Download - PEN Template - bidnet.com · Web viewThe electronic versions must be accessible, readable and saved as Microsoft Word files (See Section 4.9 of this Open Enrollment). Applicants

Open Enrollment For

RESIDENTIAL CHILD-CARE SERVICESProvided By

GENERAL RESIDENTIAL OPERATIONS OPERATING AS A RESIDENTIAL TREATMENT CENTER AND PROVIDING AN INTENSIVE PSYCHIATRIC TRANSITION PROGRAM

Procurement Number 530 - 15 - 0024

Enrollment Period Closes: March 09, 2015

INTENSIVE PSYCHIATRIC TRANSITION PROGRAMProcurement Number: 530 - 15 - 0024

TABLE OF CONTENTS

1. GENERAL INFORMATION........................................................................41.1 Scope.......................................................................................................................41.2 Point of Contact........................................................................................................41.3 Procurement Schedule.............................................................................................51.4 Amendments and Announcements Regarding this Open Enrollment.......................51.5 Eligible Applicants....................................................................................................51.6 Historical Service Utilization.....................................................................................81.7 Terms and Conditions..............................................................................................9

2. STATEMENT OF WORK.........................................................................142.1 DFPS Mission..........................................................................................................142.2 Program Purpose....................................................................................................142.3 Need for Service.....................................................................................................142.4 Eligible Population..................................................................................................152.5 Client Characteristics.............................................................................................162.6 Service Areas.........................................................................................................162.7 Service Authorization and Referral Process............................................................162.8 Service Requirements............................................................................................172.9 Minimum Qualifications..........................................................................................222.10 Subcontracting.......................................................................................................252.11 Required Record Keeping and Reports...................................................................262.12 Goal, Performance Measures and Evaluation.........................................................26

3. UTILIZATION AND COMPENSATION.......................................................303.1 Service Utilization..................................................................................................303.2 Compensation........................................................................................................303.3 Invoicing Process....................................................................................................313.4 Sequestration Impact.............................................................................................31

4. APPLICATION REQUIREMENTS..............................................................334.1 Open Enrollment Cancellation/Partial Award/Non-Award........................................334.2 Right to Reject Applications or Portions of Applications.........................................334.3 Amendments to Applications..................................................................................334.4 Corrections to an Application.................................................................................334.5 Joint Applications....................................................................................................334.6 Withdrawal of Applications.....................................................................................334.7 Debriefing..............................................................................................................34


4.8 Protest Procedures.................................................................................................344.9 Application Submission Instructions.......................................................................34

5. EVALUATION.......................................................................................385.1 Screening...............................................................................................................385.2 Best Value Factors.................................................................................................385.3 Review and Validation of Applications....................................................................385.4 Non-Responsive Applications.................................................................................405.5 Additional Information............................................................................................415.6 Additional Terms and Conditions............................................................................41

6. DEFINITIONS.......................................................................................427. APPLICATION SUBMISSION AND REFERENCE DOCUMENTS.....................47

7.1 Application for Enrollment and Readiness Questionnaire.......................................477.2 Required Forms......................................................................................................627.3 RCC Contract Standard Terms and Conditions.......................................................64

8. ORGANIZATION OF APPLICATION.........................................................65


1. GENERAL INFORMATION

1.1 Scope

The State of Texas, by and through the Texas Department of Family and Protective Services (DFPS or Department) and pursuant to its Child Protective Services (CPS) program, seeks to purchase Residential Child-Care services from DFPS Licensed General Residential Operations that operate as a Residential Treatment Center (GRO-RTC) and will provide Intensive Psychiatric Transition Program (IPTP) services in accordance with the specifications contained in and referenced by this Open Enrollment.

1.2 Point of Contact

Applicants for this Open Enrollment (Applicant) must direct all communications relating to this Open Enrollment to the Health and Human Services Commission (HHSC) Point of Contact named below. Applicants may not communicate with other DFPS staff members concerning this Open Enrollment.

An Applicant's failure to comply with these communication requirements may result in HHSC disqualifying the Applicant from being eligible to receive a contract award for this Open Enrollment.

The sole Point of Contact for any inquiries and submittals for this Open Enrollment is Procurement Project Manager Lizet Alaniz.

Physical Address for overnight, commercial, and hand-deliveries of applications: Lizet Alaniz

HHSC - Procurement and Contracting Services4405 N. Lamar Blvd. Bldg. 1, MC: 2020 Austin, Texas 78756

Mailing Address: Lizet AlanizHHSC - Procurement and Contracting Services4405 N. Lamar Blvd.MC: 2020 Austin, Texas 78756

Phone: (512) 206-4713Fax: (512) 206-4711Email Address: mailto:[email protected]

mailto:[email protected]


NOTE ON DFPS ENCRYPTED EMAILS - Email encryption offers a reliable, secure level of personal information protection when sending email messages over the Internet. The document at the following link will guide email recipients on how to access and read encrypted emails, and it provides helpful information through the process (http://www.dfps.state.tx.us/documents/Contact_Us/DFPS_Email_Encryption_Help_Document.pdf).

1.3 Procurement Schedule

HHSC will accept applications for the Open Enrollment (Application) during the Enrollment Period.

Any changes to the dates of the Procurement Schedule will be posted on the Electronic State Business Daily (ESBD).

Procurement ScheduleEnrollment Period Opens October 09, 2014Enrollment Period Closes March 09, 2015

1.4 Amendments and Announcements Regarding this Open Enrollment

HHSC will post all official communication regarding this Open Enrollment on the ESBD (see Electronic State Business Daily ) .

HHSC reserves the right to revise the Open Enrollment and to make unilateral amendments to correct grammatical, organizational and clerical errors at any time. Applications must comply with any changes, amendments, or clarifications posted to ESBD prior to the date the Application is submitted.

It is the responsibility of interested parties to periodically check the ESBD for updates to the Open Enrollment prior to submitting an Application. The Applicant’s failure to periodically check the ESBD will in no way release the Applicant from compliance with “addenda or additional information” related to requirements of the Open Enrollment.

1.5 Eligible Applicants

DFPS will accept Applications only from an individual or entity (Applicant) that:

1.5.1 Is legally authorized to do business in the State of Texas and determined to be "Active" by the Texas Comptroller of Public Accounts. Applicants can check their status at: http://www.cpa.state.tx.us/taxinfo/coasintr.html;

http://www.cpa.state.tx.us/taxinfo/coasintr.html

http://esbd.cpa.state.tx.us/

http://esbd.cpa.state.tx.us/

http://www.dfps.state.tx.us/documents/Contact_Us/DFPS_Email_Encryption_Help_Document.pdf




1.5.2 Is not barred from participating in state contracts under Government Code § 2155.077;

1.5.3 Is not debarred or suspended from participating in Federal contracts;

1.5.4 Has a valid GRO-RTC License (License) or letter of acceptance that has been issued by DFPS’ Residential Child Care Licensing (RCCL) Division.

For the License or letter of acceptance to be valid, it must be current and not have been withdrawn or denied during the Open Enrollment's Application Review Process Period, e.g. at the time of the Department’s receipt of Application, review of Application or initiated during the Department’s Readiness Assessment (see Section 5 of this Open Enrollment).

Applicant must inform the Point of Contact in Section 1.2 of this Open Enrollment if Applicant's License is withdrawn or denied at any time between receipt of Application through execution of the resulting contract.

