REQUEST FOR PROPOSAL

#2017-101

Innovations Waiver Supported Living

May 5, 2017

NOTE: Alliance reserves the right to modify this RFP to correct any errors or to clarify requirements. Any changes will be posted on our website http://www.alliancebhc.org/

Copies of all postings will be emailed directly to anyone who registers with Alliance. To register, please send an email to AllianceRFP@alliancebhc.org with your name and contact information.

Purpose: Alliance Behavioral Healthcare (Alliance) is a Local Management Entity/Managed Care Organization (LME/MCO) responsible for the delivery of publicly-funded mental health, intellectual/development disabilities and substance abuse services for people living in Durham, Wake, Johnston and Cumberland counties, the ‘Catchment Area’.

Alliance has identified the following Network needs in all counties and seeks the following services from Alliance’s Network of Providers:

Innovations Waiver-Supported Living

Minimum Qualifications: Only organizations that meet the following minimum qualifications will be considered for this RFP:

Network Providers with a current Medicaid contract for Innovations Waiver service(s). Preference given to agencies with experience providing Supported Living.

Good Standing: All applicants for participation in the Alliance Closed Network must be in good standing with all applicable oversight agencies. This means that the provider or applicant has submitted all required documents, payments and fees to the U.S. Internal Revenue Service, the NC Department of Revenue, NC Secretary of State (if organized as a corporation, partnership or limited liability company), the NC Department of Labor, and the NC Department of Health and Human Services, and has not had any sanction issued by those entities, including but not limited to the following:

• LME-MCO: Contract Termination or Suspension, Referral Freeze, Unresolved Plan of Correction, Outstanding Overpayment, Prepayment Review, Payment Suspension.

• DMA: Contract Termination or Suspension, Payment Suspension, Prepayment review, Outstanding Final Overpayment.

• DMH/DD/SAS: Revocation, Unresolved Plan of Correction. • DHSR: Unresolved Type A or B penalty under Article 3, Active Suspension of

Admissions, Active Summary Suspension, Active Notice of Revocation or Revocation in Effect.

• U.S. Internal Revenue Service/NC Department of Revenue: Unresolved tax or payroll liabilities.

• NC Department of Labor: Unresolved payroll liabilities. • NC Secretary of State: Administrative Dissolution, Revocation of Authority, Notice of

Grounds for other reason, Revenue Suspension. Providers organized as a corporate entity must have a “Current – Active” registration with the NC Secretary of State.

• Boards of Licensure or Certification for the applicable Scope of Practice. • Provider’s Selected Accrediting Body.

Providers and applicants are required to disclose any pending or final sanctions under the Medicare or Medicaid programs including paybacks, lawsuits, insurance claims or payouts, and disciplinary actions of the applicable licensure boards or adverse actions by regulatory agencies within the past five years or now pending. The provider’s or applicant’s owner(s) and managing employee(s) may not previously have been the owners or managing employees of a provider which had its participation in any State’s Medicaid program or the Medicare program

involuntarily terminated for any reason or owes an outstanding overpayment to an LME/MCO or an outstanding final overpayment to DHHS.

Alliance considers an action of DHHS, including its divisions and LME/MCOs to be final upon notification to the provider, unless such action is under appeal. For actions by DHHS or LME/MCO under appeal, Alliance may, in its discretion, pend its award or enrollment for up to 90 days to allow for a final resolution or final decision by the NC OAH. If no final decision is rendered in that time period then the provider or applicant is deemed not in Good Standing.

Timeline: Event Date/Time Public Notice of RFP May 5, 2017 Pre Bid Conference May 15, 2017 Room 104-105 RFP Questions submitted May 18, 2017 to RFP@Alliancebhc.org RFP Questions due back to providers

May 23, 2017

Intent to Submit Proposal Letter

May 25,2017 to RFP@Alliancebhc.org.

PROPOSALS DUE BY 5:00 PM

June 2, 2017

Availability of Funds: The funding for the services solicited hereunder is available on a UCR basis for consumers participating on the Innovations Waiver and meeting medical necessity for the service.

