3.RCA_Technical_Quotation_-__MH,_SU,_and_SO_(1).pdf

Federal Bureau of Prisons Community Treatment Services

Mental Health, Substance Use, & Sex Offender Specific Contract – Technical Quotation Information

Name of Company:

Authorized Negotiator:

T e l ep h on e N u mb er :

E-Mail Address:

Solicitation Number:

Directions: Please provide detailed and concise written responses to all of the areas below and submit all required documentation (e.g. licenses, map, deeds, etc.) as a completed Technical Quotation. Please limit your responses to only the information that is requested on this document.

OPERATIONS:

1. Demonstrate adherence to Cognitive Behavioral Therapy (CBT) or a compatible theoretical model:

Describe your agency’s mission statement or treatment philosophy.

Response:

Explain how any additional treatment protocols will be used and how those protocols are compatible with CBT.

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

2. Agency’s plan for addressing crisis referrals:

Describe your agency’s plan for addressing Crisis Intervention Assessments that are required to be completed within 24 hours.

Discuss specific crisis intervention procedures for emergency referral and evaluation, if the agency is unable to evaluate.

3. Maintenance of Bureau of Prison treatment files:

How will the Bureau’s treatment files be maintained on site? Include a plan for securing Bureau inmate files and maintaining them separately from non-Bureau files

Will an electronic database be utilized for the maintenance of Bureau files?

Electronic database will be utilized Electronic database will not be utilized

If yes, discuss your agency’s plan to adhere to the Bureau’s electronic security requirements. The requirements can be found attached to the solicitation (PGD 15-03, Security of Information and Information Systems) for review.

4. Submit a detailed plan regarding the ability to provide treatment services to non-English speaking inmates as necessary.

5. Develop and discuss the agency’s comprehensive inmate accountability program to be used in conjunction with the Bureau provided Treatment

Services and Accountability Log. Specifically, this must entail how every inmate is accounted for upon arrival, during treatment, and departure from the proposed site.

FACILITY:

6. Demonstrate that the proposed performance site is within geographic restrictions and is available on the contract effective date, able to accommodate the volume of treatment services and is in compliance with the Americans with Disability Act (ADA) requirements.

Required Attachments:

Map that demonstrates the proposed performance site is within the geographic restrictions as noted on the solicitation.

Deed, lease, bill of sale, option to lease, or option to buy in the name of the primary quoter/agency. This must demonstrate it is available on the contract effective date. If the proposed site is at a Residential Reentry Center, a statement must be provided regarding space that is dedicated to treatment.

Pictures, drawings, or a written description of the site’s layout, number of rooms, and size of room must be submitted. Documentation must also demonstrate the site’s ADA compliance, including restrooms.

Provide the names and type of services of businesses in the shared space or within close proximity of the same space.

7. Submit the state and local licensing statutes regarding operating a treatment (mental health, substance use, and sex offender) facility and provide the necessary license to satisfy those requirements. The information must be in the name of the Prime contractor. If a facility license does not apply, the statutes for this must be included also. Note: If in the process of obtaining a valid license, the submission of a completed application, provisional license, official email correspondence, certified letter, or other documentation can be submitted for review.

Treatment facility statutes in the state in which the services are to be conducted.

License required by the state Choose one:

Valid license Completed application

Provisional license Other:

License not required by the state (statutes are clearly marked as proof)

STAFFING:

8. Completed and signed Technical Personnel document attached to the solicitation posting. Identify the position and responsibility of all personnel proposed (including the Authorized Negotiator) to meet the SOW 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 documentation, billing invoices, or any other inmate information.

Completed and signed Technical Personnel document.

9. Ensure all personnel providing direct clinical services to Bureau inmates meet the experiential, education and licensing requirements outlined in the Statement of Work (SOW) with appropriate licensure/certification as required by the state authority were services are being provided.

Submitting out of state licenses or license reciprocity application information is unacceptable.

State in which services are to be conducted:

DEA Controlled Substance Registration Certificates for all staff with prescriptive authority.

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

Professional licenses for all staff providing direct clinical services. The license must be in the state in which the services are conducted.

License verification printouts are not acceptable substitutes, but may be submitted with original licenses to verify current expiration dates.

State statutes that address the scope of practice for each license submitted.

Any intended use of Telepsychiatry must be detailed and address the system’s ability to meet the Bureau’s electronic security requirements, as well as staffing procedures to ensure inmates are physically present with a cleared staff member at all times. The requirements can be found attached to the solicitation (PGD 15-03, Security of Information and Information Systems) for review.

Telepsychiatry will be utilized Telepsychiatry will not be utilized

TECHNICAL PERSONNEL LIST

Solicitation or Contract Number:

Agency/Company Name:

Address of Performance Site

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

Title / Position / Authorized Negotiator (point of contact for billing, clinical, etc.)

Professional License Type, DEA License, and Number

License Expiration Date

Employee or Subcontractor

Signature of Authorized Negotiator: Date:

Page: of

NOTE: Only personnel listed on this form will be considered for the solicitation or contract.