This License must be valid throughout the entire term of the resulting contract;

1.5.5 Is, or will be, the License holder or its subsidiary for one or more of its facilities Licensed by RCCL as a GRO-RTC and is located in the DFPS Service Area that the Applicant has submitted an Application to provide IPTP services (see Section 2.6 of this Open Enrollment for Service Areas);

1.5.6 Has at least one of Applicant's Licensed GRO-RTC's locations in operation for twelve (12) months immediately preceding the date of the Department’s receipt of its Application or can clearly demonstrate that the Executive Director/Administrator, has at least twelve (12) months of direct experience in managing an IPTP program or its equivalent;

1.5.6.1 The specific Applicant facility's location for which they are submitting an Application does not have to be operating for this twelve (12) month period, but does have to either have or applied for a GRO-RTC License;

1.5.6.2 The Applicant that has not been granted a License, must have received an acceptance letter from RCCL indicating that the License application is complete and has been accepted;

http://www.statutes.legis.state.tx.us/Docs/GV/htm/GV.2155.htm#2155.077

http://www.statutes.legis.state.tx.us/Docs/GV/htm/GV.2155.htm#2155.077


1.5.6.3 If the Applicant does not have a License at the time of Application submittal, the Applicant must obtain the License within sixty (60) calendar days after submitting its Contract Application;

1.5.7 Any of its Licensed facilities cannot have a RCCL Remedial Action at the time of the Department’s receipt of its Application, review of Application or initiated during the Department’s Readiness Assessment;

1.5.8 Neither the License holder nor one of its subsidiaries has a current placement or a contract suspension for IPTP services at the time of the Department’s receipt of Application, review of Application or initiated during the Department’s Readiness Assessment; and

1.5.9 Either as the License holder or its subsidiary has:

1.5.9.1 Not had a contract for Residential Child-Care Services; or

1.5.9.2 Had a contract for Residential Child-Care Services that has been terminated or not renewed for cause within the six-months period immediately preceding the date of Department’s receipt of its Application.

The remainder of the page is intentionally left blank.


1.6 Historical Service Utilization

Applicant is encouraged to consider the regional needs for services prior to submitting an Application.

1.6.1 An indicator of the level of need for this service is historical utilization data. However, no level of service is guaranteed by this procurement or constitutes any promise or guarantee of service utilization on the part of DFPS.

1.6.2 The table below reflects DFPS IPTP referrals and placements for Fiscal Year 2014 (FY14), which is September 1, 2013 through August 31, 2014. Please note that during FY14, IPTP Providers were only located in DFPS Regions 3, 4, 6, 7 and 8.

1.6.3 This table should be used for informational purposes only.

FY14 IPTP Eligible Referrals and Placements


1.7 Terms and Conditions

1.7.1 Standard Terms and Conditions

A sample Residential Child-Care Contract Form 2282cx IPTP (IPTP Contract) is in Section 7.3 of this Open Enrollment and contains the standard DFPS residential contract terms and conditions.

However, the resulting contract entered into between DFPS and successful Applicants will provide the actual terms and conditions that will govern any contract resulting from this Open Enrollment.

1.7.2 Additional Terms and Conditions

In addition to the Standard Terms and Conditions, the following are additional terms and conditions that govern the Application and any resulting contract.

1.7.2.1 Period of Performance

DFPS plans to award one or more contract(s) that will have a contract term between six (6) to twelve (12) months and will not extend past the end of fiscal year.

The actual dates of the contract term will be provided in the resulting contract.

1.7.2.2 Renewal Conditions

DFPS reserves the option to renew a contract under this Open Enrollment as provided for in the resulting contract (see IPTP Contract in Section 7.3 of this Open Enrollment).

1.7.2.3 Order of Precedence

In the event of conflicts or inconsistencies between the Standard Terms and Conditions and other documents, such conflicts or inconsistencies will be resolved by reference to the documents in the following order of priority:

1.7.2.3.1 First, the contract including the scope of work and any attachments;

1.7.2.3.2 Second, the Open Enrollment document, which includes all attachments and exhibits, and any modifications, addendum, or amendments to it; and


1.7.2.3.3 Third, the Open Enrollment application and all attachments and exhibits submitted by the Contractor.

1.7.2.4 Historically Underutilized Businesses

Because the estimated value of resulting contracts is less than $100,000, Applicants are not required to submit a HUB Subcontracting Plan (HSP) with their application at the time of submission.

In the event the Applicant’s application to the procurement meets or exceeds the $100,000 threshold, the Applicant will make a “Good Faith Effort” to comply with the HUB requirements through the development and submission of the HSP with the application response prior to application submission. If subcontractors are used in the delivery of the goods and/or services, the awarded Contractor(s) is requested to submit monthly progress reports, in the prescribed format, to HHSC’s HUB Program Office. When applicable, the reports should include a narrative description of the contractor’s good faith efforts and accomplishments, and financial information reflecting payments to all subcontractors, including HUBs.

During the term of the original contract, HHSC and the awarded Contractor(s) may have the opportunity to modify its arrangement, which may require a new scope of work through an amendment, renewal, or extension of the contract. As a result, the amendment, renewal, or extension of the contract may potentially increase the contract value to equal or exceed $100,000. As applicable and in accordance with statute and the HUB rules, the HHSC HUB Program Office may review the proposed amendment, renewal, or extension for potential subcontracting opportunities and for the inclusion of the HSP.

1.7.2.5 Texas Public Information Act

Any information submitted to HHSC or DFPS in response to this Open Enrollment is subject to public disclosure in accordance with the Texas Public Information Act (the Act), Government Code §552. HHSC or DFPS will process any request for information comprising all or part of any information submitted to HHSC or DFPS by the Applicant in accordance with the Act.


If an Applicant claims that information contained in any materials submitted to HHSC or DFPS is exempt from required public disclosure under the Act, the Applicant must clearly identify such information and the applicable exemptions in the Act and explain in detail why such exemption is applicable.

For information concerning the application of the Act’s provisions to Applicant's application and proprietary information, Applicants may consult the following:

Attorney General’s website www.oag.state.tx.us http://www.oag.state.tx.us/open/index.shtml)

Public Information Handbookhttps://www.oag.state.tx.us/AG_Publications/pdfs/publicinfo_hb.pdf

1.7.2.6 Use of Ideas by the State of Texas

DFPS reserves the right to use any and all ideas presented in an application unless the Applicant presents a valid legal case that such ideas are a trade secret or confidential information and identifies the information as such in its application. An Applicant may not object to the use of ideas that are not the Applicant’s intellectual property and so designated in the Application that:

1.7.2.6.1 Are known to DFPS before the submission of the Application;

1.7.2.6.2 Are in the public domain through no fault of DFPS; or

1.7.2.6.3 Become properly known to DFPS after application submission through other sources or through acceptance of the Application.

1.7.2.7 Property of DFPS

Except as otherwise provided in this Open Enrollment or the resulting contract, all products produced by Applicant as a result of this Open Enrollment or the resulting contract become the sole property of DFPS, including, without limitation, all plans, designs, software, and other contract deliverables.

https://www.oag.state.tx.us/AG_Publications/pdfs/publicinfo_hb.pdf

https://www.oag.state.tx.us/AG_Publications/pdfs/publicinfo_hb.pdf

http://www.oag.state.tx.us/open/index.shtml


1.7.2.7.1 If an Applicant develops any copyrightable material as a result of this Open Enrollment or the resulting contract, then Applicant will grant the State of Texas, DFPS, and the HHSC a royalty-free, non-exclusive, and irrevocable right to reproduce, publish, or otherwise use, and to authorize others to use the work for governmental purposes.

