ALTR-24 RFR - RESTATED 5-14-24.docx

For Internal Discussion Purposes Only

The Commonwealth of Massachusetts Department of Developmental Services (DDS) Central Office

Address: 1000 Washington Street Suite 410 Boston, MA 02108

Contact: Timothy Cahill

Email: DDSPOSProcurement@mass.gov

Request for Response (RFR)

Document Title: Adult Long Term Residential Services - 24

COMMBUYS BID Number: BD-23-1023-1023C-1023L-85261

DDS RFR Document Number: ALTR-24

Restated: May 14, 2024

It is the responsibility of the prospective Bidder and awarded Contractor to maintain an active registration in COMMBUYS and to keep current the email address of the Bidder’s contact person and prospective contract manager, if awarded a contract, and to monitor that email inbox for communications from the Purchasing Department, including requests for clarification. The Purchasing Department and the Commonwealth assume no responsibility if a prospective Bidder’s/awarded Contractor’s designated email address is not current, or if technical problems, including those with the prospective Bidder’s/awarded Contractor’s computer, network or internet service provider (ISP) cause email communications sent to/from the prospective Bidder/Awarded contractor and the Purchasing Department to be lost or rejected by any means including email or spam filtering. To register go to www.COMMBUYS.com.

This BID requires the submission of electronic quotes. All Bidders are advised to allow adequate time for submission of their quotes by considering potential online impediments like Internet traffic, Internet connection speed, file size, and file volume. DDS 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.

To receive a contract with the Commonwealth, a vendor must be active in The Massachusetts Management Accounting and Reporting System (MMARS). MMARS is the official accounting system of the Commonwealth and once registered a vendor will be issued a Vendor Customer Code number or a “VC” number. This VC number is used for all contracts that a vendor has with state agencies. An organization with existing state contracts, or a vendor who has had state contracts with any state agency in the past, has been registered in MMARS and does not need to re-submit paperwork unless existing information in MMARS will need to be updated. Bidders that don’t have a Vendor Customer Code or have changes to information or forms currently on file should send an email to: DDSPOSProcurement@mass.gov

Public Records: All information, documents, and attachments submitted as a response to this RFR(RFQ) are considered a public document subject to the Massachusetts Public Records Law, M.G.L., c. 66, s. 10, and to c. 4, s. 7, ss. 26. Please be aware that checking the “confidential” box in COMMBUYS does not bar these documents from being released as a public record pursuant to these statutes once the procurement is awarded, unless statutorily exempt from disclosure.

Contents

1.0 Procurement Scope and Description

The Department of Developmental Services (DDS) is issuing this BID to identify a qualified list of providers of Adult Long-Term Residential (ALTR) service. ALTR includes an array of services and supports in a home-based setting on a 24-hour basis. Services are designed to promote the independence, health and well-being, self-determination, and community inclusion of a person who has significant, long-term physical, cognitive, sensory, health and/or behavioral health needs. These services are long-term in nature and intended to offer the individual services within their primary residence. Individuals eligible for ALTR must have DDS adult eligibility for Intellectual / Developmental Disability (I/DD) or be enrolled in the Acquired Brain Injury (ABI) Residential Habilitation Waiver or Moving Forward Plan (MFP) Residential Supports Waiver. Individuals may also exhibit co-morbid conditions, such as a history of substance abuse, psychiatric/behavioral disorder, and/or significant medical needs.

This BID also includes Emergency Stabilization Residential services. These services are targeted to DDS eligible adults who are 18 years of age and over who are unable to remain in their current living situation due to a variety of reasons, are homeless, or need to be removed from their home. This service consists of supports that provide a temporary, flexible and individualized residential option to adults in a residential setting 24 hours a day, 7 days a week.

To submit a response/quote, the bidder must meet at least one of the following: 1) Contracted and licensed by DDS to provide residential services, 2) Contracted and licensed by DDS to provide Shared Living, In Home Supports or Community Based Day Supports, 3) Special Education Residential School, or 4) Residential, group home or shelter provider for another state agency.

1.1 Procurement and Contract Structure

This Request for Response incorporates all relevant provisions of 801 CMR 21.00 Procurement of Commodities and Services, the Standard Contract Form and Instructions, the Commonwealth Terms and Conditions for Human and Social Services, the Operational Services Division’s REQUIRED SPECIFICATIONS for POS from September 1, 2019, Attachment C and any amendments and/or additions to these documents during the life of this BID.