The service codes and rates are:

T2033 Supported Living – Level 1 152.47 per day T2033 HI Supported Living – Level 2 184.09 per day T2033 TF Supported Living – Level 3 215.17 per day

There are no start-up funds available.

Scope of Proposal

Supported Living is a new service in the Innovations Waiver amended effective 11/1/16.

Supported Living provides a flexible partnership that enables a person to live in their own home with support from an agency that provides individualized assistance in a home that is under the control and responsibility of the person. The service includes direct assistance as needed with activities of daily living, household chores essential to the health and safety of the individual, budget management, attending appointments, and interpersonal and social skills building to

enable the individual to live in a home in the community. Training activities, supervision, and assistance may be provided to allow the person to participate in home life or community activities. Other activities include assistance with monitoring health status and physical condition, and assistance with transferring, ambulation and use of special mobility devices. Transportation is an inclusive component of Supported Living to achieve goals and objectives related to these activities with the exception of transportation to and from medical services covered through the Medicaid State Plan.

This service is distinct from Residential Supports in that it provides for a variety of living arrangements for individuals who choose to live in their own home versus the home of a provider. A person’s own home is defined as the place the person lives and in which the person has all of the ownership or tenancy rights afforded under the law. This home must have a separate address from any other residence located on the same property. Persons living in Supported Living arrangements choose who lives with them, are involved in the selection of direct care staff, and participate in the development of roles and responsibilities of staff. Persons receiving Supported Living have the right to manage personal funds as specified in the Individual Support Plan. A formal roommate agreement, separate from the landlord lease agreement, is established and signed by individuals whose names are on the lease.

The provider of Supported Living services must not:

a. Own the persons’ home or have any authority to require the persons to move if the person’s changes service providers.

b. Own, be owned by, or be affiliated with any entity that leases or rents a place of residence to a person if such entity requires, as a condition of renting or leasing, the person to move if the Supported Living provider changes.

The Supported Living provider is responsible for providing an individualized level of supports determined during the assessment process, including risk assessment, and identified and approved in the Individual Support Plan (ISP) and have 24-hour per day availability, including back-up and relief staff and in the case of emergency or crisis. Some persons receiving Supported Living services may be able to have unsupervised periods of time based on the assessment process. In these situations a specific plan for addressing health and safety needs must be included in the ISP and the Supported Living provider must have staffing available in the case of emergency or crisis. Requirements for the person’s safety in the absence of a staff person must be addressed and may include use of telecare options. When assessed to be appropriate, via the Supports Intensity Scale. Assistive Technology elements may be utilized in lieu of direct care staff.

To ensure the intent of the definition to support persons to live in a home of their own and achieve independence, Supported Living must not be provided in a home where a person lives with family members unless such family members are persons receiving Supported Living, a spouse, or a minor child. Family member is defined as a parent, grandparent, sibling, grandchild, and other extended family member. In addition, it also includes step-parent, non-minor step-child and step-sibling and non-minor adoptive relationship. All persons receiving Supported Living services who live in the same household must be on the lease except the person who is a live-in caregiver, if a caregiver lives in the household.

Reimbursement for Supported Living will not include payment for services provided by the spouse of a person or to family members as defined in this service definition or legal guardian. The Supported Living provider and provider staff must not be a member of the person’s immediate family as defined in this service definition and reimbursement will not include payment for Supported Living provided by such persons.

A Supported Living home must have no more than three (3) adult residents including any live-in caregiver providing supports per SL2011-202/HB509. A live-in caregiver is defined as an individual unrelated to the person and who provides services in the person’s home through the Supported Living provider agency and is not on the lease.

The provider must develop an individualized staffing plan and schedule. The staffing plan is based on the person’s preference and on the assessment and ISP process, including risk assessment. The plan must ensure staffing is adequate to protect the health and safety of the person and to carry out all activities required to meet the outcomes and goals identified in the ISP. The plan must address staff coverage for back-up and relief staff.