1.7.2.7.2 This Section does not apply to any report, document, or other data, or any invention of Applicant which existed prior to, or was developed or discovered independently from, its activities related to or funded by this Open Enrollment or the resulting contract.

1.7.2.8 Copyright Restrictions

DFPS will not consider any Application that bears a copyright.

1.7.2.9 Severability Clause

Invalidity or unenforceability of one or more provisions of this Open Enrollment or the resulting contract will not affect any other provision of this Open Enrollment or the resulting contract. If a part of the Open Enrollment or the resulting contract is determined invalid or unenforceable, then both parties agree to replace the invalid provision with a clause of as similar terms as may be legally possible in order to make the prior intent of such provision legal, valid and enforceable.

1.7.2.10 Uniform EIR Accessibility Clause

This Section of the Open Enrollment will apply if the resulting contract requires the Contractor to procure or develop Electronic and Informational Resources (EIR) for DFPS or to change any of DFPS’ EIR.

This Section also applies if the contract requires the Contractor to perform a service or supply goods that include EIR that DFPS employees are required or permitted to access or members of the public are required or permitted to access.

If this Section is applicable to the resulting contract, the Contractor must comply with the EIR Accessibility Requirement and follow these terms and conditions at:


http://architecture.hhsc.state.tx.us/myweb/Accessibility/docs/HHSUniformEIRAccessibilityClause.doc.


http://architecture.hhsc.state.tx.us/myweb/Accessibility/docs/HHSUniformEIRAccessibilityClause.doc

http://architecture.hhsc.state.tx.us/myweb/Accessibility/docs/HHSUniformEIRAccessibilityClause.doc


2. STATEMENT OF WORK

2.1 DFPS Mission

The mission of DFPS is to protect Children, the elderly, and people with disabilities from abuse, neglect, and exploitation by working with clients, families, and communities.

2.2 Program Purpose

The purpose of the Child Protective Services (CPS) Program is to protect Children and to act in the Children’s best interest. CPS focuses on Children, and their families, and seeks active involvement of the Children’s parents and other Family Members to solve problems that lead to abuse or neglect. The objectives of CPS are to:

2.2.1 Prevent further harm to Children and to keep Children with their families when possible;

2.2.2 Provide permanence for Children in Substitute Care by resolving family safety concerns and returning Children to their families; and

2.2.3 Provide permanence for Children who cannot return to their families.

2.3 Need for Service

DFPS provides Residential Child-Care services to Children in their managing conservatorship.

Specifically, DFPS has determined that there is a continuing need to seek the services of IPTP providers who will provide care, custody, supervision, assessment, training, education and treatment services that meet the needs of these Children.

These Children have a history of psychiatric hospitalizations and need IPTP Services to safely stabilize and enable them to transition to and function in Less Restrictive Settings.

Licensed Contractors may either create new IPTP beds or convert existing Substitute Care ones into IPTP placement beds in the Service Area for which they are submitting an Application.

NOTE ON the DFPS Foster Care Redesign Initiative: DFPS is currently in the process of rolling out Foster Care Redesign in the State of Texas. In the Region 3b catchment area (Tarrant, Palo Pinto, Parker, Johnson, Hood, Somervell and Erath Counties), DFPS has awarded a Single-Source Continuum Contract (SSCC) to ACH Child and Family Services, who is now responsible for developing and ensuring a full continuum of paid foster care services for all


children and youth in this area through their subsidiary, Our Community. Our Kids (OCOK).

Beginning on September 1, 2014, DFPS began referring all children and youth from within the Region 3b catchment area to OCOK. OCOK will in turn refer those children to its network of contracted service providers, which may or may not include providers awarded contracts through this procurement. Service providers, including those that are awarded contracts through this procurement, may continue to receive referrals directly from DFPS for children that are not from within the Region 3b catchment area. In order to receive referrals of children and youth from the Region 3b catchment area, providers must contact OCOK. Contact information for the Region 3b catchment area SSCC can be found at:

ACH Child and Family Services:http://www.achservices.org/

Our Community, Our Kids:http://www.ourcommunity-ourkids.org/

As DFPS continues to move forward with Foster Care Redesign, it will procure additional SSCC services. In catchment areas where DFPS procures an SSCC, the Department will eventually transition all referrals in that catchment area to the selected SSCC. DFPS encourages all residential child care providers to stay informed of this process through the ESBD and the Department's Foster Care Redesign website, located at:

https://www.dfps.state.tx.us/Adoption_and_Foster_Care/About_Foster_Care/redesign.asp

2.4 Eligible Population

For services provided through DFPS Residential Child-Care contracts, Contractor must provide the authorized services to Children referred for IPTP to the Contractor directly by DFPS state office Placement staff.

Eligible Children referred to Contractor will have a history of psychiatric hospitalizations. The eligible client population will consist of Children who:

2.4.1 Have been in DFPS conservatorship and/or Extended Foster Care for the last ninety (90) calendar days;

2.4.2 Have had at least one (1) psychiatric hospitalization in the preceding twelve (12) months;

2.4.3 Are either ready for discharge from a psychiatric hospital or are at imminent risk of a subsequent psychiatric hospitalization; and



http://www.ourcommunity-ourkids.org/

http://www.achservices.org/


2.4.4 The CPS Assistant Commissioner or their designee has determined to be in crisis and in need of acute stabilization.

2.5 Client Characteristics

See Section 7.1.2(14) of this Open Enrollment for a list of Targeted Characteristics and behaviors that may be exhibited by Children requiring placement.

2.6 Service Areas

2.6.1 The geographic area to be served consists of DFPS’ Regions 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, and11. A map of DFPS regions may be accessed at: http://www.dfps.state.tx.us/PCS/Regional_Contracts/map.asp.

2.6.2 The Applicant must specify the Region in which its Residential Child-Care Operation is located and Licensed (or has a valid RCCL acceptance letter) and provide the physical address for its location in the Application (see Section 7.1.1 of this Open Enrollment).

The Operation's physical address must be identical to the address on the RCCL License.

2.7 Service Authorization and Referral Process

2.7.1 The CPS state office Placement Program Specialist will contact the Contractor to confirm that the Contractor has a vacancy based on information submitted to the CPS Child Placement Vacancy Database and request that the Contractor consider the Child for placement.

2.7.2 If the Contractor is willing to consider the Child for placement, the DFPS Program Specialist will forward to the Contractor the IPTP referral form, the Child's psychological evaluation, the Child's most recent psychiatric hospitalization records, and the Child’s Common Application Form (Form 2087), which includes the Child's history and background information.

2.7.3 If the Contractor accepts the Child for placement and this is the best placement option for the child, the Child's DFPS caseworker/supervisor will call the appropriate Contractor staff to schedule a day and time for the Child's placement.

2.7.4 Service authorization to provide residential services to a Child is given when Form 2085-FC (Foster Care Placement Authorization) is signed by all designated DFPS staff and a copy of the signed form is given to the Contractor.

2.7.5 Contractors may accept a Child into IPTP only after DFPS has made a placement determination and issued an IPTP Service Authorization.

http://www.dfps.state.tx.us/PCS/Regional_Contracts/map.asp


2.8 Service Requirements

The links below serve as reference guides for prospective Applicants and are provided as a courtesy for use by parties interested in learning about procurement and contracting opportunities with DFPS.

These guides contain basic program, procurement, and contracting information only and are not intended as a comprehensive review of all applicable state law or a substitute for legal counsel by a licensed attorney. Applicants are strongly encouraged to carefully review the information provided at the links below and utilize the information in the development of policies, procedures and responses required by this Open Enrollment.