This procurement will result in a Master List of providers who have been deemed qualified to provide Adult Long Term Residential and Emergency Residential Services and have been awarded a contract. Proposals will be reviewed and scored by Procurement Management Teams (PMT) composed of representatives from the DDS Regional and Area Offices.

Qualified providers will sign a Standard Contract Form that will be issued by the Department’s Central Office. The Master Agreement contract does not guarantee the bidder a specific level of funding. Funding will be managed by the DDS Regional Contract Offices either through a Service Summary Form or other forms determined by the Department to track authorized units of service and the rate of service/s. Providers must receive written authorization from DDS prior to delivering services under this RFR.

1.2 Applicable Procurement Law

1.3 Whether Single or Multiple Contractors are Required for Contract(s)

Check One (“X”):

1.4 Calendar Rule Type

Open May be reopened at a time and for a duration deemed necessary by the Department.

No responses will be received after the bid open date unless the Department choses to reopen the RFR at a later date.

|X|

Rolling Bidders may submit unsolicited proposals during the entire contract period. Providers can continue to submit proposal up to June 30, 2032. Proposals submitted after the initial due date will be reviewed and scored on a quarterly basis unless otherwise noted in the RFR/BID

1.5 Acquisition Method

1.6 Use of Procurement by a Single or Multiple Departments

Massachusetts Commission for the Blind Massachusetts Rehabilitation Commission

The Purchasing Department reserves the right to add or remove additional authorized users during the contract term.

*Criteria and standards for residential care may differ from those stated in this RFR

1.7 Expected Duration of Contract

Anticipated Duration up to: Ten (10) Years

Final End Date of this Contract: June 30, 2033

1.8 Anticipated Expenditure, Funding or Compensation for Expected Duration

Estimated Value of Procurement: $19,000,000,000

All services in this RFR are subject to appropriation. Should funding levels be adjusted significantly, the Department may seek provider re-affirmation of willingness to continue under modified program requirements.

At any time during the duration of the contract, the Department may conduct reviews of services and may consider taking corrective action, up to and including cessation or termination of all or part of the services covered under the Contract. Reasons for taking corrective action include: the provider has not satisfactorily achieved performance goals; the needs of the individuals change to the extent that they can no longer be appropriately served under the original terms of this procurement; a provider is unable to meet licensing or certification standards, or DDS determines that a significant change in services is in the best interests of the individuals served or the Department. Generally, unless a termination notice has been given pursuant to the Commonwealth Terms and Conditions for Human and Social Services, the Master Agreement contract will remain in force for the duration of the procurement. The Department reserves the right to make contract awards for a shorter duration when it is in the best interests of individuals, the Department, or the Commonwealth.

Check One (“X”):

Will Federal Funds be used to fund any part of Contract(s)?

*Providers receiving federal grant funds may be considered sub-recipients for federal grant purposes and will be required to comply with applicable federal requirements, including but not limited to sub-recipient audit requirements under OMB Circular A-133.

Capital, Trust and Federal Accounts Only Any funds designated in the budget that are unspent in any fiscal year will not be available for expenditure in the subsequent fiscal year.

Notice Concerning Rates of Payment: M.G.L. c 118E An Act Relative to Rates for Human and Social Service programs provides that the Secretary of Health and Human Services has the sole responsibility for established rates of payment for social service programs purchased by governmental units of the Executive Office. Contractors will be reimbursed on a unit rate or accommodation rate based on rates established by the Executive Office Health and Human Services as stated in 101 CMR 420.00 Rates for Adult Long Term Residential Services and other applicable rate regulations as may be amended from time to time during the duration of the Contract. The rates of payment and reimbursement structures may change during the life of the Contract.

1.9 Contracting Structure

The Department will process two types of service engagements with qualified providers: 1) Engagements that specify per diem billing rates and the number of units to be purchased. The engagement will note the expected expenditure level the Department anticipates the provider will be paid based on the projected number of units to be provided at the agreed upon rate/s, and 2) Occupancy Form/Worksheet that signifies the rate the Department will reimburse the provider to cover occupancy costs associated with each site. Occupancy expenses reimbursed through this contract include but are not limited to reasonable costs associated with, lease or rental payments, depreciation, interest associated with long term debt, insurance, maintenance, and utilities.

