0.a. Solicitation No. 15BCTS23Q00000023 - Greenville, SC.pdf
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- Solicitation number
- 15BCTS23Q00000023
About this file
This solicitation requests proposals for outpatient substance use disorder, medication assisted treatment, mental health, and sex offender treatment services in Greenville, South Carolina. Offerors must provide individual and group counseling, intake assessments, treatment planning, medication administration and monitoring at fixed prices. The Department of Justice Bureau of Prisons seeks these services from the date of award through a base period of 12 months and up to four 12-month option periods, or a potential six-month extension. The solicitation is set aside for small businesses and offers are due by December 26, 2023. Award is anticipated to be made within 90 days thereafter.
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Other files
| File | Type | Posted |
|---|---|---|
| 6. Quotation Attachment Form.xlsx | XLSX spreadsheet | |
| 0. Cover Letter - Greenville, SC.pdf | ||
| 3. Technical Quotation Information Packet.docx | DOCX document | |
| 4. Business Quotation Information Packet.pdf | ||
| 5. Whistleblower Information.pdf | ||
| 2. CTS 2022 Statement of Work.pdf | ||
| 1. Section 2.1, Continuation of SF-1449.pdf |
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15BCTS23Q00000023 Page 1 of 90
SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES
NOTE: OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24 AND 30.
1. REQUISITION NUMBER PAGE 1 OF
5. SOLICITATION NUMBER
15BCTS23Q00000023
2. CONTRACT NUMBER 3. AWARD/EFFECTIVE
DATE
4. ORDER NUMBER 6. SOLICITATION ISSUE
DATE
11/28/2023
7. FOR SOLICITATION
INFORMATION CALL:
a. NAME
Coretta MaGee cmagee@bop.gov
b. TELEPHONE NUMBER (No collect calls)
202-598-6114
8. OFFER DUE DATE / LOCAL
TIME
12/26/2023 12:00 ET
CODE 15BCTS
Federal Bureau of Prisons
Community Treatment Services Contracting
320 First Street NW
Suite 901-5
Washington, DC 20534
9. ISSUED BY UNRESTRICTED OR X SET ASIDE:100.00 % FOR
X SMALL BUSINESS
HUBZONE SMALL
BUSINESS
SERVICE-DISABLED
VETERAN-OWNED
SMALL BUSINESS
(SDVOSB)
WOMEN-OWNED SMALL
BUSINESS (WOSB)
ECONOMICALLY DISADVANTAGED
WOMEN-OWNED SMALL BUSINESS
(EDWOSB)
8(A)
NORTH AMERICAN
INDUSTRY CLASSIFICATION
STANDARD (NAICS):
621420
SIZE STANDARD:
19,000,000
10. THE ACQUISITION IS
SEE SCHEDULE
11. DELIVERY FOR FREE ON BOARD
(FOB) DESTINATION UNLESS
BLOCK IS MARKED
12. DISCOUNT TERMS
13a. THIS CONTRACT IS A
RATED ORDER UNDER THE
DEFENSE PRIORITIES AND
ALLOCATIONS SYSTEM -
DPAS (15 CFR 700)
13b. RATING
X REQUEST
FOR QUOTE
(RFQ)
INVITATION
FOR BID
(IFB)
REQUEST
FOR
PROPOSAL
(RFP)
14. METHOD OF SOLICITATION
15B300CODE15. DELIVER TO
Federal Bureau of Prisons South East Regional Office 3800 Camp Creek PKWY SW Building 2000 Atlanta, GA 30331
CODE 15BCTS16. ADMINISTERED BY
Federal Bureau of Prisons Community Treatment Services Contracting 320 First Street NW Suite 901-5 Washington, DC 20534
Coretta MaGee
(O) 202-598-6114 cmagee@bop.gov
FACILITY
CODE
CODE
TELEPHONE NUMBER
17a. CONTRACTOR/
OFFEROR
15B300CODE18a. PAYMENT WILL BE MADE BY
Federal Bureau of Prisons South East Regional Office 3800 Camp Creek PKWY SW Building 2000 Atlanta, GA 30331
BOP-RSD-CRBCTS-BILL-ATL@bop.gov
17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN
OFFER SEE ADDENDUM
18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK
BELOW IS CHECKED
19.
