Medical Services-Consultants RFR~3.doc

The Commonwealth of Massachusetts

Executive Office of Health and Human Services

Massachusetts Rehabilitation Commission

600 washington Street, boston, Massachusetts

Request for Response (RFR)

Document Title: MEDICAL SERVICES/CONSULTANTS FOR

MRC CONSUMERS

COMMBUYS Bid#: Bid BD-17-1071-AO-CON01-10034 Agency Document Number: MRC MEDSERVICES 09-16

RFR: Medical Services/Consultants for MRC Consumers

Boston, MA 02111-1704

Tuesday, October 18, 2016 at 4 PM Responses to questions will be posted on COMMBUYS by: Tuesday, October 25, 2016 at 4 PM

See attached Job Aid; Help Desk No. 1-888-627-8283

1. ACQUISITION METHOD

Contracts under this Request for Response (RFR) will be 100% funded with federal funds under the Workforce Innovation and Opportunity Act of 2014. The contracts will not have a maximum obligation, but will be rate contracts subject to the rules and regulations set forth by the Massachusetts Division of Health Care, Finance and Policy as amended. The rates will be adjusted as new rates and regulations are established or changed. There are no negotiated rates allowed for this contract. The rates can be viewed on the EOHHS website: http://www.mass.gov/eohhs/gov/laws-regs/hhs/community-health-care-providers-ambulatory-care.html

2. SINGLE OR MULTIPLE CONTRACTORS

This RFR is for multiple contracts to be used by the procuring department using a prequalification list to be developed from responding physicians, clinicians, and/or facilities/agencies. If you choose just to be facility/agency specific, please note this in your response to the RFR.

This RFR is a rolling RFR. Interested applicants may submit responses at any time until 03/31/2022 (six months prior to RFR duration end date). Responses for contracts with start date of 01/01/2017 must be submitted by Wednesday, November 9, 2016.

3. SINGLE OR MULTIPLE DEPARTMENT PARTICIPATION

Option to Allow Other Departments to Contract Under RFR

4. ANTICIPATED DURATION OF CONTRACT AND ANY RENEWAL OPTIONS

Anticipated Initial Contract Duration:

01/01/2017 – 9/30/2022 Anticipated Options to Renew:

One (1) option to renew for Five (5) years

Anticipated Total Duration:

01/01/2017 – 09/30/2027

5. ANTICIPATED EXPENDITURES, FUNDING OR COMPENSATION

Amounts indicated are only estimates. Contract amounts during the period of any contract are subject to a selected Bidder’s response, and may increase or decrease based upon contract negotiation, performance selected, appropriation or availability of funds.

Estimated Total Annual Funds: Up to $500,000

6. DESCRIPTION AND PURPOSE OF PROCUREMENT

A. Introduction

The Massachusetts Rehabilitation Commission (MRC) promotes the equality, empowerment, and independence of individuals with disabilities in the Commonwealth of Massachusetts. These goals are achieved through enhancing and encouraging personal choice and the right to succeed in the pursuit of independence and employment in the community. MRC provides comprehensive services to individuals with disabilities that maximize quality of life, independent living, and economic self-sufficiency through integrated competitive employment in the community. In addition, the Massachusetts Rehabilitation Commission (MRC) is the general Vocational Rehabilitation (VR) agency in Massachusetts.

B. Purpose of the Procurement:

The Massachusetts Rehabilitation Commission (MRC) is seeking contractors for the purpose of providing medical and consulting services. MRC’s objective through this RFR is to provide VR consumers applying for and receiving Vocational Rehabilitation Services an accurate and timely medical consultation and diagnostic services to determine his/her eligibility for Vocational Rehabilitation and to assist with the planning, diagnostic, and medical services as part of a consumer service plan. MRC wishes to satisfy its responsibilities by contracting with appropriately licensed health professionals in the Commonwealth of Massachusetts qualified to perform such reviews.

C. Description of the Procurement:

MRC is seeking to develop a network of medical/consulting service providers throughout the Commonwealth of Massachusetts, including, but not limited to basic medical evaluations and services; psychiatric, psychological, audiological, eye, dental evaluations; providing appropriate treatment such as therapy (occupational, physical and speech), lab testing, surgery, dentistry, etc., in all of the above areas for people with disabilities who are consumers of the Massachusetts Rehabilitation Commission. All services will be subject to the Fee Schedule set forth by Massachusetts Division of Health Care Finance and Policy with all current and future amendments and regulations. To locate the rates can be viewed on the EOHHS website: http://www.mass.gov/eohhs/gov/laws-regs/hhs/community-health-care-providers-ambulatory-care.html . The fee schedule is in alignment with the Mass Health Fees in most cases.