Service Engagement ALTR Providers will work collaboratively with the DDS Area Office or ABI/MFP Director to develop the staffing plan for each site. This staffing plan will inform the model rate for the site. This rate includes the programmatic resources necessary to provide the individual direct care and support services, including consultants, materials and supplies, vehicles/transportation, and administrative services attributed to the service portion of the program. The approved rate for a site will be based on the capacity of the site, the number of full-time equivalents (FTEs) at the site and any add-on costs that are required to address the unique needs of individuals. Payments for services will be made on a per person/per day basis. If two or more sites are included in a service engagement, the Department will issue a single blended billing rate in accordance with 101 CMR 420.03(5) which shall apply to all individuals receiving services under the engagement.

Qualified providers cannot bill for an individual if the person is absent from home on a particular day unless previously approved by the Department. The Department has issued guidance that outlines situations where DDS will reimburse providers for absences or illnesses to keep a bed available for the return of the individual to the program.

Emergency Stabilization Residential: Service Engagement Providers of Emergency Stabilization Residential services will be reimbursed on a monthly accommodation rate. The Area Office will work with the provider to determine the appropriate staffing plan, number of FTEs and add-on costs required to provide services at the site. The daily rate for the site will be converted to an accommodation rate in recognition of fluctuations in the number of beds that may be occupied on a daily basis.

Occupancy The Department determines occupancy rates using an Occupancy Worksheet. The Worksheet converts the daily rate for agreed upon occupancy costs to a monthly accommodation rate for billing purposes. In cases in which multiple sites are included in an occupancy contract, the Department will blend the site cost into a single accommodation rate.

Offsetting Revenue Recurring income and other public benefits received by individuals residing at the site (e.g., wages from employment, Social Security Disability Income (SSDI), Supplemental Nutritional Assistance Program (SNAP), Section 8 Housing Vouchers) must be used to offset the cost of ALTR services. The Department is the “payer of last resort” for ALTR services and ALTR providers must maximize the collections of revenue available from other sources in accordance with 115 CMR 3.05 to apply as an offset to the rate paid by DDS. These funds are often referred to as “charges for care”. Charges for care revenue are first used to offset the cost of room and board associated with ALTR sites and then to offset the cost of operating the service if offsets exceed the approved occupancy expenses. When the program residents’ contributions exceed the cost of operating a site, the Department will not provide a separate payment for occupancy. Unless explicitly directed by DDS, ALTR providers must collect from individuals the maximum amounts allowable under 115 CMR 3.05.

Qualified providers operating ALTR services as a result of this procurement will be asked to demonstrate how they plan to maintain existing levels of offsetting revenues and to maximize collection of additional third-party revenues, as appropriate, as well as to identify anticipated funds from other sources. State funds are not to be used for services and goods that can be purchased from other means available to the person or the provider.

Start-up and Capital Contracts These contracts may be issued to cover approved costs associated with opening a new residential site. The Department cannot reimburse providers for costs incurred before the Start Up or Capital contract is executed. The Department publishes start up and capital asset guidance documents, as well as required start-up and capital contract worksheets and instructions, and other related documents on the DDS Purchase of Services (POS) web site. Over the life of the contract, these documents may be updated to reflect changes in approval processes, funding limits, etc. All capital assets purchased through this mechanism must be maintained in accordance with 808 CMR 1.00.

During the life of this procurement, existing resources may be reassigned, service needs of individuals may change and the Department may update process and forms for managing services to accommodate new methodologies for determining rates and reimbursing providers. Service and occupancy engagements that result from this RFR may be amended to accommodate any of these changes and updates to regulation during the life of this procurement.

Commercial Earnings Fees (for profit entities): Refer to 808 CMR 1.00. Compliance, Reporting and Auditing for Human and Social Services, 1.03 (6). The commercial earning fee shall be equal to the current surplus revenue retention limit stated in 808 CMR 1.03 (7).

EOHHS Qualification Process: New Providers Providers who have not been actively qualified by an EOHHS agency based on their submission of financial and organizational information must take steps to begin the POS Qualification Process prior to submitting response/quote in COMMBUYS. To receive forms and instructions regarding the POS Qualification Process, new providers should send an email to DDSPOSProcurement@mass.gov.

2.0 Service Description

Adult Long Term Residential services are an array of services and supports provided in individuals’ homes on a 24-hour basis that promote the independence, health and well-being, self-determination, and community inclusion of a person who has significant, long-term physical, cognitive, sensory, health and/or behavioral health needs. ALTR services are long-term in nature and intended to offer the individual services within their primary residence.

ALTR supports must be designed for each individual utilizing person-centered planning and coordination. This is an approach to assessment, planning, and coordination of services and supports that is focused on the individual’s goals, needs, preferences, and values. The person directs the development of the plan, which describes the life they want to live in the community. Services and supports are coordinated across providers and systems to carry out the plan and ensure fidelity with the person’s expressed goals, needs, preferences, and values.

