1. Master Respite Application Requirements.6.5.17~1.docx
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- Solicitation number
- BD-18-1022-DMH08-8220A-18593
- Issued by
- Massachusetts
About this file
This document contains the application requirements for a Request for Applications (RFA) issued by the Massachusetts Department of Mental Health (DMH) to establish a pool of qualified providers for Site-Based Respite and Mobile Respite Services. DMH is seeking to enter into a Master Agreement with all qualified providers to allow DMH Areas to purchase these services on an as-needed basis. The application requirements outline the information needed from applicants, including details on the applicant's background and organizational structure, staff qualifications, service model and delivery, site-based and mobile respite offerings, quality management, and reporting requirements. Applicants must submit responses in a specific format and address all requested information to be considered for the Master Agreement.
The RFA provides details on the Respite Services, including the service components, service principles and goals, and operational standards. Applicants must demonstrate their qualifications to deliver these services and meet the stated requirements. The Master Agreement will allow DMH to purchase Site-Based and Mobile Respite Services as needed from the pool of qualified providers.
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APPLICATION REQUIREMENTS
NOTE: Separate Responses must be filed for Site-Based and Mobile Respite. If an Applicant wants to qualify for more than location for Site-Based Respite or more than one DMH Site Office for Mobile Respite, then it will be necessary for the Applicant to complete certain parts of the response multiple times, one for each location or Site Office. Please watch for instructions in these Requirements as to when this must be done.
1. Application Cover Sheet: The Applicant must submit a completed Application Cover Sheet that is located in the Attachment section of the COMMBUYS File of this Bid. The Cover Sheet must be signed by an individual authorized to negotiate for and execute the contract on behalf of the Applicant. The Cover Sheet must specify if the Application is for Site-Based or Mobile Respite. It the Application is a re-application for a location or a DMH Site Office, the Cover Sheet must include a summary of the how this Application is different from the one previously filed for this location or Site Office.
2. Application Format: The Application must contain a Table of Contents and be in the following format:
· type-written 12 point Times New Roman font
· 8 ½ X 11 inch paper
· double sided (hard-copies)
· fully justified (print fully abuts both margins)
· single-spaced
· page numbers at the bottom of each page
| 3. | Design of the Application |
| a. | The Application must respond to each question and request for information in the Application Chart below. |
| b. | The Application Requirements Chart has been divided into Categories. The Application must be similarly divided into the same Categories and the information provided in each Category must be in the same order as it is asked for in the Application Requirements Chart. The title of the Category must be inserted in bold on a separate line, before responding to any questions/request for information in that Category. Similarly, the Applicant is instructed to repeat the number and the header of the question/request for information for which they are responding to. For example: |
Category I Applicants Background and Organizational Structure 1 Background
a. Response……..
b. Response….
2 Mission and Philosophy Response……..
Department of Mental Health Respite Services – Master Agreement Request For Applications
DMH # 2017-DMH-3048-03
June, 2017
APPLICATION REQUIREMENTS CHART
An Application may not exceed 20 pages; provided, however, that for Site-Based Respite an Applicant gets Six (6) additional pages for each location it is seeking to qualify for over one (e.g., it an applicant is proposing three (3) locations, it would get an extra 18 pages). Similarly, for Mobile Respite an Applicant gets three additional five (6) pages for each Site Office it is seeking to qualify for over one. The page limit does not include allowable attachments.
An Applicant must respond to all questions and requests for information set forth below. It is important that the Applicant’s Application demonstrates that the Applicant understands and can meet the requirements of the RFR. The Application must be submitted in compliance with the requirements as identified above and must respond to all questions and requests for information set forth below.
