Shared Living 2025 RFR Specifications - Final.docx

For Internal Discussion Purposes Only

The Commonwealth of Massachusetts Department of Developmental Services (DDS) Central Office

Address: 1000 Washington Street Suite 410 Boston, MA 02108

Contact: Timothy Cahill

Email: DDSPOSProcurement@mass.gov

Request for Response (RFR)

Document Title: Shared Living 2025

COMMBUYS BID Number: BD-24-1023-1023C-1023L-98547

DDS RFR Document Number: Shared Living-25

Posted: February 16, 2024

It is the responsibility of the prospective Bidder and awarded Contractor to maintain an active registration in COMMBUYS and to keep current the email address of the Bidder’s contact person and prospective contract manager, if awarded a contract, and to monitor that email inbox for communications from the Purchasing Department, including requests for clarification. The Purchasing Department and the Commonwealth assume no responsibility if a prospective Bidder’s/awarded Contractor’s designated email address is not current, or if technical problems, including those with the prospective Bidder’s/awarded Contractor’s computer, network, or internet service provider (ISP) cause email communications sent to/from the prospective Bidder/awarded Contractor and the Purchasing Department to be lost or rejected by any means including email or spam filtering. To register go to www.COMMBUYS.com.

This BID requires the submission of electronic quotes. All Bidders are advised to allow adequate time for submission of their quotes by considering potential online impediments like Internet traffic, Internet connection speed, file size, and file volume. DDS is not responsible for delays encountered by Bidders or their agents, or for a Bidder’s local hardware failures, such as computers or related networks, associated with bid compilation or submission. Bids submitted via COMMBUYS are time stamped by the COMMBUYS system clock which is considered the official time of record.

To receive a contract with the Commonwealth, a Bidder must be active in The Massachusetts Management Accounting and Reporting System (MMARS). MMARS is the official accounting system of the Commonwealth and once registered a contractor will be issued a Vendor Customer Code number or a “VC” number. This VC number is used for all contracts that an awarded Contractor has with state agencies. A Contractor with existing state contracts, or a Contractor who has had state contracts with any state agency in the past, has been registered in MMARS and does not need to re-submit paperwork unless existing information in MMARS will need to be updated. Bidders that don’t have a Vendor Customer Code or have changes to information or forms currently on file should send an email to: DDSPOSProcurement@mass.gov

Public Records: All information, documents, and attachments submitted as a response to this RFR(RFQ) are considered a public document subject to the Massachusetts Public Records Law, M.G.L., c. 66, s. 10, and to c. 4, s. 7, ss. 26. Please be aware that checking the “confidential” box in COMMBUYS does not bar these documents from being released as a public record pursuant to these statutes once the procurement is awarded, unless statutorily exempt from disclosure.

Contents

1.0 Procurement Scope and Description

The Department of Developmental Services (DDS or the Department) is issuing this BID to identify a qualified list of Shared Living provider. Shared Living, also known as Placement Services, is a 24 hour, 7 days a week residential support option that matches an individual with a Shared Living caregiver. This arrangement is overseen by a Shared Living provider (also known as the placement agency) that is licensed and holds a contract with the Department of Developmental Services to provide Shared Living services.

A Shared Living provider recruits caregivers, assesses their abilities, provides training, coordinates the matching and placement of individuals with caregivers, and provides ongoing supports.

Shared Living is available to individuals who need daily structure and supervision and includes adaptive skill development, assistance with activities of daily living, support for meaningful involvement in the community, transportation, independent living skill acquisition such as safety sign recognition and money management, and social and leisure skill development.

Shared Living is intended to be long-term in nature. Individuals eligible for Shared Living must have DDS adult eligibility for Intellectual / Developmental Disability (I/DD) or be enrolled in the Acquired Brain Injury (ABI) Residential Habilitation Waiver or Moving Forward Plan (MFP) Residential Supports Waiver. Individuals may also exhibit co-morbid conditions, such as a history of substance abuse, psychiatric/behavioral disorder, and/or significant medical needs. Referrals to Shared Living will be managed by the Department’s Area and Regional Offices.

1.1 Procurement and Contract Structure

This Request for Response (RFR) incorporates all relevant provisions of 801 CMR 21.00 Procurement of Commodities and Services, the Standard Contract Form and Instructions, the Commonwealth Terms and Conditions for Human and Social Services, the Operational Services Division’s REQUIRED SPECIFICATIONS for POS from September 1, 2019, Attachment C, and any amendments and/or additions to these documents during the life of this BID.