A multi-disciplinary team approach should be used for the provision of services. Providers will engage a team of direct support professionals, licensed nurses, and other clinical professionals to effectively coordinate and provide the supports to meet individual needs and the collective needs of the small group of individuals living together.

Services and supports may include, but are not limited to, assistance with acquisition, retention, or improvement in skills related to activities of daily living, household management, community involvement, medication and medical management, and financial management. Behavioral/clinical support, supervision, transportation, and assistance to maintain housing that meets their needs and interests are also components of this service.

Supports should be designed to develop and promote individuals’ rights and dignity, effective communication, goal development, skill acquisition, community membership, mutual relationships, individual control, decision-making, and to optimize their personal and environmental safety and physical and mental health. In addition, ALTR services support each individuals’ independence and comports fully with standards applicable to Home and Community Based settings delivered under Section 1915(c) of the Social Security Act, including those requirements applicable to provider-owned or controlled homes, except as supported by the individual’s specific assessed need and set forth in the person-centered plan.

ALTR providers must promote the use of Supportive Technology in accordance with the principles and practices of the DDS Technology Forward initiative. Supportive Technology should be utilized to increase opportunities for individuals to achieve greater independence and control over their lives. Supportive technology in conjunction with the design of the home should meet individuals’ environmental accessibility needs to be as independent as possible. This may include outfitting homes with individual specific assistive technology devices identified through an assistive technology assessment. Direct support provided remotely via technology can be operated by the ALTR provider or through partnership with a vendor that provides direct support via technology. Direct support provided via technology can only be used with individuals that demonstrate that they can be effectively supported with this type of modality.

ALTR providers are required to facilitate the process of selecting and acquiring the home and are responsible for ongoing maintenance and upkeep of the physical location. Homes / apartments must meet standards established by the building codes for residential homes, standards in the DDS Licensure and Certification Manual and Appendices, as well as comply with the Americans with Disability Act (ADA). Individuals must be served in homes that meet their specific accessibility needs. Individuals with accessibility needs must be offered a living arrangement that meets the requirements of the Architectural Access Board (AAB) / ADA standards for accessible housing.

2.1 Characteristics of Population to be Served

Individuals are prioritized to receive 24-hour residential services pursuant to 115 CMR 6.08(3)(b)(1) if the supports are necessary to protect the health or safety of the individual or others. Individuals may also be prioritized for ALTR services because they are residing in an institutional setting and seek to transition to receiving services in a community-based home.

Individuals eligible for ALTR must have DDS adult eligibility for I/DD or be enrolled in the ABI Residential Habilitation Waiver or MFP Residential Supports Waiver. Individuals may also exhibit co-morbid conditions, such as a history of substance abuse, psychiatric/behavioral disorder, and/or significant medical needs.

Over the lifetime of this procurement DDS may modify eligibility standards, processes for assessing individuals to be prioritized for residential services, and populations eligible for residential services pursuant to DDS Regulation or Policy.

2.2 Statement of Human Rights

DDS adopts each of the following statements in furtherance of the goal of respecting the people they serve.

Dignity: Individuals have the right to be treated with respect, including respect for ethnic and cultural diversity.

Self-determination: Individuals must have the opportunity to make meaningful choices and to make informed decisions about their lives. Informed decision-making includes the right to decide to take reasonable risks. It also requires adequate support to help the individual understand and weigh the risks and benefits of their decisions, as needed.

Communication: Individuals have the right to communicate with others and to fully express themselves. Individuals shall have access to the assistance necessary to communicate, including access to adaptive equipment, to alternative hearing and communication devices.

Relationships: Individuals have the right to visit others and to receive visitors, including the right to have friendships and relationships with mutually consenting adults.

Privacy: Individuals have the right to privacy. This includes privacy during care of personal needs, privacy in communication, privacy in visits, privacy in one’s home and personal space, and confidentiality of personal information.

Personal Safety: Individuals have the right to be safe and the right to be free from harm or abuse.

Personal Property: Individuals have the right to obtain, keep, use, and dispose of personal possessions.

Education, Employment, and Compensation: Individuals have the right to equal access to opportunities for education and for employment. Individuals who are employed have the right to be fairly compensated for the work that they do.

Community Membership: Individuals have the right to expect that services and supports will be provided in a manner that promotes their ability to live in the least restrictive, and most typical, settings appropriate to them. Supports and services shall encourage and maintain meaningful community membership. As members of a community, all individuals have a responsibility to respect other people and to exercise their rights with due regard for the rights of other members of the community.