Federal funds will be used to fund contracts under this RFR.

D. Listing of Specialties and Languages:

In order to more effectively use these services for MRC consumers, we are requesting that you list all specialties and any additional languages besides English in which you and/or your staff are fluent in the language. For example: American Sign Language (ASL), Spanish, French/Creole, Chinese, Khmer, Vietnamese, Portuguese, etc.

7.CONTRACT SPECIFICATIONS AND CONTRACTOR QUALIFICATIONS

The purpose of a response to this RFR is to demonstrate the qualifications, competence and capability of the agency seeking to undertake the medical services in conformity with the requirements of this Request for Responses. The respondents to this RFR should demonstrate the qualifications of the medical services organization and of the particular staff to be assigned to this engagement. They should also specify an approach that will meet the requirements of the RFR. The proposal should address all the points outlined in this RFR document. The proposal should provide a straightforward, concise description of the applicant’s capabilities to satisfy the requirements of the RFR.

The proposal must not exceed 10 pages; it must be double spaced, 12-pt type, 1 inch margins all around. Supplemental materials such as: staff resumes, budget form and budget justification narratives, organizational charts, and Supplier Diversity Office certifications are excluded from the page limit. You may either complete the attached Form (See Attachment 2) or submit your response in narrative form as your proposal. Required documents must be submitted.

Responses must be submitted to COMMBUYS (https://www.commbuys.com/bso/) by Wednesday, November 9, 2016 at 4 PM, for contracts starting 1/1/2017, deadline time is based on the time according to the COMMBUYS system. All responses must include the cover page outlined in Attachment 1, as well as the Rate Schedule as outlined in Attachment 3.

The RFR response should follow the outline provided below. This template references the order and content of the proposal specifications (described later in this section), which in turn corresponds to the evaluation criteria described in the Proposal Evaluation. The proposal form (Attachment 2) also follows this outline.

An affirmative statement should be included indicating that the agency is properly registered/licensed to operate in Massachusetts. A proposal submitted by an individual shall include a copy of the physician’s/clinician’s/medical provider’s current professional license. In the case of corporations/agencies, the proposal shall include a copy of the license to practice medicine for each proposed physician/clinician. Should this license expire during the course of the contract, it is the health care professional’s obligation to send a copy of the license renewal to MRC.

1) The applicant will briefly describe and outline their qualifications, Licenses, Certifications and capabilities to provide medical and/or consulting services detailing the specific medical consulting services to be provided. You should provide proof of Professional Liability Insurance.

2) The applicant will briefly outline their experience, including services to individuals with disabilities; a description of the medical services and capabilities in providing services; the number of years providing specific medical or consulting services; the size of the agency, how many doctors, nurses and other staff it employs and location of the office(s) from which the agency conducts business and its ability to provide medical services in a timely fashion. The proposal should also include organizations for which the agency provides medical services and references from those organizations.

3) The applicant will identify and discuss their geographical service area capabilities.

4) The applicant should reference the rate schedule to be used for this RFR set forth by the Massachusetts Division of Health Care, Finance and Policy as amended. The rates will be adjusted as new rates and regulations are established or changed.

http://www.mass.gov/eohhs/gov/laws-regs/hhs/community-health-care-providers-ambulatory-care.html

5) The applicant will outline their process to submit timely clinical/service reports and information to MRC.

6) The applicant will outline their process to submit timely service billing.

7) Supplier Diversity Office (SDO) Certification: The applicant will submit proof of a SDO certification.

8) The applicant will identify any language proficiency such as but not limited to American Sign Language (ASL), Spanish, French/Creole, Chinese, Khmer, Vietnamese, Portuguese, etc.

8. EVALUATION PLAN FOR MEDICAL SERVICES/CONSULTANTS FOR MRC VR CONSUMERS

MRC is seeking to develop a statewide network of medical/consulting service providers throughout the Commonwealth of Massachusetts, with the following expertise including, but not limited to basic medical evaluations, diagnostic testing and services in the following areas: psychiatric, psychological, audiological, eye, dental evaluations; providing appropriate testing, evaluation, treatment such as medical, therapy, lab testing, surgery, dentistry, etc., in all of the above areas for people with disabilities who are consumers of the Massachusetts Rehabilitation Commission.