This procurement will result in a Master List of Shared Living providers who have been deemed qualified to provide placement services. Proposals will be reviewed and scored by Procurement Management Teams (PMT) composed of representatives from the DDS Regional and Area Offices.

Qualified Shared Living providers will sign a Standard Contract Form that will be issued by the Department’s Central Office. The Master Agreement contract does not guarantee the Shared Living provider a specific level of funding. Funding will be managed by the DDS Regional Contract Offices either through a Service Summary Form or other forms determined by the Department to track authorized units of service and the rate of service/s. Qualified Shared Living providers must receive written authorization from DDS prior to delivering services under this RFR.

1.2 Applicable Procurement Law

1.3 Whether Single or Multiple Providers are Required for Contract(s)

Check One (“X”)

1.4 Calendar Rule Type

Open May be reopened at a time and for a duration deemed necessary by the Department.

No responses will be received after the bid open date unless the Department choses to reopen the RFR at a later date.

|X|

Rolling Bidders may submit unsolicited proposals during the entire contract period. Bidders can continue to submit proposal up to June 30, 2033. Proposals submitted after the initial due date will be reviewed and scored on a quarterly basis unless otherwise noted in the RFR/BID

1.5 Acquisition Method

1.6 Use of Procurement by a Single or Multiple Departments

Massachusetts Commission for the Blind Massachusetts Rehabilitation Commission

The Purchasing Department reserves the right to add or remove additional authorized users during the contract term.

*Criteria and standards for residential care with this Departments may differ from those stated in this RFR

1.7 Expected Duration of Contract

Anticipated Duration up to: Ten (10) Years

Final End Date of this Contract: June 30, 2034

1.8 Anticipated Expenditure, Funding or Compensation for Expected Duration

Estimated Value of Procurement: $1,500,000,000

All services in this RFR are subject to appropriation. Should funding levels be adjusted significantly, the Department may seek provider re-affirmation of willingness to continue under modified program requirements.

At any time during the duration of the contract, the Department may conduct reviews of services and may consider taking corrective action, up to and including cessation or termination of all or part of the services covered under the Contract. Reasons for taking corrective action include: the Shared Living provider has not satisfactorily achieved performance goals; the needs of the individuals change to the extent that they can no longer be appropriately served under the original terms of this procurement; a Shared Living provider is unable to meet licensing or certification standards, or DDS determines that a significant change in services is in the best interests of the individuals served or the Department. Generally, unless a termination notice has been given pursuant to the Commonwealth Terms and Conditions for Human and Social Services, the Master Agreement contract will remain in force for the duration of the procurement. The Department reserves the right to make contract awards for a shorter duration when it is in the best interests of individuals, the Department, or the Commonwealth.

Check One (“X”):

Will Federal Funds be used to fund any part of Contract(s)? Check One (“X”):

*Shared Living providers receiving federal grant funds may be considered sub-recipients for federal grant purposes and will be required to comply with applicable federal requirements, including but not limited to sub-recipient audit requirements under OMB Circular A-133.

Capital, Trust and Federal Accounts Only Any funds designated in the budget that are unspent in any fiscal year will not be available for expenditure in the subsequent fiscal year.

Notice Concerning Rates of Payment: M.G.L. c 118E An Act Relative to Rates for Human and Social Service programs provides that the Secretary of Health and Human Services has the sole responsibility for established rates of payment for social service programs purchased by governmental units of the Executive Office. Shared Living providers will be reimbursed on a unit rate or accommodation rate based on rates established by the Executive Office Health and Human Services as stated in 101 CMR 411.00 Rates for Certain Placement, Support and Shared Living Services and other applicable rate regulations as may be amended from time to time during the duration of the Contract. The rates of payment and reimbursement structures may change during the life of the Contract.

Commercial Earnings Fees (for profit entities) Refer to 808 CMR 1.00. Compliance, Reporting and Auditing for Human and Social Services, 1.03 (6). The commercial earning fee shall be equal to the current surplus revenue retention limit stated in 808 CMR 1.03 (7).

EOHHS Qualification Process: New Providers Providers who have not been actively qualified by an EOHHS agency based on their submission of financial and organizational information must take steps to begin the POS Financial Qualification Process prior to submitting response/quote in COMMBUYS. To receive forms and instructions regarding the POS Qualification Process, new providers should send an email to the following address: DDSPOSProcurement@mass.gov Only proposals from providers that are assigned an Unconditional Status will be evaluated.

