controlled substance care teams, to reduce the inappropriate use of opioids by patients and rates of opioid addiction (90 points); (4) address any unmet social service needs that create barriers to managing pain effectively and obtaining optimal health outcomes (90 points); (5) provide prescriber and dispenser education and assistance to reduce the inappropriate prescribing and dispensing of opioids (90 points); (6) promote the adoption of best practices related to opioid disposal and reducing opportunities for illegal access to opioids (90 points); and (7) engage partners outside of the health care system, including schools, law enforcement, community partners and social services, to address root causes of opioid abuse and addiction at the community level (150 points). Meeting the required project goals should lead to achieving these grant outcomes and performance measures: a) changes in (ultimately decreasing) the number of opioid prescriptions; b) decreasing the number of emergency room visits related to opioid use and other health care provider visits resulting from opioid use or abuse; c) decreasing the rates of opioid addiction in the community; and d) building a strengthened community system to respond to and to prevent drug overdose. The strength of community system measure will be developed, tested and revised by the selected pilot prevention projects. The MDH has contracted with CHI St. Gabriel s Health Care in Little Falls, MN to conduct project evaluation. Applicants may suggest other performance measures they believe will indicate project success. Each pilot program must also: o Name a physician/prescriber as the program champion for the organization; this champion will also serve as the subject matter expert for prescribers (40 points); o Agree for at least one prescriber (either with or in collaboration with the organization) to become licensed by the Drug Enforcement Agency (DEA) to prescribe buprenorphine-naloxone (Suboxone) and learn to implement a medication assisted treatment (MAT) program (80 points); o Dedicate the time and resources necessary to support an active multidisciplinary care team (40 points); o Obtain medical home certification (if not already so certified) (20 points); o Collect measurement and outcome data including: 12

13 A registry or panel of patients with chronic opioid prescriptions (10 points); Baseline and tapers (10 points); Payor mix data (10 points); Referrals to community resources and to behavioral/mental health treatment facilities (20 points); Community engagement and participation (40 points); Opioid prescriptions filled from at least one local pharmacy (10 points); Heroin and prescription drug overdoses (fatal and nonfatal) in county/service area (10 points); and Minutes from meetings of a community task force that holds regularly scheduled meetings (20 points). Additional activities may be proposed that, in the estimation of the applicant, will contribute to project success. Grantee Past Performance and Due Diligence Review Process It is the policy of the State of Minnesota to consider a grant applicant's past performance before awarding subsequent grants to them. State policy requires states to conduct a financial review prior to a grant award made of $25,000 and higher to a nonprofit organization, in order to comply with Policy on the Financial Review of Nongovernmental Organizations Notification All applicants, successful and non-successful, will be notified (letter or ) as to the status of their application by March 15, Funded applicants will start work on or before March 30,

14 RFP Part 3 14 OPIOID ABUSE PREVENTION PILOT PROJECTS GRANT RFP 3.1 Application Deadline Applications submitted by courier or postal service must be physically received no later than 4:30 p.m. Central Time, on February 26, 2018 at Suite 220 of the Golden Rule Building, 85 East Seventh Place, Saint Paul, MN Applications submitted electronically must be ed to dana.farley@state.mn.us and received by MDH by 11:59 p.m. on February 26, Late applications will not be accepted. It is the applicant s sole responsibility to allow sufficient time to address all potential delays caused by any reason whatsoever. MDH will not be responsible for delays caused by mail, delivery, computer or technology problems. The applicant will incur all costs incurred in applying to this RFP. 3.2 Application Submission Instructions Applications may be submitted via courier, postal service or . If submitted by courier or postal service, please deliver to: Mr. Dana Farley, MS Drug and Alcohol Policy Prevention Director Minnesota Department of Health P.O. Box 64882, 85 East Seventh Place, Suite 220 Saint Paul, MN If submitted by , please send to: dana.farley@state.mn.us 3.3 Application Instructions You must submit the following in order for the application to be considered complete: Completed Attachment A (includes work plan, budget and budget narrative) Incomplete applications will not be evaluated. Applications must include all required application materials, including attachments. Do not provide any materials that are not requested in this RFP, as such materials will not be considered nor evaluated. MDH reserves the right to reject any application that does not meet these requirements. By submitting an application, each applicant warrants that the information provided is true, correct, and reliable for purposes of evaluation for potential grant award. The submission of inaccurate or misleading information may be grounds for disqualification from the award, as well as subject the applicant to suspension or debarment proceedings and other remedies available by law.

