ESBD_422457_1748526888634_Exhibit B - Price Form.xlsx
XLSX spreadsheet 31 KB Posted
- Attached to
- TREATMENT, RE-ENTRY, AND AFTERCARE SERVICES
- Solicitation number
- 644-25-031325
- Issued by
- Texas
About this file
This document is a Price Form (Exhibit B) for Solicitation No. 644-25-031325, outlining a comprehensive service contract for direct care, professional, and supportive services primarily focused on youth and family interventions. The pricing schedule includes 24 distinct service lines covering a wide range of professional services such as family counseling, crisis intervention, parent training, youth mentoring, gang intervention, anger management, independent living support, therapeutic foster care, case management, life skills training, job readiness, and vocational training. The document provides separate pricing tables for primary and secondary service areas, with both tables requiring firm fixed unit hourly rates for each service line.
The pricing structure is designed with flexibility, emphasizing that there is no guaranteed number of referrals and that payments to the awarded respondent will vary based on actual participant referrals. The pricing form requires respondents to input specific hourly rates for each service, with clear instructions that a unit price of $0.00 or failure to complete the Excel form will result in a non-responsive bid. The document allows for both face-to-face and telehealth service delivery options, and includes provisions for missed appointments (limited to two per youth per month). The pricing form also indicates potential consideration for travel or service delivery reimbursement in rural areas, either incorporated into the hourly rate or specified under non-direct supportive services.
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Text version
PRICING SCHEDULE
| EXHIBIT B PRICE FORM |
| SOLICITATION No. 644-25-031325 |
RESPONDENT NAME:
INSTRUCTIONS TO RESPONDENT: RESPONDENT SHALL INPUT A UNIT PRICE FOR EACH LINE ITEM OR RESPONSE WILL BE CONSIDERED NON-RESPONSIVE. A UNIT PRICE OF $0.00 ON ANY LINE ITEM WILL BE CONSIDERED NON-RESPONSIVE.
| Having carefully examined all the specifications and requirements of this solicitation and any attachments thereto, the Respondent proposes to furnish the services required pursuant to this solicitation. |
| Pricing for Services Offered (Price will be firm fixed price) |
| Provide firm fixed Unit per hour rates for services listed in the table below for service contract. |
| Payments to awarded Respondent will vary depending on number of actual referrals of participants. |
| THERE IS NO GUARANTEED NUMBER OF REFERRALS. | ||||
| Direct Care Services Delivered by Licensed Professional (e.g., LPC, LCSW, LMFT, LCDC) | ||||
| Line # | DESCRIPTION OF SERVICE | Hourly Rate | Per Hour | Total Cost |
| 1 | Family Counseling with Youth (Face to Face or Telehealth) | $ - 0 | 1 | $ - 0 |
| 2 | Family Counseling without Youth (Face to Face or Telehealth) | $ - 0 | 1 | $ - 0 |
| 3 | Crisis Intervention with/ Youth Family (Face to Face or Telehealth) | $ - 0 | 1 | $ - 0 |
| 4 | Parent Training (Face to Face or Telehealth) | $ - 0 | 1 | $ - 0 |
| 5 | Family Reunification Program (face to Face or Telehealth) | $ - 0 | 1 | $ - 0 |
| 6 | Other: please specify | $ - 0 | 1 | $ - 0 |
| 7 | Other: please specify | $ - 0 | 1 | $ - 0 |
| Other Professional Services | ||||
| Line # | DESCRIPTION OF SERVICE | Hourly Rate | Per Hour | Total Cost |
| 8 | Wrap-around (face-to-face) | $ - 0 | 1 | $ - 0 |
| 9 | Youth Mentoring (face-to-face) | $ - 0 | 1 | $ - 0 |
| 10 | Animal Therapy (face-to-face) | $ - 0 | 1 | $ - 0 |
| 11 | Gang Intervention (face-to-face) | $ - 0 | 1 | $ - 0 |
| 12 | Anger Management (face-to-face or telehealth) | $ - 0 | 1 | $ - 0 |
| 13 | Independent Living (face-to-face) | $ - 0 | 1 | $ - 0 |
| 14 | Therapeutic Foster Care | $ - 0 | 1 | $ - 0 |
| 15 | Intensive Case Management(face-to-face) | $ - 0 | 1 | $ - 0 |
| 16 | Care Coordination (face-to-face) | $ - 0 | 1 | $ - 0 |
| 17 | Life Skills Program (face-to-face) | $ - 0 | 1 | $ - 0 |
| 18 | Youth Assistance/Advocacy (face-to-face) | $ - 0 | 1 | $ - 0 |
| 19 | Job Readiness Skills training (face-to-face) | $ - 0 | 1 | $ - 0 |
| 20 | Recovery Coach | $ - 0 | 1 | $ - 0 |
| 21 | Vocational Training/Program | $ - 0 | 1 | $ - 0 |
| 22 | Other: please specify | $ - 0 | 1 | $ - 0 |
| Supportive (Non-Direct Care) Services | ||||
| Line # | DESCRIPTION OF SERVICE | Hourly Rate | Per Hour | Hourly Rate |
| 23 | Missed Appointments- not to exceed 2 per youth per month. | $ - 0 | 1 | $ - 0 |
| 24 | Other: please specify | $ - 0 | 1 | $ - 0 |
| TOTAL FOR ALL LINES ON SCHEDULE | $ - 0 | |||
| FAILURE TO RETURN THIS PRICE FORM IN EXCEL WILL RESULT IN THE RESPONSE BEING CONSIDERED NON-RESPONSIVE. |
&P - &N
Secondary Service Area Pricing
| EXHIBIT B.1 SECONDARY SERVICE AREA PRICE FORM |
| SOLICITATION No. 644-25-031325 |
RESPONDENT NAME:
INSTRUCTIONS TO RESPONDENT: RESPONDENT SHALL INPUT A UNIT PRICE FOR EACH LINE ITEM OR RESPONSE WILL BE CONSIDERED NON-RESPONSIVE. A UNIT PRICE OF $0.00 ON ANY LINE ITEM WILL BE CONSIDERED NON-RESPONSIVE.