1.9 Contracting Structure

Service Engagement Shared Living services will be authorized by DDS Area Office staff and the Regional Contract Office will process a Service Summary Form (SSF) or similar document with awarded Bidder. Until a Master Agreement contract is signed, a Service Summary Form cannot be executed. The Service Summary Form will note the expected expenditure level the Department anticipates the awarded Bidder will be paid based on the projected number of units to be provided at the agreed upon rate(s).

The Departments will use the rates outlined in 101 CMR 411.00 to determine the level of compensation for services, but will blend the resources for the operational service component and the stipends paid to caregivers along with any resources added for hourly supports to create a single blended billing rate rather than requiring billing to be done for each of the discrete components (i.e. operational rate, stipend rate, and add on rates) as noted in 101 CMR 411.00.

Rate Methodology Rates for Shared Living services will consist of two primary parts - Operational Rates and Caregiver Stipends. In addition, supplemental staffing resources may be purchased as an add-on to support individuals with more challenging needs and behaviors as outlined in 101 CMR 411.00. A standardized assessment tool will be developed that will assist in determining an operational rate and caregiver stipend in accordance with guidance issued by the Department. The tool will take into consideration the characteristics, needs, and abilities of the individuals to be supported. Results of this assessment shall be used by all parties to reach agreement as to the appropriate tier for the individual and the stipend rate for the caregiver.

Operational Rates Operational Rates will support caregiver recruitment, oversight, training, and support (including respite hours, as applicable), as well as all administrative supports to the Shared Living program that contribute to the successful placement of individual service recipients. These rates will be expressed in tiers as outlined in 101 CMR 411.00 based on the level of need of the individual service recipient.

Caregiver Stipend A separate rate methodology has been developed to determine the applicable amount to be paid to Shared Living providers to provide caregiver stipends for the purpose of reimbursing the costs associated with shared living placements. To arrive at a stipend level for a particular individual, the Department and the Shared Living provider will use a standardized assessment tool.

Amounts paid to Shared Living providers to support caregiver stipends must be utilized by Shared Living providers strictly for this purpose outlined in this RFR or the funds are to be returned to the Commonwealth. The Department may require periodic and/or occasional specialized reporting from Shared Living providers regarding the use and ongoing tracking of amounts paid to support caregiver stipends.

Hourly Staffing 101 CMR 411.00 includes hourly rates to support the provision of additional direct care, clinical, and/or nursing staff that maybe required for individuals participating in Shared Living services. The need for such staffing supports must be incorporated into a medical care plan, a Positive Behavioral Health Plan, or identified in an assessment tool. These hourly staffing rates support the addition of staff in Shared Living placements where additional staffing resources are required to maintain a safe and healthy living arrangement. Training and supervision for these staff should be consistent with the services provided. All hourly staffing rates must be authorized by a DDS Area Office. Shared Living providers are required to notify the Area Office if unable to staff these hours.

Offsetting Revenue Recurring income and other public benefits received by individuals (e.g., wages from employment, Social Security Disability Income (SSDI), Supplemental Nutritional Assistance Program (SNAP), Section 8 Housing Vouchers) must be used to offset the cost of Shared Living services. The Department is the “payer of last resort” for Shared Living services and Shared Living providers must maximize the collections of revenue available from other sources in accordance with 115 CMR 3.05 to apply as an offset to the rate paid by DDS. These funds are often referred to as “charges for care”. Unless explicitly directed by DDS, Shared Living providers must collect from individuals the maximum amounts allowable under 115 CMR 3.05.

1.10 Overview of Program Models/Service Types

Shared Living contains three distinct Operational Tiers based on the characteristics set forth below. Each individual receiving Shared Living services will be assigned a service level and an associated operational rate. In addition, each individual’s Shared Living services will include a caregiver stipend amount, which will generally relate to the assigned level of service described below.

Level A: This service level provides the most basic level of recruitment, placement, training, oversight services, and living situations referred to above. Individuals in this “basic” level may exhibit the following characteristics:

· Minimal/infrequent need for behavioral, psychiatric, or medical interventions/supervision;

· “Home alone” status indicated on their ISP;

· Need for routine respite services with no additional staff support;

· Consistent attendance in a work or day program;

· No Risk Management Plan;

· Independence in most personal care areas with limited or no need for physical assistance or personal care monitoring or only verbal prompting for personal care activities.