ALTR Service expectations relative to Human Rights Human Rights are at the core of service delivery. As such, ALTR Service Providers must have policies and procedures to address and support Human Rights in compliance with the requirements of DDS regulations 115 CMR 3.09 Protection of Human Rights/Human Rights Committees. For example, individuals and guardians must be trained and supported to learn about human rights and each provider must have a clearly outlined grievance process to address complaints.

ALTR Service Expectations relative to Title VI of the Civil Rights Act of 1964 Title VI of the Civil Rights Act of 1964 prohibits certain types of discrimination in programs that utilize federal funds. Home and Community Based Waiver services are examples of programs that are partially funded with federal waiver dollars. DDS and DDS qualified providers must comply with Title VI requirements. The Department and ALTR providers must not exclude, deny benefits to, or otherwise discriminate against any applicant for services or person supported based on race, color or national origin in the admission to or participation in any of its programs and activities. Prohibited practices include, but are not limited to, the following:

1. Denying any service, opportunity, or other benefit for which an applicant or person supported is otherwise qualified.

2. Providing any applicant or person supported with any service or other benefit which is different or is provided in a different manner from that which is provided to others in the same program.

3. Subjecting any person supported to segregated or separate treatment in any manner related to the receipt of a service.

4. Restricting any person supported in any way in the enjoyment of services, facilities or any other advantage, privilege or benefit provided to others in the same program.

5. Adopting methods of administration that would limit participation or subject any group of applicants or persons supported to discrimination.

6. Addressing an applicant or person supported in a manner that denotes inferiority because of race, color, or national origin.

7. Subjecting any applicant or person supported to racial or ethnic harassment, to a hostile racial or ethnic environment or to a disproportionate burden of environmental health risks.

8. Denying a person supported (or person who has been previously deprived of the opportunity) eligibility to participate as a member of a planning or advisory body which is an integral part of the program.

2.3 Person Centered Planning

ALTR supports must be developed utilizing a person-centered planning (PCP) approach. PCP is a process for selecting and organizing the services and supports that an individual may need to live in the community. Most important, it is a process that is directed by the person who receives the supports.

The PCP approach identifies the person’s strengths, goals, medical needs, needs for home and community based services, and desired outcomes. The approach also identifies the person’s preferences in areas such as recreation, transportation, friendships, therapies and treatments, housing, vocational training and employment, family relationships, and social activities. Unique factors such as culture and language also are addressed. These elements are included in the Individual Service Plan (ISP), which is developed based on those considerations and in conformity with 115 CMR 6.20 – 6.25.

PCP should incorporate the following elements:

Communication: Communication and services must be provided in a manner that is accessible to individuals ( cognitively, visually, and linguistically) and accommodations must be made for translation of documents, interpretation into other languages, or production of documents in alternate formats as appropriate.

Personal Preferences: Understanding of the individual’s personal preferences: those preferences that “work” and “do not work.”

a. Works: What situations or factors create happiness, motivation or well-being, or encourage learning, communication or relationship building?

b. Does Not Work: What situations or factors cause discomfort, reduce motivation, or discourage learning, communication or maintaining relationships? What situations or factors are likely to place the individual, or his/her community, at risk?

Quality of Life & Values: The individual is encouraged to clarify the traditions and values that must be honored; what must continue in his/her life; and what is personally important.

Future Goals: Individuals should be assisted in identifying the goals they wish to accomplish, both short-term and longer term. These goals may be articulated by the individual and/or guardian or may be suggested by others based on knowledge of or more formal assessment of the individual.

Action Plan: Individuals should be assisted to identify the steps needed to achieve the goals identified. This will include the actions required, the individual(s) responsible, and the anticipated timeline.

The outcome of the person-centered planning process must be documented the person’s ISP in accordance with 115 CMR 6.20-6.25. Providers are required to implement the ISP and to provide staff training and instruction necessary to ensure proper implementation. Providers must ensure that the completion of ISP action steps or achievement of ISP outcomes are carried out. This includes implementing instructions written by other providers (i.e., therapists or behavior service providers). It is expected that when new staff instructions become necessary, providers will collaborate and cooperate in developing the instructions and provide training and support to ensure that the instructions are followed. Providers are required to document implementation of the ISP, including progress in completing action steps and achieving outcomes.

