Technical Quotation Information Packet.docx
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- 15BCTS22Q00000027
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FEDERAL BUREAU OF PRISONS
COMMUNITY TREATMENT SERVICES
TECHNICAL QUOTATION INFORMATION
| Name of Company: | Click or tap here to enter text. |
| Authorized Negotiator: | Click or tap here to enter text. |
| Solicitation Number: | Click or tap here to enter text. |
Directions: Provide a detailed and concise written response to all of the areas below and submit all supplementary documentation as a completed technical quotation packet. Please limit your responses to what is requested in this document.
1. Telehealth Requirement – TeleMAT: The Quoter must use telehealth services to provide TeleMAT.
a. Provide evidence of ability to deliver MAT services by telehealth only. The response shall not exceed five pages in total.
RESPONSE: Attach evidence of ability to provide TeleMAT. ☐
2. Telehealth Requirement - Accessibility: The Quoter must provide information to offenders on how to access any digital platform that may be used in the delivery of telehealth services for MAT
a. Submit a plan for informing offenders on the use of any digital platform to access MAT services, including downloading the application, navigating in the virtual platform, or using their device (smartphone, laptop, or tablet) to participate in MAT sessions.
RESPONSE: Attach plan for informing offenders on use of digital platform. ☐
3. Staffing Requirement: The Quoter must have key personnel to meet the solicitation requirements. The Quoter must ensure all personnel providing MAT services to offenders meet the experiential, educational, and appropriate licensure/certification as required by the state authority where the services will be rendered.
a. Submit the Technical Personnel document that identifies the position and responsibility of all personnel proposed to meet or exceed the minimum staffing requirements of key personnel identified in the Decisional Rule Criteria (2.1 of SF 1449). All key personnel and administrative positions must be identified on this document.
RESPONSE: Attach Technical Personnel document. ☐
b. Submit copies of current and valid professional licenses for key personnel who will provide MAT services to offenders.
· Staff licenses for medical staff (e.g., medical doctor, physician assistant, nurse practitioner) must meet the standards of practice established by the applicable state’s professional regulatory board in the state where services will be rendered.
· If unable to produce an original license, provide a license verification sheet with a copy of a government-issued photo identification card for the staff member.
RESPONSE: Attach professional licenses for all clinical staff listed as key personnel on 3a. ☐
c. Submit resumes for key personnel who will provide MAT services to offenders.
RESPONSE: Attach resumes for all clinical staff listed as key personnel on 3a. ☐
d. Submit a Drug Enforcement Agency Controlled Substance Registration Certificate for qualified practitioner(s) with prescriptive authority who meet the standards of practice established by the state’s professional regulatory board to provide MAT evaluations and follow-up services.
RESPONSE: Attach DEA certificates for qualified practitioners listed on 3a. ☐
e. Submit DATA 2000 waiver identification number (X-number) for certified practitioner(s) to prescribe and administer buprenorphine.
RESPONSE: List DATA 2000 waiver identification number for qualified practitioners listed on 3a on Technical Personnel document. ☐
4. Operational Requirement – Urine Drug Testing (UDT): The Quoter must conduct urine drug testing to offenders receiving MAT services.
a. Submit procedures for utilizing Urine Drug Testing (UDT) to monitor offenders for adherence to MAT medication.
RESPONSE: Attach UDT procedures to monitor offenders receiving MAT. ☐
5. Operational Requirement - Diversion: The Quoter must implement procedures for the prevention of diversion.
a. Submit a plan for preventing diversion when providing MAT services to offenders.
RESPONSE: Attach plan to prevent diversion when providing MAT to offenders.☐ Technical Personnel List 3a
Name of Company:
Solicitation Number:
| Last Name, First Name |
| Required Key Personnel |
| Professional License and No. or Admin Position Title |
| License Expiration Date |
| DATA 2000 waiver id no. (X-number) |
| Employee or Subcontractor |
| EVALUATION USE ONLY |
| AN |
| AD |
| Med. Staff |
| 1 | |||||||
| Click here to enter text. | ☐ | ☐ | ☐ | **** | Click to enter date. | **** | Choose an item. |
| ☐ Cert |
| 2 | |||||||
| Click here to enter text. | ☐ | ☐ | ☐ | **** | Click to enter date. | **** | Choose an item. |
| ☐ Cert |
| 3 | |||||||
| Click here to enter text. | ☐ | ☐ | ☐ | **** | Click to enter date. | **** | Choose an item. |
| ☐ Cert |
| 4 | |||||||
| Click here to enter text. | ☐ | ☐ | ☐ | **** | Click to enter date. | **** | Choose an item. |
| ☐ Cert |
| 5 | |||||||
| Click here to enter text. | ☐ | ☐ | ☐ | **** | Click to enter date. | **** | Choose an item. |
| ☐ Cert |
| 6 | |||||||
| Click here to enter text. | ☐ | ☐ | ☐ | **** | Click to enter date. | **** | Choose an item. |
| ☐ Cert |
| 7 | |||||||
| Click here to enter text. | ☐ | ☐ | ☐ | **** | Click to enter date. | **** | Choose an item. |
| ☐ Cert |
| 8 | |||||||
| Click here to enter text. | ☐ | ☐ | ☐ | **** | Click to enter date. | **** | Choose an item. |
| ☐ Cert |
| 9 | |||||||
| Click here to enter text. | ☐ | ☐ | ☐ | **** | Click to enter date. | **** | Choose an item. |
| ☐ Cert |
| 10 | |||||||
| Click here to enter text. | ☐ | ☐ | ☐ | **** | Click to enter date. | **** | Choose an item. |
| ☐ Cert |
| 11 | |||||||
| Click here to enter text. | ☐ | ☐ | ☐ | **** | Click to enter date. | **** | Choose an item. |
| ☐ Cert |
| 12 | |||||||
| Click here to enter text. | ☐ | ☐ | ☐ | **** | Click to enter date. | **** | Choose an item. |
| ☐ Cert |
| 13 | |||||||
| Click here to enter text. | ☐ | ☐ | ☐ | **** | Click to enter date. | **** | Choose an item. |
| ☐ Cert |
| 14 | |||||||
| Click here to enter text. | ☐ | ☐ | ☐ | **** | Click to enter date. | **** | Choose an item. |
| ☐ Cert |
| 15 | |||||||
| Click here to enter text. | ☐ | ☐ | ☐ | **** | Click to enter date. | **** | Choose an item. |
| ☐ Cert |
Key Personnel: AN (authorized negotiator), AD (administrative staff), Med. Staff (medical staff)
File details come from the government source that posted it. Updated .