Level B: Individuals in this “intermediate” level may exhibit the following characteristics:

· Need for a positive behavior support plan, targeting a specific set of behaviors and requires clinical consultation with caregiver;

· Regular psychiatric support needs and/or a Mental Health diagnosis that has a direct impact on the individual’s activities of daily living, ability to attend programs, and/or quality of home life;

· Forensic involvement which may include status as a Level 1 sex offender, exhibited non-adjudicated sexual behaviors, and/or conditions of probation;

· Need for functional behavior assessment and/or augmentative communication supports;

· Medical conditions resulting in the need for partial physical assistance for some personal care activities and intermittent need for medical monitoring and intervention such as that provided by an LPN or RN consultant;

· Individual is deaf and/or deaf blind and requires provider and/or caregiver with ASL or other specialized communication skills.

Level C: Individuals in this “intensive” level may exhibit the following characteristics:

· Require in certain instances an individualized Positive Behavior Support (PBS) plan where currently a Level 2 Plan is in effect or a brief or fully developed Functional Behavioral Assessment depending on the needs and behavioral challenges presented by the individual or require some degree of psychiatric/psychological consultation and added staff on a regular basis to support the individual and caregiver;

· Mental Health diagnosis that requires frequent psychiatric support/history of hospitalizations and added staff needed on a regular basis for supervision;

· Autism Spectrum Disorder (ASD) resulting in frequent self-injurious behavior or aggression and the need for additional trained staff supports to implement consistent behavioral approach including functional behavioral assessment (using DDS format) followed by data collection activities and on-going monitoring and analysis;

· Forensic issues involving a Level 2 or 3 sex offender status, “eyes on” supervision at all times, numerous conditions of probation, unadjudicated serious sexual behavior problems;

· Individual is deaf and/or deaf blind and exhibits other Level C characteristics;

· Medical conditions resulting in the need for frequent interventions and/or full hands-on physical assistance for all personal care needs; added staff needed to provide care and supervision and RN consultation needed frequently; home provider needs to be a certified CNA or LPN;

· As a result of any of the conditions/characteristics listed above, individual frequently remains at home instead of attending a work or day program.

2.0 Service Description

Shared Living is a 24 hour/7 day per week service that is individually tailored to participants who need daily structure and supervision. Shared Living includes services that assist with the acquisition, retention, or improvement of skills related to the individual living in the community. These services include adaptive skill development, assistance with activities of daily living, support for meaningful involvement in the community, transportation, independent living skill acquisition such as safety sign recognition and money management, social and leisure skill development, that assist the participant to reside in the least restrictive setting appropriate to their needs. This service also includes the provision of medical and health care services that are integral to meeting the daily needs of the individuals. Transportation between the individual’s place of residence and other service sites or places in the community will be required as a component of this service. Transportation includes but is not limited to; medical appointments, day programs, or community events.

Shared Living providers recruit caregivers, assess caregivers abilities, coordinate placement between an individual and a caregiver, train caregivers, and provide guidance, supervision, and oversight for caregivers. An executed agreement between the Shared Living provider and the caregiver clarifies the roles and responsibilities of each party. Shared Living integrates the participant into the usual activities of the caregiver's family life. In addition, the individual will have the opportunity for learning, developing, and maintaining skills including in such areas as ADLs, IADLs, social and recreational activities, and personal enrichment.

Shared Living services must be designed for each individual utilizing person-centered planning and coordination. This is an approach to assessment, planning, and coordination of services and supports that is focused on the individual’s goals, needs, preferences, and values. The person directs the development of the plan, which describes the life they want to live in the community. Services and supports are coordinated across providers and systems to carry out the plan and ensure fidelity with the person’s expressed goals, needs, preferences, and values.

Supports should be designed to develop and promote individuals’ rights and dignity, effective communication, goal development, skill acquisition, community membership, mutual relationships, individual control, decision-making, and to optimize their personal and environmental safety and physical and mental health. In addition, Shared Living services support each individuals’ independence and comports fully with standards applicable to Home and Community Based settings delivered under Section 1915(c) of the Social Security Act.

Shared Living providers must promote the use of Supportive Technology in accordance with the principles and practices of the DDS Technology Forward initiative. Supportive Technology should be utilized to increase opportunities for individuals to achieve greater independence and control over their lives. Supportive Technology in conjunction with the design of the home should meet individuals’ environmental accessibility needs to be as independent as possible. This may include outfitting homes with individual specific assistive technology devices identified through an assistive technology assessment. Direct support provided remotely via technology can be operated by the Shared Living provider or through partnership with a contractor that provides direct support via technology. Direct support provided via technology can only be used with individuals that demonstrate that they can be effectively supported with this type of modality.