Reimbursement for Supported Living will not be made for room and board with the exception of a reasonable portion that is attributed to a live-in caregiver who is unrelated to the person and who provides services in the person’s home. Reimbursement does not include the cost of maintenance of the dwelling. Residential expenses, e.g. phone, cable, food, rent, must be apportioned between the residents of the home, and when applicable, the live-in caregiver. Rates for Supported Living include payments of relief and back-up staff.

Homes leased under Section 8 Housing are licensed and inspected by the local housing agency and must meet the housing quality standards per 24CFR 882-109.

Staffing Plan for Supported Living Services

The provider must develop an individualized staffing plan and schedule. The staffing plan is based on the person’s preference and on the assessment and ISP process, including risk assessment. The plan must ensure staffing is adequate to protect the health and safety of the person and to carry out all activities required to meet the outcomes and goals identified in the ISP. The plan must address staff coverage for back-up and relief staff.

Supported Living levels are determined by clinical and supports assessments which include, but are not limited to: the Supports Intensity Scale, “clinical description,” and person centered planning.

Level One: Level A and B

Level one is intended to serve persons who require minimal support to perform the activities of daily living and to remain safe and healthy. Staffing is based on the preferences and the assessed needs of the person but does not require staff to be in the home or awake at night.

Level Two: Levels C and D

Level two is intended to serve persons that requires moderate support to perform the activities of daily living and to remain safe and healthy. Staffing is based on the preferences and the assessed needs of the person. The live-in caregiver or staff must be onsite, but not necessarily awake, at night. Alternatively, appropriate technology may be used to ensure supervision.

Level Three: Levels E, F, and G

Level three (3) is intended to serve persons who require consistent onsite access to staff for assistance with most or all activities of daily living. Examples include basic self-care tasks such as eating, dressing, bathing and toileting; as well as more complex activities of daily living. The person requires continuous supervision including awake overnight staff in order to remain safe and healthy. Level Three supports include arrangements in which a person is living in his/her own home with overnight and awake staff as identified in the ISP.

Special Needs Adjustment

A special adjustment is available for Levels 1-3. The adjustment does not change the Level designated for the person, but adjusts the Level to meet one or more of the following circumstances:

a. The individual is in circumstances that are time limited but that require support at a higher level than described by the Level and the current rate does not cover the cost. This can be accomplished by approval of an enhanced rate request. For example, the person has a serious injury or illness or behavioral or mental health crisis requiring additional support on a temporary basis. A special adjustment may be approved for up to 90 days and may be extended for an additional 90 days.

b. The person needs a roommate and requires a special adjustment until one moves in. A special adjustment may be approved for up to 90 days and may be extended for an additional 90 days.

c. The person is transitioning from a higher level of care, i.e. inpatient hospital, ICF/IID, and a rate adjustment is needed to ensure success during the transition process.

d. Persons who require a continued Special Needs Adjustment due to medical or behavioral health issues may be reassessed for appropriateness of Level.

Supported Living is not available at the same time of day as Community Networking, Day Supports, Supported Employment or one of the State Plan Medicaid services that works directly with the person.

Exclusions

a. Supported Living cannot be provided in inpatient hospitals, nursing facilities, and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIFD) or residential group homes licensed under 10A NCAC 27G .5600

b. Supported Living will not be reimbursed for persons under age 18 since the home must be under the control and responsibility of the residents.

c. Persons receiving Supported Living must not receive: Community Living and Supports, Respite, or State Plan Personal Care Services.

d. Persons receiving Supported Living may only receive Home Modifications if the home is owned by the person. If the home is rented only Home Modifications that are portable and can be removed once the persons no longer leases the residence may be used. All requirements under the Fair Housing Act at 42 U.S.C. §§ 3601 – 3619 must be met by the landlord.

e. Supported Living is not available at the same time of day as Community Networking, Day Supports, Supported Employment or one of the State Plan Medicaid services that works directly with the person.

f. Relatives who own provider agencies must not provide Supportive Living services to family members. Other staff employed by the provider agency may provide services to the individual

Special Conditions:

• Alliance anticipates the need for a maximum of four providers to cover the Alliance Behavioral Healthcare catchment. Preference may be given to providers with capacity to serve multiple counties throughout the Alliance catchment area.

