234332 Application - Public Health Care Services Capacity Enhancement_Amended_6_27_24.docx

The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health 250 Washington Street, Boston, MA 02108-4619 Template Rev 3.0

APPLICATION RESPONSE FORM, INSTRUCTIONS, AND CHECKLIST

General Instructions:

1. See the RFR and COMMBUYS posting for complete procurement specifications.

2. All responses are to be submitted using the online submission tools available to Vendors registered in COMMBUYS. There is no charge to register in COMMBUYS. To Register go to www.COMMBUYS.com and click on the “Register” link on the front page. Bidders are solely responsible to monitor COMMBUYS for Bid amendments, if any. Bidders may monitor the record by frequently checking the Amendment Section on the Summary screen for the BID in COMMBUYS.

3. All Bidders are advised to allow adequate time for submission by considering potential online submission impediments like Internet traffic, Internet connection speed, file size, and file volume. DPH is not responsible for delays encountered by Bidders or their agents, or for a Bidder’s local hardware failures, such as computers or related networks, associated with bid compilation or submission. Bids submitted via COMMBUYS are time stamped by the COMMBUYS system clock which is considered the official time of record.

Formatting Instructions:

This document was prepared using Microsoft Word’s forms feature. Complete the form on your computer using Microsoft Word.

1. Save this document file to your computer.

2. Enter your responses in the text box, moving between the text boxes using the tab key on your keyboard.

3. Responses to check boxes are made by clicking once on the check box. To remove the X from a check box, click on the check box again.

4. Text responses are limited to a maximum number of characters and the limits are noted in each question. Once the maximum character limit is reached, MS Word will not allow more than this limit. Please note that a space is counted as a character and using the enter key to begin a new line in a response is also counted as a character. It is not recommended that applicants insert graphics into the responses. Spell-check does not work in text boxes.

5. Those with visual impairments may use an electronic text reader by unlocking the Application Response Form.

APPLICATION RESPONSE COVER PAGE

Make this the first page of your proposal.

RFR TITLE: Public Health Care Services Capacity Enhancement RFR # 234332

Address:

E-Mail: [ ]

A note about the text boxes [ ]: Text input is limited to a maximum number of characters. MS Word will not allow more than this limit. Spaces, commas, line breaks, etc. are counted as characters. The spell-check feature does not work in a text box.

Section A:

Service Area A1: Therapeutic Services

Enter your response in the text boxes using Microsoft Word.

1. Describe your organization’s experience with administering or dispensing therapeutics in an outpatient setting for treatment or pre- or post-exposure prophylaxis and your organizational capacity to implement the requirements described in Section 2(A)(1) of the RFR.

(Text input limit 18,000 characters, approximately 3,000 words):

Enter text here; text limit 18,000 characters

2. Include your organization’s maximum rate for the highest paid professional likely to be involved with projects under this contract, in all categories, including all fringe, benefits and agency overhead.

Enter text here: text limit 18,000 characters

3. Describe any specific activities your organization would need to complete to be fully prepared and operational to provide Therapeutic Services to patients if the Department enters into an engagement with your organization under this master agreement. In addition, please note any associated one-time start-up costs.

These activities may possibly include but are not limited to:

· updating or expanding EMR capability.

· reviewing and updating as necessary pharmacy procedures, expertise; and capacity.

· identifying, securing, and equipping space in which Therapeutic Services would be provided to patients.

· identifying and training staff who will support the provision of Therapeutic Services.

· other (describe)

Enter text here, 18,000 character limit

Section B:

Service Area A2: Regional Lead for Therapeutic Services

4. If your organization is seeking to be an Approved Vendor to provide this service, you must also complete Section A. Describe your organization’s experience with coordinating health and medical services across multiple organizations within a geographic region to ensure consistent provision of appropriate services, and to collect, maintain, and report data on the provision of such services to the Department as requested by the Department. In addition, please note any associated one-time start-up costs.

Section C:

Service Area B: Deployable Medical Teams

5. If your organization is seeking to be an Approved Vendor to provide this service, describe your organization’s experience with identifying and deploying clinical and non-clinical staff to respond to emergencies impacting the healthcare system domestically or internationally. In addition, please note any associated one-time start-up costs.

6. Describe your organization’s capacity to field, train, maintain, and equip teams of clinical and non- clinical personnel in 7-person, 14-person or 35-person configurations capable of accomplishing mission ready packages that may possibly include but are not limited to mass casualty event triage, establishment and operation of alternate care sites or field hospitals, healthcare facility staffing support, and public health interventions.

Section D:

Service Area C: Management and Coordination of Healthcare, Medical, and Ancillary Support Services

7. Describe your organization’s experience and capacity to provide the services as described in Section 2(C) of the RFR. Indicate knowledge of and experience working with the Department.

8. Describe your provider recruitment plan include deployment roster, plan, and timeframes.

9. Include your organization’s maximum rate for the highest paid professional likely to be involved with projects under this contract, including all fringe, benefits, transportation, lodging, and agency overhead.

Enter text here: text limit 18,000 characters

10. Describe any specific activities, as well as the timeframe, your organization would need to be fully prepared and operational to provide Management and Coordination of Healthcare, Medical, and Ancillary Support Services if the Department enters into an engagement with your organization under this master agreement. In addition, please note any associated one-time start-up costs.

Enter text here, 18,000 character limit

Section E: AFFIRMATIONS

[ ] By entering an X in the check box, the Applicant affirms that unless otherwise specified at the time of engagement the Applicant will accept patients by self-referral or referral from a provider regardless of whether the patient is in the Applicant’s patient panel.

[ ] By entering an X in the check box, the Applicant affirms that all individuals who provide services on an engagement with DPH pursuant to this master agreement DPH will be appropriately licensed and/or Board certified. A copy of license(s) may be required at the time of engagement.

[ ] By entering an X in the check box, the Applicant affirms that it shall obtain a Standard (Employer) Access Massachusetts Criminal Offender Record Information check on any individual who will be working with patients who receive services through an engagement with DPH under this master agreement.

[ ] By entering an X in the check box, the Applicant affirms that they will provide for their employees’ salaries, any fringe benefits, and malpractice insurance.

APPLICATION RESPONSE SUBMISSION PAGE

Organization I affirm that I will comply with the requirements of this Request for Response and with the terms of this proposal.

APPLICATION INSTRUCTIONS

1. Save, read, and review the completed Application Response Form. Check entries in the text boxes to assure that the input limits did not shorten your response. Proofread text; spell-check does not work in the text boxes.

2. Upload in COMMBUYS the Application Response Form with the attachments according to the application Checklist.

3. Confirm that “No Charge” is checked or a dollar amount entered in the Unit Cost field on the Item screen in COMMBUYS. The “No Charge” selection will not be construed by the Purchaser to mean an offer to provide service or products at no charge.

4. Submit your electronic quote in COMMBUYS. (Vendors must be registered in COMMBUYS to submit quotes) image1.png