Monitored Visitation Provider Packet.xlsx
XLSX spreadsheet 103 KB Posted
- Attached to
- Monitored Visitation Services
- Solicitation number
- RFP - 10A - 202607116
- Issued by
- Maine
About this file
This is a Provider Packet for the Maine Department of Health and Human Services, Office of Child and Family Services (DHHS/OCFS), designed to collect quarterly reporting information from providers of Monitored Visitation Services under the Family Visitation Program. The packet requires providers to submit comprehensive documentation including performance measure reports, staff reports, monitored visitation narratives, and monthly invoice reports on a quarterly basis, with submissions due within 30 days following the end of each quarter. The contract terms span two years, with reporting periods beginning October 1, 2026, and continuing through September 30, 2028, divided into eight quarterly reporting cycles with specific due dates ranging from January 30 to October 30 of each year. Providers must document all monitored visits within 24 hours of completion and include video documentation of visitation sessions.
The packet establishes three key performance measures that providers must meet: 90 percent of completed monitored visitation referrals must be scheduled within seven calendar days; monitored visitation workers must intervene 100 percent of the time when child safety is compromised; and 100 percent of appropriate referrals must receive services up to the maximum number of authorized units. Direct service hours are reported in quarter-hour increments and include face-to-face contacts, collateral contacts, case conferences, court time, video preparation, and administrative documentation. Billing provisions allow providers to claim one hour for no-shows or cancellations by parties other than the provider occurring less than 24 hours before scheduled visits. The packet requires annual TANF reporting detailing program descriptions, internal controls for data accuracy, expenditure tracking for clothing and food, and attestation of compliance with all federal and state regulations and agency policies.
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Other files
| File | Type | Posted |
|---|---|---|
| RFP 202607116 Q | — | |
| RFP 202607116 Monitored Visitation_FINAL.docx | DOCX document | |
| RFP 202607116 Monitored Visitation Proposed Services Response Form.docx | DOCX document |
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Text version
1. Attestation & Signature Page
| DHHS/OCFS PROVIDER PACKET | ||
| ***Do not create additional tabs to this document*** | ||
| PROVIDER NAME: | QUARTER BEING REPORTED: | |
| AGREEMENT #: | DATE COMPLETED: | |
| VENDOR CODE: | ||
| SERVICE GROUP: | FAMILY VISITATION PROGRAM - MONITORED VISITATION |
Dear Provider, This Provider Packet collects information that is required as part of your Agreement with OCFS. Please complete all shaded gray areas of this form before submitting. You will also complete each tab with the requested information and submit any other required material listed below in the supplemental information area. A list of due dates has been provided below. This information must be reported no later than 30 days from the end of each quarter.
Once complete, you will submit by email to the Contract Administrator listed in your Agreement along with the following: OCFS-PMR.DHHS@maine.gov and Program Manager. We thank you for your efforts in providing this information to ensure compliance with your OCFS contract.
| QUARTERS REPORTED: | DUE BY: | |
| Y1-Q1: | 10/1/2026 to 12/31/2026 | January 30 |
| Y1-Q2: | 1/1/2027 to 3/31/2027 | April 30 |
| Y1-Q3: | 4/1/2027 to 6/30/2027 | July 30 |
| Y1-Q4: | 7/1/2027 to 9/30/2027 | October 30 |
| Y2-Q1: | 10/1/2027 to 12/31/2027 | January 30 |
| Y2-Q2: | 1/1/2028 to 3/31/2028 | April 30 |
| Y2-Q3: | 4/1/2028 to 6/30/2028 | July 30 |
| Y2-Q4: | 7/1/2028 to 9/30/2028 | October 30 |
| REQUIRED REPORTS: | WHEN TO PROVIDE: |
| Performance Measure Report | QUARTERLY |
| Staff Report | QUARTERLY |
| Monitored Visitation Narrative | Within 24 hours of Visit |
(Submitted with Visit Video)
| Monitored Visitation Monthly Invoice Report | MONTHLY WITH INVOICE |
| Annual TANF Report | ANNUALLY |
| I, | the undersigned on behalf of | 0 |
| attest the information included is true to the best of my abilities and knowledge. I do attest to the agency being in compliance with all Federal and State rules and regulations and adherence to all agency established policies and procedures. |
| Electronic Signature: |
| Date: |
2. Performance Measure Report
| 0 | QUARTER BEING REPORTED: | 0 | |
| 0 | DATE COMPLETED: | 10/1/2026 to 12/31/2026 |
tc={A780347C-AB03-4904-84DC-8D87D658B12D}: [Threaded comment]
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Comment:
| Dates will need to be updated | 1/1/2027 to 3/31/2027 | 4/1/2027 to 6/30/2027 | 7/1/2027 to 9/30/2027 | 10/1/2027 to 12/31/2027 | 1/1/2028 to 3/31/2028 | 4/1/2028 to 6/30/2028 | 7/1/2028 to 9/30/2028 | ||||||||
| YEAR 1 - QUARTER 1 | YEAR 1 - QUARTER 2 | YEAR 1 - QUARTER 3 | YEAR 1 - QUARTER 4 | YEAR 2 - QUARTER 1 | YEAR 2 - QUARTER 2 | YEAR 2 - QUARTER 3 | YEAR 2 - QUARTER 4 |