1. FY2015 Residential Child-Care Contracthttp://www.dfps.state.tx.us/pcs/residential_contracts/contract_forms.asp

2. Information on applying for a DFPS license http://www.dfps.state.tx.us/Application/Forms/showFile.aspx?Name=CCL-ApplicantsGuide-Letter.pdf.

The information provided in these guides is not legally binding on HHSC or DFPS and is subject to change without notice at any time.

2.8.1 General Service Requirements

Contractors must meet the requirements and provide the services in the IPTP Contract (see Section 7.3 of this Open Enrollment) and RCCL Minimum Standards for GRO-RTCs; see:

http://www.dfps.state.tx.us/Child_Care/Child_Care_Standards_and_Regulations/default.asp .

Please note that when there is a reference to RCCL Minimum Standards in this Open Enrollment, the Applicant will access this link for information on these RCCL Minimum Standards.

2.8.2 Specific Requirements for a GRO-RTC Providing IPTP Services

In addition to complying with the General Service Requirements stated in Section 2.8.1 above, Contractors who provide services to Children who exhibit or have the following conditions must comply with the corresponding service requirements noted in Sections 2.8.3 and 8 of this Open Enrollment.

For a description of these requirements and to ensure compliance, the Contractor needs to refer to the IPTP Contract (See Section 7.3 of this Open Enrollment).

http://www.dfps.state.tx.us/Child_Care/Child_Care_Standards_and_Regulations/default.asp

http://www.dfps.state.tx.us/Child_Care/Child_Care_Standards_and_Regulations/default.asp

http://www.dfps.state.tx.us/Application/Forms/showFile.aspx?Name=CCL-ApplicantsGuide-Letter.pdf

http://www.dfps.state.tx.us/Application/Forms/showFile.aspx?Name=CCL-ApplicantsGuide-Letter.pdf

http://www.dfps.state.tx.us/pcs/residential_contracts/contract_forms.asp


2.8.3 The Contractor's IPTP must:

2.8.3.1 Provide required services in a safe, structured treatment environment to stabilize a Child’s behavior and prepare the Child for placement in a Less Restrictive Setting within sixty (60) calendar days.

However, the Contractor may request from CPS Assistant Commissioner, a one-time Child-specific extension to extend services for up to sixty (60) additional calendar days.

2.8.3.2 Provide Stabilization and Treatment Services involving the following:

2.8.3.2.1 Collaborating with the Interdisciplinary Team;

2.8.3.2.2 Coordinating with the psychiatric hospital from which the Child has been discharged to ensure the Child’s needs are met during their stay in the IPTP;

2.8.3.2.3 Completing a Treatment/Stabilization plan within seven (7) calendar days of placement; and

This treatment plan will be updated every fourteen (14) calendar days until the Child is discharged from the IPTP;

2.8.3.2.4 Coordinating with local psychiatric hospitals for Children who demonstrate a Decompensation;

2.8.3.2.5 When returning to the IPTP after hospitalization, the Contractor will conduct a Treatment/Stabilization plan review within forty-eight (48) hours;

2.8.3.2.6 Addressing the targeted behaviors through a wide range of diagnostic and Treatment Services such that the Child’s characteristics and behaviors improve and the Child may be transitioned into a Less Restrictive Setting;

2.8.3.2.7 Providing at least two (2) group therapy sessions per week and two (2) individual therapy sessions per week for each Child in


the IPTP program and any additional therapy that the Child’s needs;

2.8.3.2.8 Ensuring that individuals providing group and individual therapy are qualified Behavioral Health Care professionals;

2.8.3.2.9 Providing specialized treatments when needed, such as substance abuse and anger management treatments;

2.8.3.2.10 Providing other therapeutic modalities as necessary to stabilize behaviors and ensure improvement in Children’s overall functioning to effectuate their transition to a Less Restrictive Setting;

2.8.3.2.11 Providing appropriate academic settings for educational services;

2.8.3.2.12 Conducting the on-going assessment of a Child's progress in the IPTP to make discharge planning determinations and discharge recommendations in accordance with the IPTP Contract’s Section 10 (see Section 7.3 of this Open Enrollment);

2.8.3.2.13 Participating in pre-placement contacts as requested by the CPS caseworker with the Child’s potential or actual subsequent placement;

2.8.3.2.14 Cooperating with the CPS caseworker to accomplish pre-placement visits as appropriate for the Child’s circumstances and needs;

2.8.3.2.15 Expecting to serve Children in DFPS foster care between twelve (12) and twenty-two (22) years old and having one or more of the targeted behaviors listed in Section 7.1.2(12) of this Open Enrollment;

2.8.3.2.16 Providing supervision that at a minimum will include 24-hour staffing patterns to provide appropriate supervision to ensure compliance with DFPS RCCL Minimum Standards;


2.8.3.2.17 Maintaining daily progress notes by staff supervising Children; and

For purposes of this Open Enrollment, all Children served under the Contract are considered “Children receiving Treatment Services for an emotional disorder” per RCCL Minimum Standards.

2.8.4 Provide Discharge Planning to meet these RCCL Minimum Standards requirements and comply with all discharge requirements contained in the IPTP Contract (see Section 7.3 of this Open Enrollment).

2.8.5 Establish reporting mechanisms for all reports required in the IPTP Contract (see Section 7.3 of this Open Enrollment).

2.8.6 Ensure the provision of effective communication for Children placed with the Contractor who have hearing impairments, which includes but is not limited to:

2.8.6.1 Providing sign-fluent staff, contracting with an interpreter, or providing an assistive listening device;

2.8.6.2 Ensuring the provision of effective communication for Children during therapy and/or when with a psychiatrist. Examples include: providing sign-fluent staff; contracting with an interpreter; or providing an assistive listening device. Interpreters used should be certified at Level III or above or equivalent, as determined by the Texas Department of Assistive and Rehabilitative Services’ (DARS) Office for Deaf and Hard of Hearing Services’ Board for the Evaluation of Interpreters (http://www.dars.state.tx.us/dhhs/bei.shtml); or

2.8.6.3 Providing or arranging continuing training and development in sign language for all staff and employees with direct interaction with the Child who has a hearing impairment. Options for staff include participating in a community-based sign language class, instruction from a person who is fluent in sign language and has shown a capability for instructional skills, video sign language training and on-line sign language training.

2.8.7 For services to Children who have a visual impairment Contractors must provide referral information to the Local School District and the DARS Division for Blind Services; refer to: http://www.dars.state.tx.us/dbs/index.shtml.

2.8.8 Contact with Siblings

http://www.dars.state.tx.us/dbs/index.shtml

http://www.dars.state.tx.us/dhhs/bei.shtml


Contractor will initiate Personal Contact between a Child and a Child's sibling(s) who is/are in foster care:

2.8.8.1 At least one time per month in a face-to-face meeting if siblings are separated but within one hundred (100) miles of each other; or

2.8.8.2 By initiating twice monthly Telecommunications if separated by more than one hundred (100) miles during which the Child and their siblings’ discussion and actions are not directed by the Contractor.

2.8.8.3 Exceptions to these requirements include the following:

2.8.8.3.1 Prohibited by court order;

2.8.8.3.2 Contrary to the best interest of the Children as reflected in any of the Plans of Service of the Child or the Child's sibling(s);

2.8.8.3.3 The Regional Program Director’s written approval; or

2.8.8.3.4 A mental health professional treating the Child, or any of the Child's siblings, has determined and documented that visits should not occur.