ITEM NUMBER
20.
SCHEDULE OF SUPPLIES/SERVICES
21.
QUANTITY
22.
UNIT
23.
UNIT PRICE
24.
AMOUNT
Delivery Date: 12/01/2023
Outpatient substance abuse (SU), Medication Assisted Treatment (MAT), Mental Health (MH) & Sex Offender Treatment (SOT) Services in Greenville, SC Firm Fixed Price
See Continuation Sheet(s) (Use Reverse and/or Attach Additional Sheets as Necessary)
25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Government Use Only)
X 27a. SOLICITATION INCORPORATES BY REFERENCE (FEDERAL ACQUISITION REGULATION) FAR 52.212-1, 52.212-4. FAR 52.212-3
AND 52.212-5 ARE ATTACHED. ADDENDA
ARE X ARE NOT ATTACHED
27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED
X 28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN 1 COPIES TO
ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH
OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE
TERMS AND CONDITIONS SPECIFIED.
29. AWARD OF CONTRACT: REFERENCE _____________________________
OFFER DATED _________________ . YOUR OFFER ON SOLICITATION (BLOCK
5) INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH
HEREIN, IS ACCEPTED AS TO ITEMS:
30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)
30b. NAME AND TITLE OF SIGNER (Type or print) 30c. DATE SIGNED 31b. NAME OF THE CONTRACTING OFFICER (Type or print)
Coretta MaGee
31c. DATE SIGNED
AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION IS NOT USABLE
STANDARD FORM 1449 (REV. 11/2021)
Prescribed by GSA - FAR (48 CFR) 53.212
023-23
15BCTS23Q00000023 Page 2 of 90
19.
ITEM NUMBER
20.
SCHEDULE OF SUPPLIES/SERVICES
21.
QUANTITY
22.
UNIT
23.
UNIT PRICE
24.
AMOUNT
32a. QUANTITY IN COLUMN 21 HAS BEEN
RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: _________________________________
32b. SIGNATURE OF AUTHORIZED GOVERNMENT
REPRESENTATIVE
32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT
REPRESENTATIVE
32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT
REPRESENTATIVE
32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE
PARTIAL FINAL
33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED
CORRECT FOR
COMPLETE PARTIAL FINAL
36. PAYMENT 37. CHECK NUMBER
38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY
41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 42a. RECEIVED BY (Print)
41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE
42b. RECEIVED AT (Location)
42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS
STANDARD FORM 1449 (REV. 11/2021) BACK
15BCTS23Q00000023 Page 3 of 90
Table of Contents
Section Description Page Number
Solicitation/Contract Form 1 Commodity or Services Schedule 2 Contract Clauses
DOJ-05 Security of Department Information and Systems DOJ-05 (OCT 2023) DOJ-08 Continuing Contract Performance During a Pandemic Influenza or other National Emergency
(OCT 2007)
52.204-27 Prohibition on a ByteDance Covered Application (Jun 2023) DOJ-02 Contractor Privacy Requirements (JAN 2022) 52.202-1 Definitions (Jun 2020) 52.204-19 Incorporation by Reference of Representations and Certifications (Dec 2014) 52.21-603-70 Contracting Officer's Representative (COR) (June 2012) 52.216-18 Ordering (Aug 2020) 52.216-19 Order Limitations (Oct 1995) 52.216-21 Requirements (Oct 1995) 52.217-8 Option to Extend Services (Nov 1999) 52.232-18 Availability of Funds (Apr 1984) 52.232-19 Availability of Funds for the Next Fiscal Year (Apr 1984) 52.237-7 Indemnification and Medical Liability Insurance (Jan 1997)
BOP 2852.242-71 EVALUATION OF CONTRACTOR PERFORMANCE UTILIZING CPARS (APR
2011) 52.212-3 Offeror Representations and Certifications-Commercial Products and Commercial Services (Nov 2023) 52.212-5 Contract Terms and Conditions Required To Implement Statutes or Executive Orders- Commercial Products and Commercial Services (Nov 2023) 52.203-17 Contractor Employee Whistleblower Rights (Nov 2023) DOJ-01 Whistleblower Information Distribution (Oct 2021) DOJ-03 Personnel Security Requirements For Contractor Employees (Nov 2021) 52.204-21 Basic Safeguarding of Covered Contractor Information Systems (Nov 2021) 52.217-9 Option to Extend the Term of the Contract (Mar 2000)
3 List of Attachments 4 Solicitation Provisions
52.233-2 Service of Protest (Sept 2006) 2852.233-70 Protests Filed Directly with the Department of Justice (NOV 2020) 52.209-7 Information Regarding Responsibility Matters (Oct 2018) 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (Nov 2021) 52.204-26 Covered Telecommunications Equipment or Services-Representation (Oct 2020) 52.216-1 Type of Contract (Apr 1984) 52.217-5 Evaluation of Options (July 1990)
15BCTS23Q00000023 Page 4 of 90
Section 1 - Commodity or Services Schedule
SCHEDULE OF SUPPLIES/SERVICES
CONTINUATION SHEET
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0001 (2001) Substance Use Disorder Treatment Planning and Follow-up
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Base Period: Date of award - 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0002 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Base Period: Date of award - 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0003 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum; Quantity: 48 Estimated Maximum Quantity: 1200
Base Period: Date of award - 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
1,200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0004 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Base Period: Date of award - 12 months
Use the Guaranteed Maximum Quantity when developing the total amount
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0005 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
25 EA $________ $_________________
15BCTS23Q00000023 Page 5 of 90
Base Period: Date of award - 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0006 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 30 Estimated Maximum Quantity: 2640
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
2,640 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0007 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0008 MAT – Follow-Up & Report (4004)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 360
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
360 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0009 MAT - Intake Screening (4005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0010 MAT - Administration of Medication (4045)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Base Period: Date of award - 12 months
20 EA $________ $_________________
15BCTS23Q00000023 Page 6 of 90
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0011 MAT Psychiatric Evaluation & Report (4050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0012 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0013 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 35
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
35 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0014 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0015 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
50 EA $________ $_________________
15BCTS23Q00000023 Page 7 of 90
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0016 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0017 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 1200
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0018 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 1800
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,800 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0019 Case Management Services (6029)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 1200
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0020 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
100 EA $________ $_________________
15BCTS23Q00000023 Page 8 of 90
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0021 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0022 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0023 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0024 Sex Offender Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0025 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 15