Evaluation of Responses:

Submitted RFR responses will be evaluated by an MRC evaluation team, comprised of at least 3 MRC staff with subject matter experience and expertise. The RFR evaluation team will utilize the evaluation criteria and scoring process described below. Responses will be reviewed and awarded based on the scoring process and criteria described in this RFR. The maximum score that can possibly be awarded per reviewer will be 86 and the minimum score to be considered for award per reviewer is 50.

Points

Points

Points

Evaluation of RFR response will be based on the quality of each submission and the total score on the evaluation sheet per submission. Please see Attachment #4 for the scoresheet.

9. CONTRACT PERFORMANCE

Upon award of the contract, the vendor will be evaluated on timely and adequate completion of the required project deliverables specified in this RFR.

1. Maintain appropriate Licenses or Certifications: The contractor will be responsible Maintaining the appropriate licenses and or certifications plus professional liability insurance.

2. Timely delivery of services in geographical areas identified: The contractor will be responsible for the provisions of timely services in geographical services areas identified in proposal.

3. Provision of quality services. The contractor will be responsible for providing professional and quality services.

4.

Utilization of rate schedule: The contractor will be responsible for utilizing the established rate schedule

5. Timely and accurate submission of fiscal billing reports:

The contractor will be responsible for accurate and timely submission of fiscal billing reports.

6. Timely and accurate submission of clinical reports and information to MRC and the MRC consumer: The contractor will be responsible for providing timely and accurate clinical reports and information to MRC Counselor and the MRC Consumer.

Description of Task, Deliverables, Completion Schedule and Estimated Resources.

MRC is seeking contractors for the purchase of/or providing medical services including but not limited to basic medical evaluations and services, psychiatric, psychological, audiological, eye, dental evaluations, providing appropriate treatment such as therapy (occupational, physical and speech), lab testing, surgery, dentistry, etc., in all of the above areas to people with disabilities who are consumers of the Massachusetts Rehabilitation Commission. All services will be subject to the Fee Schedule set forth by Massachusetts Division of Health Care Finance and Policy with all current and future amendments and regulations. To locate the rates can be viewed on the EOHHS website: http://www.mass.gov/eohhs/gov/laws-regs/hhs/community-health-care-providers-ambulatory-care.html . The fee schedule is in alignment with the Mass Health Fees in most cases.

10. CULTURAL COMPETENCE

MRC is committed to awarding contracts to providers that demonstrate cultural competency. Programs shall ensure equal access to services. The following strategies are recommended:

Agency Commitment: Agency Board of Directors and administrators make a commitment to creating an environment that clearly supports services for cultural and linguistic minority populations through the mission and goals of the agency.

Consumer Services: Program policies include language that contributes to enhancing equal access to services for all individuals residing in the Commonwealth. Program design, content, and materials are culturally and linguistically appropriate. Planning, implementation, and evaluation efforts include members of the target population. Where possible, prevention, treatment, and rehabilitation strategies are participatory in nature in order to provide opportunities for skill building and to facilitate self-empowerment. All consumers receive information on accessing health and human services including education on potential barriers and assistance in overcoming them. The program location and outreach activities are in settings that are most effective in reaching the target population.

Staff: All staff and volunteers, especially those who have direct contact with consumers, reflect the diversity of the culture and language of the community/target population. Services to non-English speaking consumers are provided by bilingual/bicultural staff. Policies on recruitment, screening, and interviewing encourage hiring of individuals whose cultural and linguistic backgrounds are appropriate. If the program does not have bilingual/bicultural staff, there is extensive training to ensure sensitive and appropriate prevention, treatment, and rehabilitation services.

11. AUDIT

During the term of this Agreement and for a period of six years thereafter, the Massachusetts Rehabilitation Commission, its auditors, the Operational Services Division, the Office of the Inspector General or other authorized representatives shall be afforded access at reasonable times to Contractor's accounting records, including sales information on any system, reports or files, in order to audit all records relating to goods sold or services performed pursuant to this Agreement. If such an audit indicates that Contractor has materially overcharged the Massachusetts Rehabilitation Commission, then the Contractor shall remit the overcharged amount and be responsible for payment of any costs associated with the audit.