CATEGORY I: APPLICANT’S BACKGROUND AND ORGANIZATIONAL STRUCTURE
Questions/Requests For Information
1. Background Subsections 1.2, 1.3 and 1.4; Sections 4, 5 and 6
| a |
| Describe your organization’s history and work experience (include number of years) as it is relevant to providing Respite Services. Identify the length of time your organization has served adults who have serious and/or long term mental illness and identify the types of services provided to these individuals. |
| b |
| As experience in providing behavioral health services is often related to the capabilities, skills and training of key staff or to a specific approach or approaches which have been adopted by an agency, describe how, if at all, those staff capabilities, skills and trainings and/or approaches will be utilized in your Respite Services. |
| c |
| Describe your organization’s track record of success, especially as is relevant to the services Respite Services is expected to provide. Be certain to define success for this purpose. Also indicate the extent to which these successes have been provided in the geographic area you are proposing to serve. |
| d |
| Describe why your organization is capable to take on the provision of Respite Services on an as needed basis. Identify if you organization is on any other Master Service agreement involving Health and Human Services, and what those agreements are. Further describe if you have received any statement of works and/or purchase agreements under the Master Service Agreements and how you agency has been able to address the additional business. If you are unable to provide this information, describe why you feel your organization is qualified to manage a Master Service Agreement. |
2. Mission and Philosophy Subsections 1.3, 1.4 and Section 3
Describe your organization’s mission and philosophy and how Respite Services will fit within the overall mission and direction of your organization. Describe how your organization’s mission and philosophy are consistent with DMH’s vision and mission (Section 3) and the description, principles and goals of Respite Services as set forth in Subsections 1.2, 1.3 and 1.4.
3. Organizational Culture Subsection 1.3 and Section 3
Describe how Recovery, Trauma Informed Care, Person Centered and Strength Based services and peer support are incorporated into the culture of your organization. Give specific examples such as corporate policies and procedures, employee trainings, staff positions, assessment of staff competencies, staff supervision, and quality management to demonstrate your organizational culture.
4. Applicant’s Organizational Support
Describe how your organization will provide oversight, consultation and support for the Respite Services. Attach an organizational chart depicting how the Respite Services will fit in your organizational structure. Describe why this was decided this way and the advantages this structure will provide the Respite services.
5. Other, if Applicable
Other, if applicable. Describe other qualifications of your organization that DMH should consider in determining if your organization is qualified to provide this service.
6. Risk Mitigation Subsection 6.14
Attach your organization’s proposed Risk Mitigation Protocol for Respite Services.
7. Information Technology Requirements Subsection 6.22
Indicate if your organization meets the Information Technology (IT) requirements set forth in Subsection 6.24. If it does not, describe the steps your organization will take to ensure compliance and the expected timeframe to meet these requirements.
8. Privacy and Data Security Subsection 6.21
| a |
| Describe your organization’s internal security and privacy procedures and policies applicable to personal information (including, but not limited to, personal health information). The description should include information on applicable policies and procedures you have regarding electronic, as well as paper information. |
| b |
| Describe the training you provide to employees, Persons Served, and others regarding confidentiality and security and indicate if this if this will be the same training provided to those who will be providing Respite Services; if it will be different, explain how. |
| c |
| Describe the particulars of any circumstances over the past five (5) years in which your organization was involved in a breach or a complaint involving the security, confidentiality or integrity of data of an individual. If a complaint was lodged, indicate what organization(s) was involved in the investigation of the complaint and the outcome of the breach and/or complaint. |
| d |
| Describe the potential circumstances in delivering services where an authorization will be needed from a Person Served to share his/her information. |
9. Corrective Action Plan/Audit Resolution Agreement Subsection 6.23
If your organization is under a Corrective Action Plan (CAP) or Audit Resolution Agreement (ARA), indicate the current status and why this should not be considered in determining if your organization can successfully undertake this Respite Services Contract and fulfill the requirements of the Request for Response (RFR).
10. Debarment Subsection 6.23
Indicate if your agency is now or has ever been subject to a state or federal debarment order. If your organization has been subject to a debarment order, specify the date and the circumstances surrounding it.
11. Complaint Process Subsection 6.15
Attach your proposed complaint process.
