RFA 202606106 Rural Health Transformation Funding for CP_FINAL (1).docx

STATE OF MAINE

Department of Public Safety Bureau of Emergency Medical Services

RFA# 202606106

Rural Health Transformation Funding for Community Paramedicine

RFA Coordinator

Submitted Questions Due Date

August 4, 2026, no later than 4:00 p.m., local time

no later than 4:00 p.m., local time

TABLE OF CONTENTS

Page

A. PURPOSE AND BACKGROUND

B. GENERAL PROVISIONS

C. ELIGIBILITY TO SUBMIT APPLICATIONS

D. CONTRACT TERM

E. AWARDS

F. APPLICABLE LEGISLATION

A. VENDOR SELF SERVICE SYSTEM (VSS)

B. QUESTIONS

C. AMENDMENTS

D. APPLICATION SUBMISSION

A. EVALUATION PROCESS – GENERAL INFORMATION

B. SCORING WEIGHTS & PROCESS

C. NEGOTIATIONS

D. SELECTION AND AWARD

E. APPEAL OF CONTRACT AWARDS

A. CONTRACT DOCUMENT

B. STANDARD STATE CONTRACT PROVISIONS

PUBLIC NOTICE

State of Maine Department of Public Safety

RFA# 202606106

Rural Health Transformation Funding for Community Paramedicine

The State of Maine is seeking applications for EMS agencies to either initiate or expand Community Paramedicine Services within their service area. Priority will be given in areas with a dearth of CP coverage, specifically Washington and Aroostook counties.

A copy of the RFA and all related documents can be obtained through the Vendor Self Service System (VSS): https://mevss.hostams.com/PRDVSS1X1/AltSelfService

Applications must be submitted to the Office of State Procurement Services, via the Vendor Self Service System (VSS). Application submissions must be received no later than 4:00 p.m., local time, on August 17, 2026. Applications will be opened the following business day.

RFA TERMS/ACRONYMS with DEFINITIONS

The following terms and acronyms, as referenced in the RFA, have the meanings indicated below:

State of Maine Department of Public Safety Bureau of Emergency Medical Services

RFA# 202606106

Rural Health Transformation Funding for Community Paramedicine

PART I INTRODUCTION

A. Purpose and Background

The Department of Public Safety (Department) is seeking applications for EMS agencies to initiate or expand Community Paramedicine services in rural areas as defined in this Request for Applications (RFA) document. This document provides instructions for submitting applications, the procedure and criteria by which the awarded Applicant(s) will be selected, and the contractual terms which will govern the relationship between the State of Maine (State) and the awarded Applicant(s).

Funding for this RFA is anticipated to come through the Rural Health Transformation Program (RHTP). The goal of these funds is to support the initiation and expansion of Community Paramedicine (CP) programs across the state. The funds should support access to CP services for rural Mainers, with a particular focus on Washington and Aroostook counties.

The grant information is included below:

Grant Number: RHTCMS332075-01-01 Grant Award Name: Maine’s Rural Health Transformation Plan proposes a new approach to delivering rural health care so that rural Mainers will have a resilient and integrated rural healthcare system accessible to all.

CFDA Number: 93.798 CFDA Name: Rural Health Transformation Program Federal Awarding Agency: Centers for Medicare and Medicaid Services

FAIN: RHTCMS332075

Federal Funds Obligated: $190,008,051.09 Federal Award Date: 2/27/2026 Program Grant Administrator: Bethany Hamm

This grant period is from 12/29/25 – 10/30/26

B. General Provisions

1. From the time this RFA is issued until award notification is made, all contact with the State regarding this RFA must be made through the RFA Coordinator identified on the cover page of this RFA. No other person/State employee is empowered to make binding statements regarding this RFA. Violation of this provision may lead to disqualification from the application process, at the State’s discretion.

2. Issuance of the RFA does not commit the Department to issue an award or to pay expenses incurred by an Applicant in the preparation of a response to the RFA. This includes attendance at personal interviews or other meetings, where applicable.

3. All applications must adhere to the instructions and format requirements outlined in the RFA and all written supplements and amendments (such as the Summary of Questions and Answers), issued by the Department. Applications must follow the format and respond to all questions and instructions specified in Part III of the RFA.

