Question: What are the training requirements to become eligible to contract with MCOs to provide these new crisis services? 

Answer: The Center for Evidence to Practice, in partnership with LDH and MCOs, is planning on a combination asynchronous (on your own), live online, and in person training. The exact hours are not finalized, but at least 16 to 20 hours of pre-service training can be anticipated (possibly more). This will be training focused only on crisis services. Agencies will be expected to provide other orientation training for their employees, including basic first aid, CPR, etc. As part of training, monthly coaching sessions will be scheduled with teams for the first six months of service delivery.

 

Question: We currently have a crisis intervention program at our agency. We provide crisis stabilization and intervention services to clients. In order for us to provide any crisis intervention services to these clients, are we required to apply for the Crisis Response System?  

Answer: All Medicaid behavioral health providers are expected to have a crisis care/urgent care policy or plan for their clients. Crisis care is already a specified part of ACT, PSR, CPST programs. This training is specific for providers that will be part of Louisiana’s new crisis response system and the service definitions specified here at ldh.la.gov/Crisis. For providers to be eligible for contracting with MCOs for these services, they must complete the training as part of the initial launch of these services. 

 

Question: Has LDH thought about including universities in these conversations as part of workforce development? 

Answer: LDH welcomes input from universities as we continue to develop the crisis system.  Currently, LDH is working with Louisiana State University Health Sciences Center – New Orleans (LSUHSC-NO) School of Public Health, through the Center for Evidence to Practiceto: 

• Collaborate with communities throughout Louisiana, developing a readiness process for implementation of these crisis services 
• Develop a training curriculum for crisis providers 
• Identify a potential provider workforce and implement training curriculum and ongoing coaching to ensure appropriate delivery of services; and 
• Develop and conduct continuous quality monitoring & quality improvement activities 

 

Question: What is the anticipated volume for each service? 

Answer: Please find answers related to the Crisis Response System at https://ldh.la.gov/Crisis.

 

Question: What is the per diem reimbursement? 

Answer: In the RFA, Appendix B has all four levels of crisis care and their reimbursement rates listed. 

 

Question: Is the Peer Support Specialist employee a requirement? 

Answer: Peer supports are a key component of best practices in crisis response. Although they may not be specifically required, having peer supports for the person-centered and recovery focused elements of the system are a high priority.  Please see Crisis Response System at https://ldh.la.gov/Crisis.

 

Question: Can I apply for multiple regions? For example I currently provide mobile crisis services in region X can I apply regions Y and Z? 

Answer: Yes, and the applicant should consider the emphasis is on regional coverage. So consider the needs of the entirety of the regions being proposed to cover (not only single parishes within regions). Applicants select the levels of care and the regions they are apply to be trained to serve at the beginning section of the application. 

 

Question: Is there a fee for the training? 

Answer: No; however, agencies should consider the other costs associated with training. These may include team members’ salaries, loss of revenue while in training, costs that may be associated with any travel to and from in-person training events. 

 

Question: Will agencies/providers need to apply each year to cover these services or is this for a particular period of time? 

Answer: If the question is about contracting/credentialing with MCOs to provide services, that would be specific to those contract arrangements, and that is beyond the scope of this RFA. If this is specific to training, once trained, agency staff are ready to provide crisis services as per the service definitions of the state. Contracting/credentialing with the MCOs is a separate process. 

 

Question: Would you consider providing the training twice so that agencies could have their entire staff attend the training?  There may be an issue with maintaining current operations if all staff are being trained at one time. 

Answer: Yes, we would consider. Currently, we are on track to complete the initial training in January 2022 for mobile crisis and community supports. Depending on the demand for a second training, we may schedule a second group to be trained in close timing with the first. Much will depend on how many agencies may need this consideration and the availability of trainers. 

 

Question: Will there be other opportunities to apply if not able to meet current application deadline? 

