3.CTS_Technical_Quotation_Form_-_Contract_3.docx

Federal Bureau of Prisons Community Treatment Services Contract

IMPORTANT INFORMATION TO KNOW:

Technical Quotation forms posted with this solicitation must be completed in their entirety and submitted with attachments required; no other format utilized will be accepted for review.

It is imperative that the Technical Quotation information is legible, detailed oriented and limited to the requested information (e.g., do not provide the history of Cognitive Behavioral Therapy, or the benefits of such; do not provide an explanation of what a Clinical Assessment is, or why it is beneficial).

The Technical Quotation forms must reference only the specific location for the proposal submitted (e.g., provide specific information such as the hospital that will be utilized during a crisis; if the quotation is for a city in Kentucky, do not provide a for the South Beach solicitation on the same documentation).

All information must be answered on the Technical Quotation form provided, unless otherwise specified. Limit the number of attachments submitted to those specifically requested. Information submitted beyond what is required or sections written in as will not be considered for review or evaluation.

The Technical Quotation form provides directions on labeling attachments. Please ensure that attachments are sequential, labeled correctly, and correspond to the appropriate question.

The Decision Rule Criteria (DRC) is located on second page of this document and also located on the solicitation posted on FedBizOpps. Please refer to this when completing the packet for submission. Failure to provide the requested documentation will delay the ability to review the quotation in its entirety.

Technical Quotation information responses with use of subcontractor(s) and/or multiple site locations (within the geographical restrictions) must adhere to the following:

Submission of one, comprehensive Technical Quotation (from only the Primary Contractor), that addresses all factors on the form, including providing required attachments.

The Technical Personnel form must be organized per site. The Authorized Negotiator must be identified on the prime contractor’s form, and sign all of the Technical Personnel form(s) submitted.

D

OPERATIONS:

1. Quoter must demonstrate adherence to the Cognitive Behavioral Therapy (CBT) theoretical model. Solicitations with sex offender treatment must note any affiliation with the Association for the Treatment of Sexual Abusers (ATSA).

2. Quoter must have a plan for completing crisis intervention assessments within 24-hours of request by CTS staff. Provide crisis intervention procedures for emergency referral and evaluation of inmates if the inmate cannot be evaluated by the agency.

3. Quoter must have a comprehensive inmate accountability program to be used in conjunction with the Bureau provided Treatment Services and Accountability log that ensures every inmate is accounted for upon arrival, during treatment, and departure from the proposed performance sites. Quoter must provide a plan that:

Adheres to the Adam Walsh Child Protection and Safety Act of 2006 (Public Law 109-248) requirements as mandated by the state (provide state statute);

Describes how they will notify CTS and Residential Reentry Center (RRC) immediately of any absences/late arrivals;

Addresses supervision of inmates while in common areas, to include hallways, restrooms and lobbies (specifically if there are businesses, including your own, which cater to or provide services to children);

Addresses a method for notifying RRC of inmate departure from treatment facility; and Includes a mechanism for regulating inmate’s cell phone use while in the treatment facility.

4. Quoter must have a plan that details how treatment files for Bureau inmates shall be maintained.

If paper: Detail how Bureau inmate files will be maintained separately from non-Bureau files, kept on-site, and secured.

If electronic: Any intended use of electronic database systems must address the electronic system’s ability to meet the Bureau’s electronic security requirements (PGD 15-03, Security of Information and Information Systems). Submit proof that the proposed system meets the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requirements.

FACILITY:

5. Quoter must demonstrate ability to legally provide treatment services on the contract effective date:

Must submit state or local licensing statutes to operate a treatment facility for substance use, mental health, and/or sex offender treatment (as applicable). If state or local law does not require facility licensing, the quoter must provide the statute that this factor does not apply, or submit official documents that allow services to be performed (e.g., email from regulatory board);

Must provide the required state license(s) to provide treatment services at the propose performance site(s); or If the quoter is in the process of obtaining a valid license, they may submit the completed application, provisional license, official email correspondence, certified letter and/or other official documentation.

6. Quoter must provide the following information for all proposed performance sites:

Proof that the proposed performance site(s) is within the solicitation’s geographic and mass transit restrictions;

A deed, lease, bill of sale, options to lease, or option to buy in the name of the Quoter. If the proposed performance site is at an RRC, the Quoter must submit a statement that services will be provided in a space dedicated to treatment. All documentation submitted must show the proposed performance site will be available on the contract effective date;

Proof of compliance with National Fire Safety Association (www.nfpa.org) guidelines for fire safety and room occupancy size;

Proof of compliance with Americans with Disabilities Act (ADA), or a plan for ADA compliance, to include restroom accommodations; and Must submit a plan for maintaining confidentiality for all treatment sessions in accordance with HIPAA and American Counseling Association (ACA) standards.