4. Applicants will take careful note that in evaluating an application submitted in response to this RFA, the Department will consider materials provided in the application, information obtained through interviews/presentations (if any), and internal Departmental information of previous contract history with the Applicant (if any). The Department also reserves the right to consider other reliable references and publicly available information in evaluating the Applicant’s experience and capabilities.

5. The application must be signed by a person authorized to legally bind the Applicant and must contain a statement that the application and the pricing contained therein will remain valid and binding for a period of 180 days from the date and time of the bid opening.

6. The RFA and the awarded Applicant’s application, including all appendices or attachments, will be the basis for the final contract, as determined by the Department.

7. Following announcement of an award decision, all records and documents regarding this RFA, including bid submissions, will be public records, available for public inspection pursuant to 5 M.R.S. §1825 B (6 &15) and the State of Maine Freedom of Access Act (FOAA) (1 M.R.S. § 401 et seq.). State contracts and information related to contracts, including all records, documents, supporting documents, and bid submissions, are public records unless otherwise excepted by statute (Id).

8. Subject to the above and pursuant to applicable law, in the event that an Applicant believes any information that it submits in response to this RFA is confidential, it must mark that information accordingly, and include citation to legal authority in support of the Applicant’s claim of confidentiality. In the event that the Department receives a FOAA request that includes submissions marked as confidential, the Department shall evaluate the information and any legal authority from the Applicant to determine whether the information is an exception to FOAA’s definition of public record. If the Department determines to release information that an Applicant has marked confidential, it shall provide advance notice to the Applicant to allow for them to seek legal relief.

9. The Department, at its sole discretion, reserves the right to recognize and waive minor informalities and irregularities found in applications received in response to the RFA.

10. If awarded a contract resulting from this RFA, vendors shall be required to disclose, in writing and in accordance with applicable Maine law, any actual or potential conflicts of interest. Such disclosure must include any financial, professional, or personal relationships that could give rise to a conflict of interest or the appearance of a conflict of interest. Failure to disclose a known conflict or appearance of conflict may result in disqualification, contract termination, or other remedies as provided by law.

11. All applicable laws, whether or not herein contained, shall be included by this reference. It shall be the Applicant’s responsibility to determine the applicability and requirements of any such laws and to abide by them.

C. Eligibility to Submit Applications

In order to be considered for Grant funding under this application process, Applicants must be or provide:

1. Eligible organizations include all Maine EMS licensed agencies, including non-transporting and ground ambulance services. Agencies may collaborate with other agencies.

2. Agencies must serve an HRSA eligible rural zip code. Eligibility can be determined utilizing the Rural Health Grants Eligibility Analyzer.

3. The lead agency must receive or maintain a Community Paramedicine license within the contract period.

4. Agencies may participate in multiple group/regional applications, however, an agency may only serve as the lead agency on one (1) application.

D. Contract Term

The term of anticipated contract period resulting from this RFA is defined in the table below. The dates below are estimated and may be adjusted, as necessary, in order to comply with all procedural requirements associated with the RFA, the specific project awarded, and the contracting process. The actual contract start date will be established by a completed and approved contract.

E. Awards

The Department anticipates making multiple awards as a result of this RFA process. The department anticipates having $4,964,064 available across all awards for FY2026.

An individual agency may request a maximum award of $500,000 for FY2026.

Agencies that apply as a group may request up to an additional $250,000 for regional projects, for a maximum request of $750,000. This could include QA/QI projects, educational projects, or collaborative planning. Preference will be given to those who have broad projects in Washington, Aroostook and Lincoln counties.

The Department may award all, part, none, or modify this allocation at its discretion. Applications with the highest scores will receive awards in descending order.

The Department reserves the right to make partial awards, eliminate the lowest scoring application(s) and/or make awards for amounts less than requested, whichever is in the best interest of the State.

PART II ACTIVITIES AND REQUIREMENTS

A. Required Activities

1. Receive or maintain a Community Paramedicine license throughout the contract period.

2. Desired outcomes from the RHTP Sub-Grants are promoting timely access to high-quality care by transforming care capacity through Community Paramedicine. These funds will support overall sustainable access to care. These funds will support agencies with initial community paramedicine program start-up costs or overall program improvement.