Assessment of Individual Needs Providers must assess individuals in conformity with 115 CMR 6.22 and within the first 90 days of service provision to determine their level of support relative to their unique needs. Providers must continue to re-assess individuals’ abilities and needs on an ongoing basis and as their needs change to ensure their support plans are still relevant and that the provision of services are done in accordance with their ISP.

Some considerations when comprehensively evaluating individual needs and determining the overall staffing plan:

· Independence: The individual’s ability to be on their own for periods of time (with or without supportive technology).

· Medical: Whether the individual has significant medical condition(s) and the type of support needed by staff to promote optimal health.

· Forensic: The individual’s need for supervision and support to reduce the risk to self/ others.

· Clinical / Behavioral: The individual’s support needs for behavioral or mental health symptoms that pose a risk to self/ others or adversely impact their quality of life.

· Communication: The individual’s preferred language and communication modality as well as the supports needed to effectively communicate.

· Physical: The individual’s ability to safely ambulate or support needs to complete activities of daily living such as the ability to transfer to/ from beds/ seats, and feed and dress themselves, etc.

· Community Engagement: The individual’s ability access and participate in community activities independently, with support staff, and/or with the use of technology.

Over the lifetime of this procurement, DDS may implement policies for standardized individual assessment processes.

2.4 Medical and Behavioral Health Care Management Requirements ALTR providers must have the organizational capacity to effectively support individuals to access the necessary medical and behavioral health services to meet their medical and clinical needs. Additionally, effective oversight and coordination needs to ensure that individuals are supported to receive integrated medical and behavioral health services to optimize their overall well-being and promote a continuity of care.

Nursing and clinical supports must be sufficient to support individuals to actualize these outcomes and should include direct skilled nursing and /or clinical services as well as supervision, case management, clinical / nursing coordination based on each individual’s needs.

Individuals must have supports to manage their own health care. Health care supports should be person-centered and promote individuals’ ability to attain the following outcomes:

1. Individuals make person-centered decisions about healthy lifestyle, such as food choices, and activity.

2. Individuals participate in decisions about their health.

3. Individuals have adequate contact with health practitioners regarding their physical and mental health.

4. Individuals receive preventive health care and services, including recommended physical and dental exams.

5. Individuals receive timely assessment, treatment, and follow up for acute and chronic health issues.

6. Individuals are supported to follow their prescribed treatment plans (e.g., medications, special diets, health management plans, Behavioral Support Plans (BSPs).)

7. Individuals’ health related information, both current and historical, is documented accurately and available when needed.

8. Individuals shall have some form of identification which includes emergency contact information with them at all times.

Providers must employ a Registered Nurse and a Senior Positive Behavior Supports (PBS) qualified clinician that oversee medical and behavioral / clinical needs of all individuals supported. These professionals are integral in the assessment of the individuals’ needs and oversee and coordinate the implementation activities noted above. Direct observation, supervision, monitoring, and staff training at each of the homes is required. All providers are required to incorporate health management policies into overall agency operations. These policies shall include information on the management, supervision, and documentation of health care for individuals supported.

Providers must have a clearly defined system to assess and monitor the health care needs of individuals, implement health care protocols, support medication administration, respond to routine and emergency health related issues, and maintain an adequate level of licensed personnel to do so. Providers must have systems to monitor staff’s knowledge and effective implementation of health care protocols, medication administration, and health care supports and equipment.

Nursing Nurses are expected to maintain a presence or connection with each individual that lives in a home and should know the direct support staff. They are responsible for, among other things:

· Care coordination and case management

· Ensuring staff maintain Medication Administration Program (MAP) certification and conducting MAP audits

· Assessing the individuals’ needs and coordinating the individuals’ health care appointments

· Assessing and coordinating the individual’s medical and clinical needs and developing a plan to address

· Creating health care plans and discharge plans for individuals

· Training staff on the health needs of individuals

· Monitoring implementation and effectiveness of health care protocols and medication

· Facilitating the need for emergency health care consultations and care

· Incidental provision of direct nursing services for individuals (episodic care)

· Advocating for health care services for individuals

Behavioral Health and Clinical Services for Individuals The provision of behavioral health and clinical services in ALTR programs must be conducted in accordance with the PBS framework as defined in 115 CMR 5.14, or other such regulations as may be amended or promulgated over the lifetime of this procurement. All ALTR providers must have the following elements to support the implementation of PBS: a PBS Leadership Team; a PBS Action Plan; Targeted, Intensive or Universal Supports; as defined in 115 CMR 5.14(3)and 5.14(5); and a system of data-based decision making for both individual treatment decision and for system decisions.

