250533 Application Ambulatory Services for Substance Use and Addictive Disorders Updated 3-6-24.docx

APPLICATION RESPONSE COVER PAGE

Make this the first page of your proposal.

RFR TITLE: Ambulatory Services for Substance Use and Addictive Disorders ____ RFR Number: 250533

Organization Organization Name: [ ]

Address:

City: [ ] State: [ ] Zip: [ ]

Vendor Code: [ ]

CEO (Chief Executive Officer) First Name: [ ] Last Name: [ ]

FEIN: [ ]

Contact Person First Name: [ ] Last Name: [ ]

Title: [ ]

Telephone: ( ) - FAX: ( ) -

E-Mail: [ ]

Contact Person Address (if different):

City: [ ] State: [ ] Zip: [ ]

Location of Proposed Service Program Name: [ ]

Program Address:

City: [ ] State: [ ] Zip: [ ]

RFR #___ 250533 ___

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.

QUESTIONS FOR RESPONSE

Enter your response in the text boxes using Microsoft Word.

1. Prior to entering into a contract with DPH a bidder must demonstrate that it meets minimum administrative and fiscal standards established through the Executive Office of Health and Human Services (EOHHS) provider qualification policy. Potential bidder’s new to the state system must upload completed provider qualification application materials as part of the response to this RFR. See the Provider Qualification Folder (PROQUAL) for instructions and forms. Bidders with current human and social services contracts (MM3/M03 contracts) must have filed their Uniform Financial Statements and Independent Auditor's Report (UFR) with the Operational Services Division EFile system.

|X| New provider – Uploaded requested documents to COMMBUYS.

|X| Existing provider – UFR on file at the OSD EFile website.

2. (a) Attach an organizational chart that shows the location of the proposed program within your agency.

|X| Organization Chart uploaded to COMMBUYS. (2 points)

(b) Describe how the proposed program will link with the mission and programs described in your agency’s mission statement (text input limit 1,250 characters, approximately 200 words). (2 points)

A note about the text boxes: Type or paste text into the gray areas. 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.

Enter text here: text limit 1,250 characters

3. (a) Bidders are required to make a meaningful financial commitment (“SDP Commitment”) by partnering with one or more SDO-certified or recognized diverse business enterprise or non-profit organization. It is desirable that Providers aim to direct at least 1% of their Commonwealth contract revenue toward spending with SDP Partners. The Provider’s percentage of spending with SDP Partner(s) for the prior fiscal year can be seen as “PERCENT (%) OF POS SPEND” on the completed “SDP Plan Form for POS” for that fiscal year. (15 points).

Bidders can

· upload a copy of the SDP Plans most recently filed through the Uniform Financial Reporting (UFR) system

· upload an updated SDP Plan using the SDP Form for POS found in the attachment section on COMMBUYS

· if a new provider complete the SDP Plan for POS and upload with your response

Contractors seeking assistance in the development of their SDP Plans or identification of potential SDP Partners may visit the SDP webpage, www.mass.gov/sdp, or contact the SDP Help Desk at sdp@mass.gov

|_| SDP plan form for POS uploaded to COMMBUYS

(b) Bidders should describe how the current or planned operations of their organization support racial/health equity (10 points).

Enter text here: text limit 1,250 characters

4. Provide an abstract for each of the proposed programs (text input limit 2,500 characters, approximately 600 words): (4 points)

Enter text here; text limit 5000 characters

On the chart below please indicate with an “X” in the left column all services you are applying to provide. You may check more than one service.

Services for Specialty Populations

5. (a) Provide a percentage breakdown by job category and race/ethnicity of your agency’s staff on the Agency Staff Demographics Table available in the COMMBUYS Bid Attachment Section. Please enter percentages as whole numbers (e.g., 2.3% = 2%). (2 points)

|_| Agency Staff Demographics Table uploaded to COMMBUYS.

