261034 Application Family Support Living~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: Family Supportive Living

RFR # 261034

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 #____261034__

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.

(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).

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 of the proposed program (text input limit 1,875 characters, approximately 300 words):

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%).

|_| 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)

Enter text here; text limit 2,500 characters

2. Describe your capacity and plans for implementing family recovery support services including case management within a recovery-oriented and trauma informed living environment. Describe how you plan to supervise and sustain an inclusive and participatory environment that supports the needs of the families in a trauma informed and strength-based way. Describe the case management and planning supports provided for pregnant and postpartum mothers, including the Plan of Safe Care and collaboration with birthing hospitals, other providers and DCF. (text input limit 7,500 characters, approximately 1000 words, (6 points):

Enter text here; text limit 7,500 characters

6. 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.

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.

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.

7. 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).

8. 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):

9. Attach a sample seven-day week schedule of activities including group and individual services and provide any additional narrative explaining the daily schedule including case management, groups, life-skills development, recreational activities and general milieu management.

|_| Sample seven-day week schedule of activities is uploaded to COMMBUYS. (2 Points)

10. A. Describe your experience with and capacity to support parents who are in early recovery from SUD in their role as parents. Describe the types of parenting support and services that will be available both internally and externally. Describe how you will train and support staff to have both recovery and parenting support skills. 7,500 characters, approximately 1000 words, (6 Points)

Enter text here; text limit 7,500 characters

B. Attach relevant parenting support MOUs/Linkage Agreements.

|_| MOUs/linkage agreements uploaded to COMMBUYS (2 Points)

11. Describe your experience with and capacity to work with people with opioid use disorder utilizing medication for opioid use disorder (MOUD) methadone, buprenorphine, naltrexone in a Family Supportive Housing setting by responding to the following:

a. Describe your policies and procedures regarding MOUD in this setting including how transportation will occur, type and frequency of communication between MOUD provider and FSH case manager, storage of controlled substances at the program site, and policy on handling MOUD if resident leaves the program prematurely.

b. Describe your policies and procedures on overdose prevention including availability of NARCAN onsite, assessing risk for relapse, overdose, and/or how to assess the need for MOUD if resident has a history of OUD and is not on MOUD.

(text input limit 8,000 characters, approximately one and a half pages, (6 points):

Enter text here; text limit 8,000 characters

12. A. Describe how you will provide services and linkages to services for the children of the program. Please include services such as childcare, on-site developmental services/activities for children not yet accessing child-care, after school programming for school age children, as well as adolescents during after school hours. Describe how the program will support parents to ensure that appointments for children’s medical and/or mental health services are kept, including the Children’s Behavioral Health Initiative (CBHI) services, Early Intervention, Home Visiting and other appropriate services? (text input limit 5,000 characters, approximately 600 words, (6 points):

Enter text here; text limit 5,000 characters

B. Attach MOUs/linkage agreements with surrounding Opioid Treatment Programs (OTP) as well as Office Based Opioid Treatment programs (OBOT) where buprenorphine, or extended-release naltrexone are prescribed |_| MOUs/linkage agreements uploaded to COMMBUYS (2 Points)

13. A. Describe your plan for providing linkages and referrals to community-based supports including permanent housing and employment training and search services in order to achieve self-sufficiency? What is your plan in supporting families to achieve self-sufficiency and to transition into the community within one to two years? (text input limit 5,000 characters, approximately 600 words, (6 points):

Enter text here; text limit 5,000 characters

B. Attach relevant employment and housing MOUs/Linkages Agreements |_| MOUs/linkage agreements uploaded to COMMBUYS (2 Points)

14. A. Describe your plan for providing linkages and referrals to community-based supports including primary care, HIV/AIDS counseling and testing, family planning and women’s health services, domestic violence and sexual exploitation support services, and tobacco cessation services in order to promote health, wellness and overall family well-being? (text input limit 5,000 characters, approximately 600 words, 6 points):

Enter text here; text limit 5,000 characters

B. Attach relevant MOUs/Linkage Agreements |_| MOUs/linkage agreements uploaded to COMMBUYS (2 Points)

15. A. Describe your plan to provide services to DCF involved families and to pregnant and postpartum women and their infants. Please include:

· Approach to working with DCF including support for parents in coordinating the communication with DCF

· Prenatal care, support and education;

· Planning for delivery and hospital arrangements and possible “rooming-in” as needed

· Developing a plan of safe care for coordination of services for mother and infant for first year postpartum

· Family planning education, counseling and gynecological services

· Pediatric care;

· Parenting skills training and support;

· Coordination of Medication for Opioid Use Disorder (MOUD) for pregnant women and postpartum mothers (text input limit 8,000 characters, approximately one and a half pages, (6 points)

Enter text here; text limit 8,000 characters

B. Attach relevant MOUs/Linkage Agreements |_| MOUs/linkage agreements uploaded to COMMBUYS (2 Points)

16. Please describe how the program will support the transition of the family into the community and how follow-up with families after discharge will occur including frequency and length of follow-up. Address how program will engage the family in managing the continuation of their on-going supports as needed including recovery supports, housing, child-care, work, and health and other necessary social services.

(text input limit 5,000 characters, approximately 600 words, 6 points):

Enter text here; text limit 5,000 characters

17. Site control must include a commitment from the property owner that the applicant can site and operate the proposed FSH at the site. Provide address and location, floor plans with number, size, and purpose of rooms. Describe how site and layout is appropriate for the program using criteria from the Specifications section of the RFR and the Facility Checklist, see the ADA Compliance Coordination (https://www.ada.gov/) (text input limit 5,000 characters, approximately 800 words, 3 points)

|_| Floor Plan uploaded to COMMBUYS – Confidential must be checked on the quote attachment screen (2 Points) |_| All documents, such as lease, to demonstrate site control of the proposed facility uploaded to COMMBUYS (2 Points)

Enter text here; text limit 5,000 characters

19. Start-up cost-reimbursement: If you are requesting funding for start-up costs, please provide a line-item budget using the Program Budget form on the Forms and Terms screen. For a list of position codes for the form go to: www.mass.gov/anf/docs/osd/forms/attachmts/postitles.doc.

DPH anticipates funding the purchase of capital items under this RFR. Capital items are defined in 808 CMR 1.00 as “an asset or group of assets of nonexpendable personal property having a useful life of more than one year and an acquisition cost which equals or exceeds the capitalization level established and certified by the Contractor.” Only movable items will be reimbursed through this capital purchase process. If your proposal includes capital items, complete the Capital Budget form available at the COMMBUYS Bid File Attachments Section. Capital items must be specifically and individually approved by the DPH program prior to the purchase of the item. These must be purchased within the start-up period.

Capital items must be specifically and individually approved by the DPH program prior to the purchase of the item. These must be purchased within the 3-month start-up period.

Capital Budget form is attached. (No Points) Program Budget form is attached. (No Points)

Provide a program budget justification narrative with the attachments reflecting each line in the Program/Capital Budget form. Demonstrate how each budget item supports the overall program. (6 points) (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