S_Amendment 0001_15BCTS24Q00000002.pdf
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- 15BCTS24Q00000002 - SU/MH/SOT in Evansville, IN
- Solicitation number
- 15BCTS24Q00000002
About this file
This document is an amendment to a solicitation for Substance Use, Mental Health, and Sex Offender Treatment Services in Evansville, Indiana. The Bureau of Prisons is seeking one contractor to provide these community-based outpatient services for male and female offenders residing at the local Residential Re-entry Center, on home confinement, or on Federal Location Monitoring. The services required include treatment planning, intake screening and assessments, individual and group counseling, case management, medication administration and monitoring, and related services.
The contract will be an Indefinite Delivery, Indefinite Quantity type with firm-fixed unit prices. The base period is 1 month through 12 months, with four 12-month option years. Guaranteed minimum and estimated maximum quantities are provided for each service. This requirement will be set-aside for small businesses. The solicitation closing date has been extended to August 15, 2024 at 12:00 ET.
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15BCTS24Q00000002/0001 Page 1 of 72
AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT
1. CONTRACT ID CODE PAGE OF PAGES
1 72
2. AMENDMENT/MODIFICATION NUMBER
3. EFFECTIVE DATE
07/24/2024
4. REQUISITION/PURCHASE REQUISITION NUMBER 5. PROJECT NUMBER (If applicable)
15BCTSCODE
Federal Bureau of Prisons Community Treatment Services Contracting 320 First Street NW Suite 901-5 Washington, DC 20534
Roderick D. Bryant
(O) (202) 451-7925 rbryant1@bop.gov
6. ISSUED BY CODE7. ADMINISTERED BY (If other than Item 6)
9A. AMENDMENT OF SOLICITATION NUMBER
15BCTS24Q00000002
CODE FACILITY CODE
8. NAME AND ADDRESS OF CONTRACTOR (Number, street, country, state and ZIP Code) (X)
X 9B. DATED (SEE ITEM 11)
07/24/2024
10A. MODIFICATION OF CONTRACT/ORDER
NUMBER
10B. DATED (SEE ITEM 13)
11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS
X XThe above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers is extended, is not extended.
Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing items 8 and 15, and returning __1__copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.
12. ACCOUNTING AND APPROPRIATION DATA (If required)
13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.
IT MODIFIES THE CONTRACT/ORDER NUMBER AS DESCRIBED IN ITEM 14.
CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT
ORDER NUMBER IN ITEM 10A.
B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).
C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:
D. OTHER (Specify type of modification and authority)
E. IMPORTANT: Contractor is not, is required to sign this document and return _______ copies to the issuing office.
14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)
The purpose of this amendment is to update attached Section 2.1, Continuation of SF-1449; Business Quotation Information, and extends the solicitation closing date.
THIS AMENDMENT EXTENDS THE SOLICITATION CLOSING DATE/TIME TO: 08/15/2024 - 12:00 ET US/Eastern
Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.
15A. NAME AND TITLE OF SIGNER (Type or print) 16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)
Gary Clark Senior Contracting Officer
(Signature of person authorized to sign)
15B. CONTRACTOR/OFFEROR 15C. DATE SIGNED
By (Signature of Contracting Officer)
16B. UNITED STATES OF AMERICA 16C. DATE SIGNED
07/24/2024 Previous edition unusable STANDARD FORM 30 (REV. 11/2016)
Prescribed by GSA FAR (48 CFR) 53.243
15BCTS24Q00000002/0001 Page 2 of 72
Table of Contents
Section Description Page Number
Solicitation/Contract Form 1 Commodity or Services Schedule 2 Contract Clauses