(b) Describe the population your agency serves across all programs, in terms of its racial, ethnic, linguistic, cultural, gender and age characteristics. What neighborhood(s) or town(s) does your agency serve? (text input limit 2,500 characters, approximately 400 words) (2 points)

Enter text here; text limit 2,500 characters

6. Briefly describe your experience in providing the type of program proposed in this RFR (text input limit 2,500 characters, approximately 400 words): (6 points)

7. Please describe how you will collaborate with Medication Assisted Treatment (MAT) programs and how you will support clients accessing MAT. Describe any existing agreements or collaborative relationships between your agency and MAT providers. (6 points)

Complete and attach the Levels of Cooperative Activities Chart for this program available in the COMMBUYS Bid Attachment Section. (2 points)

|_| Levels of Cooperative Activities Chart uploaded to COMMBUYS.

8. If the proposal being submitted contains subcontracts, name the proposed subcontractors. Describe how the subcontracts will function, including descriptions of responsible parties and structures for operation and accountability. All subcontracts are subject to DPH approval. If you are proposing to use subcontractors, complete the Direct Care Proposed Subcontractor Identification List, found in the COMMBUYS Bid Attachment Section. (text input limit 2,500 characters, approximately 400 words):

|_| Proposed Subcontractor Identification List uploaded to COMMBUYS (if applicable).

9. Federal standards direct agencies to deliver effective, understandable and respectful care that is provided in a manner compatible with a client’s cultural health beliefs and practices and preferred language. Please describe your program’s client population and your strategies for delivering culturally competent and linguistically appropriate services. For assistance in developing strategies to provide culturally and linguistically appropriate standards of care, please see the Cultural and Linguistic Appropriate Services Standards and Guidelines attachment available at the COMMBUYS Bid Attachment Section. (text input limit 2,500 characters, approximately 400 words): (6 points)

10. Please describe how your program provides staff training on trauma informed care, provides supervision to support this training and a trauma informed approach, and how the program staff use a trauma informed approach in their work. (6 points)

Enter text here; text limit 1,250 characters

11. Please describe how your program incorporates the assessment, treatment, or referral of clients with medical and/or mental health disorders that may co-occur with their substance use. (6 points)

12. Please affirm that your program can provide an adequate number of qualified personnel to fulfill service objectives and needs of the clients as required by 105 CMR 164.048 (no points)

|_| YES |_| NO

Instructions: For questions 16 a-h answer only those questions that correspond to the services for which you are applying to provide.

13.

a. For providers applying for Pre and post adjudicated services, please describe your current or proposed referral, communication, and collaboration process with the court system. (4 points)

b. For providers applying for Pre and post adjudicated services, please describe how you currently and/or propose to address the root causes of criminal behavior, promoting rehabilitation and reintegration into the community. (4 points)

c. For providers applying for Second Offender Aftercare (SOA), please describe your current or proposed referral, communication, and collaboration process with the court system. (4 points)

d. For providers applying for Second Offender Aftercare (SOA), please describe the current or proposed individualized treatment approach to underscore the consequences of substance use while driving along with other personalized treatment goals. (4 points)

e. For Providers applying for Problem Gambling Services, please describe your current clinician and supervisor certifications or plan for attaining certifications. (4 points)

f. For Providers applying for Recovery Coaching, please describe your current or proposed staff and supervisor training and certification process. Please indicate how many staff are currently certified to provide recovery coaching, if applicable. (4 points)

g. For Providers applying for Family Intervention Services, please describe the experience your agency has with adopting evidence-based practices, implementation successes and challenges, and strategies developed and utilized to address these challenges. (4 points)

14. Additionally, for Family Intervention Services, please describe: A) the intended staffing pattern to support implementation of the A-CRA model; B) the names, educational level attained, and professional licensure of each staff currently delivering or intended to be delivering A-CRA services; C) age group (13-17 and/or 18-25) intended to be served including specific cultural groups being targeted; D) describe a plan for supporting staff to attend training, pursue and complete certification in A-CRA (text input limit 2,500 characters, approximately 400 words): (6 points)

