15. MASTER Respite Evaluation Tool 6 5 17~1.docx

MASTER AGREEMENT RESPITE SERVICES EVALUATION TOOL WORKSHEET

____-- Site-Based Respite Locations: _________________________________________________

____ Mobile Respite DMH Site Offices: ________________________________________________________________

___ Re-application: Date of original Application__________ Cover sheet includes summary of changes____- (Requirements) See Subsection 9.7 for limits on re-applications.

MINIMUM SUBMISSION REQUIREMENTS CHECKLIST

Part I RFA Application Submission Format (RFA Subsections 9.1, 9.2 and 9.3):

___ Separate applications for On-Site and Mobile Respite ___ Electronic Application was received on COMMBUYS: _________ date and ____ time. (Needs to be submitted before 3/31/2027) ___ Hardcopy Application in a package/box_________ date (Bothe electronic and hard copy need to be submitted prior to review) ____ Application Cover Sheet as a label to Hardcopy Application

Part II Application Format:

1. Application must be in the following format (Application Requirements):

___ 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) ___ one-inch margins ___ single-spaced ___ page numbers at bottom of each page ___ Table of Contents

2. Page Limit and Attachments (RFA Subsection 9.5; Application Requirements) ___ Pages are within stated limit, OR ___ Page limits exceeded, excessive pages removed from the end of Application

___ Attachments limited to those on the List of Permitted Attachments, OR ___ Extra attachments included, but removed by DMH.

3. __- Supplier Diversity Plan Submitted (Optional) ___ Supplier Diversity Plan Form for POS Used

Part III Application Requirements (RFA Subsection 8.3 and Application Requirements) An Application must consist of the following parts:

___ Signed Application Cover Sheet ___ Application ___ An executed original Commonwealth Terms and Conditions for Human and Social Services or DMH verified that an original is on file with the State Comptroller (If by verification, initial ____) ___ An executed original Massachusetts Form W-9 or DMH verified that an original is on file with the State Comptroller (If by verification, initial ____) ___ A Contractor Authorized Signatory Listing (1 original), includes both pages with the second page notarized.

___ Two original Executed Standard Contract Forms ___ An original Authorization for Electronic Funds Payment or verified by DMH that an original has be filed with the State Comptroller (If by verification, initial ____)

The Application will be reviewed and rated in accordance with the criteria set forth in this Evaluation Tool.

DESCRIBE PRELIMINARY REVIEWS, IF ANY, BY WHOM, DATE AND ATTACH INPUT:

Department of Mental Health Respite Services-Master Agreement Request for Applications RFA File Number 2017-DMH-3048-03

APPLICATION REVIEW

For the purpose of evaluating the Application, the Application has been clustered into six (6) different Categories as indicated below. There are two steps to evaluating the Application. The first step is to assign each Application category a rating using the following criteria:

Excellent (E) – The Application is comprehensive, feasible and appropriate. It satisfies all RFA requirements and exceeds many of the requirements. No weaknesses are identified. It demonstrates an excellent understanding of the services to be provided and the issues/barriers that a Contractor may need to address when providing services. It exceeds the needs of DMH.

Very Good (VG) – The Application is comprehensive, feasible and appropriate. It satisfies all RFA requirements and exceeds some of the requirements. Identified weaknesses, if any, are minor. It demonstrates a good understanding of the services to be provided and the issues/barriers that a Contractor may need to address when providing services. It exceeds the needs of DMH.

Good (G) – The Application is comprehensive, feasible and appropriate. It satisfies all the RFA requirements. It has weaknesses and/or does not exceed any specifications. Identified weaknesses, if any, are minor. It demonstrates a reasonable understanding of the services to be provided and the issues/barriers that a Contractor may need to address when providing services. It meets the needs of DMH.

Fair (F) – The Application is not fully comprehensive, feasible or appropriate. It satisfies most, but not all of the RFA requirements. Weaknesses are identified; they may or may not be substantial. It demonstrates a reasonable understanding of the services to be provided and the issues/barriers that a Contractor may need to address when providing services. It does not meet the needs of DMH.

Poor (P) – The Application is not fully comprehensive, feasible or appropriate. It does not satisfy most of the RFA requirements. Weaknesses are identified and they are substantial. It does not demonstrate a reasonable understanding of the services to be provided and the issues/barriers that a Contractor may need to address when providing services. It is not responsive to the needs of DMH.