3. All awarded Applicants will be required to provide quarterly updates, project deliverables, and a brief project case study that communicates lessons learned.

B. Allowable Use of Funds

1. Prevention and chronic disease: Promoting evidence-based, measurable interventions to improve prevention and chronic disease management.

2. Provider payments: Providing payments to health care providers for the provision of health care items or services, subject to restrictions described in the funding policies and limitations section of the NOFO.

3. Consumer tech solutions: Promoting consumer-facing, technology-driven solutions for the prevention and management of chronic diseases.

4. Training and technical assistance: Providing training and technical assistance for the development and adoption of technology-enabled solutions that improve care delivery in rural hospitals, including remote monitoring, robotics, artificial intelligence, and other advanced technologies.

5. Workforce: Recruiting and retaining clinical workforce talent to rural areas, with commitments to serve rural communities for a minimum of five (5) years.

6. IT advances: Providing technical assistance, software, and hardware for significant information technology advances designed to;

a. Improve efficiency,

b. Enhance cybersecurity capability development, and

c. Improve patient health outcomes.

7. Appropriate care availability: Assisting rural communities to right-size their health care delivery systems by;

a. identifying needed preventative,

b. ambulatory,

c. pre-hospital,

d. emergency,

e. acute inpatient care,

f. outpatient care, and

g. post-acute care service lines.

8. Behavioral health: Supporting access to opioid use disorder treatment services (as defined in section 1861(jjj)(1) of the Social Security Act), other substance use disorder treatment services, and mental health services.

9. Innovative care: Developing projects that support innovative models of care that include value-based care arrangements and alternative payment models, as appropriate.

10. Additional uses designed to promote sustainable access to high-quality rural health care services, as determined by the Administrator:

11. Capital expenditures and infrastructure: Investing in existing rural health care facility buildings and infrastructure, including minor building alterations or renovations and equipment upgrades to ensure long-term overhead and upkeep costs are commensurate with patient volume, subject to restrictions in the funding policies and limitations.

12. Fostering collaboration: Initiating, fostering, and strengthening local and regional strategic partnerships between rural facilities and other health care providers to promote quality improvement, improve financial stability of rural facilities, and expand access to care.

C. Non-Allowable Use of Funds

1. Pre-award costs.

2. Meeting matching requirements for any other federal funds or local entities.

a. Services, equipment, or supports that are the legal responsibility of another party under federal, State, or tribal law, such as vocational rehabilitation or education services.

b. Services, equipment, or supports that are the legal responsibility of another party under any civil rights law, such as modifying a workplace or providing accommodations that are obligations under law.

3. Goods or services not allocable to the project:

4. Supplanting existing State, local, tribal, or private funding of infrastructure or services, such as staff salaries.

5. Construction or building expansion, purchasing or significant retrofitting of buildings, cosmetic upgrades, or any other cost that materially increases the value of the capital or useful life as a direct cost.

6. The cost of independent research and development, including their proportionate share of indirect costs. See 2 CFR 300.477.

7. Funds related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order.

8. Purchase of covered telecommunications and video surveillance equipment (See 2 CFR 200.216) as well as financial assistance to households for installation and monthly broadband internet costs.

9. Meals, unless in limited circumstances such as:

a. Subjects and patients under study.

b. Where specifically approved as part of the project or program activity, such as in programs providing children’s services.

c. As part of a per diem or subsistence allowance provided in conjunction with allowable travel.

10. Activities prohibited under 2 CFR 200.450 and the HHS Grants Policy Statement, including but not limited to:

a. Paying the salary or expenses of any grant recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order proposed or pending before the Congress or any State government, State legislature, or local legislature or legislative body.

b. Lobbying, but awardees can lobby at their own expense if they can segregate federal funds from other financial resources used for lobbying.

i. For guidance on some types of costs that we restrict or do not allow, see 2 CFR Part 200 Subpart E - General Provisions for Selected Items of Cost.