2.9 Minimum Qualifications

2.9.1 Minimum Staffing Qualifications

Applicant must ensure compliance with minimum staffing requirements as required in the IPTP Contract (See Section 7.3 of this Open Enrollment) and the applicable RCCL Minimum Standards.

Current resumes of professional and key management staff, which includes the President/CEO, Executive Director/Administrator, Comptroller/CFO, Program Director, Clinical Director and Licensed Child-Care Administrator of the Operation, or equivalent positions. Resumes must be submitted with the Readiness Questionnaire (See Section 7.1.2 of this Open Enrollment).

2.9.2 Minimum Organizational Qualifications

Applicant must ensure compliance with minimum organizational qualifications as required in the IPTP Contract (See Section 7.3 of this Open Enrollment) and RCCL Minimum Standards.

2.9.3 Financial Capacity

An Applicant must supply the following evidence of financial stability sufficient to demonstrate reasonable stability and solvency appropriate to the requirements of this Open Enrollment (See Organization of Application in Section 8 of this Open Enrollment).

2.9.3.1 If the Applicant's Operation or its parent organization has been in operation for one (1) or more years, it must submit current financial statements and reports for itself and the parent organization (if Operation has a parent organization) to include:

2.9.3.1.1 A Balance sheet;

2.9.3.1.2 Statement of income and expense;

2.9.3.1.3 Statement of changes in financial position;

2.9.3.1.4 Cash flows;

2.9.3.1.5 Capital expenditures; and

2.9.3.1.6 Annual Audit (if available).

NOTE: Personal financial statements will only be accepted from Applicants who are sole proprietors.


2.9.3.2 Applicants whose Operation or its parent organization has not been in operation or has been in operation for less than one (1) year, must submit the following for the Applicant and its parent organization:

2.9.3.2.1 A projected 12-month budget of income and expenses; and

2.9.3.2.2 Documentation of reserve funds or available credit at least equal to operating costs for the first three (3) months of operation.

2.9.3.3 As applicable, Applicants must submit annual Internal Revenue Service (IRS) reporting Forms 990; 1065; 1120; 1040C; 940; and 941.

2.9.3.4 If any change that impacted the Applicant's ownership has occurred in the last twelve (12) months prior to Application submission or is anticipated during the twelve (12) months following submission, the Applicant must describe these circumstances and when the change occurred or is likely to occur.

2.9.4 DFPS Background Check Policy

In addition to complying with the Background History Check requirements of RCCL Minimum Standards, anyone who is a Principal or has access to the financial operations of the organization, including a subcontractor, must comply with the Purchased Client Services Background Check Policy at http://www.dfps.state.tx.us/PCS/About_PCS/Background_Check_Policy.asp.

2.9.4.1 The Applicant must submit Forms 2970c and 2971c, and any other forms required in the Purchased Client Services Background Check Policy.

2.9.4.2 A Principal is defined as any person who has the ability to make unilateral fiscal decisions on behalf of the Contractor. The following positions are assumed to have such ability:

2.9.4.2.1 Executive Director;

2.9.4.2.2 Chief Executive Officer;

2.9.4.2.3 Comptroller; and

2.9.4.2.4 Chief Financial Officer.

http://www.dfps.state.tx.us/PCS/About_PCS/Background_Check_Policy.asp



2.9.5 Minimum Insurance Requirements

In order to mitigate risk under this Open Enrollment's resulting Contract, DFPS will require the Contractor to submit all required insurance/bond coverage that meets or exceeds current minimum DFPS insurance requirements and provide the Certificate of Insurance with the signed contract to include in the Contract file before this Contract is finally executed.

2.9.5.1 The Contractor will provide DFPS with documentation that meet these requirements; which can include, but is not limited to insurance policies, accords, certificates, self-insurance plans and/or bonds. DFPS reserves sole discretion to determine whether a document provided to DFPS meets the current minimum insurance requirements, coverage and/or limits.

2.9.5.2 If the coverage will be provided through an insurance policy(ies) or other similar insurance document(s), then the issuing insurance company has to be authorized to do business in the State of Texas and have "B" or higher rating.

2.9.5.3 If the coverage will be provided through a Self-Insurance Plan, then the plan submitted will cover any losses to the same manner as provided for in the more commonly seen insurance policy.

2.9.5.4 If the coverage will be provided through a bond or other financial instrument, then the issuer must be authorized to do business in the State of Texas.

2.9.5.5 The following current DFPS minimum insurance coverage and limits must be maintained throughout the resulting Contract term:

2.9.5.5.1 Commercial General Liability Insurance or equivalent insurance coverage including, but not limited to, liability with minimum combined bodily injury (including death) and property damage limits of $300,000 per occurrence, and $600,000 aggregate;

2.9.5.5.2 Commercial Crime Insurance or equivalent insurance coverage to cover losses from fraudulent and dishonest acts with a minimum limit of $25,000;


The Commercial Crime Insurance or equivalent insurance coverage must include a third party endorsement and an employee dishonesty endorsement or equivalent endorsements;

2.9.5.5.3 Professional Liability insurance, or equivalent insurance coverage to cover losses from errors and omissions during professional services with a minimum limit of $300,000 per occurrence, and $600,000 aggregate.

2.9.5.6 Contractor Notice to DFPS of Any Material Changes

Contractor will immediately provide written notice to DFPS of any material changes to any document submitted under this Subsection; such notification also includes cancellation of coverage before the expiration date (i.e., end of policy period) of the applicable document.

2.9.5.7 Renewals or New Coverages during Contract Period

Contractor will be responsible for ensuring that any document submitted under this Subsection is current and in full force and effect. If the document has a period of coverage, then the Contractor will ensure that after each renewal, they immediately provide the new coverage document. In the event that the Contractor obtains coverage from a new issuer or insurer, then the Contractor will immediately provide this document to DFPS.

2.9.5.8 Request for Documents

Contractor will provide any required documents under this Subsection without expense or delay to DFPS.

2.10Subcontracting

Contractor must ensure compliance with the subcontracting requirements in Section 53 of the IPTP Contract in Section 7.3 of this Open Enrollment and RCCL Minimum Standards.

2.11Required Record Keeping and Reports

2.11.1 Contractor must ensure compliance with record keeping and Report requirements provided for in the IPTP Contract (See Section 7.3 of this Open Enrollment) and RCCL Minimum Standards.

2.11.2 Cost Report - Current DFPS Contractors may submit one annual cost report for GRO-RTC and IPTP services provided within the same


Licensed Operation as required by 1 TAC §§355.7101-7103.

2.12Goal, Performance Measures and Evaluation

2.12.1 Goal

The goal of the Intensive Psychiatric Transition Program is to safely stabilize Children who have a history of psychiatric hospitalizations or who are at imminent risk of a subsequent psychiatric hospitalization and enable this population to successfully transition to less restrictive settings.

2.12.2 Performance Evaluation

Contractor performance evaluation is based on:

2.12.2.1 Assessment of the output and outcome performance measures provided below and in the IPTP Contract (See Section 7.3 of this Open Enrollment);

2.12.2.2 Compliance with the IPTP Contract terms and conditions;

2.12.2.3 Compliance with RCCL Minimum Standards;

2.12.2.4 Records required to be kept by Contractor and DFPS; and

2.12.2.5 Contract Monitoring performed by Department staff.

2.12.3 Performance Measures

The Contractor will achieve the Performance Measures stated below throughout the contract term. DFPS may compute new baselines for some measures and may also revise the indicators, targets, data sources or methodologies for the measures during the contract term. A current detailed description of each Performance Measure can be found in Attachment F of the current contract. http://www.dfps.state.tx.us/pcs/residential_contracts/contract_forms.asp

DFPS will track Contractor performance throughout the contract term. Any and all analyses can be used by DFPS to make decisions about contract status, determine subsequent performance targets or the need for contract changes, or to adjust the nature and intensity of DFPS' contract monitoring and quality assurance activities and keep stakeholders informed about the success of the DFPS contracting efforts.