CATEGORY II. STAFF POSITIONS, QUALIFICATIONS, AND REQUIREMENTS
COMPLETE A SEPARATE CATEGORY II RESPONSE FOR EACH PROPOSED LOCATION FOR SITE-BASED RESPITE OR DMH SITE OFFICE FOR MOBILE RESPITE FOR WHICH YOU ARE SEEKING TO BE QUALIFIED FOR THE PURPOSE OF THE MASTER SERVICE AGREEMENT
Notes: (1) If the response for each location or Site Office will be identical – just indicate that on the additional Category II Responses; (2) In responding to these Questions/Request For Information assume that you are providing services at your stated capacity level for each location or DMH Site Office.
Questions/Requests For Information
12. Availability
· Identify each location you are proposing for Site-Based Respite and the capacity of each location for referrals from DMH at any one time under a Purchase Agreement.
· Identify each DMH Site Office you are proposing for Mobile Respite and the capacity of the Service for each proposed DMH Site Office for referrals from DMH at any one time.
13. Staff Positions Subsection 6.12.1, Sections 4, 5 and 6
Describe your proposed staffing for this location/Site Office assuming you have received referrals up to you stated capacity. Include as attachments job descriptions, including education training and experience requirements, for all Direct Care Supervisors, all Direct Care Program Staff and managerial and executive staff. Describe how staff will work as an integrated team. Also describe how the multidisciplinary nature of the proposed team(s).
14. Staff Deployment
Subsections 6.12.1, 6.12.2, 6.12.3 Sections 4, 5 and 6
Indicate how your proposed staff deployment will ensure that:
· The services to be provided are adequate and appropriately staffed for Site-Based or Mobile Respite Services.
· The Services will be able to provide the service components set forth in Section 5 as may be required by a Person Served. Address each component in your response (address all ten components) be specific as possible.
· The Services standards set forth in Section 6 will be met. Address the role of staff members in conducting assessments, IAP development, discharge planning and community linkages.
· Staff is appropriately qualified and trained in the areas of assessing and treating persons with serious mental illness and co-occurring disorders, and the Respite Service Principles set forth in Subsection 1.3
· Peers are incorporated into the service model with clearly defined roles and with sufficient support, supervision and consultations. Specify what the defined roles may be.
· All staff receive regular supervision and consultation; and
· Clinical staff is available for consultation.
15. Organizational Chart Subsection 6.12.3
Provide, as an attachment, an organizational chart for the Respite Services to be provided at this location or Site office – that shows reporting/supervision lines.
CATEGORY III. SERVICE MODEL AND SERVICE DELIVERY
Questions/Requests For Information
16. Service Model
Sections 4, 5 and 6, Subsections 1.3 and 1.4.
Subsections1.2, 5.6, 5.10, 6.8 and 6.13)
Subsection 6.1
| a |
| Describe your proposed service model for Site-Based or Mobile Respite Services will |
provide the Respite Services components set forth in Section 5:
· Consultation and Assessments
· Crisis Management
· Symptom Management
· Medication Education and Self Management
· Substance Use Services
· Coordination and Communication with Health Care System
· Support Services
· Skill Building Activities
· Peer Support Services
· Community Inclusion and Social connection
| b |
| Describe how you will partner and coordinate with other stakeholders involved with Person Served, including other DMH service providers. |
| c |
| Describe how you will insure Respite Services will be available and accessible twenty four (24) hours a day, seven (7) days per week. |
17. Service Delivery
Describe your proposed service delivery model for Site-Based/Mobile Respite Services which addresses the following:
| a |
| The rapid response and time limited aspects of Respite Services will be addressed. |
| b |
| The service delivery model will be flexible enough to meet the needs of each Person Served. |
| c |
| Describe how you service delivery model will utilize and integrate peers. |
18. Referrals and Enrollment
Subsections 6.3 and 6.4
Describe your proposed Respite Services referral and enrollments protocols which address the following:
| a |
| How the referral and enrollment procedures will meet the enrollment timelines for both Site-Based and Mobile settings. |
| b |
| How you will seek and document Persons’ Served consent to participate in Respite Services. |
| c |
| Attach a copy of your referral and enrollment protocols. |