12. SUPPLIER DIVERSITY PROGRAM (SDP)

The Supplier Diversity Program (formerly known as Affirmative Market Program) was established in September, 2010 via Executive Order 524 to promote equality in the state contracting market by ensuring full participation of minority and women owned business enterprises (M/WBEs) in all areas of state contracting including construction, design, goods and services. The Executive Order consolidates the State Office of Minority and Women Assistance (SOMWBA) and Affirmative Market Program (AMP) into a new Supplier Diversity Office (SDO) that is part of the Operational Services Division. Similarly, Executive Order 546 established the Service-Disabled Veteran-Owned Business Enterprise (SDVOBE) Program to encourage the participation of businesses owned and controlled by service-disabled veterans in all areas of state procurement and contracting, thereby including them in the SDP.

The essence of both Executive Orders is to provide policies to promote the award of state contracts in a manner that develops and strengthens certified M/WBEs and SDVOBEs, because a diverse business community strengthens the economy and is beneficial to all of the citizens of the state.

In support of both Executive Orders, the state tracks SDP spending through POS contracts. As a result, providers that are issued a contract from this procurement will be required to submit a “Supplier Diversity Program (SDP) Plan Form for Purchase of Service (POS)” on a yearly basis with their Uniform Financial Report (UFR) through the Operational Services Division (OSD) eFiling site. Providers that file a UFR exemption request are required to submit the SDP Plan Form for POS with their exemption request. The plan will be evaluated yearly by the Commonwealth Department with the most Purchase of Service funding to a provider during the previous fiscal year. This Department is commonly referred to as the Principal Purchasing Agency (PPA).

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 are required to complete the Form and include it with their proposal. The “SDP Plan for POS” can be found in the File Attachments Section of the respective Bid Solicitation on www.COMMBUYS.com.

The evaluation criteria for this POS solicitation do not dedicate a specific percentage of the total evaluation points to the SDP Plan. However the Strategic Sourcing/Procurement Management Team (SST/PMT) has developed strong evaluation benchmarks in order to identify robust plans. While the Plan is not assigned any points in the evaluation process, the Department is unable to issue a contract to an organization that has not submitted a Plan that demonstrates a strong commitment to working with M/WBEs and SDVOBEs.

Resources available to assist providers in identifying SDP Certified Partners include:

Potential Minority Business Enterprises (MBE) and Women Business Enterprises (WBE) partners can be found on the Supplier Diversity Program webpage (www.mass.gov/sdp ). For a complete list of certified vendors, refer to: https://www.sdo.osd.state.ma.us/BusinessDirectory/BusinessDirectory.aspx

Resources available to assist providers in finding potential Service-Disabled Veteran-Owned Business Enterprise (SDVOBE) partners can be found on the Supplier Diversity Office Webpage (www.mass.gov/sdo ).

The Operational Services Division offers SDP trainings for providers. The dates of upcoming SDP trainings can be found on the OSD Training & Outreach Webpage. In addition, the SDP Webinar can be located on the Supplier Diversity Program webpage (www.mass.gov/sdp)

13. DEBRIEFINGS AND APPEALS

Debriefing

Any Bidder that has filed an eligible response, but who is not selected, may request a debriefing to understand the basis for the decision and review all materials relevant to the review and the qualification and selection process. The request must be in writing and received within 14 calendar days of notification of such being sent to the Bidder. A Bidder aggrieved by the decision must participate in a debriefing as a prerequisite to filing a request for an administrative appeal. All requests for a debriefing must be sent by certified mail and addressed to:

Attn: Director of Contracts

Contracts Department

600 Washington St., 1st Floor

Boston, MA 02111

If a debriefing is properly requested, one will be scheduled within 14 calendar days of the date the request was received. If necessary, a brief extension shall be allowed by mutual agreement of the Bidder and MRC. At the debriefing, a Bidder shall be allowed to review public records directly related to the selection decision.

Administrative Appeals

A Bidder that is not selected and who attends a debriefing may appeal the decision to the Commissioner of MRC. Requests for appeal must be sent by certified mail and addressed to:

Commissioner

600 Washington St., 2nd Floor

Boston, MA 02111

The appeal must be filed within 14 calendar days of the debriefing meeting. The appeal must be in writing specifying the basis for the appeal and it must be based on one or more of the following grounds:

a. The procurement failed to comply with applicable regulations and guidelines. These are limited to the requirements of 801 CMR 21.00 or any successor regulations, the policies in the Operational Services Division (OSD) Procurement Information Center, subsequent policies and procedures issued by OSD and the specifications of the RFR; or

b. There was a fundamental unfairness in the procurement process.

The burden of proof rests with the Bidder to provide sufficient and specific evidence in support of its claim.

