5.Technical_Quotation_Information_Packet.pdf

Updated: 02/01/2018

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 clinical license for Maine). Do not provide information for other locations on this document (e.g., If the solicitation is for the Brickell area of Miami, provide only the information that is site and location specific. Do not provide information 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.

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.

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.

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.

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 ensure 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 listed below:

a) 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);

Note: Label attachments for this factor: 3a – Adam Walsh/State Statute

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

c) 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);

d) Addresses a method for notifying RRC of inmate departure from treatment facility; and

e) Includes a mechanism for regulating inmate’s cell phone use while in the treatment facility.

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?

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

FACILITY

5. Demonstrate the ability to legally provide treatment services on the contract effective date:

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:

☐ Treatment facility licensing required:

☐ 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, provisional license, official email correspondence, certified letter, business license and/or other official documentation is acceptable.

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

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: Provide an office diagram with dimensions of both individual counseling offices and group rooms. Therapeutic group room must be no less than 200 square feet, with the ability to hold 13-15 adults comfortably seated in chairs in a circular fashion.

Note: Label attachments for this factor: 6c – Office Diagram

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

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

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: Prescriptive Authority (resume, professional license, and DEA Certificate required).

Note: Label attachments for this factor: 8d – Prescriptive Authority

E: Intended use of Telepsychiatry:

☐ Telepsychiatry will not be utilized ☐ Telepsychiatry will be utilized

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: 8e – 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)

Position Professional License Type/Number

DEA License/Number License Expiration

Date Employment

Status

BOP

Use Only

1 Indicate Position Choose Status ☐L ☐R ☐V

2 Indicate Position Choose Status ☐L ☐R ☐V

3 Indicate Position Choose Status ☐L ☐R ☐V

4 Indicate Position Choose Status ☐L ☐R ☐V

5 Indicate Position Choose Status ☐L ☐R ☐V

6 Indicate Position Choose Status ☐L ☐R ☐V

7 Indicate Position Choose Status ☐L ☐R ☐V

8 Indicate Position Choose Status ☐L ☐R ☐V

9 Indicate Position Choose Status ☐L ☐R ☐V

Signature of Authorized Negotiator:

Date: 6/12/2019

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

Appendix A - Page: Choose an item. of Choose an item.

8 – Technical Personnel

Number

Agency/Company Name

Address of Performance Site(s)

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

Position Professional License Type/Number

DEA License/Number License Expiration

Date Employment

Status

1 Indicate Position Choose Status ☐L ☐R ☐V

2 Indicate Position Choose Status ☐L ☐R ☐V

3 Indicate Position Choose Status ☐L ☐R ☐V

4 Indicate Position Choose Status ☐L ☐R ☐V

5 Indicate Position Choose Status ☐L ☐R ☐V

6 Indicate Position Choose Status ☐L ☐R ☐V

7 Indicate Position Choose Status ☐L ☐R ☐V

8 Indicate Position Choose Status ☐L ☐R ☐V

9 Indicate Position Choose Status ☐L ☐R ☐V

Signature of Authorized Negotiator:

Date: 6/12/2019

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

Appendix A - Page: Choose an item. of Choose an item.

8 – Technical Personnel

Professionals Scope of Practice Summary APPENDIX B

STATE:

PROFESSION

LICENSING BOARD

AND

WEBSITE

SCOPE OF PRACTICE

SCOPE

of

LICENSE

Choose an item.

Choose an item.

Professionals Scope of Practice Summary APPENDIX B

STATE:

PROFESSION

LICENSING BOARD

AND

WEBSITE

SCOPE OF PRACTICE

SCOPE

of

LICENSE

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.

9d – Scope of Practice Summary

**APPENDIX EXAMPLES**

Number

Please refer to solicitation posting for number.

Agency/Company Name

Sunny Days Treatment Center

Address of Performance Site(s)

Site 1: 234 Anywhere Place, Somewhere, USA Site 2: 1456 Almost There Lane, Somewhere, USA

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

Position Professional License

Type/Number DEA License/Number

License Expiration Date

Employment Status

1 Turner, Cindy Authorized Negotiator Licensed Mental Health Counselor LMHC5845

June 30, 20xx Employee ☐L ☐R ☐V

2 Armstrong, James Clinical Staff Licensed Clinical Social Worker

LCSW5421

June 30, 20xx Employee ☐L ☐R ☐V

3 Fox, Jessica Clinical Staff Certified Addictions Professional

CAP36214

May 30, 20xx Employee ☐L ☐R ☐V

4 Judd, Thomas Medical Staff Medical Doctor - ME105845

DEA: JHN14254

December 31, 20xx

Subcontractor ☐L ☐R ☐V

5 Middles, Susan Clinical Staff Psychologist

PY8858

March 31, 20xx Employee ☐L ☐R ☐V

6 Newton, Phillip Clinical Staff Provisional Clinical Social Worker

PSW239

September 30, 20xx

Employee ☐L ☐R ☐V

7 Contino, Julie Clinical Staff Provisional Mental Health Counselor PMH976

July 31, 20xx Employee ☐L ☐R ☐V

8 Zada, Maria Clinical Staff Certified Addiction Counselor

CAC5456

November 1, 20xx

Employee ☐L ☐R ☐V

9 Indicate Position Choose Status

☐L ☐R ☐V

Signature of Authorized Negotiator:

Date: 10/01/20xx

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

Appendix A - Page: 1 of 1

8 – Technical Personnel

Professionals Scope of Practice Summary APPENDIX B

STATE: Somewhere (SW), USA

PROFESSION

LICENSING BOARD AND

WEBSITE

SCOPE OF PRACTICE

SCOPE

of

LICENSE

Licensed Professional Clinical Counselors

(LPCC)

SW Board of Behavioral Health and Therapy 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)

Practice Independently

Licensed

Professional

Counselors (LPC)

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)

Requires Supervision

Licensed Psychological Practitioner (LPP)

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)

Requires Supervision

Licensed Graduate Social Worker

(LGSW)

SW Board of Social Work www.socialwork.state.sw.us

May engage in clinical practice under supervision of an independent clinical social worker.

(S.W. 148D.050)

Requires Supervision

Clinical Social Worker (LICSW)

SW Board of Social Work 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.

(S.W. 148D.050)

Practice Independently

Licensed Social Worker (LSW)

SW Board of Social Work 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)

CASAC Level 2

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)

CASAC

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)

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.