2.1 Characteristics of Population to be Served

Individuals are prioritized to receive 24-hour residential services pursuant to 115 CMR 6.08(3)(b)(1) if the supports are necessary to protect the health or safety of the individual or others. Individuals may also be prioritized for Shared Living services because they are residing in an institutional setting and seek to transition to receiving services in a community-based home.

Individuals eligible for Shared Living must have DDS adult eligibility for I/DD or be enrolled in the ABI Residential Habilitation Waiver or MFP Residential Supports Waiver. Individuals may also exhibit co-morbid conditions, such as a history of substance abuse, acquired brain injury, psychiatric/behavioral disorder, and/or significant medical needs.

Over the lifetime of this procurement, DDS may modify eligibility standards, processes for assessing individuals to be prioritized for Shared Living services, and populations eligible for Shared Living pursuant to DDS Regulation or Policy.

2.2 Shared Living Service Expectations Relative to Human Rights Human Rights are at the core of service delivery. As such, Shared Living providers must have policies and procedures to address and support Human Rights in compliance with the requirements of DDS regulations 115 CMR 3.09 Protection of Human Rights/Human Rights Committees. For example, individuals and guardians must be trained and supported to learn about human rights and each provider must have a clearly outlined grievance process to address complaints.

Shared Living Service Expectations relative to Title VI of the Civil Rights Act of 1964 Title VI of the Civil Rights Act of 1964 prohibits certain types of discrimination in programs that utilize federal funds. Shared Living is an example of a program that are partially funded with federal waiver dollars. DDS and DDS qualified Shared Living providers must comply with Title VI requirements. The Department and Shared Services providers must not exclude, deny benefits to, or otherwise discriminate against any applicant for services or person supported based on race, color, or national origin in the admission to or participation in any of its programs and activities. Prohibited practices include, but are not limited to, the following:

1. Denying any service, opportunity, or other benefit for which an applicant or person supported is otherwise qualified.

2. Providing any applicant or person supported with any service or other benefit which is different or is provided in a different manner from that which is provided to others in the same program.

3. Subjecting any person supported to segregated or separate treatment in any manner related to the receipt of a service.

4. Restricting any person supported in any way in the enjoyment of services, facilities or any other advantage, privilege or benefit provided to others in the same program.

5. Adopting methods of administration that would limit participation or subject any group of applicants or persons supported to discrimination.

6. Addressing an applicant or person supported in a manner that denotes inferiority because of race, color, or national origin.

7. Subjecting any applicant or person supported to racial or ethnic harassment, to a hostile racial or ethnic environment or to a disproportionate burden of environmental health risks.

Denying a person supported (or person who has been previously deprived of the opportunity) eligibility to participate as a member of a planning or advisory body which is an integral part of the program.

2.3 Person Centered Planning

Shared Living services must be developed utilizing a person-centered planning (PCP) approach. PCP is a process for selecting and organizing the services and supports that an individual may need to live in the community. Most important, it is a process that is directed by the individual who receives the supports. The PCP approach identifies the individual’s strengths, goals, medical needs, needs for home and community-based services, and desired outcomes. These elements are included in the Individual Service Plan (ISP), which is developed based on those considerations and in conformity with 115 CMR 6.20 – 6.25.

When implementing the PCP approach, Shared Living providers are encouraged to become familiar with the Charting the LifeCourse framework and use the framework tools and resources with families and individuals. This framework provides both foundational principles and values for person-centered thinking approaches, as well as, concrete tools, and resources to support individuals and families in developing a vision and pursuing full and rich lives in the community. DDS is committed to the integration and use of the Charting the LifeCourse framework to support individuals and families across the lifespan. Shared Living providers bidding on these services are encouraged to explore and utilize this framework and tools to enhance the way families are supported. Additional information on Charting the LifeCourse can be found at: https://www.lifecoursetools.com/.

Shared Living providers are required to implement the ISP and to provide staff training and instruction necessary to ensure proper implementation. Shared Living providers must ensure that the completion of ISP action steps or achievement of ISP outcomes are carried out. This includes implementing instructions written by other providers (i.e., therapists or behavior service providers). It is expected that when new staff instructions become necessary, Shared Living providers will collaborate and cooperate in developing the instructions and provide training and support to ensure that the instructions are followed. Shared Living providers are required to document implementation of the ISP, including progress in completing action steps and achieving outcomes.