Requests for an appeal must specify in sufficient detail the basis for the appeal. Sufficient detail requires the identification of an applicable regulation or guideline that was not complied with or the specific facts that demonstrate that the procurement was unfair. MRC reserves the right to reject appeal requests based on grounds other than those stated above, or those submitted without sufficient detail on the basis for the appeal.

Administrative appeals are not subject to the formal procedures specified in M.G.L. c. 30A, §§ 10 & 11.

A pending appeal will not prohibit MRC from proceeding with the selected Bidder, awarding a contract or making referrals to the selected Bidder.

Acceptance/Denial of the Appeal

Within 21 calendar days of the receipt of request for an appeal, MRC will schedule a hearing date or notify the Bidder that the appeal has been deemed without merit and that it will not be heard. The Bidder and the MRC may mutually agree to extend the date for the hearing. The Commissioner’s decision on the appeal will be put in writing and sent to the Bidder within 60 calendar days of the date of the hearing on the Bidder’s appeal.

Appeals to the Operational Services Division

Non-successful Bidders who participate in the appeal process described in this Section and remain aggrieved by the decision of the Agency may appeal the decision to the Operational Services Division (OSD). The basis for an appeal to OSD is limited to the following grounds:

a.

The competitive procurement conducted by MRC failed to comply with applicable regulations and guidelines. These would be limited to the requirements of 801 CMR 21.00 or any successor regulations, the policies in the OSD Procurement Information Center, subsequent policies and procedures issued by OSD and the specifications of the RFR; or b.

There was a fundamental unfairness in the procurement process. The allegation of unfairness or bias is one that is easier to allege than prove; consequently, the burden of proof rests with the Bidder to provide sufficient and specific evidence in support of its claim. OSD will presume that MRC conducted a fair procurement absent documentation to the contrary.

Requests for an appeal must be sent to OSD to the attention of the State Purchasing Agent at Room 1017, One Ashburton Place, Boston, MA 02108 and be received within 14 calendar days of the postmark of the notice of the Agency’s decision on the appeal. Appeal requests must specify in sufficient detail the basis for the appeal. Sufficient detail requires a description of the published policy or procedure which was applied and forms the basis for the appeal and presentation of all information that supports the claim under paragraphs a. or b. above. OSD reserves the right to reject appeal requests based on grounds other than those stated above or those submitted without sufficient detail on the basis for the appeal.

The decision of the State Purchasing Agent shall be rendered, in writing, setting forth the grounds for the decision within 60 calendar days of receipt of the appeal request. Pending appeals to the State Purchasing Agent shall not prohibit MRC from proceeding with executing contracts.

14. ADDITIONAL INFORMATION

a) The Bidder(s) is responsible for any and all costs associated with the preparation of the RFR response.

b) All response submissions, regardless of whether a contract is ultimately awarded to a particular Bidder, become the property of the Massachusetts Rehabilitation Commission.

c) The Agency may, during response review or at any time prior to selection, cancel a Request for Response or reject any or all responses if the Agency determines that such action is in the best interest of the Commonwealth.

d) The Massachusetts Rehabilitation Commission and the Commonwealth of Massachusetts make no guarantee that any commodities or services will be purchased from any contract resulting from this RFR.

e) The MRC reserves the right to renegotiate and adjust rates, performance terms, and/or performance measures at any time during the life of the contract.

f) All materials developed by the selected Contractor(s) under this contract such as handouts, outlines, mailing lists, workshop agenda, publicity notices, and other materials will remain the property of the MRC.

g) The Massachusetts Rehabilitation Commission anticipates monitoring and evaluating the Contractor’s performance on an ongoing basis. Any contract resulting from this solicitation may be terminated at any time if the Contractor is unable to meet performance standards after given a reasonable opportunity to improve performance.

h) This Request for Response is developed in good faith based on needs known at the time of document preparation. Should additional information become available during the term of this contract suggesting the advisability of a different strategy and/or additional contract goals or performance benchmarks, the MRC reserves the right to modify the contract accordingly, including adjusting the contract term, dates of performance, and/or contract maximum obligation.

i) A Bidder unable to offer the exact commodity or service described in this RFR but believing a comparable one can be provided, is encouraged to respond and should fully explain why the substitute commodity or service meets the specifications set forth in this RFR.

j) The qualified provider must maintain an e-mail account capable of handling e-mails and attachments of appropriate size and of accessible formatting type.

k) Bidders are prohibited from communicating directly with any employee of MRC regarding this RFR, except as specified in this RFR; and no other individual Commonwealth employee or representative is authorized to provide any information or respond to any question or inquiry concerning this RFR. Bidders may contact the Contact Person(s) for this RFR if this RFR is incomplete or the Bidder is having trouble obtaining any required attachments electronically through COMMBUYS.

