260334 Application Residential Recovery Services~1.docx

The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health 250 Washington Street, Boston, MA 02108-4619 Rev 8

APPLICATION RESPONSE FORM, INSTRUCTIONS, AND CHECKLIST

For use with the M03/MM3 RFR

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.

RFR #______

APPLICATION RESPONSE COVER PAGE

Make this the first page of your proposal.

RFR TITLE: Residential Recovery Services

RFR # _260334_

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 # 260334

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.

Programs should respond to all questions EXCEPT Question 11, which should only be answered if a program intends to provide services to Pregnant and Post-Partum People. Additionally, COC RRS providers with a current BSAS contract need not provide an answer to Question #21.

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. (20 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 of the proposed program, including treatment model (i.e., Recovery Home, Therapeutic Community, Social model), location(s), which gender(s) you will serve, priority population(s) and/or special needs, and number of beds provided for this program. If you are planning to provide specialized services for pregnant and/or postpartum people, please identify if you will be serving only pregnant people or both pregnant and postpartum people with infants. (text input limit 1,875 characters, approximately 300 words): (4 points)

Enter text here; text limit 1,875 characters

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 1,250 characters, approximately 200 words): (4 points)

Enter text here; text limit 1,250 characters

7. The Department expects health and human service providers and residents to come together to collaboratively identify local and regional health priorities, design community-based prevention plans, and track success in achieving healthier communities through collaborations both internal and external and by participation in a local Coalition that meets the minimum requirements established in the 2015 DPH Coalition Principles and Guidelines.

https://www.mass.gov/service-details/healthy-communities-and-community-engagement-capacity-building.

a) Describe how internal and external collaborations have and will enhance your ability to target, plan, provide and evaluate the proposed program. Note how these collaborations will directly benefit the priority population, promote efficiency and/or improve effectiveness. (4 points)

b) Name a coalition that that you plan to participate in and describe how this participation will enhance the work of the proposed program. Participation in a coalition is a requirement of DPH funding. To find coalitions in your area visit http://www.hriainstitute.org/coalitions.(2 points)

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

|_| Levels of Cooperative Activities Chart uploaded to COMMBUYS. (2 points)

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): (No points)

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

9. Describe how your program builds and sustains relationships with community-based services, with the goal of establishing individualized care plans to appropriately support treatment and aftercare placement for residents. Supportive services may include linkages to Peer Recovery Support Centers, Recovery Coaching, Mental Health, Medication for Addiction Treatment, Primary Care, Family Planning, Intimate Partner Violence, and other health and wellness-related resources. (text input limit 1,250 characters, approximately 200 words): (6 points)

Enter text here; text limit 1,250 characters

10. 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)

If your program plans on serving Pregnant and Postpartum people, please answer. If not, skip this question.

11. Describe your plan to provide enhanced services to Pregnant and Postpartum people. Describe how staffing will be trained to support this population, number of crib bedrooms if serving postpartum people with infants, how care coordination and day-to-day programming will meet the requirements of the RFR and will provide effective treatment for Pregnant and Postpartum people. Describe the following service components in your answer.

· Care coordination for OB-GYN care, pediatric care, and primary care including family planning and birthing hospital coordination including pre-birth preparations;

· Support for and development of the Family Care Plan including any post-birth planning meetings with DCF;

· Dyadic support for infant bonding, feeding supports, safe sleep and care of infant with prenatal substance exposure;

· Care coordination with MAT provider if applicable including advocacy for split dosing and dose adjustments;

· Infectious disease counseling and testing;

· Tobacco cessation supports and referrals;

· Linkages to Early Intervention Services;

· Support with regular communication with DCF if involved.