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
15 EA $________ $_________________
15BCTS23Q00000023 Page 9 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0026 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 620
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
620 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0027 Sex Offender Group Counseling (6022)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 900
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
900 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0028 Sex Offender Relationship and Parenting Counseling (6032)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0029 (2001) Substance Use Disorder Treatment Planning and Follow-up
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 1: 13 - 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0030 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 1: 13 - 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
15BCTS23Q00000023 Page 10 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0031 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum; Quantity: 48 Estimated Maximum Quantity: 1200
Option Year 1: 13 - 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
1,200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0032 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 1: 13 - 24 months
Use the Guaranteed Maximum Quantity when developing the total amount
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0033 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 1: 13 - 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0034 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 30 Estimated Maximum Quantity: 2640
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
2,640 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0035 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS23Q00000023 Page 11 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0036 MAT – Follow-Up & Report (4004)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 360
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
360 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0037 MAT - Intake Screening (4005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0038 MAT - Administration of Medication (4045)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0039 MAT Psychiatric Evaluation & Report (4050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0040 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS23Q00000023 Page 12 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0041 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 35
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
35 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0042 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0043 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0044 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0045 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 1200
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
1,200 EA $________ $_________________
15BCTS23Q00000023 Page 13 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0046 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 1800
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,800 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0047 Case Management Services (6029)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 1200
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0048 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0049 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0050 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS23Q00000023 Page 14 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0051 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0052 Sex Offender Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0053 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 15
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
15 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0054 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 620
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
620 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0055 Sex Offender Group Counseling (6022)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 900
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
900 EA $________ $_________________
15BCTS23Q00000023 Page 15 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0056 Sex Offender Relationship and Parenting Counseling (6032)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0057 (2001) Substance Use Disorder Treatment Planning and Follow-up
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 2: 25 - 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0058 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 2: 25 - 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0059 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum; Quantity: 48 Estimated Maximum Quantity: 1200
Option Year 2: 25 - 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
1,200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0060 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 2: 25 - 36 months
Use the Guaranteed Maximum Quantity when developing the total amount
15BCTS23Q00000023 Page 16 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0061 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 2: 25 - 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0062 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 30 Estimated Maximum Quantity: 2640
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
2,640 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0063 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0064 MAT – Follow-Up & Report (4004)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 360
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
360 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0065 MAT - Intake Screening (4005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS23Q00000023 Page 17 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0066 MAT - Administration of Medication (4045)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0067 MAT Psychiatric Evaluation & Report (4050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0068 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0069 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 35
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
35 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0070 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS23Q00000023 Page 18 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0071 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0072 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0073 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 1200
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0074 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 1800
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,800 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0075 Case Management Services (6029)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 1200
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS23Q00000023 Page 19 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0076 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0077 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0078 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0079 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0080 Sex Offender Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS23Q00000023 Page 20 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0081 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 15
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
15 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0082 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 620
