2-DHHS26131 RFP Instructions and Checklist.docx

Utah Department of Health and Human Services DHHS26131 Community-Based Peer Support Program RFP Application Instructions and Checklist

Responses should contain only documentation requested in this solicitation. DHHS will not review information submitted by a vendor that is not requested in this solicitation.

Document Submission Instructions

1. Submit a completed, signed, and dated Form #1 IRS Form W-9.

2. Complete and submit Form #2a: Conflict of Interest Disclosure Statement OR Complete and submit Form #2b: Governmental Entity Conflict of Interest Certification (for government agencies, political subdivisions, municipalities, public schools, etc.).

3. Complete and submit Form #3: Budget Utilization Form outlining how your organization would spend the allotted funds.

4. Submit a proposal narrative according to the following instructions.

Proposal Narrative Instructions

Section 1: Cover Page

1. Name of the Offeror organization.

2. Name, title, email, and phone number of the Offeror’s primary contact person responsible for management and implementation of this contract, if awarded.

3. Proposal abstract: An abstract of your proposal, not to exceed 250 words.

Section 2: Mandatory Minimum Requirements (MMR). In this section, Offerors must provide a narrative describing how they meet the mandatory minimum requirements. To do so, provide the following:

1. MMR 1: The contractor shall be an emerging organization currently engaging with mental health or substance use recovery community including peer supports as defined as employing no more than 10 full-time employees. (SOW 2.1(1))

Please describe how the Offeror organization meets this requirement.

2. MMR 2: The contractor shall serve a population in an area with a mental health provider shortage area, as defined by the Health Resources Services Administration (https://data.hrsa.gov/topics/health-workforce/shortage-areas/by-address). (SOW 2.1(2))

Please describe how the Offeror organization meets this requirement.

3. MMR 3: The contractor shall provide mental health prevention and treatment services, with a minimum 60% of the agency's service population seeking mental health prevention, treatment, and recovery services. (SOW 2.1(3))

Please describe how the Offeror organization meets this requirement.

Section 3: Scorable Technical Criteria (TC). In this section, Offerors must provide a narrative describing how they will meet the scope of work. To do so, provide the following:

1. TC 1: Describe your plan to ensure at least one peer support specialist engages in the Peer Support Steering Committee or the Utah Behavioral Health Advisory Council as outlined in the Scope of Work (SOW) 3.1(1). (Criteria weight 5)

2. TC 2: Describe your plan to engage in technical assistance from a national substance use or mental health agency as outlined in the SOW 3.1(2). (Criteria weight 5)

3. TC 3: Select one of the four Allowable Activities described in the SOW 3.2 and clearly state which activity you have selected. (Criteria weight 2)

Scores for this criteria will be awarded as follows (see attached scoresheet for the full evaluation score breakdown):

· Offerors selecting Allowable Activity 1 (hire at least one FTE PSS) will be scored a 2 (4 points total).

· Offerors selecting Allowable Activity 2 (provide direct PSS services to a primary population in an area with a mental health provider shortage) will be scored a 3 (6 points total).

· Offerors selecting Allowable Activity 3 (provide supervisor training to one or more PSS) will be scored a 4 (8 points total).

· Offerors selecting Allowable Activity 4 (establish a Family-Run Organization within Utah) will be scored a 5 (10 points total).

4. TC 4: For the Allowable Activity you selected above, describe your plan to fulfill the selected activity as outlined in the SOW 3.2. (Criteria weight 20)

5. TC 5: Describe how you plan to track and maintain the required data as outlined in SOW 3.3. (Criteria weight 5)

6. TC 6: In one page or less, describe and justify the budget proposed in Form #3: Budget Utilization Form. (Criteria weight 10)