APPLICATION RESPONSE SUBMISSION PAGE

Organization

CERTIFICATION OF ASSURANCE OF COMPLIANCE:

ADA/ 504 and NON-DISCRIMINATION BASED ON DISABILITY

All MDPH- funded projects must certify that the Applicant Organization will comply with all state and federal requirements regarding equal employment opportunity, nondiscrimination and civil rights for persons with disabilities. The Applicant must complete a Certification of Assurance of Compliance-ADA/504/Non-Discrimination based on Disability. By signing, the Applicant formally notifies MDPH that the Applicant is in compliance and shall maintain compliance with all applicable requirements.

· I , certify, that the Applicant is in compliance and shall maintain compliance with all applicable federal and state laws protecting the rights of persons with disabilities, including but not limited to the Americans with Disabilities Act (“ADA”), 42 12131-12134; Section 504 (“504”) of the Rehabilitation Act of 1973, 29U.S.C. §§ U.S.C. § 794; Article CXIV of the Massachusetts Constitution; and Chapter 6, §§ 185-87; Chapter 93, § 103; Chapter 151B; and Chapter 272, §§ 92, 98, and 98A of the Massachusetts General Laws.

· I understand that federal and state laws prohibit discrimination in public accommodations and employment based solely on disability. I recognize that to make goods, services, facilities, privileges, advantages, or accommodations readily accessible to and usable by persons with disabilities, the Applicant, under the ADA, must:

· remove architectural and communication barriers in existing facilities, when readily achievable and, if not readily achievable, must use alternative methods;

· purchase accessible equipment or modify equipment;

· modify polices and practices; and

· furnish appropriate auxiliary aids and services where necessary to ensure effective communication.

I recognize that Section 504 of the Rehabilitation Act requires recipients of federal funds (either directly or through contracting with a governmental entity receiving federal funds) to make their programs, services, and activities, when viewed in their entirety, accessible to qualified and/or eligible people with disabilities. I understand that reasonable accommodation is required in both program services and employment, except where to do so would cause an undue hardship or burden. I also understand that the Massachusetts Constitution Article CXIV provides that no otherwise qualified individual shall, solely by reason of disability, be excluded from the participation in, denied the benefits of, or be subject to discrimination under any program or activity within the Commonwealth.

· I agree the Applicant shall cooperate in any compliance review and to provide reasonable access to the premises of all places of business and employment and to records, files, information, and employees therein for reviewing compliance with Section 504, the ADA, the Massachusetts Constitution, other applicable state and federal laws, and this Contractual Agreement.

· I agree that any violation of the specific provisions and terms of this Assurance and/or Corrective Action Plan and/or Special Contract Conditions required herein or Section 504 or the ADA, shall be deemed a breach of a material provision of the Contract between the Department and the Contractor. Such a breach shall be grounds for cancellation, termination, or suspension, in whole or in part, of this Contract by the Department.

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

Authorized Signatory:

First Name: [ ] Last Name: [ ]

Title: [ ]

By clicking the check box, the submitter attests that s/he is an agent of the Bidder with authority to sign on the Bidder’s behalf and is agreeing all affirmations listed above.

CHECKLIST OF ATTACHMENTS TO THE APPLICATION RESPONSE FORM

All documents listed below must be submitted via COMMBUYS in order for you response to be considered complete. Files must be uploaded and follow the naming convention indicated in the chart.

Assign when creating documents

Scanned documents will be accepted. All scanned documents must be scanned in such a way that they can be read on a computer monitor and printed on 81/2” x 11” paper, unless otherwise specified. Attachments must be uploaded individually and cannot be combined in a zipped file.

Addendums or uploads not specifically requested in this document, the RFR or on the COMMBUYS Bid Solicitation will not be reviewed.

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. Proof read 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)