Appendix 4 Psychological Report Template.pdf

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Attached to
COMMUNITY-BASED BEHAVIORAL HEALTH EVALUATIONS FOR MULTIPLE REGIONS
Solicitation number
BPM053561
Issued by
Maryland

About this file

This is a Psychological Report Template appendix supporting a behavioral health evaluation procurement by the Maryland Department of Juvenile Services (DJS) for community-based evaluations across three geographic regions (Eastern, Capital South, and Western). The Department seeks contractor services to provide psychological evaluations, psychiatric evaluations, Certificate of Need (CON) evaluations, psychosexual evaluations, consultations, and court appearances for adjudicated and pre-adjudicated delinquent youth ages 12-20 referred through court order. Estimated annual service volumes include 150 psychological evaluations, 20-50 updated evaluations by region, 15 psychological and psychiatric consultations each, 5 court appearances, 5 CON psychiatric evaluations, 3 updated CON evaluations, 50 psychosexual evaluations, and 100 missed appointments. Services will be delivered at contractor offices, youth homes, or local DJS offices with approval. A virtual pre-bid conference is scheduled for March 18, 2026 at 11:00 a.m., with written questions due March 25, 2026 at 2:00 p.m. and bids due April 1, 2026 at 2:00 p.m. via eMMA. The Department intends to make up to three awards, one per region, with a contract term of five years from June 1, 2026 through May 31, 2031 and no renewal options.

Bidders must employ staff holding current Maryland licenses with demonstrated experience: psychologists require at least two years post-doctoral experience evaluating adolescents, and psychiatrists require at least two years post-fellowship experience. Bidders must demonstrate two years of experience within the past five years providing community-based mental health evaluations to court-involved youth, supported by three reference letters. Virtual evaluations will be billed at a 20% reduction from the set fee, while in-person evaluations are billed at the full rate. A 5% Minority Business Enterprise (MBE) subcontracting participation goal has been established; MBE-certified prime contractors may self-perform 2.5% with the remaining 2.5% fulfilled by subcontractors. Fixed-price bidding applies. Insurance requirements include Commercial General Liability ($1 million per occurrence / $3 million aggregate), Professional Liability ($1 million per claim / $3 million aggregate), Cyber Security/Data Breach ($5 million per occurrence), and Workers' Compensation. Contractor personnel must complete CJIS criminal background checks prior to assignment, with prohibitions on individuals with convictions for crimes against property, theft, fraud, crimes against public administration, or violence. All staff must comply with Child Protective Services clearances and Prison Rape Elimination Act requirements. No federal funding is involved, and travel is not reimbursed.

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Appendix 7 Psychosexual Eval Report Template.pdf PDF
5.1 Appendice Table.pdf PDF
FINAL IFB- 26-MULTI-CS-BH-001- Community Behavioral Health Evals 2.17.26 TW.SJ.OAG.RC.JG.pdf PDF
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Attendee List, Meeting Agenda & Q & A's- Community Behavioral Health Evals @ Multi Regions- 26-MULTI-CS-BH-001.pdf PDF
Appendix-4.-MBE-Participation-Goal.pdf PDF
Appendix 4 Psychological Report Template.pdf PDF
Appendix 2 Community Office Locations.pdf PDF
Attachment-I.-Conflict-of-Interest-Affidavit.pdf PDF
eMMA COVER Letter- 26-MULTI-CS-BH-001.pdf PDF
Amendment #1- Community Based Behavioral Health Evals @ Multi Regions- 26-MULTI-CS-BH-001.pdf PDF
Attachment-U.-Contract-Affidavit.pdf PDF
Attachment-2.-Pre-Bid_-Pre-Proposal-Conference-Response-Form-26-MULTI-CS-BH-001.pdf PDF
FINAL IFB- 26-MULTI-CS-BH-001- Community Behavioral Health Evals 2.17.26 TW.SJ.OAG.RC.JG.pdf PDF
Appendix 6 Psychiatric Eval & Certificate of Need Templates.pdf PDF
Appendix 1 Abbreiviations and Definitions.pdf PDF
Attachment-U.-Contract-Affidavit.pdf PDF
Appendix 8 DJS Policy List - Community Evaluation Contract.pdf PDF
Appendix 5 Updated TOJ Template January 2025.pdf PDF
Attachment-F.-Bidder-Offeror-Information-Sheet.pdf PDF
Attachment-A.-Bid-Proposal-Affidavit.pdf PDF
BID FORM- BH Evals Regions Capital, Eastern, Western 5 Year Contract- .xlsx XLSX spreadsheet
5.1 Appendice Table.pdf PDF
Professional Services Supplemental- BPM053561- Behavioral Health Evals- 26-MULTI-CS-BH-001.pdf PDF
eMMA COVER Letter- 26-MULTI-CS-BH-001.pdf PDF
Appendix-4.-MBE-Participation-Goal.pdf PDF
Appendix 2 Community Office Locations.pdf PDF
Appendix 7 Psychosexual Eval Report Template.pdf PDF
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