| Performance Measure | Numerator Definition | Denominator Definition | Target % | District | Q3 Numerator | Q3 Denominator | Actual % | Q4 Numerator | Q4 Denominator | Actual % | Q4 Numerator | Q4 Denominator | Actual % | Q4 Numerator | Q4 Denominator | Actual % | Q3 Numerator | Q3 Denominator | Actual % | Q4 Numerator | Q4 Denominator | Actual % | Q4 Numerator | Q4 Denominator | Actual % | Q4 Numerator | Q4 Denominator | Actual % | |
| A. | Ninety percent 90% of completed Monitored Visitation referrals must be scheduled for a Visit to be conducted within seven (7) calendar days. | The number of visits that were scheduled within seven (7) calendar days this quarter. | The total number of referrals completed this quarter. | 90% | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | |||||||||||||||||
| B. | Monitored Visitation workers must intervene one hundred percent (100%) of the time when Safety is compromised to ensure Visits are emotionally and physically Safe. | The number of safety interventions used by a worker during visits this quarter. | The total number of safety issues, that require safety intervention, during visits this quarter. | 100% | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | |||||||||||||||||
| F. | 100% of appropriate referrals will receive services up to the maximum number of authorized units. | The total number of appropriate referrals who receiced services up to the maximum number of authorized units this quarter. | The total number of appropriate referrals received this quarter. | 100% | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! |
Dates will need to be updated
3. Staff Report
| PROVIDER NAME: | 0 | QUARTER BEING REPORTED: | 0 | ||
| AGREEMENT #: | 0 | DATE COMPLETED: | |||
| STAFF REPORT | |||||
| STAFF MEMBER NAME: | POSITION TITLE: | DEGREE: | VALID |
STATE
DRIVERS LICENSE
Y/N (If applicable to position) YEARS OF EXPERIENCE WORKING WITH YOUTH: STAFF
CONTACT
PHONE: STAFF CONTACT EMAIL: NOTES REGARDING ANY CHANGES IN INFORMATION FROM PREVIOUS QUARTER:
4. Monitored Visitation
| MONITORED VISITATION NARRATIVE | |
| CLIENT CASE ID: | DATE OF VISITATION: |
| AGENCY CASE ID #: | AGENCY: |
| SCHEDULED START TIME: | SCHEDULED END TIME: |
| ACTUAL START TIME: | ACTUAL END TIME: |
| LOCATION: | VISIT MONITORS: |
| ADULTS IN ATTENDANCE AND ROLE: | |
| CHILD(REN) IN ATTENDANCE: | |
| GENERAL NOTES: |
NUMBER OF SAFETY INTERVENTIONS AND TIME IN RECORDING TO VIEW:
DESCRIBE INTERVENTIONS NEEDED TO ENSURE CHILD(REN)'S PHYSICAL OR EMOTIONAL SAFETY:
IF THE VISIT WAS TERMINATED, EXPLAIN THE CIRCUMSTANCES RESULTING IN TERMINATION:
NOTES REGARDING ANY ADDITIONAL COMMUNICATION WITH PARENTS OUTSIDE OF THE ACTUAL VISIT:
5. Mnthy Monitored Invoice Repo
| PROVIDER NAME: | MONTH BEING REPORTED |
| AGREEMENT #: |
| Definition of Direct Service Staff Hours: | ||
| Direct service hours are reported as Units of service in one-quarter hour (15 minute) increments and include: | ||
| 1. | Actual time spent working with the family (i.e. face to face and telephone contacts, and collateral contacts, as needed to arrange visitation). The nature of telephone and collateral contacts will be documented in writing and maintained in the client file; | |
| 2. | Actual time spent in case conferences with Department staff; | |
| 3. | Actual time spent participating in multi-disciplinary telephone conferences scheduled by Department staff; | |
| 4. | Actual time spent in court, as well as the actual travel time to and from court; | |
| 5. | Actual time spent preparing and submitting video documentation (approximately fifteen [15] minutes/visit); | |
| 6. | Actual time spent attempting to provide service (waiting for client for prearranged visit, rescheduling visits, etc.); | |
| 7. | Actual time spent documenting reportable incidents and interventions; | |
| 8. | A no-show or visit cancelled by someone other than the Provider in less than twenty-four (24) hours of the scheduled start time may be billed for one (1) hour and half of any additional time over one (1) hour based on the length of the scheduled visit. (In addition to the time billed for attempting to provide the service, as defined above.) |
MONITORED VISITATION
MONTHLY INVOICE REPORT
| District | Case ID # | Referral | |
| Date | Service |
Start Date Total Billable
| Units | Visit |
| Hours | Initials of Staff |
During
| Visit | Visitor Role | Number of Interventions | NO SHOW |
| (X) | Cancelled |
by Other (List Reason) Cancelled by Client
(X) Cancelled by Provider
(X) Cancelled by Dept.
| (X) | Documentation |
| TIME in UNITS | Other |
Admin
| TIME in UNITS | Coordination with Other |
| TIME in UNITS | FTM |
| TIME in UNITS | Court Prep |
| TIME in UNITS | Court Testimony |
TIME in UNITS
6. Annual TANF Report
| Contract # | 0 |
| Vendor Name | 0 |
| Funding Source | |
| CFDA Number | |
| Program/Service Description and Use of Funds |
A. Please provide a desciription of the program/service this grant will fund and how these funds will be used.
B. Please provide a description of your internal controls that you will use to verify accuracy of data collected then subsequently reported.
C. Please provide a description of how you anticipate the use of funds to meet the federal block grant's purpose, and parameters.
| Additional information needed per quarter | Y1 Q1 | Y1 Q2 | Y1 Q3 | Y1 Q4 | Y2 Q1 | Y2 Q2 | Y2 Q3 | Y2 Q4 |
| Total Expenditures: | ||||||||
| Expenditures spent on clothing: | ||||||||
| Expenditures spent on food: |
File details come from the government source that posted it. Updated .