Assessment of Individual Needs Shared Living providers must assess individuals in conformity with 115 CMR 6.22 and within the first 90 days of service provision to determine their level of support relative to their unique needs. Shared Living providers must continue to re-assess individuals’ abilities and needs on an ongoing basis and as their needs change to ensure their support plans are still relevant and that the provision of services are done in accordance with their ISP.

2.4 Medical and Behavioral Health Care Management Requirements Shared Living providers must have the organizational capacity to effectively ensure that individuals and caregivers are supported to understand their options and to access the necessary medical and behavioral health services to meet their medical and clinical needs. Additionally, effective oversight and coordination needs to ensure that individuals are supported to receive integrated medical and behavioral health services to optimize their overall well-being and promote a continuity of care.

Individuals must have supports to manage their own health care. Health care supports should be person-centered and promote individuals’ ability to attain the following outcomes:

1. Individuals make person-centered decisions about healthy lifestyle, such as food choices and activity.

2. Individuals participate in decisions about their health.

3. Individuals have adequate contact with health practitioners regarding their physical and mental health.

4. Individuals receive preventive health care and services, including recommended physical and dental exams; ensuring the annual preventative health screening (Form HC-1) is completed and all appointments with health care providers are scheduled.

5. Individuals receive timely assessment, treatment, and follow up for acute and chronic health issues.

6. Individuals are supported to follow their prescribed treatment plans (e.g., medications, special diets, health management plans, Behavioral Support Plans (BSPs).

7. Individuals’ health related information, both current and historical, is documented accurately and available when needed.

8. Individuals shall have some form of identification which includes emergency contact information with them at all times.

A Registered Nurse and a Senior Positive Behavior Supports (PBS) qualified clinician should be available to oversee medical and behavioral / clinical needs of all individuals supported. These professionals are integral in the assessment of the individuals’ needs and oversee and coordinate the implementation activities noted above. Direct observation, supervision, monitoring, and caregiver training for each person is required. All Shared Living providers are required to incorporate health management policies into overall agency operations. These policies shall include information on the management, supervision, and documentation of health care for individuals supported.

Shared Living providers must have a clearly defined system to assess and monitor the health care needs of individuals, implement health care protocols, support medication administration, respond to routine and emergency health related issues, and maintain an adequate level of licensed personnel to do so. Shared Living providers must have systems to monitor caregivers’ knowledge and effective implementation of health care protocols, medication administration, and health care supports and equipment.

Behavioral Health and Clinical Services for Individuals Behavioral health and clinical services offered to individuals receiving Shared Living services must be conducted in accordance with the PBS framework as defined in 115 CMR 5.14, or other such regulations as may be amended or promulgated over the lifetime of this procurement. All Shared Living providers must have the following elements to support the implementation of PBS: a PBS Leadership Team; a PBS Action Plan; Targeted, Intensive or Universal Supports; as defined in 115 CMR 5.14(3) and 5.14(5); and a system of data-based decision making for both individual treatment decision and for system decisions. PBS qualified clinicians must meet the standards defined in 115 CMR 5.14(10) or other such regulations as may be amended or promulgated over the lifetime of this procurement.

Clinical experts such as Social Workers, Psychologists, Assistive Technology Professionals, Behaviorists, Counselors, and Speech and Language Pathologists should be engaged when needed to integrate the various clinical services into the individuals’ ISP. When individuals have co-morbidities, organizational support, training, and clinical expertise in such fields as substance abuse, trauma informed care, mental health, autism, deaf or hard of hearing, visually impaired and physical disabilities should be available to develop individualized multi-disciplinary treatment plans. The clinicians are responsible for, among other things:

· Care coordination and case management within their field of expertise

· Assessing the individuals’ needs and coordinating the relevant clinical appointments

· Assessing and coordinating the individual’s clinical needs and developing a plan to address

· Creating clinical plans for individuals that are the least restrictive/intrusive to effectively support the person in accordance with 115 CMR 5.14

· Assessing environment for adaptations, assistive technology needs, and equipment that could assist the individual to be more independent

· Training staff on the clinical needs of individuals

· Development of strategies to address clinical needs

· Monitoring implementation and effectiveness of strategies

· Facilitating the need for further clinical consultations and care

· Incidental provision of direct services for individuals (episodic care)

· Work in collaboration with the Area Office BCBA to support the clinical needs of individuals

2.5 Staff and Care Giver Qualifications and Training

Shared Living utilizes a team of support professionals that have a variety of skills and qualifications. Shared Living will typically include the following types of professionals:

· Program Director

· Case Worker

· Placement Specialist

· Nursing and Clinical professionals

Shared Living staff must meet the minimum experience and training requirements established in this procurement. Staff with titles that require professional licensure or certification must maintain active licensure/certification throughout their employment. Additionally, DDS expects Shared Living providers to engage in ongoing training and professional development activities for Shared Services staff.