11. New construction is unallowable. Supplanting funding for in-process or planned construction projects or directing funding towards new construction builds is unallowable. Renovations or alterations, as described in category J within the NOFO of the program requirements and expectations use of funds section, are allowed if they are clearly linked to program goals. Category J funding cannot exceed 20% of the total funding CMS awards States in a given budget period.

12. To replace payment for clinical services that could be reimbursed by insurance. We will not accept payments to clinical services if they duplicate billable services and/or attempt to change payment amounts of existing fee schedules. If you plan to fund direct health care services, you must justify why they are not already reimbursable, how the payment will fill a gap in care coverage (such as uncompensated care or services not covered by insurance), and/or how they transform the current care delivery model. Funding for provider payments, as described in category B of the program requirements and expectations use of funds section, cannot exceed 15% of the total funding CMS awards States in a given budget period.

13. Funding cannot be used for initiatives that fund certain cosmetic and experimental procedures that fall within the definition of a specified sex-trait modification procedure at 45 CFR 156.400 because that is beyond the scope of this program.

14. No more than 5% of total funding CMS awards to a State in a given budget period can support funding the replacement of an EMR system if a previous HITECH-certified EMR system is already in place as of September 1, 2025.

15. Funding towards initiatives similar to the “Rural Tech Catalyst Fund Initiative” cannot exceed the lesser of (1) 10% of total funding awarded to a State in a given budget period or (2) $20M of total funding awarded to a State in a given budget period, and funding is subject to all restrictions and requirements described in the example initiative.

16. Clinician salaries or wage supports for facilities that subject clinicians to non-compete contractual limitations.

17. None of the funding must be used by the State for an expenditure that is attributable to an intergovernmental transfer, certified public expenditure, or any other expenditure to finance the non-Federal share of expenditures required under any provision of law.

18. SSA Section 2105(c), paragraphs (1), (7), and (9) apply as funding limitations. These limitations are related to general limitations, limitations on payment for abortions, and citizenship documentation requirements for payments made with respect to an individual.

D. Reporting Requirements

1. Awarded Applicants will be required to adhere to all Department reporting requirements outlined in the contract resulting from this RFA process. Specific reporting requirements will be determined during contract negotiations.

PART III KEY PROCESS EVENTS

A. Vendor Self Service System (VSS)

1. The Office of State Procurement Services Vendor Self Service System website is found at the link below: https://www.maine.gov/dafs/bbm/procurementservices/vendors/vendor-self-service-system

2. A copy of the RFA and all associated documents will be published in VSS.

3. Only documents published in VSS will be considered binding.

4. Any interested party may view open solicitations in VSS using the Public Access feature.

5. Vendors must have an active User ID and password in VSS to submit questions and respond to solicitations, including this RFA.

a. Vendor registration instructions and User Guide may be found at the link above, which include steps for searching for an existing account/User ID, or registering for a new account/User ID.

b. Vendors interested in responding to a solicitation are encouraged to obtain a User ID and password for VSS as soon as possible.

6. Vendors must have an active Vendor Code (VC or VS) to contract with the department.

B. Questions

1. General Instructions: It is the responsibility of all Applicants and other interested parties to examine the entire RFA and to seek clarification, in writing, if they do not understand any information or instructions.

a. Questions must be submitted in VSS as soon as possible but no later than the date and time published in VSS.

b. Questions should be clearly stated and reference the applicable section and/or page number of the RFA.

c. The Department assumes no liability for assuring accurate/complete/on time transmission and receipt.

2. Question & Answer Summary: Responses to all questions will be compiled in writing and published in VSS no later than seven (7) calendar days prior to the Application Submission Deadline. It is the responsibility of all interested parties to go to VSS to obtain a copy of the Question & Answer Summary. Only those answers issued in writing in VSS will be considered binding.

C. Amendments

All amendments released in regard to the RFA will be published in VSS. It is the responsibility of all interested parties to go to VSS to obtain amendments. Only those amendments published in VSS are considered binding.

D. Application Submission

1. Applications Due

a. Application submissions must be received no later than the Application Submission Deadline (closing date) published in VSS.

b. Any application submissions or any additional or revised application files received after the Application Submission Deadline will be rejected without exception.

