Co-occurring Enhanced Residential_RFR Application.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. Delete this instructions page before submitting your proposal.

6. 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 Rehabilitation Services/COE 3.1

RFR # 190527

Organization Organization Name: [ ]

Address:

City: [ ] State: [ ] Zip: [ ]

Vendor Code: [ ]

CEO (Chief Executive Officer) First Name: [ ] Last Name: [ ]

Telephone: ( ) - E-Mail: [ ]

FEIN: [ ]

Contact Person First Name: [ ] Last Name: [ ]

Title: [ ]

Telephone: ( ) - FAX: ( ) -

E-Mail: [ ]

Contact Person Address (if different):

City: [ ] State: [ ] Zip: [ ]

Organization Information

Is your agency pre-qualified to conduct business with the Commonwealth? |_| Yes |_| No

If so, which Massachusetts Department is your Principal Purchasing Agent (PPA): [ ]

Location of Proposed Service Program Name: [ ]

Program Address:

City: [ ] State: [ ] Zip: [ ]

RFR #190527

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. (a) Attach an organizational chart that shows the location of the proposed program within your agency.

|X| Organization Chart attached. (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

Attach a copy of your organization’s most recent mission statement to this response.

|_| Most recent mission statement uploaded to COMMBUYS. (1 Point)

(c) Supplier Diversity Plan form for POS (posted in the COMMBUYS Bid Attachment Section): Bidders are to submit a copy of their most recently submitted “SDP Plan Form for POS” with their proposal to signify to the Procurement Management Team that a form has been submitted. Bidders that do not currently hold POS contracts with Commonwealth Departments, Bidders that are exempt from filing a UFR or Bidders who have not yet submitted a SDP Plan Form for POS with their most recent UFR are required to complete the Form and include it with their proposal. (No Points)

|_| Copy of SDP plan form is uploaded to COMMBUYS (original was submitted with UFR) or |_| Original SDP plan form is uploaded to COMMBUYS.

2. 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): (5 points)

Enter text here; text limit 2,500 characters

3. 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 is uploaded to COMMBUYS (if applicable).

4. Provide a brief abstract of the proposed program model, including location(s), which gender you will serve, priority population (pregnant/post-partum, young adult, etc.) and/or special needs. How many beds are you providing for the model you are proposing and how many beds are you providing for reunifications if you are proposing a model serving women and their infants/children? Please indicate if these are new beds or conversion of existing beds. (text input limit 1,875 characters, approximately 300 words, 3 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%).

|_| Agency Staff Demographics Table uploaded to COMMBUYS. (2 points)

(b) What neighborhood(s) or town(s) does your agency serve? (text input limit 2,500 characters, approximately 400 words) (2 points)

6. Describe the treatment model for the proposed program. (3 Points). If the model specializes in a priority population (Pregnant and Postpartum women and their infants, Young Adults, etc.) please describe how your model will serve this population. Briefly describe your experience providing 3.1 COE and the model that you have selected (4 points). (text input limit 7,500 characters, approximately 1200 words, 7 points):

Enter text here; text limit 7500 characters

7. Describe your approach and ability (including clinical expertise in assessment and treatment) to serve clients that have co-occurring disorders, trauma histories, resistance to treatment, and cognitive impairments (including traumatic brain injuries or fetal alcohol spectrum disorders (FASD) (text input limit 5,000 characters, approximately 800 words, 5 points):

Enter text here; text limit 5,000 characters

8. Describe your program’s implementation and delivery strategies for assessing clinical appropriateness (ASAM criteria Level 3.1 Clinically Managed Low-Intensity Residential Services, Co-Occurring Enhanced), establishing treatment goals, and providing evidence-based practice(s) utilizing individual and group models. Provide details regarding implementation of service specifications outline in the RFR. (Text input limit 9,500 characters, approximately one and a half pages, 15 Points)

Enter text here; text limit 9,500 characters

9. If you are planning on serving Women including Pregnant and Postpartum women and their children/infants in your program, please answer. If not, skip to question 10. Note: Men’s programs that skip this question will not be penalized.