The second step is to give the Application an overall rating based on the ratings given to each Category and the level of importance (weight) assigned to each Category as indicated below. If an Application has been submitted for more than one location (Site-Based) or DMH Site Office (Mobile Respite), then the Applicant will receive an overall rating for each location/Site. The overall rating will be calculated by using the same scores for Categories I, III and VI for all and using the location/site specific scores for Categories II and IV and V. Applicants were instructed to provide different responses to Categories II and IV; one each for each location/site. To be deemed qualified for a DMH Site Office or location an Applicant must receive an overall rating of “good” for its Application for these locations and sites.

Category Number and Title:

I. Bidder’s Background and Organizational Structure 25% Rating: Excellent, Very Good, Good, Fair, Poor (Circle One)

Base your comments on the evaluation criteria set forth above.

The comment section must be completed if the category is rated “Excellent” or “Very Good” – must indicate what requirements were exceeded, what preferences were met and if applicable, identify points for contract negotiations.

The comment section must be completed if the category is rated “Fair” or “Poor” – must indicate what requirements were not met and what, if any, issues exist.

Provide details. Be specific as to what was missing and/or how the Bidder failed to meet the specified requirement and/or how the Bidder exceeded requirements. It is not enough to say requirements were not met or were exceeded.

___ Bidder’s history and work experience is relevant to providing Respite Services.

___ The staff capabilities, skills and trainings and/or approaches described by the Bidder are consistent with the requirements of the RFA and it is reasonable to believe they will meet the needs of individuals to be served and DMH.

___ The Bidder has a track record of success and it is reasonable to believe the organization is capable of taking on the Contract.

___ The Bidder appears to understand that this service will be purchased on as needed and that it will be able to provide the services on that basis.

___ The Bidder describes a mission and philosophy that is consistent with DMH and with the principles and goals of Respite Care. (Section 3 and Subsection 1.3 and 1.4)

___ Recovery, Trauma Informed Care, Person Centered and Strength based Services and Peer Support appear to be incorporated into the Applicant’s culture as demonstrated by its examples. (Subsection 1.3)

___ It is reasonable to believe the Bidder’s has an organizational structure that will provide adequate oversight, consultation and support for Respite Services.

___ The Bidder’s Risk Mitigation Protocol is appropriate for Respite Services and is consistent with the DMH Community Risk Policy. (Subsection 6.14) ___ It is reasonable to believe the Bidder has the IT infrastructure to execute the requirements set forth in RFA Subsection 6.22 or has proposed a sound and reasonable plan to insure the requirements will be met by the start of the Contract.

___ It is reasonable to believe the Bidder’s internal privacy and data security policies and procedures are appropriate for Respite Services. (Subsection 6.21)

___ Bidder indicates its CAP or ARA status. If the Bidder is under a CAP/ARA it is reasonable for DMH to believe that the Bidder can still successfully undertake the Contract. (Subsection 6.23)

___ Bidder indicates its debarment status. (Subsection 6.23)

___ Bidder’s proposed complaint process is in compliance with DMH Regulations. (Subsection 6.15)

Category Number and Title:

II. Staff Positions, Qualifications, and Requirements 20% Rating: Excellent, Very Good, Good, Fair, Poor (Circle One)

If an Applicant wants to qualify for more than one location (Site-Based) or Site Office (Mobile) the Applicant needed to submit a different response to Category II for each location/Site Office for which it wants to be qualified. THE REVIEW COMMITTEE NEEDS TO COMPLETE THIS CATEGORY II WORKSHEET FOR EACH LOCATION/SITE OFFICE RESPONSE THE APPLICANT SUBMITTED AND GIVE EACH RESPONSE A CATEGORY II RATING.

Base your comments on the evaluation criteria set forth above.

The comment section must be completed if the category is rated “Excellent” or “Very Good” – must indicate what requirements were exceeded, what preferences were met and if applicable, identify points for contract negotiations.

The comment section must be completed if the category is rated “Fair” or “Poor” – must indicate what requirements were not met and what, if any, issues exist.

