List of Permitted Application Attachments Amended and RestatedRespsite Master Agreement.7.1.20.doc
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- Solicitation number
- BD-21-1022-DMH08-8220A-53630
- Issued by
- Massachusetts
About this file
This document is an Amended and Restated List of Permitted Application Attachments for a Respite Services - Master Agreement Request for Applications issued by the Massachusetts Department of Mental Health (DMH). The RFA seeks to establish a pool of qualified providers from which DMH Areas can purchase Site-Based Respite and/or Mobile Respite Services on an as-needed basis. The document outlines 24 different attachments that applicants may include with their responses, covering areas such as organizational charts, staffing, service delivery models, enrollment protocols, assessment tools, medication policies, and contract forms.
The contract opportunity is open to providers in the state of Massachusetts. No additional details are provided regarding pricing terms, set-asides, incumbent providers, funding sources, or contract term and renewal options.
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Text version
DEPARTMENT OF MENTAL HEALTH
RESPITE SERVICES – MASTER AGREEMENT
DMH # 2017-DMH-3048-03
July 2020
AMENDED AND RESTATED LIST OF PERMITTED APPLICATION ATTACHMENTS
1. Agency Organizational Chart (Application Requirement I.D)
2. Risk Mitigation Protocol (Application Requirement I.F)
3. Complaint Process (Application Requirement I.L)
4. Job Descriptions (Application Requirement II.B)
5. Blended Capacity or Peer Respite: Sample staffing schedule (Application requirement II.B)
6. Service Delivery Organizational Chart (Application Requirement II.D)
7. Peer Respite: Service Delivery Model (Application Requirement III.A)
8. Site Only, Blended Capacity or Mobile Only: Enrollment Protocol (Application Requirement III.C)
9. Peer Respite: Protocol for when at capacity (Application Requirement III.C)
10. Peer Respite: Protocol for support outside the Site Based Location (Application Requirement III.C)
11. Peer Respite: Protocol for Assisting Person Served in obtaining other appropriate services (Application Requirement III.C)
12. Peer Respite: Emergency Medical and Psychiatric Service Policy (Application Requirement III.C)
13. Site Only, Blended Capacity or Mobile Only: Assessment Tool and relevant Forms (Application Requirement III.D)
14. Peer Respite: Service Description (Application Requirement III.D)
15. Site Only, Blended Capacity or Mobile Only: CPS Form (Application Requirement III.E)
16. Site Only, Blended Capacity or Mobile Only: Discharge Form (Application Requirement III.G) (
17. Peer Respite: Protocol for Completion or Termination of Services (Application Requirement III.G)
18. Site Only, Blended Capacity or Mobile Only: Medication Policies and Procedure (Application Requirement III.H)
19. Two scenarios (Application Requirement IV.A)
20. Responses to the two scenarios (Application Requirement IVA)
21. Site Only, Blended Capacity, Peer Respite: Floor Plan (Application Requirment V.A)
22. Site Only, Blended Capacity, Peer Respite License/MCSR (Application Requirement V.A)
23. Site Only, Blended Capacity, Peer Respite Contract Forms (Application Requirement V.A)
24. Contract Forms (Application Requirement VII)
· Form W-9
· Authorized Signatory Listing
· Executed Standard contract Form (that indicate that the Commonwealth terms and Conditions for Human and Social Services are applicable.
· Supplier Diversity Plan for POS
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