STAFFING:

7. Quoter must complete and sign the Technical Personnel document. This document must identify the position and responsibility of all personnel proposed to meet the solicitation requirements, to include all employees, subcontractors, volunteers, and interns who have face-to-face interaction with inmates or who have access to their personally identifiable information, treatment records, contract

8. Quoter must ensure all personnel providing clinical services to Bureau inmates meet the experiential, educational, and appropriate licensure/certification as required by the state authority where the services will be provided.

Must submit resumes for all personnel providing direct clinical services to Bureau inmates;

Must submit copies of original professional licenses or renewal cards for each applicable staff member. License verification printouts are not acceptable substitutes, but may be submitted in conjunction with copies of licenses or renewal cards to verify current expiration dates; and Must complete the Mental Health/Behavioral Health Professionals Scope of Practice Summary to include all licenses listed on the Technical Personnel document.

Solicitations with mental health/psychiatric treatment:

Must have a qualified practitioner with prescriptive authority that meets the standards of practice established by his/her state’s professional regulatory board to provide medication monitoring and psychiatric evaluations;

Must submit Drug Enforcement Agency Controlled Substance Registration Certificates for all staff with prescriptive authority; and

Federal Bureau of Prisons Community Treatment Services Technical Quotation Information

Name of Company: Click or tap here to enter text.

Authorized Negotiator: Click or tap here to enter text.

E-Mail Address: __________________________________________

Solicitation Number: Click or tap here to enter text.

Subcontracting: ☐ Will be utilized ☐ Will not be utilized

Location(s): ☐ One location ☐ More than one location

Directions: Provide detailed and concise written responses to all of the areas below and submit required attachments as a completed Technical Quotation. Please limit your responses to only the information that is requested by this document. All information provided on this document must be typed; no hand written submissions will be considered for review.

OPERATIONS

1. Adherence to the Cognitive Behavioral Therapy (CBT) theoretical model:

Provide a clear statement demonstrating the agency’s adherence to Cognitive Behavioral Therapy.

Response:

Click or tap here to enter text.

Solicitations with sex offender treatment line items:

Note any affiliation with Association for the Treatment of Sexual Abusers (ATSA).

Response:

Click or tap here to enter text.

2. Agency’s plan for addressing crisis referrals:

Provide specific, local information (Identifying such things as: Person(s) providing service, emergency psychiatric care facility, local hospital with crisis unit, state mandated crisis management procedures) for the agency’s plan to address Crisis Intervention Assessments (i.e., immediate or situational crisis) within 24 hours of notification.

Response:

Click or tap here to enter text.

Provide specific, local information for crisis intervention procedures (e.g., the emergency psychiatric care facility, local hospital with crisis unit, state mandated crisis management procedures) with regard to emergency referral and evaluation, if the agency is unable to evaluate.

3. Provide a comprehensive inmate accountability program, to be used in conjunction with Bureau provided Treatment Services and Accountability log, that ensures every inmate is accounted for upon arrival, during treatment, and departure from the proposed performance site(s). The plan must provide the information required in the Decision Rule Criteria (3a, 3b, 3c, 3d, and 3e).

4. Maintenance of Bureau of Prison treatment files:

☐ Electronic database will be used ☐ Electronic database will not be used

If paper: How will the Bureau’s treatment files be maintained separately from non-Bureau files, kept on-site, and secured?

Response:

Click or tap here to enter text.

If electronic: Proof must be submitted that demonstrate the system requirements meet the Bureau’s electronic security requirements (PDG15-03, Security of Information and Information Systems). Submit proof that the proposed system meets HIPAA of 1996 requirements.

Note: Label attachments for this factor: 4 – Electronic Treatment Files

Response:

Click or tap here to enter text.

FACILITY

Required Attachments:

A: Submit the state or local licensing statutes to operate a facility for substance use, mental health, and/or sex offender treatment (as applicable). If state/local laws do not require facility licensing, the quoter must provide official documentation that allow for services to be performed (e.g., email from treatment specific regulatory board).

Clearly marked state statutes regarding treatment facility licensing:

Substance Use Mental Health Sex Offender Treatment Treatment facility licensing not required:

Substance Use Mental Health Sex Offender Treatment Note: Label attachments for this factor: 5a – Facility Statutes

B/C: Attach required state license(s) to provide treatment services at the proposed performance site(s). If in the process of obtaining a valid license, submission of the completed application, Note: Label attachments for this factor: 5b – Facility License (if applicable to the state, each license must be labeled for clarity (e.g., Substance Use, Mental Health, and/or Sex Offender Treatment). Label any other documentation for this submission: 5c – Facility Other.