DFPS will manage Performance Measure reporting. For each fiscal year, a final analysis of aggregate data will occur when all data for that fiscal year become available. The Contract Performance Measures are defined in Attachment F of the IPTP Contract (See Section 7.3 of this Open Enrollment).

2.12.3.1 Contract Output Measures

2.12.3.1.1 Output #1. Each Child's Education Portfolio is up-to-date.

2.12.3.1.2 Output #2. Children placed with a Contractor remain in the care of the Contractor until achieving a Successful Discharge from the IPTP.

2.12.3.2 Contract Outcome

2.12.3.2.1 Outcome #1. Children are safe in care.

2.12.3.2.2 Outcome #2. Children in foster care are able to maintain healthy Connections with caring Family Members who can provide a positive influence in their lives.

2.12.3.2.3 Outcome #3. Children in foster care are able to maintain Connections to siblings.

2.12.3.2.4 Outcome #4. Children transition to a Less Restrictive Setting within 60 days of placement.

2.12.3.2.5 Outcome #5. Children remain in a Less Restrictive Setting following Successful Discharge from the Intensive Psychiatric Transition Program (IPTP).

2.12.3.2.6 Outcome #6. Children benefit from routine recreational activities, including Extracurricular Activities.

2.12.3.3 Performance Measure Reporting

The Contractor will be responsible for collecting and reporting performance measure data for Output #1, Outcome #2 and Outcome #3 by:


2.12.3.3.1 Ensuring registration of an account in the Performance Management Evaluation Tool (PMET) system, if an account has not already been established;

2.12.3.3.2 Reporting the results for each Performance Period into the PMET system;

2.12.3.3.3 Operating in accordance with the PMET instructions found at https://www.dfps.state.tx.us/application/PCSPMET/default.aspx Select Help, then PMET User Guide;

2.12.3.3.4 Complying with report date time frames by entering into the PMET system within 30 days of the end of the Performance Period in accordance with the table below; and

Performance Period Reporting Period Entry into PMETFirst Quarter Sept, Oct, Nov December 1-30Second Quarter Dec, Jan, Feb March 1-30Third Quarter Mar, Apr, May June 1-30Fourth Quarter Jun, Jul, Aug September 1-

30

2.12.3.3.5 Maintaining documentation for each performance period in a manner that allows for testing the validity of the results reported.

2.12.3.3.6 Please note that data for the Performance Measure Output #2 and Outcomes #1, 4, 5 and 6, are not the Contractor's responsibility to report into PMET. These Performance Measures are calculated using DFPS data.

https://www.dfps.state.tx.us/application/PCSPMET/default.aspx

https://www.dfps.state.tx.us/application/PCSPMET/default.aspx


3. UTILIZATION AND COMPENSATION

3.1 Service Utilization

DFPS does not guarantee any minimum level of utilization or specific number of referrals. Service utilization rates will vary according to the needs of DFPS staff, individual clients and DFPS budgetary allocations. Actual service utilization is within the discretion of DFPS.

3.2 Compensation

3.2.1 Method of Payment

This contract will be paid on a fixed daily unit rate. All payments under this contract must be made in accordance with the Texas Prompt Payment Act, Texas Government Code Chapter 2251.

3.2.2 Regulation Compliance

Contractor will remain in compliance with the applicable provisions of 45 CFR Part 74, Office of Management and Budget (OMB) Circulars A-110, A-21, A-87, and A-122, Uniform Grant Management Standards (UGMS) and 40 TAC Chapter 732.

3.2.3 Fee Schedule

Payment will be by reimbursement based on a fixed daily unit rate of $374.33 per day per Child served. The Contractor agrees to this basis for payment and to adhere to the fiscal and billing policies and Procedures of the Department as stated in the Contract.

The Department is not obligated to pay costs or to pay more than the Contractor’s allowable unit rate.

The Department will make reasonable efforts to process payments in an accurate and timely manner.

DFPS recognizes that interim hospitalization may be needed to stabilize behavior or psychiatric problems. The following will apply if such hospitalization occurs:


3.2.3.1 The Department may compensate the Contractor for a bed while a Child is away from the facility if the Contractor agrees to accept the Child and is admitted back into the IPTP. The maximum number of calendar days for this compensation is seven (7) per episode of absence unless granted a written extension by the Department.

3.2.3.2 The Department will not compensate the Contractor as stated in Section 3.2.3 unless the Child is admitted back into and placed in the Contractor’s IPTP after release from the hospital.

3.2.3.3 The Contractor will be responsible for reimbursement to the Department of any amount paid, pursuant to Section 3.2.3, for a Child not admitted back into the IPTP.

3.2.4 Funding Limitations

3.2.4.1 DFPS does not guarantee funding at any level and may increase or decrease funds at any time during the term of a contract resulting from this Open Enrollment.

3.2.4.2 Contractors may not use funds received from DFPS to replace any other federal, state, or local source of funds awarded under any other contract. Additionally, Contractors may not use DFPS funds as match (in-kind or cash match) for any other funding opportunity (grant application) in which the Contractor may be participating.

3.3 Invoicing Process

Contractors are not required to submit invoices to receive payment. Payment is based on the Child's placement. Once approved by DFPS regional billing staff, invoices are automatically generated on a monthly basis through IMPACT, the DFPS automation system. See notification requirements in Section 43 of the IPTP Contract in Section 7.3 of this Open Enrollment.

3.4 Sequestration Impact

Sequestration refers to the automatic spending cuts that are required under the 2011 Budget Control Act. This law required $1.2 trillion in automatic cuts to mandatory and discretionary programs to begin in 2013 if Congress failed to pass legislation that would reduce the nation’s deficit by at least $1.5 trillion during the next decade. The failure of Congress to pass any deficit reduction legislation has triggered the automatic cuts required under sequestration.


These across-the-board cuts began January 2, 2013, and continue for the next ten (10) years. The cuts must be split equally between security and non-security programs, according to the Budget Control Act.

DFPS has determined that this Open Enrollment has the potential to be impacted by these budget cuts.



4. APPLICATION REQUIREMENTS

4.1 Open Enrollment Cancellation/Partial Award/Non-Award

DFPS reserves the right to cancel this Open Enrollment, to make a partial award or to make no award if it determines that such action is in the best interest of the State of Texas.

4.2 Right to Reject Applications or Portions of Applications

DFPS may reject any and all Applications or any portions of one.

4.3 Amendments to Applications

Applicants have the right to amend their Applications by submitting a written amendment to the Point of Contact in Section 1.2 of this Open Enrollment, at any time prior to:

4.3.1 Notification to Applicant that its Application has been deemed unresponsive pursuant to Section 5.4 of this Open Enrollment;

4.3.2 The closing of the enrollment period in Section 1.3 of this Open Enrollment; or

4.3.3 Notification to Applicant that their Application has been forwarded to the DFPS Residential Child-Care Contracts Division for the Readiness Assessment described in Section 5 of this Open Enrollment.