Minimum Hiring Requirements The following requirements must be met for all staff who are employed to deliver services stated in this RFR. Certain positions have established additional minimum requirements.

· Be 18 years of age or older

· High school diploma, GED or equivalent, or relevant experience or competencies

· Criminal Offense Records Inquiry (CORI)

· Pursuant to M.G.L. c. 19B, §19, all individuals who qualify to provide these services who have the potential for unsupervised contact with persons with an intellectual or developmental disability are subject to fingerprint-based national background checks (NBC)

· Pursuant to M.G.L. c. 19C, §15, employers that provide services to individuals between the ages of 18 to 59 with ID or DD are required to consult the Disabled Persons Protection Commission (DPPC) Registry of Abuse Care Providers prior to hiring prospective employees

In addition to the above:

· Caregivers must be 21 years of age or older in accordance with 115 CMR 7.11(1)(c)

· Any household members, age 15 or older, or persons regularly on the premises of the home that are age 15 or older, shall be subject to a criminal offender record information check pursuant to Public Law 92–544.

Training Requirements All Shared Living staff (including supplemental) and caregivers must complete the following mandated trainings pursuant to 115 CMR 7.05(6) and DDS guidelines. Over the lifetime of this procurement regulations may be amended and training requirements may be modified by DDS.

· First Aid

· CPR

· Formal Fire Safety

· Basic Fire Safety

· Human Rights Officer/Advocate

· Incident Reporting

· PBS Universal Supports

· Universal Precautions

· Transmission Prevention for specific diseases (COVID 19)

· Human Rights

· DPPC/Mandated Reporter Training

Additional trainings and competencies training requirements:

· Safety Plan

· Healthy diets (Executive Order509 training)

· Unique needs of individuals (e.g., diabetes; ASL; communication)

· Restrictive interventions

· Restraint - implementers

· Signs and symptoms of illness

· Handling medical emergencies

· Health-related supports and protective equipment

· Medical Monitoring Devices

Respite Respite refers to supports and services that are provided for short term relief for Shaved Living caregivers, or short-term stabilization services for individuals due to behavioral or environmental circumstances.

Shared Living providers must have a robust plan on how they will provide short-term respite as well as emergency respite in the absence of caregivers. Shared Living providers and caregivers should develop respite and back-up plans for all individuals in Shared Living to prevent any unnecessary disruptions in care.

Shared Living providers are responsible for coordinating and funding respite for caregivers which can be in the form of hourly or overnight care and maybe provided in the home of the caregiver, or outside the home. Specific parameters will be issued outside of this BID through policy or updating of guidance documents.

2.6 Shared Living Caregivers and Provider Expectations

Determination of Support Time Needed Caregivers are responsible for providing an appropriate level of services and supports up to 24 hours per day during the hours the individual supported is not receiving day services or is not at school or work, based on the individual’s support needs. Individuals supported should receive the amount of support they need to meet their goals, build skills, and develop further independence while also, consistent with the CMS Home and Community Based Services Rule (“the Community Rule”), have freedom in choosing to spend time alone or engage in activities without the caregiver or staff present, unless there are identified and documented safety concerns within the ISP that cannot be mitigated to a tolerable level of risk. Shared Living providers are responsible for providing an appropriate level of supports, including supportive technology, in-person staff, and natural supports, as applicable, to ensure each individual’s health and safety, while maximizing personal choice and independence, and not restricting individual rights and freedoms, except as minimally necessary and in accordance with the Community Rule. In addition, caregivers are responsible for providing sufficient support for individuals to enable them to engage in the community in ways which are meaningful and in line with their preferences on a frequent and on-going basis.