2. Delivery Instructions

a. Application submissions must be submitted to the Office of State Procurement Services via VSS.

b. Only application submissions received via VSS will be considered. The Department assumes no liability for assuring accurate/complete receipt.

c. Submissions containing links to file sharing sites or online file repositories will not be accepted as submissions. Only application submissions that have the actual requested files attached will be accepted.

d. Encrypted submissions received which require opening attachments and logging into a proprietary system will not be accepted. Applicants should work with their Information Technology team to ensure that the application submission will not be encrypted due to any security settings.

e. File size limits are 15MB per file. Applicants may separate their submissions into multiple files, as necessary, due to file size concerns.

3. Submission Format

a. Applicants must submit at least one (1) file, labeled and including the required information as defined below:

File Name: RFA# 202606106 Application Submission – [Applicant’s Name]

· Must contain: Applicant’s completed Application Form and all required information and attachments as stated in the form.

b. The Application Form must be submitted as a single, typed file. If including attachments in the same file presents a file size issue, Applicants may submit those attachments as a separate, clearly labeled file.

c. Applicants must include any forms provided in the RFA (such as the Application Form) or reproduce those forms as closely as possible.

d. Applicants are not to provide additional attachments beyond those specified in the RFA or Application Form for the purpose of extending their response. Materials not requested will not be considered part of the application and will not be evaluated.

PART IV APPLICATION EVALUATION AND SELECTION

A. Evaluation Process – General Information

1. An evaluation team, composed of qualified reviewers, will judge the merits of the applications received in accordance with the criteria defined in the RFA.

2. Officials responsible for making decisions on the award selection will ensure that the selection process accords equal opportunity and appropriate consideration to all who are capable of meeting the specifications. The goals of the evaluation process are to ensure fairness and objectivity in review of the applications and to ensure that all contracts are awarded to the Applicants that provide the best value to the State of Maine.

3. The Department reserves the right to communicate and/or schedule interviews/presentations with Applicants, if needed, to obtain clarification of information contained in the applications received. The Department may revise the scores assigned in the initial evaluation to reflect those communications and/or interviews/presentations.

4. Changes to applications, including updating or adding information, will not be permitted during any interview/presentation process and, therefore, Applicants must submit applications that present their rates and other requested information as clearly and completely as possible.

5. Failure to respond to all questions and instructions throughout the RFA may result in the application being disqualified as non-responsive or receiving a reduced score. The Department, and its evaluation team, has sole discretion to determine whether a variance from the RFA specifications will result either in disqualification or reduction in scoring of an application.

B. Scoring Weights & Process

1. Scoring Weights: The score will be based on a 100-point scale and will measure the degree to which each application meets the following criteria. The information required in each section of the Application Form aligns with the Scoring Criteria defined below.

2. Scoring Process: For applications that demonstrate meeting the eligibility requirements defined in Part I, if applicable, the evaluation team will use a consensus approach to evaluate and score all sections listed above. Members of the evaluation team will not score those sections individually but, instead, will arrive at a consensus as to assignment of points for each of those sections.

C. Negotiations

1. The Department reserves the right to negotiate with the awarded Applicant(s) to finalize a contract.

2. The Department reserves the right to terminate contract negotiations with an awarded Applicant who submits a proposed contract significantly different from the application they submitted in response to the advertised RFA.

3. In the event that an acceptable contract cannot be negotiated with an Applicant, the Department may withdraw its award and negotiate with the next-highest ranked Applicant, and so on, until an acceptable contract has been finalized. Alternatively, the Department may cancel the RFA, at its sole discretion.

D. Selection and Award

1. The final decision regarding the award of the contract will be made by representatives of the Department subject to approval by the State Procurement Review Committee.

2. Notification of conditional award selection or non-selection will be made in writing by the Department.

3. Issuance of the RFA in no way constitutes a commitment by the State of Maine to award a contract, to pay costs incurred in the preparation of a response to the RFA, or to pay costs incurred in procuring or contracting for services, supplies, physical space, personnel or any other costs incurred by an Applicant.

