Attachment H_Attestations A-B-C-D_07.2025.pdf
PDF 135 KB Posted
- Attached to
- Mobile Crisis Services State and local contract opportunity
- Solicitation number
- 2025-052
- Issued by
- Broome County, New York
About this file
This document is a Request for Proposal (RFP) for Mobile Crisis Services issued by Broome County, involving multiple state and local mental health and crisis support agencies including the New York State Office of Mental Health (OMH), NYS Office of Addiction Services and Supports, and the Broome County Mental Health Department. The RFP requires potential service providers to complete four detailed attestations confirming their understanding and commitment to specific requirements, including becoming credentialed as a Mobile Crisis Services provider under Mental Hygiene Law §9.58, developing relationships with local behavioral health programs, adhering to programmatic and billing guidance from various state and federal agencies, and agreeing to program deliverables outlined in the Mobile Crisis Guidelines for Broome County.
The attestations mandate that the selected agency will collaborate with a comprehensive crisis continuum of care, including local hospital emergency departments, the Comprehensive Psychiatric Emergency Program at United Health Services, the planned Supportive Crisis Stabilization Center, the region's 988 Suicide and Crisis Lifeline provider, local law enforcement, and the county mental health department. The document requires potential providers to demonstrate compliance with multiple regulatory bodies, including Broome County, New York State agencies, and federal Centers for Medicare and Medicaid Services (CMS), ensuring a robust and coordinated approach to mobile mental health crisis intervention and support services.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment A_NYS Crisis Intervention Benefit_02.2025.pdf | ||
| Attachment B_SPA Updates to Mobile Crisis Services_02.01.2024.pdf | ||
| Attachment F_Mobile Crisis Costing Model_OMH.CCSI_04.2025.xlsx | XLSX spreadsheet | |
| Attachment G_Mobile Crisis Medicaid Reimbursement Rates_06.30.2025.xlsx | XLSX spreadsheet | |
| Attachment C_NYS OMH Mobile Crisis Program Guidance_09.20.2019.pdf | ||
| Attachment D_Mobile Crisis Guidelines for BC_07.2025.pdf | ||
| Attachment E_Mobile Crisis Budget Template_07.2025.xlsx | XLSX spreadsheet | |
| Attachment I_NYS OMH Telehealth Guidance_04.2023.pdf | ||
| Attachment J_RFP Evaluation Rubric_07.2025.pdf | ||
| RFP-2025-052 - Mobile Crisis Services.pdf |
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Text version
Broome County RFP Mobile Crisis Services
Attestations A – B – C - D
Attestation A:
By signing below, as a duly authorized representative, of the applicant organization, I attest understanding that, if awarded the RFP, the agency is required to engage in the process outlined by New York State Office of Mental Health (OMH) to become credentialed as a Mobile Crisis Services provider pursuant to Mental Hygiene Law §9.58.
Name: [print]
Signature:
Date:
Attestation B:
By signing below, as a duly authorized representative, of the applicant organization, I attest understanding that, if awarded the RFP, the agency is required to develop relationships and work closely with all behavioral health programs within Broome County’s Crisis Continuum of Care including, but not limited to local hospital emergency departments, - local hospital emergency departments, the existing Comprehensive Psychiatric Emergency Program located at United Health Services, Binghamton General Hospital, the planned Supportive Crisis Stabilization Center, the region’s 988 – Suicide and Crisis Lifeline provider, Broome-based law enforcement, and the Broome County Mental Health Department – Local Government Unit.
Name: [print]
Signature:
Date:
Attestation C:
By signing below, as a duly authorized representative, of the applicant organization, I attest understanding that, if awarded the RFP, the agency is required to adhere to – and remain in compliance with - all guidance for programmatic implementation and billing requirements as issued from Broome County, NYS Office of Addiction Services and Supports, Office of Mental Health, and NYS Department of Health, and federal Centers for Medicare and Medicaid Services (CMS).
Name: [print]
Signature:
Date:
Attestation D:
By signing below, as a duly authorized representative, of the applicant organization, I attest the applicant has read, and agrees to the Program Deliverables, Data Collection and LGU collaboration and oversight, Program Components and Implementation Plan as outlined in the Mobile Crisis Guidelines for Broome County document [Attachment D].
Name: [print]
Signature:
Date:
File details come from the government source that posted it. Updated .