15. SUBMISSION COMPONENTS AND ATTACHMENTS

COMMBUYS is the official source of information for this Bid and is publicly accessible at no charge at www.COMMBUYS.com. Information contained in this document and in COMMBUYS, including file attachments, and information contained in the related Bid Questions and Answers (Q&A), are all components of the Bid, as referenced in COMMBUYS, and are incorporated into the Bid and any resulting contract.

Bidders are solely responsible for obtaining all information distributed for this Bid via COMMBUYS. Additionally, bidders are responsible for posting their response (called “quote”) on the system. Bidders should review the “COMMBUYS Market Center” and “COMMBUYS Registration” sections in Appendix 2 of the Appendix document for an overview of electronic submission. Additional detail is provided in the “Instructions for Vendors Responding to Bids Electronically through COMMBUYS” section, found in Appendix 5.

COMMBUYS Registration. Bidders may elect to obtain a free COMMBUYS Seller registration which provides value-added features, including automated email notification associated with postings and modifications to COMMBUYS records. However, in order to respond to a Bid, Bidders must register and maintain an active COMMBUYS Seller account. If a Bidder requires assistance with the registration process, they may contact the COMMBUYS Help desk by email at COMMBUYS@state.ma.us or by phone at 1-888-627-8283.

Quote Submission Method. Online Quote Submission via COMMBUYS is required. All Bidders must submit Quotes online using tools available only to Sellers registered in COMMBUYS. COMMBUYS provides Seller registration functionality at no charge. To register, go to www.COMMBUYS.com and click on the “Register” link on the front page. All Bidders who are awarded a contract resulting from this Bid, if any, will be required to maintain an active account during the duration of the Contract, by reviewing their registration information regularly and maintaining its accuracy.

Electronic Signatures Quotes submitted via COMMBUYS must be signed electronically by the Bidder or the Bidder’s Agent by accepting the terms and conditions of the bid on the “Terms & Conditions” tab of the Bid in COMMBUYS. By selecting “Save & Continue” on the “Terms and Conditions” tab after accepting the terms and conditions of the bid, the submitter attests that s/he is an agent of the Bidder with authority to sign on the Bidder’s behalf, and that s/he has read and assented to each document’s terms.

Responses must be submitted to COMMBUYS (https://www.commbuys.com/bso/) by Wednesday, November 9, 2016 at 4:00 PM, for contracts starting 1/1/2017, deadline time is based on the time according to the COMMBUYS system. All responses must include the cover page outlined in Attachment 1, as well as the Rate Schedule as outlined in Attachment 3. You have the option to submit your response in narrative form or by completing Attachment 2 as your proposal. In either case, all required documents noted should be provided.

The electronic response must include the following forms:

· RFR Cover Sheet (should be 1st page of response; Attachment 1)

· RFR Response Form (Attachment 2) optional

· Rate Schedule (Attachment 3)

· CORI Assurance letter (corporations/agencies)

· Supplier Diversity Office (SDO) Certification (if applicable)

· Supplier Diversity Program (SDP) Form

· Copy of applicable licenses and/or certifications (e.g., CDRS)

· Copy of company liability insurance

· Business Reference Form

· Prompt Payment Discount Form

· Massachusetts Department of Revenue Certificate of Good Standing (https://wfb.dor.state.ma.us/webfile/Certificate/Public/WebForms/Welcome.aspx )

· If you choose not to complete the Proposal Form (Attachment 2), your original written proposal must not exceed 10 pages excluding attachments, but must be double spaced, 12-pt type, 1 inch margins all around. Attachments may be up to 10 pages and should include resumes of key staff and an organization chart

Responses must be submitted to COMMBUYS. Deadline for Responses is Wednesday, November 9, 2016 at 4 PM, for contracts starting 1/1/2017, deadline time is based on the time according to the COMMBUYS system.

Additional Requirements for Financial Pre-Qualification

Provider Organizations delivering services regulated by 808 CMR 1.00 must follow the pre-qualification procedures described in this regulation.