4. The Department reserves the right to reject any and all applications or to make multiple awards.

E. Appeal of Contract Awards

Any person aggrieved by the award decision that results from the RFA may appeal the decision to the Director of the Bureau of General Services in the manner prescribed in 5 M.R.S.A. § 1825-E and 18-554 Code of Maine Rules Chapter 120. The appeal must be in writing and filed with the Director of the Bureau of General Services, 9 State House Station, Augusta, Maine, 04333-0009 within fifteen (15) calendar days of receipt of notification of conditional contract award.

PART V CONTRACT ADMINISTRATION AND CONDITIONS

A. Contract Document

1. The awarded Applicant will be required to execute a State of Maine Service Contract with appropriate riders as determined by the issuing department.

All exceptions will be negotiated between the awarded Applicant(s) and the State. The State will not accept any proposed exceptions as part of this RFA process. The State is not obligated to accept, negotiate, or compromise of any proposed exceptions.

The complete set of standard State of Maine Service Contract documents, along with other forms and contract documents commonly used by the State, may be found on the Office of State Procurement Services’ website at the following link: Office of State Procurement Services Forms Page

2. Allocation of funds is final upon successful negotiation and execution of the contract, subject to the review and approval of the State Procurement Review Committee. Contracts are not considered fully executed and valid until approved by the State Procurement Review Committee and funds are encumbered. No contract will be approved based on an RFA which has an effective date less than fourteen (14) calendar days after award notification to Applicants. (Referenced in the regulations of the Department of Administrative and Financial Services, Chapter 110, § 3(B)(i).)

This provision means that a contract cannot be effective until at least fourteen (14) calendar days after award notification.

3. The State recognizes that the actual contract effective date depends upon completion of the RFA process, date of formal award notification, length of contract negotiation, and preparation and approval by the State Procurement Review Committee. Any appeals to the Department’s award decision(s) may further postpone the actual contract effective date, depending upon the outcome. The contract effective date listed in the RFA may need to be adjusted, if necessary, to comply with mandated requirements.

4. In providing services and performing under the contract, the awarded Applicant must act as an independent contractor and not as an agent of the State of Maine.

B. Standard State Contract Provisions

1. Contract Administration Following the award, a Contract Administrator from the Department will be appointed to assist with the development and administration of the contract and to act as administrator during the entire contract period. Department staff will be available after the award to consult with the awarded Applicant in the finalization of the contract.

State of Maine RFA# 202606106 1 Rev. 11/10/2025 – DAFS/Office of State Procurement Services

PART VI APPLICATION FORM

As defined in Part III, D, 3 of the RFA, Applicants must complete the Application Form embedded below and produce all required attachments.

The Application Form may be obtained in a Word (.docx) format by double clicking on the document icon below.

Viewing this RFA in a web browser will likely not allow for opening of the embedded document. Download the RFA and view it in the desktop application to access the embedded Application Form below.

image1.jpeg image2.emf

RFA APPLICATION FORM..docx State of Maine

Department of Public Safety

RFA# 202606106

Rural Health Transformation Funding for Community Paramedicine

APPLICATION COVER PAGE

Lead Applicant’s Name:

Chief Executive - Name/Title:

Tel:

E-mail:

Headquarters Street Address:

Headquarters City/State/Zip:

(Provide information requested below if different from above)

Lead Point of Contact for Application - Name/Title:

Tel:

E-mail:

Street Address:

City/State/Zip:

· This Application and the pricing structure contained herein will remain firm for a period of 180 days from the date and time of the bid opening.

· No personnel currently employed by the Department participated, either directly or indirectly, in any activities relating to the preparation of the Applicant’s Application.

· No attempt has been made, or will be made, by the Applicant to induce any other person or firm to submit or not to submit an Application.

· The above-named organization is the legal entity entering into the resulting contract with the Department should they be awarded the contract.

· The undersigned is authorized to enter contractual obligations on behalf of the above-named organization.

To the best of my knowledge, all information provided in the enclosed application, both programmatic and financial, is complete and accurate at the time of submission.

Name (Print):

Title:

Authorized Signature:

Date:

PARTNER AGENCIES

(fill out a separate form for each partner agency)

Partner Applicant’s Name:

Chief Executive - Name/Title:

Tel:

E-mail:

Headquarters Street Address:

Headquarters City/State/Zip:

(Provide information requested below if different from above)

Lead Point of Contact for Partner - Name/Title:

Tel:

E-mail:

Street Address:

City/State/Zip:

· This Application and the pricing structure contained herein will remain firm for a period of 180 days from the date and time of the bid opening.