ALTR providers must employ a Senior PBS qualified clinician that is organized in the lead clinical role for ALTR services and has oversight of the behavioral / clinical needs of individuals, implementation of clinical and behavioral supports, and all clinical staff providing ALTR services. The Senior PBS qualified clinician can be a psychologist, applied behavioral analyst, independent clinical social worker, masters/doctoral level speech pathologist, masters/ doctoral level special education certified teacher, or licensed mental health counselor.

Clinical experts such as Social Workers, Psychologists, Assistive Technology Professionals, Behaviorists, Counselors, and Speech and Language Pathologists should be engaged when needed to integrate the various clinical services into the individuals’ ISP. When individuals have co-morbidities, organizational support, training, and clinical expertise in such fields as substance abuse, trauma informed care, mental health, autism, deaf or hard of hearing, visually impaired and physical disabilities should be available to develop individualized multi-disciplinary treatment plans. The clinicians are responsible for, among other things:

· Care coordination and case management within their field of expertise

· Assessing the individuals’ needs and coordinating the relevant clinical appointments

· Assessing and coordinating the individual’s clinical needs and developing a plan to address

· Creating clinical plans for individuals that are the least restrictive/intrusive to effectively support the person in accordance with 115 CMR 5.14

· Assessing environment for adaptations, assistive technology needs, and equipment that could assist the individual to be more independent

· Training staff on the clinical needs of individuals

· Development of strategies to address clinical needs

· Monitoring implementation and effectiveness of strategies

· Facilitating the need for further clinical consultations and care

· Incidental provision of direct services for individuals (episodic care)

2.5 Staff Qualifications and Training

ALTR services utilize a team of support professionals that have a variety of skills and qualifications. ALTR services will typically include the following types of professionals:

· Direct Support Professionals

· House Managers

· Licensed Practical Nurses

· Registered Nurses

· Clinical Services Staff – may include, but are not limited to, physical and occupational therapists, speech and language pathologists, physical therapy and occupational therapy assistants, dietitians, orientation and mobility (O&M) specialists, and behavior analysts or specialists.

Staff providing ALTR services must meet the minimum experience and training requirements established in this procurement. Staff with titles that require professional licensure or certification must maintain active licensure/certification throughout their employment. Additionally, DDS expects providers to engage in ongoing training and professional development activities for ALTR staff.

Minimum Hiring Requirements The following requirements must be met for all staff who are employed to deliver services stated in this RFR. Certain positions have established additional minimum requirements.

· Be 18 years of age or older

· High school diploma, GED or equivalent, or relevant experience or competencies

· Criminal Offense Records Inquiry (CORI)

· Pursuant to M.G.L. c. 19B, §19, all individuals who qualify to provide these services who have the potential for unsupervised contact with persons with an intellectual or developmental disability are subject to fingerprint-based national background checks (NBC)

· Pursuant to M.G.L. c. 19C, §15, employers that provide services to individuals between the ages of 18 to 59 with ID or DD are required to consult the Disabled Persons Protection Commission (DPPC) Registry of Abuse Care Providers prior to hiring prospective employees

Training Requirements All ALTR staff must complete the following mandated trainings pursuant to 115 CMR 7.05(6) and DDS guidelines. Over the lifetime of this procurement regulations may be amended and training requirements may be modified by DDS.

· First Aid

· CPR

· Formal Fire Safety (one person per site)

· Human Rights Officer (one person per site)

· Human Rights

· Positive Behavior Supports

· Incident Reporting

· Universal Precautions

· Transmission for Specific Communicable Diseases

· Medication Administration Program

· Healthy Diets

· Signs and symptoms of illness

· Restrictive Interventions

· Emergency situations potentially requiring restraint

· Mandated Abuse, Omission, and Neglect Reporting

Additionally, staff must receive training related to the unique needs of individuals (e.g., diabetes; ASL, communication) residing in the homes where they will be working.

Additional Requirements for House Managers

· Preferred Bachelor’s degree or 3 years of relevant experience

· Supervisory experience and ability to guide Direct Support Professionals

· Experience with I/DD

· Organization skills / case management and care coordination

· Scheduling

· Fiscal management

· Familiarity with Centers for Medicaid and Medicare Services (CMS) Direct Service Workforce (DSW) Core Competencies

PBS Qualified Clinician ALTR providers must employ a Senior PBS qualified clinician that is organized in the lead clinical role for ALTR services and has oversight of the behavioral / clinical needs of individuals, implementation of clinical and behavioral supports, and all clinical staff providing ALTR services.