(text input limit 3,750 characters, approximately 600 words): (10 points)

Enter text here; text limit 3,750 characters

12. Provide a weekly, seven-day schedule of activities. Schedules will include clinical and psychoeducational groups with topics and facilitators, in-house meetings, community engagement, life skills, chores, medication pass, appointments, and additional services deemed necessary by the provider. Include an explanatory narrative, which includes the capacity to provide the required amount of individual and group clinical services. Refer to the DPH regulations at 105 CMR 164 (mass.gov) . (text input limit 3,750 characters, approximately 600 words, 4 points):

|_| Sample weekly chart (Monday thru Sunday) scheduled Activities Chart uploaded to COMMBUYS (2 Points)

13. Provide a weekly chart of staff shift coverage, for all shifts, based on COC RFR Staffing and Minimum Requirements. Describe how you will ensure that supervision, training, and monitoring of documentation will be completed. How will you recruit a culturally and linguistically diverse staff that reflects the backgrounds of the program’s residents? (text input limit 2,500 characters, approximately 400 words): (4 points)

|_| Required staffing coverage for positions Chart uploaded to COMMBUYS (2 points)

14. How does your program a) receive referrals, b) manage your waitlist, and c) assess applicants? How does your program accommodate referrals from various service settings (i.e. community-based setting, higher levels of care, and criminal justice system) and reduce barriers to allow for timely entry and enrollment in the program? (text input limit 5,000 characters, approximately 800 words): (6 points)

Enter text here; text limit 5,000 characters

15. Describe how your program utilizes evidence-based practices in case management, psycho-educational, and clinical aspects of the program. Describe how your program will train and integrate ASAM criteria. (6 points)

16. Describe how your program engages and supports participants in aftercare planning in consideration of various reasons for discharge. (text input limit 5,000 characters, approximately 800 words): (6 points)

17. Describe your program’s policy and practice around return to use. Describe your use of Harm Reduction Initiatives inclusive of Naloxone distribution for all participants. (text input limit 5,000 characters, approximately 800 words): (6 points)

18. Describe your approach and abilities (including clinical expertise in assessment and treatment) to serve people that have co-occurring disorders, trauma histories, differences in cognitive abilities, and other disabilities (including traumatic brain injuries or fetal alcohol spectrum disorders (FASD)). Identify any screenings utilized, such as assessing for traumatic brain injury and other tools for providing services to those with disabilities. (text input limit 2,500 characters, approximately 400 words) (6 points)

|_| Most recent Trauma Informed Self-Assessment uploaded to COMMBUYS (2 Points)

19. a) Describe your policies and procedures regarding Medication for Addiction Treatment (MAT) and Medication for Opioid Use Disorder (MOUD). Demonstrate that your program has direct linkages to surrounding dosing programs as well as a primary care site where medication is prescribed and/or dispensed. Show your capacity to work with persons receiving Medication for Addiction Treatment (MAT) and Medication for Opioid Use Disorder (MOUD), as well as individuals using medication to treat other substance use disorders, physical diseases, or psychiatric disorders. (text input limit 3,750 characters, approximately 600 words, (6 points):

b) Attest that your program meets the contractual requirement for medication specialist staff. If not, provide a detailed plan with timeline for hiring and meeting this standard. How do medication specialists provide 24-hour support within the program’s milieu, including staff who are cross-trained in duties and responsibilities of the role? Describe how training, supervision, and support are provided to Medication Specialist staff. (6 points)

20. Briefly describe the Quality Improvement process specific to this proposed COC RRS program. Describe the methods you will use for quality improvement including data measurements and consumer feedback. Describe the frequency of feedback and who is involved in this process by job role. Give one or two examples of how you have used consumer feedback to improve the quality of services at your agency. (text input limit 2,500 characters, approximately 400 words, (6 points):

21. Program Budget: For cost reimbursement contracts and new contracted vendors approved for start-up, provide an annual line-item budget using the Program Budget form found in the COMMBUYS Bid Attachment Section. Use the Purchase of Service Titles - UFR Titles: www.mass.gov/anf/docs/osd/forms/attachmts/postitles.doc, for a list of position codes for the form.

COC RRS providers, with a current BSAS contract, need not provide an answer to Question #21.

|_| Program Budget form is attached.

Provide a program budget justification narrative, reflecting each line in the Program Budget form. Demonstrate how each budget item supports the overall program. (text input limit 6,000 characters, approximately one page):

Enter text here; text limit 6,000 characters

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) image1.png