19. Assessment
Subsection 6.5
Describe your proposed assessment protocol which addresses the following:
| a |
| How you will meet the timeframes for the completion of assessments. |
| b |
| How assessments will address the reason for referral. |
| c |
| How you will insure assessments are completed by and/or reviewed and signed by a Respite Services clinical staff person. |
| d |
| Attach a copy of your proposed assessment tool(s) and/or relevant form(s). |
20. Individualized Action Plans (IAP)
Subsection 6.6
Describe your Individualized Action Plan protocols which addresses the following:
| a |
| How you will meet the timeframes for the completion of IAPs. |
| b |
| How the findings of the assessment(s), including risk and/or functional assessment(s), will be used to develop IAP goals which promote recovery and resiliency. |
| c |
| How goals and interventions will be developed and designed to address the reason for referral and facilitate rapid discharge from Respite Services. |
| d |
| Identify what potential barriers could exist that would impede a Person’s Served participation in the planning process and how you would address the barriers. |
| e |
| How the Person Served, LAR, if any, and other service providers of the Person Served, including healthcare coordination resources, will engaged in planning activities to insure the Respite Services IAP is person centered and integrated with and complimentary to other IAPs the Person Served may have. |
| f |
| How self-management tools and plans will be developed, as appropriate. |
| g |
| Attach a copy of your proposed Individualized Action Plan form. |
21. Discharge Planning
Subsection 6.7
Describe your Discharge Planning protocols which addresses the following:
| a |
| How barriers to discharge will be identified and planned for. |
| b |
| How other service providers of the Person Served, including healthcare coordination resources, will be engaged in discharge planning activities to insure activities are coordinated? |
| c |
| How discharge planning activities will be reflective of and incorporate the reason for referral to Respite Services. |
| d |
| Attach a copy of your proposed Discharge Plan form. |
22. Records Subsection 6.10
Describe your protocol for how records of Persons Served will be developed, maintained and retained. Specify if records will be manual, electronic or a combination.
22. Medication Subsection 5.4 and 6.12
| a |
| Attach your medication policies and procedures. |
| b |
| Describe your staffing plan for medication administration and training; indicate licensure and/or Medication Administration Program (MAP) certification for staff as is applicable. If an Applicant proposes to meet the staffing requirements for medication administration by MAP certified staff, then it must identify its proposed DPH-registered site in Response Requirement 22. |
CATEGORY IV. SCENARIOS
COMPLETE A SEPARATE CATEGORY IV RESPONSE FOR EACH PROPOSED LOCATION FOR SITE-BASED RESPITE OR DMH SITE OFFICE FOR MOBILE RESPITE FOR WHICH YOU ARE SEEKING TO BE QUALIFIED FOR THE PURPOSE OF THE MASTER SERVICE AGREEMENT
Questions/Requests For Information
| 24. Scenarios |
| a |
| Attach two original scenarios of individuals who could possibly be referred to you for the type of Respite Services for which you are submitting an Application. The scenarios must be for the communities you expect to serve. They must provide background for the individuals and outline the reason(s) why the individuals need the Respite Services. The needs for Respite Services must vary to demonstrate your understanding of the potential client population. |
| b |
| Attach a response for each of your scenarios created in response to 24.a, above, that demonstrates your understanding of the Respite Services components and standards and the Respite Service principles and goals. Also your responses should demonstrate knowledge of resources available in the communities that you expect to serve that could be of benefit to the individuals in your scenarios. The responses should reflect what you included in your application. Be sure to describe potential consultations and assessments; possible contents of the individuals IAPs; anticipated lengths of stay, discharge criteria and what you foresee as the potential barriers to their discharge. |
CATEGORY VI. SITE-BASED LOCATION(S) AND MOBILE RESPITE DMH SITE OFFICE(S)
COMPLETE A SEPARATE CATEGORY VI RESPONSE FOR EACH PROPOSED LOCATION FOR SITE-BASED RESPITE OR DMH SITE OFFICE FOR MOBILE RESPITE FOR WHICH YOU ARE SEEKING TO BE QUALIFIED FOR PURPOSE OF THE MASTER SERVICE AGREEMENT