15 All costs incurred in responding to this RFP will be borne by the applicant. 15

16 RFP Part 4: Attachments Attachment A: Opioid Abuse Pilot Project Application Form Attachment B: Application Evaluation Criteria and Score Sheet 16

17 Attachment A: Opioid Abuse Pilot Project Application Form Opioid Abuse Prevention Pilot Projects An organization requesting participation as a Pilot Project with the Opioid Abuse Prevention Program will complete and submit this application to the Minnesota Department of Health. Applications will be reviewed in partnership with CHI St. Gabriel s Health, Little Falls, MN. Organizations requesting participation agree to the terms/expectations as part of participation, as defined below. Organization: Number of Primary Care Providers Number of Clinic Sites Name of Clinic(s)/Locations: Primary Contact: Phone: Physician Champion: Phone: CE0/Director/Admin Champion: Phone: Background and context: The Morrison County Prescription Drug Task Force and CHI St. Gabriel s Family Medical Center s Controlled Substance Care Team work collaboratively to reduce opioid use and abuse in Morrison County. They use a team-based, non-punitive approach to evaluate each patient using opioids for chronic pain and work to taper medications to safer doses for those truly needing the medication, taper off or stop those whom are abusing or diverting their medications, and monitor each patient and prescription. Using both nurse and social worker, they thoroughly evaluate each situation and person for additional social or medical needs, treating the whole person. Additionally, they work closely with community organizations and law enforcement to gain additional insight into our patients in efforts to keep our community safe and healthy. The St. Gabriel s team-based program has substantially reduced opioid prescribing and diversion. The St. Gabriel s approach also includes the use of buprenorphinenaloxone (Suboxone) prescribers. This allows for broader spectrum response to addiction thus reaching an often neglected and underserved patient population. All efforts are reproducible and necessary in order to address and treat the opioid epidemic. 17

18 Instructions (Application Guidance for Preparing your Detailed Work Plan and Timeline) Please use Attachment B as a guide to preparing and scoring your application. This will help to insure that all components are included in your proposal. It is expected that Attachment A (the completed application form) may require from five to ten pages; it should not exceed ten pages. Parameters: one-inch margins and size 12 font are required. It is the applicant s choice to single, 1.5 or double-space. Tables and charts may be single-spaced. Demonstrate to the reviewer the ability to start work within 14 days of signing the approved contract. 18

19 Project Goals: OPIOID ABUSE PREVENTION PILOT PROJECTS GRANT RFP Please describe your plan to accomplish the seven required goals. Detail and describe the major tasks to be accomplished in order to achieve the required components of the legislatively mandated community prevention projects. In your response, please o Briefly explain any initiatives currently in progress or planned within your organization to address opioid overdose prevention. o Briefly describe your plan and objectives. Objectives should be specific, measureable, attainable, realistic and time-framed. o Provide any information relevant from your community perspective. o Describe your prior experience, your capacity to accomplish your work plan, your strength of community partnerships, and your readiness to implement all aspects of the pilot prevention project proposal in partnership with the contracted evaluator. Responses should be one to three paragraphs for each of the seven project goals. Goal 1: Reduce emergency room and other health care provider visits resulting from opioid use or abuse, and reduce rates of opioid addiction in the community. Applicant Response: Goal 2: Establish multidisciplinary controlled substance care teams that may consist of physicians, pharmacists, social workers, nurse care coordinators, and mental health professionals. Applicant Response: Goal 3. Deliver health care services and care coordination, through controlled substance care teams, to reduce the inappropriate use of opioids by patients and rates of opioid addiction. Applicant Response: Goal 4. Address any unmet social service needs that create barriers to managing pain effectively and obtaining optimal health outcomes. Applicant Response: Goal 5. Provide prescriber and dispenser education and assistance to reduce the inappropriate prescribing and dispensing of opioids. Describe the types of training to be delivered to whom, by whom and how. Applicant Response: Goal 6. Promote the adoption of best practices related to opioid disposal and reducing opportunities for illegal access to opioids. Applicant Response: 19

20 7. Engage partners outside of the health care system, including schools, law enforcement, and social services, to address root causes of opioid abuse and addiction at the community level. Applicant Response: 20

21 Budget and Budget Narrative An adequately detailed budget (salary, fringe benefits, travel, supplies, contractual and indirect costs) and budget narrative must be included as part of the application to document how funds will be used to accomplish program objectives; the budget is not scored. 21