52.203-12 Limitation On Payments to Influence Certain Federal Transactions (Jun 2020) 52.204-12 Unique Entity Identifier Maintenance (Oct 2016) 52.212-4 Contract Terms and Conditions-Commercial Products and Commercial Services (Nov 2023) 52.224-1 Privacy Act Notification (Apr 1984) 52.224-2 Privacy Act (Apr 1984) 52.242-13 Bankruptcy (July 1995) 52.253-1 Computer Generated Forms (Jan 1991) 52.232-40 Providing Accelerated Payments to Small Business Subcontractors (Mar 2023) 52.203-3 Gratuities (Apr 1984) 52.242-15 Stop-Work Order (Aug 1989) 52.204-13 System for Award Management Maintenance (Oct 2018) 52.21-603-70 Contracting Officer's Representative (COR) (June 2012) 52.204-21 Basic Safeguarding of Covered Contractor Information Systems (Nov 2021)
BOP 2852.242-71 EVALUATION OF CONTRACTOR PERFORMANCE UTILIZING CPARS
(APR 2011)
DOJ-01 Whistleblower Information Distribution (Oct 2021) DOJ-03 Personnel Security Requirements For Contractor Employees (Nov 2021) 52.216-18 Ordering (Aug 2020) 52.216-19 Order Limitations (Oct 1995) 52.216-22 Indefinite Quantity (Oct 1995) 52.217-8 Option to Extend Services (Nov 1999) 52.217-9 Option to Extend the Term of the Contract (Mar 2000) 52.232-18 Availability of Funds (Apr 1984) 52.232-19 Availability of Funds for the Next Fiscal Year (Apr 1984) 52.237-7 Indemnification and Medical Liability Insurance (Jan 1997) DOJ-02 Contractor Privacy Requirements (JAN 2022) DOJ-08 Continuing Contract Performance During a Pandemic Influenza or other National Emergency (OCT 2007) 52.212-5 Contract Terms and Conditions Required To Implement Statutes or Executive Orders-Commercial Products and Commercial Services (May 2024)
3 List of Attachments 4 Solicitation Provisions
52.217-5 Evaluation of Options (July 1990) 52.204-22 Alternative Line Item Proposal (Jan 2017) 52.204-7 System for Award Management (Oct 2018) 52.212-1 Instructions to Offerors-Commercial Products and Commercial Services (Sep 2023) 52.203-18 Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements or Statements--Representation (Jan 2017) 52.204-16 Commercial and Government Entity Code Reporting (Aug 2020) 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (Nov 2021) 52.216-1 Type of Contract (Apr 1984) 52.233-2 Service of Protest (Sept 2006) 2852.233-70 Protests Filed Directly with the Department of Justice (NOV 2020) 52.209-7 Information Regarding Responsibility Matters (Oct 2018) 52.204-29 Federal Acquisition Supply Chain Security Act Orders-Representation and Disclosures (Dec 2023) 52.212-3 Offeror Representations and Certifications-Commercial Products and Commercial Services (May 2024)
15BCTS24Q00000002/0001 Page 3 of 72
Section 1 - Commodity or Services Schedule
Substance Use, Mental Health, and Sex Offender Treatment Services in Evansville, IN
Firm Fixed Price
SCHEDULE OF SUPPLIES/SERVICES
CONTINUATION SHEET
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0001 Substance Use Disorder Treatment Planning and Follow-up (2001)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0002 Substance Use Disorder Intake Screening (2005)
2 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0003 Substance Use Disorder Individual Counseling (2010)
24 Units Guaranteed Minimum; 1800 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
1,800
Change: 0
Current :
1,800
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0004 Substance Use Disorder Intake Assessment & Report (2011)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
15BCTS24Q00000002/0001 Page 4 of 72
0005 Co-occurring Intake Assessment & Report (2012)
2 Units Guaranteed Minimum; 35 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 35
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0006 Substance Use Disorder Group Counseling (2020)
120 Units Guaranteed Minimum; 2640 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
2,640
Change: 0
Current :
2,640
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0007 Substance Use Disorder Relationship and Parenting Counseling (2030)
2 Units Guaranteed Minimum; 100 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0008 Mental Health Treatment Planning and Follow-up (5001)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0009 Mental Health Intake Screening (5005)
2 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS24Q00000002/0001 Page 5 of 72
0010 Mental Health Intake Assessment & Report (5011)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0011 Psychiatric Evaluation & Report (5030)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount. .