Answer: This current RFA is for the immediate, initial launch of crisis services. As services are implemented, gaps and needs in service delivery will be assessed for the possibility of additional teams and further groups being trained. 

 

Question: What is meant by the question 4B under leadership– an example of crisis implementation we’ve already done? 

Answer:It is an important part of implementation that the applicant convey that agency leadership understands what the possible demands will be on that agency, that these services fit with the scope and vision of the agency, and that they (particularly in this initial soft launch period) will be actively working with the broader system to problem solve and improve processes. Leadership should consider if the service(s) they are asking their agency to be trained in are achievable within the capacity and capabilities of their agency. Having an example of how similar services have been implemented would build the impression that the agency is ready to take on such service implementation. 

 

Question: I need the email address to send the three letters of recommendations. I have already completed the application. 

Answer: The application is a two-step process. One is the completion of the online application form. The second is sending a minimum of three letters of recommendation/support, via email to [email protected].

 

Question: What are the firewall/boundaries expected between voluntary and involuntary individuals during treatment? Can this be determined through policy and protocol? 

Answer: If the agency provides involuntary crisis services, it is important for the applicant to demonstrate that they understand the voluntary, person-centered, resolution, and recovery focus of this new system in Louisiana. For an agency currently offering involuntary services, they would need to make clear that there would be no confusion for consumers or staff in regards to these services being kept distinctly separate. Yes, this can be determined through policy and protocol; however, those policies would need to hold up in actual practice. 

 

Question: Please explain readiness expectations for an agency in regions where they are not currently providing services but would like to? 

Answer: There is recognition that regions are diverse in crisis service offerings. Some regions already have services in place and others have very little, if any. Selection decisions for this initial launch of services will take into consideration the number of applicants for a region and indications of coverage capacities. We will also be looking for applicant’s ability to develop local collaboration and services in the absence of current structures. 

 

Question: The RFA states that the agency agrees to accept the rates in full however it does not give a timeframe? Is this for one year? 

Answer: The rates have been set and they are being reported in the RFA so that applicants can consider the business planning needed to provide services. It is anticipated that there will be a cost to onboarding team members and a gradual growth towards service capacity. In other words, we don’t anticipate the volume of services to cover all the expenses upfront and applicants should be prepared for that.  Additionally, as volume of services does increase, agencies should be ready to sustain their teams on these rates.

 

Question: Will billing for these services go through each MCO or through a different avenue?  If through the various MCO’s will their varying ways of crisis and crisis follow-up requests protocols be the same? 

Answer: This is beyond the scope of this training RFA. Medicaid billing will go through MCOs. We do intend that part of the training will cover billing and reporting processes; however, that segment of the training is still in development.  

 

Question: Does mobile response refer to individual mobile or a team mobile response? 

Answer: The current system envisioned, and to be trained, is focused on teams of no less than two mobile crisis responders that are supervised by an available, on-call, clinical supervisor (if that clinician is not part of the response team in the field). No mobile crisis response should be planned done with a single responder. For service definitions, please visit https://ldh.la.gov/Crisis. 

 

Question: The rates for crisis services have a 1-hour and per diem difference. Are there guidelines already created for when to utilize which code? 

Answer: This is beyond the scope of the training RFA and will be deferred to LDH to consider in the FAQ distribution. 

 

Question: Is it known where the crisis referrals will come from? 

Answer: Applicants should consider the need for a good working relationship in local regions. Regions will need to know what services are available and how to access them locally. Referring entities, including consumers, will have the capacity to call-in to request care. Initially, during the soft launch, these calls will go to managed care organizations, who will work with the local trained provider to connect them to a level of crisis care. Per the presentations by LDH, the intent is to move these functions to a crisis call center in conjunction with the implementation of the new 988 system. Please note that any selected crisis response applicants will need to build local networks. For example, relationships with law enforcement, may allow for a referral from a 911 caller that does not require police level intervention in a behavioral health crisis. 