· No personnel currently employed by the Department participated, either directly or indirectly, in any activities relating to the preparation of the Applicant’s Application.

· No attempt has been made, or will be made, by the Applicant to induce any other person or firm to submit or not to submit an Application.

· The above-named organization is the legal entity entering into the resulting contract with the Department should they be awarded the contract.

· The undersigned is authorized to enter contractual obligations on behalf of the above-named organization.

To the best of my knowledge, all information provided in the enclosed application, both programmatic and financial, is complete and accurate at the time of submission.

Name (Print):

Title:

Authorized Signature:

Date:

RESPONSIBLE BIDDER CERTIFICATION

Lead Applicant’s Name:

By signing this document, I certify to the best of my knowledge and belief that the aforementioned organization, its principals and any subcontractors named in this application:

a. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from bidding or working on contracts issued by any governmental agency.

b. Have not within three years of submitting the application for this contract been convicted of or had a civil judgment rendered against them for:

i. Fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a federal, state, or local government transaction or contract.

ii. Violating Federal or State antitrust statutes or committing embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property.

c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or Local) with commission of any of the offenses enumerated in paragraph (b) of this certification.

d. Have not within a three (3) year period preceding this application had one or more federal, state, or local government transactions terminated for cause or default.

e. Have not entered into a prior understanding, agreement, or connection with any corporation, firm, or person submitting a response for the same materials, supplies, equipment, or services and this application is in all respects fair and without collusion or fraud. The above-mentioned entities understand and agree that collusive bidding is a violation of state and federal law and can result in fines, prison sentences, and civil damage awards.

f. Is not a foreign adversary business entity (https://www.maine.gov/oit/prohibited-technologies).

g. Is not on the list of prohibited companies (https://www.maine.gov/oit/prohibited-technologies) or does not obtain or purchase any information or communications technology or services included on the list of prohibited information and communications technology and services https://www.maine.gov/oit/prohibited-technologies (Title 5 §2030-B).

Name (Print):

Title:

Authorized Signature:

Date:

RESPONSIBLE BIDDER CERTIFICATION

(fill out a separate form for each partner agency)

Partner’s Name:

By signing this document, I certify to the best of my knowledge and belief that the aforementioned organization, its principals and any subcontractors named in this application:

h. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from bidding or working on contracts issued by any governmental agency.

i. Have not within three years of submitting the application for this contract been convicted of or had a civil judgment rendered against them for:

i. Fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a federal, state, or local government transaction or contract.

ii. Violating Federal or State antitrust statutes or committing embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property.

j. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or Local) with commission of any of the offenses enumerated in paragraph (b) of this certification.

k. Have not within a three (3) year period preceding this application had one or more federal, state, or local government transactions terminated for cause or default.

l. Have not entered into a prior understanding, agreement, or connection with any corporation, firm, or person submitting a response for the same materials, supplies, equipment, or services and this application is in all respects fair and without collusion or fraud. The above-mentioned entities understand and agree that collusive bidding is a violation of state and federal law and can result in fines, prison sentences, and civil damage awards.

m. Is not a foreign adversary business entity (https://www.maine.gov/oit/prohibited-technologies).

n. Is not on the list of prohibited companies (https://www.maine.gov/oit/prohibited-technologies) or does not obtain or purchase any information or communications technology or services included on the list of prohibited information and communications technology and services https://www.maine.gov/oit/prohibited-technologies (Title 5 §2030-B).

Name (Print):

Title:

Authorized Signature:

Date:

APPLICATION

Eligibility

Applicants must provide documentation to demonstrate meeting the eligibility requirements stated in Part I of the RFA.

Are you an active Maine EMS licensed service?

☐ YES ☐ NO

Attach your active service license

Does the lead agency intend to apply for or maintain a Community Paramedicine license throughout the contract period?

☐ YES ☐ NO

Does your agency serve a zip code that is determined eligible for rural health grants by HRSA Rural Health Grants Eligibility Analyzer?