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0012 Crisis Intervention Evaluation & Report (6000)
1 Unit Guaranteed Minimum; 10 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 10
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0013 Mental Health Individual Counseling (6010)
24 Units Guaranteed Minimum; 1800 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
1,800
Change: 0
Current :
1,800
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0014 Case Management Services (6029)
2 Units Guaranteed Minimum; 250 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS24Q00000002/0001 Page 6 of 72
0015 Mental Health Relationship and Parenting Counseling (6031)
2 Units Guaranteed Minimum; 100 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0016 MH - Administration of Medication (6050)
1 Unit Guaranteed Minimum; 100 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0017 MH - Medication Monitoring & Report (6051)
5 Units Guaranteed Minimum; 100 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0018 Sex Offender Intake Assessment & Report (5012)
1 Unit Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0019 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
1 Units Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
15BCTS24Q00000002/0001 Page 7 of 72
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0020 Sex Offender Intake Screening (6005)
1 Units Guaranteed Minimum; 20 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 20
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0021 Sex Offender Individual Counseling (6012)
12 Units Guaranteed Minimum; 900 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0022 Substance Use Disorder Treatment Planning and Follow-up (2001)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0023 Substance Use Disorder Intake Screening (2005)
2 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0024 Substance Use Disorder Individual Counseling (2010)
24 Units Guaranteed Minimum; 1800 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
1,800
Change: 0
Current :
1,800
15BCTS24Q00000002/0001 Page 8 of 72
QUANTITY
UNIT UNIT PRICE AMOUNT
0025 Substance Use Disorder Intake Assessment & Report (2011)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0026 Co-occurring Intake Assessment & Report (2012)
2 Units Guaranteed Minimum; 35 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current : 35
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0027 Substance Use Disorder Group Counseling (2020)
120 Units Guaranteed Minimum; 2640 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
2,640
Change: 0
Current :
2,640
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0028 Substance Use Disorder Relationship and Parenting Counseling (2030)
2 Units Guaranteed Minimum; 100 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0029 Mental Health Treatment Planning and Follow-up (5001)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current : 50
15BCTS24Q00000002/0001 Page 9 of 72
QUANTITY
UNIT UNIT PRICE AMOUNT
0030 Mental Health Intake Screening (5005)
2 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0031 Mental Health Intake Assessment & Report (5011)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0032 Psychiatric Evaluation & Report (5030)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount. .
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0033 Crisis Intervention Evaluation & Report (6000)
1 Unit Guaranteed Minimum; 10 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current : 10
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0034 Mental Health Individual Counseling (6010)
24 Units Guaranteed Minimum; 1800 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
1,800
Change: 0
Current :
1,800
15BCTS24Q00000002/0001 Page 10 of 72
QUANTITY
UNIT UNIT PRICE AMOUNT
0035 Case Management Services (6029)
2 Units Guaranteed Minimum; 250 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0036 Mental Health Relationship and Parenting Counseling (6031)
2 Units Guaranteed Minimum; 100 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0037 MH - Administration of Medication (6050)
1 Unit Guaranteed Minimum; 100 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0038 MH - Medication Monitoring & Report (6051)
5 Units Guaranteed Minimum; 100 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0039 Sex Offender Intake Assessment & Report (5012)
1 Unit Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Previous :
Change: 0
15BCTS24Q00000002/0001 Page 11 of 72
Option Year 1: 13 months through 24 months
PSC: G004
Current : 25
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0040 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
1 Units Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0041 Sex Offender Intake Screening (6005)
1 Units Guaranteed Minimum; 20 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current : 20
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0042 Sex Offender Individual Counseling (6012)
12 Units Guaranteed Minimum; 900 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0043 Substance Use Disorder Treatment Planning and Follow-up (2001)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0044 Substance Use Disorder Intake Screening (2005)
2 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 50
15BCTS24Q00000002/0001 Page 12 of 72
QUANTITY
UNIT UNIT PRICE AMOUNT
0045 Substance Use Disorder Individual Counseling (2010)
24 Units Guaranteed Minimum; 1800 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
1,800
Change: 0
Current :
1,800
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0046 Substance Use Disorder Intake Assessment & Report (2011)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0047 Co-occurring Intake Assessment & Report (2012)
2 Units Guaranteed Minimum; 35 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 35
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0048 Substance Use Disorder Group Counseling (2020)
120 Units Guaranteed Minimum; 2640 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
2,640
Change: 0
Current :
2,640
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0049 Substance Use Disorder Relationship and Parenting Counseling (2030)
2 Units Guaranteed Minimum; 100 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
15BCTS24Q00000002/0001 Page 13 of 72
Current :
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0050 Mental Health Treatment Planning and Follow-up (5001)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0051 Mental Health Intake Screening (5005)
2 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0052 Mental Health Intake Assessment & Report (5011)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0053 Psychiatric Evaluation & Report (5030)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount. .