Additional information is accessible through the links below:

How to Contract with EOHHS

Provider Qualification Guide As a prerequisite for an organization entering into a contract with MRC, a bidder must demonstrate that it meets minimum administrative and fiscal standards, or is “pre-qualified.” Pre-qualification is the process the Commonwealth uses to be assured it has minimized possible risks to consumers being served through purchased programs. Bidders who are already pre-qualified by the Commission or any other Executive Office of Health and Human Services (EOHHS) agency do not need to submit pre-qualification materials as part of the RFR process as long as they are fulfilling submission requirements for the current re-qualification process. That information will automatically be requested of the provider during the annual re-qualification process for current providers.

Bidders who are not pre-qualified must submit a completed package as part of the RFR response.

Pre-qualification requires the additional following documents:

Corporations/Organizations:

· Articles of Organization

· Resumes of Principals (i.e., Chief Executive, Financial and Clinical Program Offices)

· Board of Directors Information

· Current Financial Statements including notes prepared by an independent auditor

· Certificate of Good Standing (https://wfb.dor.state.ma.us/webfile/Certificate/Public/WebForms/Welcome.aspx )

· Copy of Current Public Charities Annual Filing for non-profit organizations http://www.charities.ago.state.ma.us/

· Contractor Qualification Form

· Federally Required Disclosures Form

Individuals:

· Certificate of Good Standing (https://wfb.dor.state.ma.us/webfile/Certificate/Public/WebForms/Welcome.aspx )

· Federally Required Disclosures Form

· Line of credit letter All required forms and related instructions can be found in the “File Attachments” section of the bid on COMMBUYS.

Filing of Response All bidders must complete a quote on the COMMBUYS system. Electronic Responses must be submitted to COMMBUYS by Wednesday, November 9, 2016 at 4 PM, for contracts starting 1/1/2017, deadline time is based on the time according to the COMMBUYS system.

Contact Help Desk with submission difficulties COMMBUYS@state.ma.us or 888-627-8283.

Upon selection, the successful bidder will receive a Standard Contract packet for signature. No services should be rendered until the bidder is notified that the contract process is complete.

Ink Signatures

Original ink signatures are required only after contracts have been awarded. The Commonwealth of Massachusetts requires Contractors to submit original ink-signature versions of the following forms:

· Standard Contract Form

· Commonwealth Terms and Conditions for Human and Social Services

· Contractor Authorized Signatory Listing

· Request for Taxpayer Identification and Verification (Mass. Substitute W9 Form)

· Electronic Funds Transfer Sign Up Form

· CORI form (individuals)

Successful Bidders who agreed to the terms and conditions of these forms electronically via COMMBUYS online Quote submission tool must still submit the above forms with ink signatures within seven (7) calendar days of award notification or their contract may not be executed by the Commonwealth. Bidders who have previous contract(s) with the Commonwealth and have up-to-date, ink-signature versions of the Commonwealth Terms and Conditions and Request for Taxpayer Identification and Verification (Mass. Substitute W9 Form) on file with the Office of the State Comptroller may submit copies of the signed forms. However, a new Standard Contract Form and Contractor Authorized Signatory Listing with original ink signatures must be submitted for each new contract with the Commonwealth.

16. ADDITIONAL SPECIFICATIONS

This RFR includes additional specifications, as described in the Appendix document. The document includes the sections below:

Appendix 1 Required Terms for all RFRs

Appendix 2 RFR - Required Specifications for Purchase of Service (POS)

Appendix 3 Purchase of Service (POS) Additional Required Specifications: October 2015 Appendix 4 Instructions for Execution and Submission of Commonwealth Standard Forms

Appendix 5 Instructions for Vendors Responding to Bids Electronically through COMMBUYS Appendix 6 Glossary

ATTACHMENT 1

COVER PAGE / RFR RESPONSE SHEET

MEDICAL SERVICES/CONSULTANTS FOR MRC VR CONSUMERS

MRC MEDSERVICES 09-16

Type or Print

Company Name:

Address:

City/State/Zip:

Telephone:

Federal Tax ID #:

DUNS #:

Primary Contact Person:

Primary Contact Person Job Title:

Primary Contact Phone: _________________________________________________

Primary Contact E-mail:

Company CEO/President Name:

Company CEO/President E-mail:

Company CEO/President Phone:

Company CFO/Business Manager Name:

Company CFO/Business Manager E-mail:

Company CFO/Business Manager Phone:

ATTACHMENT 2

RFR RESPONSE FORM (OPTIONAL)

RFR - MEDICAL SERVICES/CONSULTANTS FOR MRC VR CONSUMERS

MRC MEDSERVICES 09-16

Provider Name:

Provider Address:

Provider Email:

Provider Phone:

RFR responses will be evaluated on the basis of the 8 criterion listed below. Please fill out each criteria in detail in the comment boxes or you may submit a written narrative. The use of attachments is acceptable.