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
620 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0083 Sex Offender Group Counseling (6022)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 900
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
900 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0084 Sex Offender Relationship and Parenting Counseling (6032)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0085 (2001) Substance Use Disorder Treatment Planning and Follow-up
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 3: 37 - 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
15BCTS23Q00000023 Page 21 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0086 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 3: 37 - 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0087 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum; Quantity: 48 Estimated Maximum Quantity: 1200
Option Year 3: 37 - 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
1,200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0088 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 3: 37 - 48 months
Use the Guaranteed Maximum Quantity when developing the total amount
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0089 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 3: 37 - 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0090 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 30 Estimated Maximum Quantity: 2640
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
2,640 EA $________ $_________________
15BCTS23Q00000023 Page 22 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0091 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0092 MAT – Follow-Up & Report (4004)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 360
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
360 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0093 MAT - Intake Screening (4005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0094 MAT - Administration of Medication (4045)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0095 MAT Psychiatric Evaluation & Report (4050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS23Q00000023 Page 23 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0096 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0097 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 35
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
35 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0098 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0099 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0100 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
10 EA $________ $_________________
15BCTS23Q00000023 Page 24 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0101 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 1200
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0102 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 1800
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,800 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0103 Case Management Services (6029)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 1200
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0104 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0105 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS23Q00000023 Page 25 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0106 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0107 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0108 Sex Offender Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0109 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 15
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
15 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0110 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 620
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
620 EA $________ $_________________
15BCTS23Q00000023 Page 26 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0111 Sex Offender Group Counseling (6022)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 900
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
900 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0112 Sex Offender Relationship and Parenting Counseling (6032)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0113 (2001) Substance Use Disorder Treatment Planning and Follow-up
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 4: 49 - 60 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0114 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 4: 49 - 60 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0115 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum; Quantity: 48 Estimated Maximum Quantity: 1200
Option Year 4: 49 - 60 months
Use the Guaranteed Maximum Quantity when developing the total amount.
15BCTS23Q00000023 Page 27 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0116 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 4: 49 - 60 months
Use the Guaranteed Maximum Quantity when developing the total amount
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0117 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 4: 49 - 60 monthss
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0118 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 30 Estimated Maximum Quantity: 2640
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
2,640 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0119 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0120 MAT – Follow-Up & Report (4004)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 360
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
360 EA $________ $_________________
15BCTS23Q00000023 Page 28 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0121 MAT - Intake Screening (4005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0122 MAT - Administration of Medication (4045)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0123 MAT Psychiatric Evaluation & Report (4050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0124 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0125 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 35
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
35 EA $________ $_________________
15BCTS23Q00000023 Page 29 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0126 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0127 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0128 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0129 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 1200
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0130 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 1800
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
1,800 EA $________ $_________________
15BCTS23Q00000023 Page 30 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0131 Case Management Services (6029)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 1200
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0132 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0133 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0134 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0135 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS23Q00000023 Page 31 of 90
QUANTITY
UNIT UNIT PRICE AMOUNT
0136 Sex Offender Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0137 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 15
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
15 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0138 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 620
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
620 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0139 Sex Offender Group Counseling (6022)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 900
Option Year 4: 49 - 60 months
Use the Estimated Maximum…
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