Shared Living services are preferably provided for up to two (2) individuals in a home but no more than a maximum of three (3) individuals per 115 CMR 7.08(3). A third individual may be placed in a home only after clinical review and approval by DDS. Shared Living providers must work collaboratively with the DDS and other stakeholders in the home before a 3rd person enters a home for support. Shared Living providers must develop schedules that ensure qualifications of caregivers by meeting all training requirements to include quality, care, support, health, safety, and evacuation needs of the individuals supported by the Shared Living provider. At a minimum, the qualifications of the caregivers and Shared Living provider must be adequate:

a) to meet the objectives in the ISP of each individual while promoting independence and skill development.

b) to assist each individual to achieve the stated outcomes as set forth in their ISP.

c) to meet environmental, safety, administrative, and service delivery requirements as set forth in 115 CMR 7.07.

d) to develop and competently execute safety plans for all individuals at the location(s) where supports and services are provided as required in 115 CMR 7.06.

e) to develop a safety plan that is sufficient to enable all individuals living in a household to evacuate, with or without assistance within 2.5 minutes.

f) to include skills training to maximize an individual's independence and performance of household activities and routines, participation in community recreational, cultural and leisure activities, and opportunities to maintain or expand their relationships with family and friends.

g) to demonstrate successful performance on fire drills based on assessment and completion of drills as outlined in a safety plan.

Shared Living providers must ensure sufficient qualified and trained staff to provide all authorized services in accordance with the ISP. This includes both in-person staff as well as those staff available through remote technology.

Arrangements must be made for coverage of services and supervision of caregivers as required when employees take periods of extended leave, when staff resign or are terminated from employment, or when staff are sick or otherwise unable to work due to unexpected events or circumstances. Shared Living providers are also required to assess a caregiver’s employment, if any, outside per 115 CMR 7.11(1)(d).

Shared Living providers must have written plans for ensuring continuity of care is maintained in cases where the direct caregiver has a family emergency, becomes ill, or leave or are out of state for an extended period of time. These plans must meet any out of country policies issued by DDS as well as any policy or guidance documents that are issued regarding out of state care.

2.7 Technology Forward Initiative

DDS has developed a Technology Forward Initiative to promote the use of Supportive Technology: Assistive Technology and Remote Supports & Monitoring to increase the opportunities for individuals to achieve greater independence in their lives. Assistive Technology (AT) should be explained and offered to each person so they can understand the benefits of use and make an informed decision about whether or not they want to use AT. These services should be considered when exploring services with a person with disabilities before utilizing direct support professionals to assist a person in an area that they could potentially be self-sufficient with the use appropriate assistive technology.

2.8 Provision of Direct Supports Through Remote Technology

Traditionally, Shared Living services have been provided exclusively through the provision of direct, in-person caregiver supports within the home and in the community. As part of the Technology Forward Initiative, DDS seeks to leverage remote technologies for use within Shared Living services to allow a portion of direct support hours to be provided remotely, in such cases where it has been determined that individuals can be safely supported in this manner. In 2022, the Department adopted the policy Use of Technology in DDS Services which provides the framework for providing services remotely using technology.

For individuals that demonstrate that they can effectively be supported via remote technology, such use creates an opportunity for them to increase their independence and community inclusion opportunities. With the use of remote technology, individuals can experience enhanced independence in the community which increases individual choice while minimizing risk.

Individuals who are interested in having a portion of services provided via remote technology will receive a comprehensive assistive technology and risk assessment to determine their ability to be effectively supported by staff remotely. Assessments will identify whether individuals are able to remain on their own safely and knowledgeably at home or in the community with supports delivered via remote technology. Individuals assessed as being able to be on their own at home must be capable of evacuating from the home within 2½ minutes without in-person assistance and must be able to contact staff through remote technology.

Requirements for Supports Provided Via Technology Remote technology utilized in Shared Living must conform to the requirements listed below. Additionally, when supports via remote technology are integrated in a residential home the DDS Office of Quality Enhancement (OQE) must be notified to conduct an initial review of the remote monitoring center and staffing. Subsequent to the initial implementation of this strategy, licensure of Shared Living residential service homes will be updated to include additional residential licensing standards when utilizing this service modality.

Shared Living services utilizing remote technology must provide:

· Two-way, real-time, on-demand or individual-initiated communication system for contact between the individual and remote staff. Systems must have communication capabilities necessary for the monitoring center/remote support staff to effectively interact with and address the needs of individuals at each of their locations, including emergency situations when the individual may not be able to use the telephone/communication device.

· Remote staff whose sole responsibility is to provide direct support during such times identified for remote support provision.

· Detailed and written backup procedures to address/manage system failure (e.g., prolonged power outage), fire or weather emergency, individual medical issue, or personal emergency, etc. for each location utilizing the system and included in each individual’s remote support plan.

· Emergency back-up system for the remote support center and Shared Living locations utilizing the system.

· Remote support software with dashboard that has alert system to notify staff of individuals’ status and/or ability for individuals to activate and interact…