PBS qualified clinicians must meet the standards defined in 115 CMR 5.14(10) or other such regulations as may be amended or promulgated over the lifetime of this procurement.

CMS Direct Service Workforce Core Competencies ALTR providers should provide ongoing training and professional development activities with the goal of developing the skills and competencies in accordance with the Centers for Medicaid & Medicare Services (CMS) Direct Service Workforce Core Competencies.

The core competency set is designed to inform direct support service delivery and promote best practices in community-based long-term support services. These competencies have relevance to currently employed and new direct service workers and serve as a resource in developing worker training and performance improvement practices.

CMS DSW Core Competencies focus on the following skillsets:

· Communication

· Person-Centered Practices

· Evaluation and Observation

· Crisis Prevention and Intervention, Safety, Health and Wellness

· Professionalism and Ethics

· Empowerment and Advocacy

· Community Living Skills and Supports

· Community Inclusion and Networking

· Cultural Competency

· Education, Training, and Self-Development

Requirements for Independent Contractors and Temp Agency Staff ALTR providers may engage independent contractors and / or utilize staff through temp agencies to fulfill staffing requirements. In such cases, ALTR providers must ensure that these staff comply with all the staff qualification and training requirements established in this RFR. Temp staffing agencies engaged by an ALTR provider must register with the DDS National Background Check Unit (NBCU) and complete all requisite background checks prior to staff working in a home in accordance with M.G.L. c. 19B, §19.

2.6 Determination of Staffing Plan

ALTR providers are responsible for providing an appropriate level of services and supports for up to 24 hours per day during the hours the individual supported is not receiving day services or is not at school or work, based on the individual’s support needs. Individuals supported should receive the amount of support they need to meet their goals, build skills, and develop further independence while also, consistent with the CMS Home and Community Based Services Rule (“the Community Rule”), have freedom in choosing to spend time alone or engage in activities without paid staff present, unless there are identified and documented safety concerns within the ISP that cannot be mitigated to a tolerable level of risk. Providers are responsible for providing an appropriate level of supports, including supportive technology, in-person staff, and natural supports, as applicable, to ensure each individual’s health and safety, while maximizing personal choice and independence, and not restricting individual rights and freedoms, except as minimally necessary and in accordance with the Community Rule. In addition, providers are responsible for providing sufficient support for individuals to enable them to engage in the community in ways which are meaningful and in line with their preferences on a frequent and on-going basis.

ALTR services are typically provided to up to five (5) individuals living together. ALTR providers will work collaboratively with the DDS Area Office or ABI/MFP Director to develop staffing patterns and schedules that ensure that the number, organization and qualifications of staff meet the training, care, support, health, safety, and evacuation needs of the individuals supported by the provider. Staffing patterns are developed after a full assessment of each individuals’ specific needs. At a minimum, the number and qualifications of staff must be adequate:

a) to meet the objectives in the ISP of each individual while promoting independence and skill development.

b) to assist each individual to achieve the stated outcomes as set forth in their ISP.

c) to meet environmental, safety, administrative, and service delivery requirements as set forth in 115 CMR 7.07.

d) to develop and competently execute safety plans for all individuals at the location(s) where supports and services are provided as required in 115 CMR 7.06.

e) to develop a staffing pattern that is sufficient to enable all individuals to evacuate, with or without assistance within 2.5 minutes.

f) to include skills training to maximize an individual's independence and performance of household activities and routines, participation in community recreational, cultural and leisure activities, and opportunities to maintain or expand their relationships with family and friends.

g) To demonstrate successful performance on fire drills required by 115 CMR 7.06(3)(b)7.

ALTR providers must ensure sufficient qualified and trained staff to provide all authorized services in accordance with the staffing plan. This includes both in-person staff as well as those staff available through remote technology. Providers of clinical and/or nursing services must also ensure sufficient qualified and trained staff are available to provide all authorized services.

Arrangements must be made for coverage of services and supervision of staff as required when providers or employees take periods of extended leave, when staff resign or are terminated from employment or when staff are sick or otherwise unable to work due to unexpected events or circumstances.

Providers must have written plans for ensuring that minimum staffing ratios are maintained in cases where vacancies and turnover in staff are impacting their ability to fulfil agreed upon staffing schedules. Such plans must be made available to DDS upon request.

2.7 Specialized Services

This section addresses the additional staffing requirements for specialized homes serving one or more individuals with these specific needs:

Medical: When one or more individuals have significant health care needs…