4.4 Corrections to an Application

As provided for in 40 TAC §§732.215-217, DFPS may allow for corrections to an Application during the Open Enrollment screening process.

4.5 Joint Applications

DFPS will not consider joint or collaborative Applications that require it to contract with more than one applicant.

4.6 Withdrawal of Applications

Applicants may withdraw their Application from consideration by submitting a written request for withdrawal to the Point of Contact in Section 1.2 of this Open Enrollment.

4.7 Debriefing

http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5&ti=40&pt=19&ch=732&sch=L&rl=Y


Any Applicant who is not awarded a contract may request a debriefing by submitting a written request to the Sole Point of Contact as provided in Section 1.2 of this Open Enrollment. DFPS' debriefing provides information to the Applicant(s) on the strengths and weaknesses of their Application.

4.8 Protest Procedures

The protest procedure for an Applicant who is not awarded a contract to protest an award or tentative award made by DPFS is allowed for competitive procurements. This procurement is non-competitive and cannot be protested as provided in 1 TAC §391.301.

4.9 Application Submission Instructions

4.9.1 Organization of Application

Applicant must organize and submit two (2) flash drives or compact discs of its application in the following order and format:

4.9.1.1 Application for Enrollment (See Section 7.1.1 of this Open Enrollment)

All information must be provided as requested by the Application. Incomplete Applications may not be accepted.

4.9.1.2 Supporting Documentation to Application for Enrollment (See Sections 7.1.1 and 7.1.2 of this Open Enrollment)

The Applicant must attach any supporting documentation, such as credentials and other requested documentation in the same order as they are requested in the Application.

4.9.1.3 Required Forms (See Section 7.2 of this Open Enrollment)

Required forms for this Application are included in Section 7.2 of this Open Enrollment. The Applicant must completely answer and return all required forms with their Application.

4.9.2 Additional Requirements

http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=1&pt=15&ch=391&rl=301


4.9.2.1 Each document required to be signed must have original signature(s) where indicated.

Forms requiring original signature, and requested documents that were not created by the Operation must be:

4.9.2.1.1 Saved as Adobe Acrobat Files (.pdf); and

4.9.2.1.2 Submitted electronically on each flash drive or compact disc;

4.9.2.2 Submit electronic folders as specified in the Organization of Application (See Section 8 of this Open Enrollment) as follows:

File Folder 1: Application for Enrollment (See Sections 7.1.1 and 7.1.2 of this Open Enrollment);

File Folder 2: Supporting Documentation to the Application for Enrollment, and Readiness Questionnaire, e.g. list of Board of Directors (if applicable), professional staffing plan, organizational plan and Operation's floor plan submitted to RCCL (See Section 7.1.1 and 7.1.2 of this Open Enrollment); and

File Folder 3: Required Forms (See Section 7.2 of this Open Enrollment).

4.9.2.3 It is the Applicant’s responsibility to appropriately label each document as provided for in this Open Enrollment and deliver the Application and all of its related materials to the Point of Contact in Section 1.2 of this Open Enrollment.

An Applicant proposing to provide services through more than one Operation must submit a separate Application for each Operation that has a separate License. For example, if an Applicant has two or more GRO-RTCs proposing to provide IPTP services, then they will have to submit a separate Application for each Licensed Operation.

4.9.2.4 Flash dives and compact discs must be submitted with a cover letter containing the:

4.9.2.4.1 Applicant’s/Operation’s name;


4.9.2.4.2 Operation’s point of contact;

4.9.2.4.3 Operation’s point of contact’s telephone number and Email address;

4.9.2.4.4 Procurement number; and

4.9.2.4.5 Date.

4.9.3 Electronic Copies

Applicant must submit two (2) electronic copies of its entire Application, which is comprised of the documents listed in Section 4.9.1.

The two (2) electronic versions of the Application must be submitted as two (2) separate files. The first version is to preserve the Applicant's documents as submitted and the second version will be used by DFPS Staff.

4.9.3.1 Electronic Format

Both versions of the Application must be saved as Microsoft Word files, with the exception of forms that require original signatures and requested documents that were not created by the Operation. These documents must be saved as Adobe Acrobat Files (.pdf).

4.9.3.2 Organization of Electronic Information

These documents must be saved on flash drives or compact discs labeled with the following information written on the flash dives or compact discs the:

4.9.3.2.1 Applicant’s/Organization’s Name;

4.9.3.2.2 Procurement number, IPTP; and

4.9.3.2.3 Sequential flash drive or disc number, when multiple flash drives or discs are required per electronic copy, with information presented on the flash drives or compact discs in the same order as requested in Section 4.9.1 of this Open Enrollment.

4.9.4 Delivery of Applications

Applications must be submitted to the Point of Contact in Section 1.2 of this Open Enrollment.


4.9.5 Costs Incurred

Applicants understand that issuance of this Open Enrollment in no way constitutes a commitment by DFPS to award a contract or to pay any costs incurred by an Applicant in the preparation of an Application.

DFPS is not liable for any costs incurred by an Applicant prior to issuance of or entering into a formal agreement, contract or purchase order. Costs of developing Applications, preparing for or participating in oral presentations and site visits, or any other similar expenses incurred by an Applicant are entirely the responsibility of the Applicant and will not be reimbursed in any manner by the State of Texas.



5. EVALUATION

5.1 Screening

HHSC will screen all Applications according to the evaluation process described in this Section.

5.2 Best Value Factors

In accordance with 1 TAC §391.121, the following best value factors will be considered in making any contract award:

5.2.1 The extent to which the services meet the needs of the Children for whom the services are being purchased;

5.2.2 Indicators of probable Contractor performance under the contract such as past Contractor performance, the Contractor's financial resources and ability to perform and the Contractor's experience and responsibility; and

5.2.3 The services meet the needs of DFPS.

5.3 Review and Validation of Applications

The Applicant must provide full, accurate and complete information as required by this Open Enrollment.

As part of the Application Review Process Period, DFPS staff may validate any aspect of the Application. Validation may consist of an on-site visit, review of records and confirmation of the information submitted by the Applicant with the Applicant and third parties.

5.3.1 Readiness Assessment

The required Readiness Questionnaire information and documents submitted (See Section 7.1.2 of this Open Enrollment) will be forwarded to DFPS’ Residential Child-Care Contracts Division for completion of the Readiness Assessment described in this Section prior to Contract award determination.

5.3.1.1 A Readiness Assessment will consist of:

5.3.1.1.1 An on-site visit to the Applicant’s physical facilities; and

5.3.1.1.2 Review of its Operation's submitted Readiness Questionnaire.

http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=1&pt=15&ch=391&rl=121


5.3.1.2 The Readiness Assessment is intended to provide DFPS with an assessment of Applicant’s readiness and ability to accept Children into care, perform the required program components, comply with the requirements of the IPTP Contract and achieve the goal and performance outcomes of this Open Enrollment.

This Assessment will include a review of the Applicant’s usable space and equipment, proximity and access to needed resources, ability to provide quality services, and capacity to protect the health and safety of Children in care.

This Assessment will also include a review of the Applicant's historical and current compliance with and understanding of RCCL/Residential Child Care Contracting requirements and a review of the Applicant's Readiness Questionnaire (See Section 7.1.2 of this Open Enrollment.

5.3.1.3 The Readiness Assessment is not intended to provide feedback or technical assistance to the Applicant. During the Readiness Assessment, changes or additions to the Applicant's Readiness Questionnaire (See Section 7.1.2 of this Open Enrollment) originally submitted will not be accepted.