| Having carefully examined all the specifications and requirements of this solicitation and any attachments thereto, the Respondent proposes to furnish the services required pursuant to this solicitation. |
| Pricing for Services Offered (Price will be firm fixed price) |
| Provide firm fixed Unit per hour rates for services listed in the table below for service contract. |
| Payments to awarded Respondent will vary depending on number of actual referrals of participants. |
| Reimbursement for travel or service delivery to youth in rural areas may be considered as a part of the unit per hour rate or specified as “other” in non-direct supportive services category. | ||||
| THERE IS NO GUARANTEED NUMBER OF REFERRALS. | ||||
| Direct Care Services Delivered by Licensed Professional (e.g., LPC, LCSW, LMFT, LCDC) | ||||
| Line # | DESCRIPTION OF SERVICE | Hourly Rate | Per Hour | Total Cost |
| 1 | Family Counseling with Youth (Face to Face or Telehealth) | $ - 0 | 1 | $ - 0 |
| 2 | Family Counseling without Youth (Face to Face or Telehealth) | $ - 0 | 1 | $ - 0 |
| 3 | Crisis Intervention with/ Youth Family (Face to Face or Telehealth) | $ - 0 | 1 | $ - 0 |
| 4 | Parent Training (Face to Face or Telehealth) | $ - 0 | 1 | $ - 0 |
| 5 | Family Reunification Program (face to Face or Telehealth) | $ - 0 | 1 | $ - 0 |
| 6 | Other: please specify | $ - 0 | 1 | $ - 0 |
| 7 | Other: please specify | $ - 0 | 1 | $ - 0 |
| Other Professional Services | ||||
| Line # | DESCRIPTION OF SERVICE | Hourly Rate | Per Hour | Total Cost |
| 8 | Wrap-around (face-to-face) | $ - 0 | 1 | $ - 0 |
| 9 | Youth Mentoring (face-to-face) | $ - 0 | 1 | $ - 0 |
| 10 | Animal Therapy (face-to-face) | $ - 0 | 1 | $ - 0 |
| 11 | Gang Intervention (face-to-face) | $ - 0 | 1 | $ - 0 |
| 12 | Anger Management (face-to-face or telehealth) | $ - 0 | 1 | $ - 0 |
| 13 | Independent Living (face-to-face) | $ - 0 | 1 | $ - 0 |
| 14 | Therapeutic Foster Care | $ - 0 | 1 | $ - 0 |
| 15 | Intensive Case Management(face-to-face) | $ - 0 | 1 | $ - 0 |
| 16 | Care Coordination (face-to-face) | $ - 0 | 1 | $ - 0 |
| 17 | Life Skills Program (face-to-face) | $ - 0 | 1 | $ - 0 |
| 18 | Youth Assistance/Advocacy (face-to-face) | $ - 0 | 1 | $ - 0 |
| 19 | Job Readiness Skills training (face-to-face) | $ - 0 | 1 | $ - 0 |
| 20 | Recovery Coach | $ - 0 | 1 | $ - 0 |
| 21 | Vocational Training/Program | $ - 0 | 1 | $ - 0 |
| 22 | Other: please specify | $ - 0 | 1 | $ - 0 |
| Supportive (Non-Direct Care) Services | ||||
| Line # | DESCRIPTION OF SERVICE | Hourly Rate | Per Hour | Hourly Rate |
| 23 | Missed Appointments- not to exceed 2 per youth per month. | $ - 0 | 1 | $ - 0 |
| 24 | Other: please specify | $ - 0 | 1 | $ - 0 |
| TOTAL FOR ALL LINES ON SCHEDULE | $ - 0 | |||
| FAILURE TO RETURN THIS PRICE FORM IN EXCEL WILL RESULT IN THE RESPONSE BEING CONSIDERED NON-RESPONSIVE. |
&P - &N
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