Provide details. Be specific as to what was missing and/or how the Bidder failed to meet the specified requirement and/or how the Bidder exceeded requirements. It is not enough to say requirements were not met or were exceeded.

___ Bidder’s proposed staff positions are reasonable to Respite Services in regards to titles and proposed roles, number of FTEs and the number of salaried staff. The staff is multidisciplinary in nature and the Applicant has a plan ensures that there will be integration between staff serving Persons Served to ensure communication and appropriate care. (Section 4, 5 and 6)

___ Bidder’s proposed staff positions are aligned with the clinical expectations of Respite Services. Subsection 6.12.1 and Section 6

___ Bidder’s proposed staffing meet the staffing requirements set forth in Subsection 6.12.1.

___Proposed job descriptions are reasonable for the proposed positions.

___It is reasonable to believe that the proposed staff deployment will ensure that all service components will be available as needed by Persons Served and that service standards will be met.

___It is reasonable to expect that Staff will be 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. (Subsections 6.12.2 and 1.3)

___Peers are incorporated into the service model with clearly defined roles and with sufficient support, supervision and consultations. (Subsections 6.12.3, 1.3 and 5.3)

___ Proposed staffing organizational chart clearly depicts a staffing and supervision structure that supports the implementation of the requirements of the RFA. (Subsection 6.12.3)

Category Number and Title:

III. Service Model and Service Delivery 20% Rating: Excellent, Very Good, Good, Fair, Poor (Circle One)

Base your comments on the evaluation criteria set forth above.

The comment section must be completed if the category is rated “Excellent” or “Very Good” – must indicate what requirements were exceeded, what preferences were met and if applicable, identify points for contract negotiations.

The comment section must be completed if the category is rated “Fair” or “Poor” – must indicate what requirements were not met and what, if any, issues exist.

Provide details. Be specific as to what was missing and/or how the Bidder failed to meet the specified requirement and/or how the Bidder exceeded requirements. It is not enough to say requirements were not met or were exceeded.

___ The Bidder proposes a service model for Respite that will adequately assure that the components in Section Five will be available and provided as needed by Persons served. In addition it is reasonable to believe that the Services will meet the service standards, Respite principles and goals. (Subsections 1.3 and 1.4, Sections 5 and 6)

___ Proposed service model describes how Respite Services will partner and coordinate with other stakeholders involved with Persons Served. (Subsections1.2, 5.6, 5.10, 6.8 and 6.13)

___ Proposed service model will insure Respite Services are available and accessible 24 hours/day, 7 days/weeks. (Subsection 6.1, 6.12.1)

___ The Bidder proposes a service delivery model which has the capacity to rapidly respond to Persons Served referred for Respite Services. (Subsection 6.4)

___ Proposed service delivery model reflects the time limited nature of Respite Services. (Subsection 6.4)

___ Service model is designed to be flexible to meet the needs of each person served. (Section 4) ___ Proposed service delivery model fully utilizes and integrates peers. (Subsection 5.9, 1.3 and 5.3)

___ Referral and Enrollment protocols meet the requirements of the RFA, including obtaining consent to participate. (Subsections 6.3 and 6.4)

___ Assessment protocols and assessment tools/forms meet the requirements of the RFA, including requirement that assessments are completed by or reviewed and signed by a Respite Service clinical staff person. (Subsection 6.5)

___ IAP protocols and IAP Form meet the requirements of the RFA. (Subsection 6.6)

___ Discharge planning protocols and Discharge Plan Form meets the requirements of the RFA. (Subsection 6.7)

___ Records protocols meet the requirements of the RFA. (Subsection 6.10)

___ Medication requirements of Subsection 5.4 and 6.12 are met

Category Number and Title:

IV. Scenarios 10% Rating: Excellent, Very Good, Good, Fair, Poor (Circle One)

If an Applicant wants to qualify for more than one location (Site-Based) or Site Office (Mobile) the Applicant needed to submit a separate response to Category IV for each location/Site Office for which it wants to be qualified. THE REVIEW COMMITTEE NEEDS TO COMPLETE THIS CATEGORY IV WORKSHEET FOR EACH LOCATION/SITE OFFICE RESPONSE THE APPLICANT SUBMITTED AND GIVE EACH LOCATION/SITE OFFICE RESPONSE A SEPARATE CATEGORY IV RATING.