• Providers must adhere to Clinical Coverage Policy 8P found at: https://ncdma.s3.amazonaws.com/s3fs-public/documents/files/8p.pdf

Submission Instructions:

• Indicate the Applicant name and RFP number on the front of your proposal envelope or package.

• Include the RFP # on the bottom of each page of your proposal. • Proposals must be submitted according to the Eligible Applicant Proposal Format,

described below. • Proposals must address the questions and items set out on the following pages and must

be typewritten and signed in ink by the official authorized to bind the applicant to the provisions contained within the proposal.

• Trade secrets or similar proprietary data which the Applicant or organization does not wish disclosed to other than personnel involved in the evaluation will be kept confidential to the extent permitted by state law and rule if identified as follows: Each page identified in boldface at the top and bottom as "CONFIDENTIAL." Any section of the proposal that is to remain confidential must also be so marked in boldface on the title page of that section.

• One original, signed copy of the proposal plus one electronic version on a CD. The CD shall include Adobe pdf format versions of all documents, readable by MS Office computers and file names and content must comply with the directions listed below:

o Content of each scanned document should correspond to the sections noted below For example, the CD should include separate documents for each numbered section noted below, and separate scans for each reference and attachment.

o Files should be labeled using the format YOURAGENCYNAME_SECTION LETTER. For example, the scanned document for the Financial section (budget) would be “YourAgencyName_D.”

They must be delivered in a sealed envelope no later than the date and time specified herein.

• Alliance will not be held responsible for the failure of any mail or delivery service to deliver a proposal response prior to the stated proposal due date and time.

• No fax or emailed responses will be accepted or considered. All proposals must be received by Alliance on or before 5:00 p.m. on June 1, 2017. Late proposals will not be accepted.

Hand-delivered proposals will be time-stamped and the Applicant will receive a receipt upon delivery. All proposals submitted by the deadline become the property of Alliance Behavioral Healthcare.

Proposals shall be mailed or hand delivered to:

Alliance Behavioral Healthcare ATTN: Healthcare Network Project Manager

RE: RFP # 2017-101 4600 Emperor Blvd, Suite 200

Durham, NC 27703

PROPOSALS WILL NOT BE ACCEPTED AFTER THE DUE DATE/TIME AND WILL BE RETURNED TO THE PROVIDER.

Questions concerning the specifications in this RFP will be received until 5:00 pm. Please submit all questions in writing by e-mail to AllianceRFP@alliancebhc.org. A summary of all questions and answers will be posted May 22, 2017 on the Alliance Behavioral Healthcare website at: Alliancebhc.org.

Alliance reserves the right to:

• Reject any and all offers and discontinue this RFP process at the sole discretion of Alliance without obligation or liability.

• Award more than one contract.

Eligible Applicants Proposal Format Proposals shall conform substantially to the following format using tabs to designate sections: Section A. Introduction (3 page max)

1. Describe why you believe that your organization, from a business, professional, clinical, administrative, financial and technical perspective, should be awarded a contract for the services requested. Describe any distinguishing features Alliance should know about your services and company as well as an overview of your proposal.

2. Describe generally what you are proposing to do under the scope of services. 3. Provide the following:

(i) Legal Name of Organization (ii) Federal Tax ID# (iii) Corporate Address (iv) Organizational contact person, telephone number and email address (vii) Printed name and signature of Official authorized to bind the applicant to proposal (viii) Accrediting organization, date accredited, number of years accredited (ix) Facility National Provider Identifier # (if applicable) (x) If your organization is using an outside consultant to assist with the RFP, please provide the name of the consultant.

Section B. Minimum Network Enrollment Requirements for Agency-Based Providers (7 pages max)

1. Disclose any sanctions, past or pending, under the Medicare or Medicaid programs including paybacks, lawsuits, insurance claims or payouts, and disciplinary actions of the applicable licensure boards or adverse actions by regulatory agencies within the past five years.