 

Question: The RFA states that there are distance and response time requirements for services within regions and this may lend itself to multiple locations but does not list what those are. Has are distance and response times been determined? 

Answer: Each applicant is asked to consider the entirety of a region and how they might disperse its workforce to respond per the service definitions (please visit https://ldh.la.gov/Crisis). Urban and rural response times vary and it is important for applicants to explain their readiness to provide services in both settings. 

 

Question: The RFA states that by submitting, the agency agrees to accept the rates in full. Does that exclude our ability to bill professional codes (90000s) for crisis center/BHCC service line or is this determined by the MCOs? 

Answer:This is beyond the scope of the training RFA and will be deferred to LDH to consider in the FAQ distribution.

 

Question: I submitted the application, wish to withdraw it and resubmit a revised application. May I do that?  

Answer: Yes, please email us at [email protected] to inform us that you are withdrawing your original submission and will be resubmitting a revised application. All deadlines for submission still apply and the new application must be received within the guidelines to be considered.

 

Question: The RFA states that there may be grant funding available. What is the process and steps to access the grants? 

Answer:  There are currently no additional funds or grants available to assist with implementation. However, the state is in ongoing conversations about support options to assist agencies with capacity building. This should not be depended on in this round of applications; however, we will share that information with agencies should such additional support come available. 

 

Question: How many mobile response teams are recommended for each region? 

Answer:  For each level of crisis services (there are four), there will be one provider selected for each region. This could be one provider for all four levels of care, or as many as four providers- each covering a single level of care. Applicants have the ability to select one, two, three, or all four levels of care that they are asking to be considered to be trained to provide. 

 

Question: Will agencies need to apply each year to cover these services or is this for a particular period of time? 

Answer: As services are implemented, there will be an ongoing assessment of coverage, gaps, and needs. Based on that information, new RFAs for additional agencies to be trained may be dispersed. If the question is specific to contractual relations with the MCOs to provide and bill for these services, that would be a discussion between the provider and MCOs. 

 

Question: What if two agencies wanted to work jointly on service delivery? Can they apply jointly or must they apply individually? 

Answer:If the agencies are proposing to offer two different levels of care, they can have similar collaborative answers and discuss that collaboration in their application. However, if they are applying for one (the same) level of care, only one agency can be the applicant as we are looking at the readiness of a maximum of one agency per level of care. Should the two agencies be able to demonstrate the ability to merge for contracting purposes with MCOs, that would be a question beyond the scope of this training RFA and would need to be directed to MCOs as the contracting/credentialing arm of this work. 

 

Question: Our center currently provides 24/7 crisis care in Region X, providing beds for persons experiencing mental health episodes. With that in mind, should an agency apply to provide services other than Mobile Crisis Response (MCR) when only one provider will be selected to provide each service per region? 

Answer: Yes, agencies should apply for each specific level of care (MCR, CBSS, BHCC, CS) they are expressing their readiness to be trained and will be seeking contract with MCOs to provide care for. 

Question: Do you have a time frame for when you will be accepting trainees for Region 1? 

Answer: A provider agency is currently being trained for Region 1.  As we better understand the needs of the regions, as services are implemented, there may be new options for providers to be trained. Please sign up for our mailing list, and you will receive notice of future opportunities for training as they evolve.

Question: What does the mobile crisis unit look like? 

Answer: There will be some local nuances by agency and regional needs; however, all will follow core foundational guidelines. Two people should be available to respond [into the field] and those responders should be supported by an on-call LMHP. Mobile response teams will work collaboratively with the call center(s), sharing information about the crisis and wheat to anticipate as they arrive. The call may even be transferred to the mobile team while they are in transit.  All mobile teams will be taking a person-center, resolution focused, voluntary approach. The teams will work collaboratively with the other parts of the new system (e.g., walk-in centers, community crisis supports, crisis stabilization, etc.) and existing crisis response, as needed, like law enforcement, emergency departments, etc.