Requested Information

Comments Base your comments on the evaluation criteria set forth above.

The comment section must be completed if the category is rated “Excellent” or “Very Good” – must indicate what requirements were exceeded, what preferences were met and if applicable, identify points for contract negotiations.

The comment section must be completed if the category is rated “Fair” or “Poor” – must indicate what requirements were not met and what, if any, issues exist.

Provide details. Be specific as to what was missing and/or how the Bidder failed to meet the specified requirement and/or how the Bidder exceeded requirements. It is not enough to say requirements were not met or were exceeded.

__Applicant’s scenarios demonstrate a clear understanding of the Respite Services and the individuals expected to be referred for Respite Services.

___Applicant’s responses to its scenarios demonstrate a clear understanding of the Respite Services components and specification, Respite principles and service goals as well as the resources available in the geographic area for which the Application was submitted.

Category Number and Title:

V. Site-Based Location(s) or Respite DMH Site Offices 20% Rating: Excellent, Very Good, Good, Fair, Poor (Circle One)

If an Applicant wants to qualify for more than one location (Site-Based) or Site Office (Mobile) the Applicant needed to submit a separate response to Category V for each location/Site Office for which it wants to be qualified. THE REVIEW COMMITTEE NEEDS TO COMPLETE a CATEGORY V WORKSHEET FOR EACH LOCATION/SITE OFFICE RESPONSE SUBMITTED BY THE APPLICANT AND GIVE EACH LOCATION/SITE OFFICE RESPONSE A SEPARATE CATEGORY V RATING.

Requested Information

Comments Base your comments on the evaluation criteria set forth above.

The comment section must be completed if the category is rated “Excellent” or “Very Good” – must indicate what requirements were exceeded, what preferences were met and if applicable, identify points for contract negotiations.

The comment section must be completed if the category is rated “Fair” or “Poor” – must indicate what requirements were not met and what, if any, issues exist.

Provide details. Be specific as to what was missing and/or how the Bidder failed to meet the specified requirement and/or how the Bidder exceeded requirements. It is not enough to say requirements were not met or were exceeded.

Bidder’s proposed physical site:

___ As described, it is reasonable to believe the physical site will provide adequate space to accommodate Respite Services and meets the requirements of Subsections 6.11 and 6.13.

___ The site appears to be reasonably accessible.

___ The physical site has single occupancy bedrooms to accommodate its proposed capacity.

___ Maximizes use of available public transportation.

___ Is DMH licensed or Bidder proposes a sound plan to obtain licensure.

___ Is DPH registered or Bidder proposes a sound plan to obtain certification.

DMH Site Offices:

___It appears reasonable to believe that the Applicant knows the communities to be served and has experience provided services to these communities.

__ It is reasonable to believe that the Bidder will be able to provide the Respite service components and meet the service standards with in the communities in the applicable Site Office for which it is seeking to be qualified for under the RFA.

___ The collaboration and demonstrates both a knowledge of the communities to be served and the Respite services that are to be provided under the RFA.

Category Number and Title:

V1. Quality Management, Reporting Requirements 5% Rating: Excellent, Very Good, Good, Fair, Poor (Circle One)

Requested Information

Comments Base your comments on the evaluation criteria set forth above.

The comment section must be completed if the category is rated “Excellent” or “Very Good” – must indicate what requirements were exceeded, what preferences were met and if applicable, identify points for contract negotiations.

The comment section must be completed if the category is rated “Fair” or “Poor” – must indicate what requirements were not met and what, if any, issues exist.

Provide details. Be specific as to what was missing and/or how the Bidder failed to meet the specified requirement and/or how the Bidder exceeded requirements. It is not enough to say requirements were not met or were exceeded.

___ It is reasonable to believe the Bidder’s quality management practices and operations will successfully monitor and evaluate the effectiveness of Respite Services.

___ The Bidder’s proposed process for the collection and submission of data and reports meets the requirements of RFA Subsections 6.19, 6.20 and 7.4.

___ Bidder has a reasonable understanding of the potential issues which can arise impacting the Bidder’s ability to collect and submit data and a reasonable plan to address those issues.

APPLICATION RATING CONSOLIDATION

Location/Site Office:_____________________________________

I. Bidder’s Background and Organizational Structure

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