2. Disclose if your agency has any proposed/pending merger with, or acquisition of another entity. Please note that an award of a contract to the organization making the proposal will not be assigned automatically to a new agency resulting from a merger or acquisition.

3. Disclose if the organization is affiliated by contract or otherwise, with any other provider (defined as any individual or entity providing behavioral health services).

Section C. Organizational Background and Expertise (10 pages max) Providers shall demonstrate experience and competency in the requested service(s). Stability of past operations is important. This section is intended to assess the organization’s past record of services, compliance with applicable laws, standards and regulations, the qualifications and competency of its staff, the satisfaction of consumers and family members served, systems of oversight, adequacy of staffing infrastructure, use of best practices, and quality management systems as they relate to this RFP. For this RFP describe your organization’s background and expertise in the following:

1. Provide a brief history of your organization, indicating specialties and how long your organization has been in business.

2. Describe your service philosophy and models (evidence based models if applicable) utilized in supporting individuals with high support needs to live in their own homes and have typical life experiences.

3. Describe your organization’s philosophy on the concept of self-direction. You may include any relevant Policies related to this.

4. Describe how your organization will implement the above philosophies (listed in questions 2 and 3) to individuals at all support levels, including those who may require 24-hour assistance.

5. Describe the clinical infrastructure to address challenges in meeting specific client needs. Please also describe your staff training and clinical supervision plan.

6. Please describe any additional training or development opportunities you plan to provide to your staff specific to this service definition.

7. Describe how you will address the individual staffing plan requirement, including the components each plan will include. Please include an example of a staffing plan.

8. Describe how you will address the roommate agreement component of this service, including your philosophy of how this agreement will be developed amongst roommates receiving Waiver services, as well as any live-in caregivers. This may include submitting any relevant Policies related to this. Please include an example of a roommate agreement.

9. Describe your organization’s plans for including Resource Allocation into the Individual Support Plan (ISP) process, including Supported Living Levels identified as part of Innovations Clinical Coverage Policy.

10. Include your program description and any policies and procedures covering the service not already provided as a response to any of the above questions. This may be several policies to demonstrate how these person-centered practices are embedded in various policies—financial management, staffing, recruiting, etc.

Section D. Management / Administrative Capability (5 pages max)

Financial Sustainability 1. Describe in detail your organization’s strategy to financially sustain the program.

Disclose any past, pending or proposed bankruptcy proceedings filed by the organization or any of its affiliates or subsidiaries.

2. Describe what accounting systems your agency has in place to ensure fiscal responsibility and integrity.

3. Identify whether the organization has any outstanding debt or overpayment in relation to any State or Federally-funded healthcare program (including but not limited to DMA and other LME-MCOs).

Quality Improvement

4. The successful applicant will be required to develop a quality improvement plan (if the organization doesn’t already have one) that includes expected outcomes, performance indicators (or related goals), and how individual and program progress will be measured in accordance with the applicable service definition.

5. Describe your plan to ensure consumer choice is recognized and how requests presented by consumers are reviewed and processed.

6. For this RFP, describe how your organization will utilize the data generated by the performance indicators, outcomes, survey results, stakeholder feedback to improve the quality of care.

7. Provide information about your strategies for recruitment, retention and support of qualified staffing.

8. Describe how you evaluate consumer outcomes and how you determine whether your consumers are benefitting from your services. Attach a sample of consumer outcome data for the for the most recent two years of an Innovations service including but not limited to the outcomes achieved through use of the identified evidence-based practice model(s). Compliance

9. Demonstrate the organization’s compliance with Program Integrity requirements outlined in the State and Federal law, which includes but is not limited to the False Claims Act and Patient Affordable Care Act.

10. Identify whether the organization has ever reported any Health Insurance Portability and Accountability Act (HIPAA) violations to the U.S. Office of Civil Rights and describe your organization’s procedures for ensuring the privacy and security of protected health information. Disclose if any of the violations resulted in investigations, sanctions or penalties by the OCR?