6. Provide the following information for all proposed performance site(s), to include any subcontractor locations:

A: Address that the proposed performance site(s) is within the geographic and mass transit restrictions.

Note: Label attachments for this factor: 6a – Geographic Restrictions

Response:

Click or tap here to enter text.

B: Provide a deed, lease, bill of sale, option to lease, or option to buy in the name of the quoter. If the proposed performance site is at a Residential Reentry Center, the quoter must submit a statement that services will be provided in a space dedicated to treatment. All documentation must show the proposed performance site will be available on the contract effective date.

Note: Label attachments for this factor: 6b – Facility Deed/Lease etc. (as appropriate)

C: Proof of compliance with National Fire Safety Association (www.nfpa.org) guidelines for fire safety and room occupancy size.

Note: Label attachments for this factor: 6c – NFSA

Response:

Click or tap here to enter text.

D: Proof of compliance with the American with Disabilities Act (ADA), or plan for ADA compliance, to include restroom accommodations.

Note: Label attachments for this factor: 6d – ADA

Response:

Click or tap here to enter text.

E: Submit a plan for maintaining confidentiality for all treatment sessions in accordance with HIPAA and American Counseling Association (ACA) standards.

Note: Label any attachments for this factor: 6e – Confidentiality

Response:

Click or tap here to enter text.

STAFFING

7. Completed and signed Technical Personnel document (Appendix A). Identify the position and responsibility of all personnel proposed to meet the solicitation requirements, to include the authorized negotiator, all employees, subcontractors, volunteers, and interns who have face-to-face interaction with inmates or who have access to their personally identifiable information, treatment records, contract documentation, billing invoices, or any other inmate information.

Note: For convenience, this is labeled: 7 – Technical Personnel

8. Ensure all personnel providing clinical services to Bureau inmates meet the experiential, educational, and appropriate licensure/certification as required by the state authority where the services will be provided. Submitting out of state licenses, license verification print out (in lieu of a license), or license reciprocity application information will not be reviewed.

State in which services are to be conducted: Click or tap here to enter text.

Required Attachments:

A: Resumes for all personnel providing direct clinical services to Bureau inmates.

Note: Label attachments for this factor: 8a – Staff Resumes

B: Professional licenses for all staff providing direct clinical services. The license must be in the state where services are conducted. License verification printouts are not acceptable substitutes to prove licensure. However, such printouts may be submitted with original licenses to show applicable expiration dates.

Note: Label attachments for this factor: 8b – Clinical Licenses/Certifications

C: Complete the Scope of Practice Summary (Appendix B) for all Mental Health/ Behavioral Health Professionals in the applicable state for this solicitation. It must reference all licenses and certifications submitted with this quotation.

Note: For convenience, this document is labeled: 8c – Scope of Practice Summary

D: Psychiatric Services: If applicable, is captured in 8a-c and 8e (Refer to Decisional Rule Criteria).

E: If applicable, attach DEA Controlled Substance Registration Certificates for all staff with prescriptive authority.

Note: Label all attachments for this factor: 8e – Prescriptive Authority

Telepsychiatry system information must be detailed and address the system’s ability to meet the Bureau’s electronic security requirements to include: HIPAA compliance, system housed in Continental US, and a secure network with 128-bit or higher encryption. Provide staffing procedures to ensure inmates are in the presence of an NCIC cleared, and Bureau approved, staff member at all times during the telepsychiatry session.

Note: Label any attachments for this factor: 8f – Telepsychiatry

TECHNICAL PERSONNEL LIST: APPENDIX A

Solicitation or Contract Number

Agency/Company Name

Address of Performance Site(s)

Last Name, First Name (as it appears on license)

DEA License/Number

Status

BOP

Use Only

Indicate Position

Choose Status ☐L ☐R ☐V

Indicate Position

Choose Status ☐L ☐R ☐V

Indicate Position

Choose Status ☐L ☐R ☐V

Indicate Position

Choose Status ☐L ☐R ☐V

Indicate Position

Choose Status ☐L ☐R ☐V

Indicate Position

Choose Status ☐L ☐R ☐V

Indicate Position

Choose Status ☐L ☐R ☐V

Indicate Position

Choose Status ☐L ☐R ☐V

Indicate Position

Choose Status ☐L ☐R ☐V

Signature of Authorized Negotiator:

7 – Technical Personnel

TECHNICAL PERSONNEL LIST: APPENDIX A

Solicitation or Contract Number

Agency/Company Name

Address of Performance Site(s)