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0054 Crisis Intervention Evaluation & Report (6000)
1 Unit Guaranteed Minimum; 10 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 10
15BCTS24Q00000002/0001 Page 14 of 72
QUANTITY
UNIT UNIT PRICE AMOUNT
0055 Mental Health Individual Counseling (6010)
24 Units Guaranteed Minimum; 1800 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
1,800
Change: 0
Current :
1,800
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0056 Case Management Services (6029)
2 Units Guaranteed Minimum; 250 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0057 Mental Health Relationship and Parenting Counseling (6031)
2 Units Guaranteed Minimum; 100 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0058 MH - Administration of Medication (6050)
1 Unit Guaranteed Minimum; 100 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0059 MH - Medication Monitoring & Report (6051)
5 Units Guaranteed Minimum; 100 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Previous :
15BCTS24Q00000002/0001 Page 15 of 72
Option Year 2: 25 months through 36 months
PSC: G004
Current :
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0060 Sex Offender Intake Assessment & Report (5012)
1 Unit Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0061 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
1 Units Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0062 Sex Offender Intake Screening (6005)
1 Units Guaranteed Minimum; 20 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 20
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0063 Sex Offender Individual Counseling (6012)
12 Units Guaranteed Minimum; 900 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0064 Substance Use Disorder Treatment Planning and Follow-up (2001)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Previous :
15BCTS24Q00000002/0001 Page 16 of 72
Option Year 3: 37 months through 48 months
PSC: G004
Current : 50
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0065 Substance Use Disorder Intake Screening (2005)
2 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0066 Substance Use Disorder Individual Counseling (2010)
24 Units Guaranteed Minimum; 1800 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
1,800
Change: 0
Current :
1,800
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0067 Substance Use Disorder Intake Assessment & Report (2011)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0068 Co-occurring Intake Assessment & Report (2012)
2 Units Guaranteed Minimum; 35 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current : 35
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0069 Substance Use Disorder Group Counseling (2020)
120 Units Guaranteed Minimum; 2640 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
2,640
15BCTS24Q00000002/0001 Page 17 of 72
Current :
2,640
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0070 Substance Use Disorder Relationship and Parenting Counseling (2030)
2 Units Guaranteed Minimum; 100 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0071 Mental Health Treatment Planning and Follow-up (5001)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0072 Mental Health Intake Screening (5005)
2 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0073 Mental Health Intake Assessment & Report (5011)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0074 Psychiatric Evaluation & Report (5030)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount. .
Option Year 3: 37 months through 48 months
Previous :
15BCTS24Q00000002/0001 Page 18 of 72
PSC: G004 Current : 50
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0075 Crisis Intervention Evaluation & Report (6000)
1 Unit Guaranteed Minimum; 10 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current : 10
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0076 Mental Health Individual Counseling (6010)
24 Units Guaranteed Minimum; 1800 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
1,800
Change: 0
Current :
1,800
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0077 Case Management Services (6029)
2 Units Guaranteed Minimum; 250 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0078 Mental Health Relationship and Parenting Counseling (6031)
2 Units Guaranteed Minimum; 100 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0079 MH - Administration of Medication (6050)
1 Unit Guaranteed Minimum; 100 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Previous :
15BCTS24Q00000002/0001 Page 19 of 72
Option Year 3: 37 months through 48 months
PSC: G004
Change: 0
Current :
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0080 MH - Medication Monitoring & Report (6051)
5 Units Guaranteed Minimum; 100 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0081 Sex Offender Intake Assessment & Report (5012)
1 Unit Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0082 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
1 Units Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0083 Sex Offender Intake Screening (6005)
1 Units Guaranteed Minimum; 20 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current : 20
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0084 Sex Offender Individual Counseling (6012)
12 Units Guaranteed Minimum; 900 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total
Previous :
15BCTS24Q00000002/0001 Page 20 of 72 amount.