11. Provide information about your organization’s procedures for promoting and ensuring

consumer rights, including but not limited to how you ensure privacy and security of protected health information and storage and maintenance of medical records. If an EMR/EHR is used, include the name of the system and if the system has a HIPAA compliant audit feature.

Section E. Other Attachments Provide communication from consumers supporting your organization applying to do this service with Alliance.

Proposal Evaluation: Award of a contract resulting from this RFP will be based upon the application(s) best aligned with the service objectives, and other factors as specified herein. Providers shall demonstrate experience and competency in the requested service area(s). Stability of past operations is important. RFP Proposals will be evaluated using a standardized evaluation sheet for the elements from the RFP outline. Applications will be pre-screened by Provider Network Management to ensure the organization (i) meets the minimum qualifications (ii) has completed all material sections of the RFP, and (iii) is responsive to the questions. Any applicants that are rejected for failing to meet the pre-screen criteria shall be notified in writing along with the reasons why the application was rejected. Once an application passes the pre-screen process, it will be reviewed by a Selection Committee designated by Alliance which may include Alliance staff, Area Board members, and other stakeholders deemed needed. Reviewers will utilize the Evaluation Tool attached and scores will be calculated from all the reviewers. An interview process may be utilized to gain additional information and pose questions of providers. The evaluation will include the extent to which the Applicant’s proposal meets the stated requirements as set out in this RFP as well as the Applicants’ stability, experience, and record of past performance in delivering such services. All applicants will receive written notification of the results of the evaluation of their application.

Contract Award: The successful applicant(s) chosen by Alliance will be required to execute a contract or contract amendment outlining the requirements of this RFP. Providers shall have a “no-reject policy” for referrals within the capacity and the parameters of their competencies. Providers shall agree to accept all referrals meeting criteria for services they provide when there is available capacity; a Provider’s competency to meet individual referral needs will be negotiated between Alliance and the Provider. The initial term of any contract awarded hereunder will be through June 30, 2017.

Cancellation of Contract: Alliance reserves the right to cancel and terminate any resulting contract(s), in part or in whole, without penalty, upon thirty (30) days written notice to the Provider. Any contract cancellation shall not relieve the Provider of the obligation to deliver and/or perform outstanding prior to the effective date of cancellation and transition consumers and consumer’s records. Other General Information: The following outlines additional information related to the submission of proposals:

• Alliance reserves the right to reject any and all proposals for any reason, including but not limited to false information contained in the proposal and discovered by Alliance.

• Any cost incurred by an organization in preparing or submitting a proposal is the bidder’s sole responsibility. Alliance will not reimburse any bidder for any pre-award costs incurred. All materials submitted to Alliance on or before the due date will become the property of Alliance and will not be returned.

• All proposals are subject to the terms and conditions outlined herein. All responses will be controlled by such terms and conditions. The attachment of other terms and condition by any organization may be grounds for rejection of that organization's proposal.

• In submitting its proposal, organizations agree not to use the results therefrom as part of any news release or commercial advertising without prior written approval of Alliance.

• All responses, inquiries, or correspondence relating to or in reference to the RFP, and all other reports, charts, displays, schedules, exhibits, and other documentation submitted by the organization or organization will become the property of Alliance when received.

• The signer of any proposal submitted in response to this RFP certifies that this proposal has not been arrived at collusively or otherwise in violation of either Federal or North Carolina antitrust laws.

Authorization to Submit Proposal To the best of my knowledge, my organization is able to meet all requirements necessary to apply for the services solicited in RFP # 2017-101. I am submitting the attached proposal, which, to my knowledge is a true and complete representation of the requested materials.