Describe your plan to provide enhanced services to Pregnant and Postpartum women and their infants. Describe how your site, staffing, community linkages and day-to-day programming will provide effective treatment for Pregnant and Postpartum women and their infants. Describe the following service components from the RFR in your answer.

· prenatal care, support and education;

· hospital arrangements for obstetric and gynecological services;

· family planning education/counseling;

· pediatric care;

· parenting skills training;

· methadone maintenance or other physician directed medication assisted therapy for opiate addicted pregnant women

· HIV/AIDS counseling and testing; and,

· assistance in accessing community services.

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

Enter text here; text limit 8,000 characters

10. Describe your referral network for next step placement in the continuum. (text input limit 5,000 characters, approximately 600 words, 4 points):

Attach a copy of the Levels of Cooperative Activities Chart for this program (posted in the COMMBUYS Bid Attachment Section) that effectively demonstrates that linkages cover the continuum of care

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

11. Demonstrate your experience with and capacity to work with opioid addicted people utilizing Medication Assisted Treatment (MAT) methadone, in a RRS/COE setting by responding to the following:

A. Describe your policies and procedures regarding MAT in RRS/COE settings and affirm your program’s willingness to serve these cleints.

B. Attach MOUs/linkage agreements with surrounding methadone dosing programs as well as primary care sites where buprenorphine, or extended release naltrexone are prescribed and, C. Indicate the number of persons you have served last year on MAT in an RRS setting and how many persons in an RRS/COE setting with whom you have facilitated initiation on MAT.

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

Enter text here; text limit 8,000 characters

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

12. Provide a sample seven-day week schedule of activities. Specify the capacity to provide the required amounts of individual and group services, developing life skills, and community interaction based on your proposed program size. Include any explanatory narrative. Refer to the DPH regulations at 105 CMR 164.000. (text input limit 2,500 characters, approximately 400 words, 3 points):

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

13. Provide a sample weekly chart of staff shift coverage for all shifts. How does the proposed staffing pattern demonstrate support of the program model and ability to provide best practices as described? How will staff supervision and training be provided? (2 points) How will you reach out to recruit a culturally and linguistically diverse staff that reflects the backgrounds of the program’s clients? (2 points) (text input limit 5,000 characters, approximately 800 words, 4 points):

|_| Staffing Chart of staff shift coverage uploaded to COMMBUYS (2 Points)

14. Describe your process to ensure that each client has an after care plan and case management services. (text input limit 5,000 characters, approximately 800 words, 4 points):

15. Detail your response to relapse and keeping residents engaged in treatment while residents work to achieve and maintain abstinence. Discuss your policy for transferring clients to the appropriate level of level of care and retention in your program or discharge to another level of care. (text input limit 5,000 characters, approximately 800 words, 4 points):

16. How will the proposed program measure outcomes and implement continuous quality improvement/assurance initiatives. Provide specific QI/QA initiatives planned. (text input limit 5,000 characters, approximately 800 words, 4 points):

17. Site control must include a commitment from the property owner that the applicant can site and operate the proposed 3.1 COE RRS 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 (www.mass.gov/dph/healthyaging, see the ADA Compliance Coordination link) (6 points).

(text input limit 5,000 characters, approximately 800 words, 6 points

|_| Floor Plan uploaded to COMMBUYS (1 Points) |_| All documents, such as lease, to demonstrate site control of the proposed facility uploaded to COMMBUYS (1 Points)

18. Provide an implementation plan and timeline that includes specific milestones toward gaining of licensure and/or initiation of programming and services. At a minimum, the implementation plan must include the following activities with associated dates and responsible persons: construction, renovations and furnishing of facility; hiring of key staff; facility inspections; licensing of program; and, establishing policies, procedures and linkages. (text input limit 5,000 characters, approximately 800 words, 6 points)

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 and 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