Questions/Requests For Information
25. Physical Site Site-Based Only Subsection 6.11 Subsection 6.13
| a |
| Identify the city, town or geographic locale where you propose to locate the Respite Services physical site and explain why this location was chosen. If you have an actual or planned location, provide the address, ADA compliance status, and a detailed description of the space. Verify that the physical site is properly zoned for the intended use. Describe the ways in which the physical site can be considered safe and of a size and design that is consistent with the RFR requirements. Describe how individuals will access the physical location including a description of available public transportation, if any. Indicate if the location is leased or owned. Describe why this location was selected |
| b |
| Attach a floor plan for the physical site with room dimensions. If you are proposing to co-locate the Respite Services physical site with another service space to be used by Respite Services and the other service must be clearly identified. |
| c |
| DMH License and DPH Massachusetts Controlled Substance Registration (MCSR). Describe the current status of the proposed physical site in regards to DMH licensure and DPH MCSR. If you currently hold a DMH license and/or DPH MCSR submit a copy as an attachment. For Applicants who do not hold a DMH license and/or DPH MCSR describe your plan for obtaining the needed license and/or registration. If there are any restrictions or conditions on the DMH license that you currently hold, indicate what those restrictions or conditions are. |
| d |
| Describe the collaborations and partnership you have with entities that will assist the person served in the community where the physical site is located. Include the following self-help groups, peer support, advocacy resources and other available community services. |
26. DMH Site Offices
Subsections 1.2, 1.3 and 1.4; Sections 4, 5 and 6
Subsection 6.13
| a |
| Identify the DMH Site Office to which you want to be able to provide Mobile Respite Services. Describe why this Site Office was chosen and why you are qualified to provide Mobile Respite Services to the communities covered by this Site Office. |
| b |
| Indicate if you are able to provide services to all communities served by the Site Office. If you are not able to do so, indicate what communities you are unable to serve and the reasons why. |
| c |
| Describe the collaborations and partnership you have with entities that will assist the person served in these communities. Include the following self-help groups, peer support, advocacy resources and other available community services. |
CATEGORY VII. Quality Management, Reporting Requirements
Questions/Requests For Information
27. Quality Management
Subsection 6.20
| a |
| Describe how QM is embedded in the organizational practices and operations and what, if any, changes you anticipate making based on RFR requirements. |
| b |
| Describe the information and the process you will use to monitor the effectiveness of your services. |
| c |
| Describe how your agency has recently used data to make service improvements following a quality improvement initiative. |
28. Reporting Requirements
Subsections 6.19, 6.20
| a |
| Describe how your agency will collect and submit the data that will allow DMH to monitor and evaluate the provision of services, adherence to RFR requirements, and outcome measures. |
| b |
| Identify potential issues which could arise which would impact your organization’s ability to collect and submit the data and the plan to address these. |
CATEGORY VII. Contract Forms
Questions/Requests For Information
29. Contract Forms
Contract Forms. The following forms must be submitted with the Proposal, as Attachments, unless otherwise indicated.
___ An executed Commonwealth Terms and Conditions for Human and Social Services (1 original)* ___ An executed Massachusetts Form W-9 (1 original)* ___ A Contractor Authorized Signatory Listing (1 original). Note: both pages are required, with the second page notarized) ___ An Executed Standard Contract Form (2 Originals) ___ Authorization for Electronic Funds Payment (1 original)* *Note: If An Applicant has already submitted to DMH or another Commonwealth agency signed Terms and Conditions, Form W-9, and/or Authorization for Electronic Funds Payment as listed above and such are on record with the Office of the Comptroller, it does not need to submit another. If any of these forms are not included in a response, DMH will verify that they are on record with the Office of the Comptroller.
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