________________________________________________ Authorized Signature

________________________________________________

Printed Name

________________________________________________ Title

________________________________________________

Date

Evaluation Form Alliance Behavioral Healthcare

RFP # 2017-101 Evaluator: _______________________ Agency:_______________________

SECTION A: INTRODUCTION (max. POINTS)

Evaluate the response to Section A.1. why your organization from a business, clinical admin, financial and tech perspective should get the service. (Refer to Section A.1 of the RFP

Value Explanation Comments 0 Not addressed or response of

no value

1 Limited applicability 3 Some applicability 5 Substantial or total applicability

Evaluate the response to Section A.2. Describe generally what you are going to do under scope of services(Refer to Section A.2 of the RFP submission) Value Explanation Comments 0 Not addressed or response of

no value

1 Limited applicability 3 Some applicability 5

Substantial or total applicability

Did the proposal include the requirements in question 3? Value Explanation Comments V l 0 1 Limited applicability 3 Some applicability

5 Substantial or total applicability

Some applicability SECTION B: Minimum Network Enrollment Requirements for Agency-Based Providers (max. POINTS)

Evaluate Answer to B1, sanctions, paybacks la

Value Explanation Comments 0 Not addressed or response of

no value 1 Limited applicability 3 Some applicability 5 Substantial or total applicability

Proposed/Pending mergers/acquisitions. Section B. 2 (Refer to Section B.3 of the RFP submission) Value Explanation Comments 0 Not addressed or response of

no value 1 Limited applicability 3 Some applicability 5 Substantial or total applicability

Contract affiliations or other providers(Refer to Section B.3 of the RFP submission) Value Explanation Comments 0 Not addressed or response

of no value

1 Limited applicability 3 Some applicability 5 Substantial or total

applicability SECTION C: MANAGEMENT AND ADMINISTRATIVE CAPABILITY

(max. 30 POINTS) Evaluate the organization’s history and specialities (Refer to Section C.1 of the RFP submission)

Value Explanation Comments 0 Not addressed or response

of no value

1 Limited applicability 3 Some applicability 5 Substantial or total

applicability Current service philosophy and models (Refer to Section C.2 of the RFP submission)

Value Explanation Comments 0 Not addressed or response of no

value

1 Limited applicability 3 Some applicability 5 Substantial or total applicability

Evaluate the philosophy on self-direction.(Refer to Section C.3 of the RFP submission) Value Explanation Comments 0 Not addressed or response of

no value

1 Limited applicability 3 Some applicability 5 Substantial or total applicability Evaluate how the organization implements the listed philosophies. (Refer to Section C.4 of the RFP submission)

Value Explanation Comments 0 Not addressed or response of no

value

1 Limited applicability 3 Some applicability 5 Substantial or total applicability

Evaluate how the clinical infrastructure described (Refer to Section C.5 of the RFP submission)

Value Explanation Comments 0 Not addressed or response of

no value

1 Limited applicability 3 Some applicability 5 Substantial or total applicability Evaluate specific training for this service (Refer to Section C.6 of the RFP Submission)

Value Explanation Comments 0 Not addressed or response of

no value

1 Limited applicability 3 Some applicability 5 Substantial or total applicability

Evaluate the staffing description and plan (Refer to Section C.7 of the RFP submission) Value Explanation Comments 0 Not addressed or response of

no value

1 Limited applicability 3 Some applicability 5 Substantial or total applicability Evaluate how they address the roommate agreement component (Refer to Section C.8 of the RFP submission)

Value Explanation 0 Not addressed or response of no

value 1 Limited applicability 3 Some applicability 5 Substantial or total applicability

Evaluate the plan for inclusion of Resource Allocation into the IPS process (Refer to Section C.9 of the RFP submission)

Value Explanation 0 Not addressed or response of

no value 1 Limited applicability 3 Some applicability 5 Substantial or total applicability Evaluate program descriptions and policies and procedures (Refer to Section C.10 of the RFP Submission) Value Explanation Comments 0 Not addressed or response of

no value

1 Limited applicability 3 Some applicability 5 Substantial or total applicability

SECTION D. MANAGEMENT/ADMINISTRATIVE CAPABILITY

(max. 45 POINTS)