1. Describe and outline your qualifications, Licenses (including license number), Certifications and capabilities to provide medical and/or consulting services detailing the specific medical and/or consulting services to be provided. You should provide proof of Professional Liability Insurance.

2. Briefly outline your experience and number of years of experience providing specific medical or consulting services.

3. Identify and discuss your geographical service area capabilities.

4. Reference and state the rate schedule to be used for this RFR set forth by the Massachusetts Division of Health Care, Finance and Policy as amended. The rates will be adjusted as new rates and regulations are established or changed.

http://www.mass.gov/eohhs/gov/laws-regs/hhs/community-health-care-providers-ambulatory-care.html

5. Outline your process to submit timely clinical/service reports and information to MRC.

6. Outline their process to submit timely service billing.

7. Supplier Diversity Office (SDO) Certification: The contractor will submit proof of a SDO Certification.

8. Identify any language proficiency such as, but not limited to, American Sign Language (ASL), Spanish, French/Creole, Chinese, Khmer, Vietnamese, Portuguese, etc.

ATTACHMENT 3

RATE SCHEDULE

MEDICAL SERVICES/CONSULTANTS FOR MRC VR CONSUMERS

MRC MEDSERVICES 09-16

The rates can be viewed on the EOHHS website: http://www.mass.gov/eohhs/gov/laws-regs/hhs/community-health-care-providers-ambulatory-care.html

ATTACHMENT 4

RATINGS SCORE SHEET

MEDICAL SERVICES/CONSULTANTS FOR MRC VR CONSUMERS

MRC MEDSERVICES 09-16

Responses will be evaluated on the basis of the 8 criterion listed below. Please fill out each criteria in detail in the comment boxes.

1. The applicant will briefly describe and outline their qualifications, Licenses (including license number), Certifications and capabilities to provide medical and/or consulting services detailing the specific medical and/or consulting services to be provided. You should provide proof of Professional Liability Insurance.

2. The applicant will briefly outline their experience and number of years of experience providing specific medical or consulting services.

3. The applicant will identify and discuss their geographical service area capabilities.

4. The applicant should reference and state the rate schedule to be used for this RFR set forth by the Massachusetts Division of Health Care, Finance and Policy as amended. The rates will be adjusted as new rates and regulations are established or changed.

http://www.mass.gov/eohhs/gov/laws-regs/hhs/community-health-care-providers-ambulatory-care.html

5. The applicant will outline their process to submit timely clinical/service reports and information to MRC.

6. The applicant will outline their process to submit timely service billing.

7. Supplier Diversity Office (SDO) Certification: The applicant will submit proof of a SDO Certification.

8. The contract will identify any language proficiency such as, but not limited to, American Sign Language (ASL), Spanish, French/Creole, Chinese, Khmer, Vietnamese, Portuguese, etc.

TOTAL SCORE

SCORE KEY

Criterion 1: 0 (lowest score) through 15 (highest score)

Criterion 2: 0 (lowest score) through 15 (highest score)

Criterion 3: 0 (lowest score) through 15 (highest score)

Criterion 4: 0 (lowest score) through 15 (highest score)

Criterion 5: 0 (lowest score) through 10 (highest score)

Criterion 6: 0 (lowest score) through 10 (highest score)

Criterion 7: 0 (lowest score) through 3 (highest score)

Criterion 8: 0 (lowest score) through 3 (highest score)

Please Note: This is a single document associated with a complete Bid (also referred to as Solicitation) that can be found on � HYPERLINK "http://www.commbuys.com/" �COMMBUYS� (www.COMMBUYS.com). All Bidders are responsible for reviewing and adhering to all information, forms and requirements for the entire Bid, which are all incorporated into the Bid. Bidders may also contact the COMMBUYS Helpdesk at � HYPERLINK "mailto:COMMBUYS@state.ma.us" �COMMBUYS@state.ma.us� or the COMMBUYS Helpline at 1-888-MA-STATE. The Helpline is staffed from 8:00 AM to 5:00 PM Monday through Friday Eastern Standard or Daylight time, as applicable, except on federal, state and Suffolk county holidays.

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