☐ YES ☐ NO

Provide the zip codes served:

Organization Qualifications and Experience

Applicants must describe their qualifications and skills to provide the requested services in the RFA. Applicants must include three (3) examples of projects which demonstrate their experience and expertise in performing these services as well as highlighting the Applicant’s stated qualifications and skills.

Project 1

Client Name:

Client Contact Person:

Telephone:

E-Mail:

Brief Description of Project

Project 2

Client Name:

Client Contact Person:

Telephone:

E-Mail:

Brief Description of Project

Project 3

Client Name:

Client Contact Person:

Telephone:

E-Mail:

Brief Description of Project

Subcontractors

If subcontractors are to be engaged, Applicants must describe the application and review process the Applicant will use to evaluate the qualifications and experience of potential subcontractors, and how the Applicant will ensure that debarred, suspended, or otherwise ineligible parties are excluded from all subcontract relationships.

Subcontractor 1

Subcontractor Name:

Contact Person:

Telephone:

E-Mail:

Brief Description of Anticipated Role and Qualifications

Subcontractor 2

Subcontractor Name:

Contact Person:

Telephone:

E-Mail:

Brief Description of Anticipated Role and Qualifications

Subcontractor 3

Subcontractor Name:

Contact Person:

Telephone:

E-Mail:

Brief Description of Anticipated Role and Qualifications

Organizational Chart

Applicants must provide an organizational chart. The organizational chart must include the project being proposed. Each position must be identified by position title and corresponding to the personnel job descriptions.

The organizational chart may be included below or may be attached to the application separately and appropriately labeled.

Litigation

Applicants must include a list of all current litigation in which the Applicant is named and a list of all closed cases that have closed within the past five (5) years in which the Applicant paid the claimant either as part of a settlement or by decree. For each, list the entity bringing suit, the complaint, the accusation, amount, and outcome.

Financial Viability

Applicants must provide the following information for each of the past three tax years:

a. Balance Sheets

b. Income (Profit/Loss) Statements

The financial information may be included below or may be attached to the application separately and appropriately labeled.

Certificate of Insurance

Bidders must provide a certificate of insurance on a standard ACORD form (or the equivalent) evidencing the bidder’s general liability, professional liability and any other relevant liability insurance policies that might be associated with the proposed services.

The Certificate of Insurance may be included below or may be attached to the application separately and appropriately labeled.

Rurality

Rurality will be determined by the following components, see chart below:

a. Does your agency transport to or collaborate with a rural hospital, critical access hospital or Federally Qualified Health Center?

b. Does the agency serve Washington,Aroostook or Lincoln counties?

Component

Grading Criteria for Community Rurality

Points eligible

A

If there is a rural hospital, critical access hospital or Federally Qualified Health Center the agency transports to or collaborates with the agency will receive 10 points.

If there is no rural hospital, critical access hospital or Federally Qualified Health Center the agency transports to or collaborates with the agency will receive 0 points.

B

If the agency identifies a zip code they serve in Washington, Aroostook, or Lincoln counties the agency will receive 10 points.

If the agency identifies no zip code they serve in Washington, Aroostook, or Lincoln counties the agency will receive 0 points.

Proposed Project

The proposed project must identify the scope and indicate how these funds will support the initiation or expansion of community paramedicine resources in rural Maine.

The funds must support access to CP services for rural Mainers, with a particular focus on Washington and Aroostook counties.

Include a sustainability plan for your proposed project. How will you financially sustain all aspects of the scope of work with non-grant funds in 5 years? Your plan may require different funding lines for each category. Please identify what steps you will take within the budget period to help ensure sustainable funding.

Budget

· Applicants shall identify what funds will be utilized for and provide a narrative within the explanation of expense column of the table below.

· An individual agency may request a maximum award of $500,000 for FY2026. If the application includes a regional project the maximum request may be $750,000.

· All budgeted costs must conform to the federal government’s four cost principles, including but not limited to, necessary, reasonable, allocable, and consistently treated.

Budget Category

Amount Requested

Explanation of expense

Personnel (salary and benefits)

Materials and supplies

Contracted services

Technology

Transportation

Other (specify)

Other (specify)

TOTAL REQUEST