Evaluate the organization’s strategy to financially sustain the program long term (Refer to Section D.1 in RFP submission) Value Explanation 0 Not addressed or response

of no value 1 Limited applicability 3 Some applicability 5 Substantial or total

applicability Evaluate the organization’s accounting systems to ensure fiscal responsibility and integrity. (Refer to Section D.2 of the RFP submission) Value Explanation 0 Not addressed or response

of no value 1 Limited applicability 3 Some applicability 5 Substantial or total

applicability

Evaluate whether the organization has any outstanding debt or overpayment in relation to any State or Federally-funded healthcare program (including but not limited to DMA and other LME-MCOs). (Refer to Section D. 3 of the RFP submission) Value Explanation 0 Not addressed or response

of no value 1 Limited applicability 3 Some applicability 5 Substantial or total

applicability Evaluate expected outcomes, indicators, goals of the service. (Refer to Section D. 4 of the RFP submission) Value Explanation 0 Not addressed or response

of no value 1 Limited applicability 3 Some applicability 5 Substantial or total

applicability Evaluate how the organization will utilize the data generated by the performance indicators, outcomes, survey results, stakeholder feedback to improve the quality of care for this service. (Refer to Section D.5 of the RFP submission) Value Explanation

SECTION D. MANAGEMENT/ADMINISTRATIVE CAPABILITY

(max. 45 POINTS) Evaluate the organization’s strategy to financially sustain the program long term (Refer to Section D.1 in RFP submission) Value Explanation Comments 0 Not addressed or response

of no value

1 Limited applicability 3 Some applicability 5 Substantial or total

applicability Evaluate the organization’s accounting systems to ensure fiscal responsibility and integrity. (Refer to Section D.2 of the RFP submission) Value Explanation Comments 0 Not addressed or response

of no value

1 Limited applicability 3 Some applicability 5 Substantial or total

applicability

Evaluate whether the organization has any outstanding debt or overpayment in relation to any State or Federally-funded healthcare program (including but not limited to DMA and other LME-MCOs). (Refer to Section D. 3 of the RFP submission) Value Explanation Comments 0 Not addressed or response

of no value

1 Limited applicability 3 Some applicability 5 Substantial or total

applicability Evaluate expected outcomes, indicators, goals of the service. (Refer to Section D. 4 of the RFP submission) Value Explanation Comments 0 Not addressed or response

of no value

1 Limited applicability 3 Some applicability 5 Substantial or total

applicability

Evaluate how the organization plans to ensure consumer choice is recognized(Refer to Section D.5 of the RFP submission)

Value Explanation Comments 0 Not addressed or response

of no value

1 Limited applicability 3 Some applicability 5 Substantial or total

applicability Evaluate how the organization plans to use the data (Refer to Section D. 6 of the RFP

Value Explanation Comments 0 Not addressed or response of no

value

1 Limited applicability 3 Some applicability 5 Substantial or total applicability Evaluate strategies for recruitment and retention. (Refer to Section D. 7 of the RFP)

Value Explanation Comments 0 Not addressed or response of no

l

1 Limited applicability 3 Some applicability 5 Substantial or total applicability

Evaluate the organization’s described outcomes(Refer to Section D. 8 of the RFP submission)

Value Explanation Comments 0 Not addressed or response of no

value

1 Limited applicability 3 Some applicability 5 Substantial or total applicability

Evaluate Program Integrity program (Refer to Section D.9 of the RFP)

Value Explanation Comments 0 Not addressed or response of

no value

1 Limited applicability 3 Some applicability 5 Substantial or total applicability

Evaluate privacy and security (Refer to Section D.10 of the RFP submission)

Value Explanation Comments 0 Not addressed or response of

no value

1 Limited applicability 3 Some applicability 5 Substantial or total applicability

Evaluate procedures for promoting and ensuring rights, privacy and security. (Refer to Section D.11of the RFP submission) Value Explanation Comments 0 Not addressed or response of

no value

1 Limited applicability 3 Some applicability 5 Substantial or total applicability

Section E. OTHER ATTACHMENTS (max. 10 POINTS) Evaluate Consumer Support Documents

Value Explanation Comments 0 Not addressed or response of

no value

1 Limited applicability 3 Some applicability 5 Substantial or total applicability