Last Name, First Name (as it appears on license)

DEA License/Number

Status

BOP

Use Only

Indicate Position

Choose Status ☐L ☐R ☐V

Indicate Position

Choose Status ☐L ☐R ☐V

Indicate Position

Choose Status ☐L ☐R ☐V

Indicate Position

Choose Status ☐L ☐R ☐V

Indicate Position

Choose Status ☐L ☐R ☐V

Indicate Position

Choose Status ☐L ☐R ☐V

Indicate Position

Choose Status ☐L ☐R ☐V

Indicate Position

Choose Status ☐L ☐R ☐V

Indicate Position

Choose Status ☐L ☐R ☐V

Signature of Authorized Negotiator:

7 – Technical Personnel

STATE:

WEBSITE

of

LICENSE

Choose an item.

Choose an item.

Choose an item.

Choose an item.

Choose an item.

Choose an item.

Note: Provide the Scope of Practice for all staff listed on the Technical Personnel Document. Copy and paste rows above if more needed.

8c – Scope of Practice Summary

**APPENDIX EXAMPLES**

TECHNICAL PERSONNEL LIST: APPENDIX A

Agency/Company Name

Sunny Days Treatment Center

Site 2: 1456 Almost There Lane, Somewhere, USA

Last Name, First Name (as it appears on license)

DEA License/Number

Status

BOP

Reviewer Use Only

LCSW5421

CAP36214

DEA: JHN14254

PY8858

CAC5456

Indicate Position

Choose Status ☐L ☐R ☐V

Signature of Authorized Negotiator:

8 – Technical Personnel

WEBSITE

of

LICENSE

www.bbht.state.sw.us/Home/tabid/10

The scope of practice of a licensed professional clinical counselor includes, but is not limited to:

implementation of professional counseling treatment interventions including evaluation, treatment planning, assessment, and referral;

direct counseling services to individuals, groups, and families;

counseling strategies that effectively respond to multicultural populations;

knowledge of relevant laws and ethics impacting practice;

crisis intervention;

consultation; and program evaluation and applied research.

(S.W. 148B.50)

SW Board of Behavioral Health and Therapy www.bbht.state.sw.us/Home/tabid/10

The scope of practice of a licensed professional counselor includes, but is not limited to:

· implementation of professional counseling treatment interventions including evaluation, treatment planning, assessment, and referral; direct counseling services to individuals, groups, and families;

· counseling strategies that effectively respond to multicultural populations;

· knowledge of relevant laws and ethics impacting practice; crisis intervention; consultation; and

· program evaluation and applied research.

(S.W. 148B.50)

SW Board of Psychology www.psychologyboard.state.sw.us Must be employed by a licensed psychologist or an agency that employs or contracts with a supervising licensed psychologist.

(S.W. 148.908)

www.socialwork.state.sw.us May engage in clinical practice under supervision of an independent clinical social worker.

(S.W. 148D.050)

www.socialwork.state.sw.us May engage in clinical practice. Clinical practice is the diagnosis and treatment of psychosocial function, disability, or impairment, including addictions and emotional, mental, and behavioral disorders, including plans based on a differential diagnosis. Treatment may include psychotherapy.

http://www.socialwork.state.sw.us/ Practices under supervision. May not engage in clinical practice.

Practice includes:

assessment case management ‘ client-centered advocacy client education and counseling crisis intervention referral

(S.W. 148D.050)

Office of Substance Abuse Certification www.oasis.state.sw.us/598 Functions permitted with regular supervision:

SUD and COD Screening; Intake; Orientation; SUD Assessment; SUD Diagnostic Impression; LOC as determined by LOCADTR; Treatment Planning; Individual and Group Counseling; Family Counseling*; Psycho-education; Case Management; Crisis Intervention; Client Education; Referral; Reporting & Recordkeeping; Care Coordination; Administrative Supervision.

(S.W. 148B.29)

Office of Substance Abuse Certification www.oasis.state.sw.us/598 Functions permitted with regular supervision:

SUD and COD Screening; Intake; Orientation; SUD Assessment; SUD Diagnostic Impression; LOC as determined by LOCADTR; Treatment Planning; Individual & Group Counseling; Family Counseling*; Psycho-education; Case Management; Crisis Intervention; Client Education; Referral; Reporting & Recordkeeping; Care Coordination.

(S.W. 148B.29) Requires Supervision

Note: Provide the Scope of Practice for all staff listed on the Technical Personnel Document.

9d – Scope of Practice Summary

**INTENTIONALLY LEFT BLANK**

Please remember to attach all required documentation and label appropriately.