Option Year 3: 37 months through 48 months
PSC: G004
Change: 0
Current :
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0085 Substance Use Disorder Treatment Planning and Follow-up (2001)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0086 Substance Use Disorder Intake Screening (2005)
2 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0087 Substance Use Disorder Individual Counseling (2010)
24 Units Guaranteed Minimum; 1800 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
1,800
Change: 0
Current :
1,800
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0088 Substance Use Disorder Intake Assessment & Report (2011)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0089 Co-occurring Intake Assessment & Report (2012)
2 Units Guaranteed Minimum; 35 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Previous :
15BCTS24Q00000002/0001 Page 21 of 72
Option Year 4: 49 months through 60 months
PSC: G004
Change: 0
Current : 35
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0090 Substance Use Disorder Group Counseling (2020)
120 Units Guaranteed Minimum; 2640 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
2,640
Change: 0
Current :
2,640
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0091 Substance Use Disorder Relationship and Parenting Counseling (2030)
2 Units Guaranteed Minimum; 100 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0092 Mental Health Treatment Planning and Follow-up (5001)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0093 Mental Health Intake Screening (5005)
2 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0094 Mental Health Intake Assessment & Report (5011)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Previous :
15BCTS24Q00000002/0001 Page 22 of 72
PSC: G004
Change: 0
Current : 50
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0095 Psychiatric Evaluation & Report (5030)
5 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount. .
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0096 Crisis Intervention Evaluation & Report (6000)
1 Unit Guaranteed Minimum; 10 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 10
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0097 Mental Health Individual Counseling (6010)
24 Units Guaranteed Minimum; 1800 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
1,800
Change: 0
Current :
1,800
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0098 Case Management Services (6029)
2 Units Guaranteed Minimum; 250 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0099 Mental Health Relationship and Parenting Counseling (6031)
2 Units Guaranteed Minimum; 100 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Previous :
15BCTS24Q00000002/0001 Page 23 of 72
PSC: G004
Change: 0
Current :
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0100 MH - Administration of Medication (6050)
1 Unit Guaranteed Minimum; 100 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0101 MH - Medication Monitoring & Report (6051)
5 Units Guaranteed Minimum; 100 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0102 Sex Offender Intake Assessment & Report (5012)
1 Unit Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0103 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
1 Units Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS24Q00000002/0001 Page 24 of 72
0104 Sex Offender Intake Screening (6005)
1 Units Guaranteed Minimum; 20 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 20
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0105 Sex Offender Individual Counseling (6012)
12 Units Guaranteed Minimum; 900 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0106 Substance Use Disorder Treatment Planning and Follow-up (2001)
3 Units Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0107 Substance Use Disorder Intake Screening (2005)
1 Unit Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0108 Substance Use Disorder Individual Counseling (2010)
12 Units Guaranteed Minimum; 900 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS24Q00000002/0001 Page 25 of 72
0109 Substance Use Disorder Intake Assessment & Report (2011)
3 Units Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0110 Co-occurring Intake Assessment & Report (2012)
1 Unit Guaranteed Minimum; 18 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
Previous :
Change: 0
Current : 18
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0111 Substance Use Disorder Group Counseling (2020)
60 Units Guaranteed Minimum; 1320 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
Previous :
1,320
Change: 0
Current :
1,320
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0112 Substance Use Disorder Relationship and Parenting Counseling (2030)
1 Unit Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0113 Mental Health Treatment Planning and Follow-up (5001)
3 Units Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS24Q00000002/0001 Page 26 of 72
0114 Mental Health Intake Screening (5005)
1 Unit Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0115 Mental Health Intake Assessment & Report (5011)
3 Units Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0116 Psychiatric Evaluation & Report (5030)
3 Units Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount. .
Potential 6 Month Extension
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0117 Crisis Intervention Evaluation & Report (6000)
1 Unit Guaranteed Minimum; 5 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
Previous : 5
Change: 0
Current : 5
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0118 Mental Health Individual Counseling (6010)
12 Units Guaranteed Minimum; 900 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS24Q00000002/0001 Page 27 of 72
0119 Case Management Services (6029)
1 Unit Guaranteed Minimum; 125 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0120 Mental Health Relationship and Parenting Counseling (6031)
1 Unit Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0121 MH - Administration of Medication (6050)
1 Unit Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0122 MH - Medication Monitoring & Report (6051)
3 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0123 Sex Offender Intake Assessment & Report (5012)
1 Unit Guaranteed Minimum; 13 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
Previous :
Change: 0
Current : 13
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS24Q00000002/0001 Page 28 of 72
0124 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
1 Unit Guaranteed Minimum; 13 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
Previous :
Change: 0
Current : 13
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0125 Sex Offender Intake Screening (6005)
1 Unit Guaranteed Minimum; 10 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
Previous :
Change: 0
Current : 10
EA $________…
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