22 Project Activities (the output and outcome measures) Name a physician/prescriber as the program champion for the organization and, in one to three sentences, describe the background, rationale, and interest of this program champion; this champion will also serve as the subject matter expert for prescribers (40 points); Identify at least one prescriber (either with or in collaboration with the organization) who is or will become licensed by the Drug Enforcement Agency (DEA) to prescribe buprenorphinenaloxone (Suboxone) and learn to implement a medication assisted treatment (MAT) program (80 points); Dedicate the time and resources necessary to support an active multi-disciplinary care team; describe this in up to a paragraph (40 points); Obtain medical home certification (if not already so certified) and discuss in from one to three sentences how this certification will be useful in your prevention efforts (20 points); In from one to three paragraphs (but not more than one combined page for all eight components below), describe how you will use the following measurement and outcome data to measure the success of your project: A registry or panel of patients with chronic opioid prescriptions (10 points); Baseline and tapers (10 points); Payor mix data (10 points); Referrals to community resources and to behavioral/mental health treatment facilities (20 points); Community engagement and participation (40 points); Opioid prescriptions filled from at least one local pharmacy (10 points); Heroin and prescription drug overdoses (fatal and nonfatal) in county/service area (10 points); and Minutes from meetings of a community task force that holds regularly scheduled meetings (20 points). 22

23 Attachment B: Application Evaluation Criteria and Score Sheet Attachment B is the score sheet for this RFP. Attachment B includes the selection criteria used to score the application along with the weight of each criterion. The review committee will review each applicant on a 1,000-point scale. This standardized scoring system will determine the extent to which applicants meet the selection criteria. The scoring factors and weight on which applications are judged are based on the degree to which each of the seven required project goals are addressed in the application and are specific, measurable, attainable, realistic and time-framed. These factors will be assessed in the narrative as the applicant describes their prior experience, their capacity to accomplish their work plan, their strength of community partnerships, and their readiness to implement all aspects of the pilot prevention project proposal in partnership with the contracted evaluator. An adequately detailed budget and narrative must be included as part of the application; the budget will not be scored. Applicants are encouraged to score their own application using the evaluation score-sheet before submitting their application. This step is not required, but may help ensure applications address the criteria evaluators will use to score applications. 1,000 points are possible. Project Goals 1. Reduce emergency room and other health care provider visits resulting from opioid use or abuse, and reduce rates of opioid addiction in the community. 2. Establish multidisciplinary controlled substance care teams that may consist of physicians, pharmacists, social workers, nurse care coordinators, and mental health professionals. 3. Deliver health care services and care coordination, through controlled substance care teams, to reduce the inappropriate use of opioids by patients and rates of opioid addiction. 4. Address any unmet social service needs that create barriers to managing pain effectively and obtaining optimal health outcomes. 5. Provide prescriber and dispenser education and assistance to reduce the inappropriate prescribing and dispensing of opioids. 6. Promote the adoption of best practices related to opioid disposal and reducing opportunities for illegal access to opioids. Points available

24 7. Engage partners outside of the health care system, including schools, law enforcement, and social services, to address root causes of opioid abuse and addiction at the community level. 150 Project Goals Point Total (max 690) Meeting the required project goals should lead to achieving these grant outcomes and performance measures: a) changes in (ultimately decreasing) the number of opioid prescriptions; b) decreasing the number of emergency room visits related to opioid use and other health care provider visits resulting from opioid use or abuse; c) decreasing the rates of opioid addiction in the community; and d) building a strengthened community system to respond to and to prevent drug overdose. Applicants may suggest other performance measures they believe will indicate project success. Project Activities Name a physician/prescriber as the program champion for the organization; this champion will also serve as the subject matter expert for prescribers Agree for at least one prescriber (either with or in collaboration with the organization) to become licensed by the Drug Enforcement Agency (DEA) to prescribe buprenorphine-naloxone (Suboxone) and learn to implement a medication assisted treatment (MAT) program Dedicate the time and resources necessary to support an active multidisciplinary care team Points Available Seek medical home certification (if not already so certified) 20 Collect measurement data on a registry or panel of patients with chronic opioid prescriptions 10 Collect measurement data on baseline and tapers 10 Collect measurement data on payor mix 10 24

25 Collect measurement data on referrals to community resources and to behavioral/mental health treatment facilities 20 Collect measurement data on community engagement and participation 40 Collect measurement data on opioid prescriptions filled from at least one local pharmacy Collect measurement data on heroin and prescription drug overdoses (fatal and nonfatal) in county/service area Collect measurement and outcome data on minutes from meetings of a community task force that holds regularly scheduled meetings Project Activities Point Total (max 310) 25

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