1-6 -Attachment H - Blank RFP Budget for MH (1).xlsx

This is a blank RFP budget submission form for Community Behavioral Health Center services issued by Montgomery County Department of Health and Human Services, Office of Mental Health, in Pennsylvania. The RFP seeks proposals from behavioral health providers to deliver prevention and student assistance program services, as well as intervention services, to Montgomery County Public School Districts serving kindergarten through grade 12 students. The county is divided into two service clusters encompassing four regions, with one provider to be selected per cluster; selected providers may provide services across multiple clusters. The budget form requires submission of comprehensive cost projections organized into multiple expense categories including staff and habilitation, room and board maintenance, property and equipment, transportation, residential adaptation, and agency administration costs. Applicants must also project anticipated revenue from sources such as HealthChoices (Magellan), third-party insurance, and other income sources, with the final amount requested from Montgomery County calculated as total expenses minus anticipated income.

The budget submission template requires detailed line-item accounting with specific cost center codes and mandates that variance from baseline projections be noted and explained at a three percent threshold. Applicants must provide supporting schedules for wages and salaries, specifying position titles, hours, full-time equivalent status, and annual salary rates for each staff position. The form includes sections for capital equipment and asset procurement, requiring itemization of quantities, descriptions, and cost eligibility determinations for items in specific budget categories. While the document does not specify explicit funding amounts, set-asides for disadvantaged enterprises, incumbent vendor information, or formal response deadlines, it establishes the financial framework for evaluating proposals based on organizational capacity to deliver integrated prevention, student assistance, and intervention services across the designated school district regions in Montgomery County.