Changes or additions will only be allowed as provided for in Section 4.3 of this Open Enrollment.

5.3.1.4 During the Readiness Assessment, DFPS will meet with only the Applicant's Executive Director or Chief Executive Officer or an equivalent position within your Operation. That individual must be prepared to respond to questions that correspond to requirements of IPTP Contract (See Section 7.3 of this Open Enrollment) and participate in the on-site visit.


5.3.2 Timeframe for Readiness Assessment to Contract Execution

DFPS estimates that the entire process for contract to be fully executed for Residential Child-Care Treatment services will take approximately ninety (90) to one hundred twenty (120) calendar days from the date of referral to Residential Contracts is made from the Procurement Manager to complete the Operation's Readiness Assessment.

These times are an estimate and will vary due to a variety of circumstances; however, DFPS will make its best efforts to meet this timeframe.

5.4 Non-Responsive Applications

5.4.1 Unless subject to Section 4.4 of this Open Enrollment, an Application will be considered non-responsive and will not be considered further when any of the following conditions occurs:

5.4.1.1 The Application is not signed;

5.4.1.2 The Applicant’s response is not clearly legible and typewritten;

5.4.1.3 The Applicant fails to meet major Open Enrollment specifications, including:

5.4.1.3.1 The Applicant fails to submit the required application, supporting documentation or forms;

5.4.1.3.2 The Applicant is not eligible under Section 1.5 of this Open Enrollment; or

5.4.1.3.3 The Applicant does not accept the payment rate established in the Open Enrollment;

5.4.1.4 The Application is not received by the closing of the enrollment period in Section 1.3 of this Open Enrollment; and

5.4.1.5 The Applicant does not have a License prior to or within sixty (60) calendar days after submitting the Application.

5.4.2 If an Application is determined to be non-responsive while this Open Enrollment is still open, the Applicant may submit another separate and complete Application prior to the enrollment deadline in Section 1.3 of this Open Enrollment.


If no responsive Applications for this Open Enrollment are received, DFPS reserves the right to award a contract based on noncompetitive negotiations.

5.5 Additional Information

5.5.1 By submitting an Application, the Applicant grants DFPS the right to obtain information from any lawful source regarding the Applicant’s and its directors’, officers’, and employees’:

5.5.1.1 Past business history, practices, and conduct;

5.5.1.2 Ability to supply the goods and services; and

5.5.1.3 Ability to comply with contract requirements;

5.5.2 By submitting an Application, an Applicant generally releases from liability and waives all claims against any party providing DFPS information about the Applicant. DFPS may take such information into consideration in evaluating Applications.

5.6 Additional Terms and Conditions

Any terms and conditions attached to this Open Enrollment or Application will not be considered unless specifically referred to in this Open Enrollment and may result in disqualification.



6. DEFINITIONS

For the purposes of this Open Enrollment, the following terms will have the definitions stated below.

TERM DEFINITIONApplicant Any individual or entity that submits an Application for

enrollment pursuant to this Open Enrollment.Application Application includes the Application for Enrollment,

Readiness Questionnaire, Required Forms, and including all attachments, appendices and exhibits required to be submitted.

Application Review Process Period

The period of time that includes the Open Enrollment screening, Residential Child-Care Readiness Assessment of the submitted application, the notification of Contract award or non-award, and the disposition of a protest.

Child (Children) Person(s) eligible for services from birth through the end of the month in which the Child turns twenty-two (22) years of age.

Contractor Any Applicant who is awarded a contract pursuant to this Open Enrollment or who has an existing contract to provide Residential Child-Care services.

Decompensation The deterioration of mental health in an individual with previously maintained psychiatric illness leading to a diminished ability to think and carry on daily activities

Extended Foster Care

A program for young adults eighteen (18) to twenty-two (22) years of age who are eligible, and have signed an agreement to participate in this program. A Young Adult who turns eighteen (18) while in the conservatorship of DFPS who is continuing to receive Extended Foster Care services is eligible for Extended Foster Care services through the end of the month in which the Young Adult reaches the age limit referenced in A) through F), so long as sufficient documentation is provided on a periodic basis as required by the terms of the Young Adult's Extended Foster Care Agreement to demonstrate that the Young Adult is:A) Regularly attending high school or enrolled in a program

leading toward a high school diploma or GED up to the end of the month of the Young Adult's twenty-second (22nd) birthday;

B) Regularly attending an institution of higher education or a post-secondary vocational or technical program up to the end of the month in which the Young Adult turns


twenty-one (21) years of age. These Young Adults can remain in care to complete vocational-technical training classes regardless of whether or not the Child has received a high school diploma or GED certificate. (40 TAC §700.316)

C) Actively participating in a program or activity that promotes, or removes barriers to employment through the end of the month in which the Young Adult turns twenty-one (21) years of age.

D) Employed for at least eighty (80) hours per month through the end of the month in which the Young Adult turns twenty-one (21) years of age.

E) Incapable of doing any of the above due to a documented medical condition through the end of the month in which the Young Adult turns twenty-one (21) years of age. (40 TAC §700.316)

F) Accepted for admission to a college, or vocational program that does not begin immediately. In this case, the Young Adult's eligibility is extended three and a half months after the end of the month in which the Young Adult receives his/her high school diploma or Graduate Equivalency Diploma (GED) certificate.

(40 Texas Administrative Code (TAC) §700.316)Family Member For the purposes of this contract, a person who is a Relative

or Fictive Kin of the Child in conservatorship.Fictive Kin A person who has a significant, long-standing relationship

with a Child in DFPS conservatorship or with the Child's family.

Interdisciplinary Team

A team of professionals that includes representation from at least three disciplines of study.

IPTP Residential Child-Care Contract (IPTP)

The resulting contract entered into between successful Applicants and DFPS. See Section 7.3 of this Open Enrollment for a sample of the current version.

Less Restrictive Setting

A more home-like, less institutionalized Substitute Care placement that meets the needs of the Child.

License A current, valid license issued by the Department’s RCCL to operate as a GRO-RTC.

New Applicant Applicant who does not have an existing contract with DFPS to provide IPTP services or Applicant who has an existing contract but is proposing to provide Residential Child-Care services not currently under contract with DFPS.

Operation A person or entity offering a program that may be subject to


RCCL's regulation. An Operation includes the building and grounds where the program is offered, any person involved in providing the program, and any equipment used in providing the program. An Operation includes a GRO-RTC.

Personal Contact A meeting, either face-to-face or by telecommunication, during which the parties' discussion and actions are not directed.

Policy Principles, rules and guidelines formulated or adopted by an organization to assist it in reaching its long-term goals, reflect the requirements of the IPTP Contract and influence and determine all major decisions, actions and activities that take place within their set boundaries.

Procedure Established and specific methods to carry out Policies in the day-to-day functions of the organization that identify:A) The staff position/title responsible for the managerial

oversight of the Policy and its Procedures;B) Specific processes which describe the method or series

of actions used to implement Policy;C) The staff position/title responsible for the

implementation of the Policy and its Procedures; andD) The timeframe in which the Procedure(s) will be

performed.Qualified Behavioral Health Care Professional

A person enrolled as a Star Health behavioral health care provider.

Readiness Assessment

An evaluation of Applicant’s readiness and ability to accept Children into care, perform the required program components, comply with the requirements of the IPTP Contract and achieve the goal and performance outcomes of the Open Enrollment.

Regional Placement Team

CPS staff members that review information of Children in DFPS conservatorship, track placement vacancies, and identify options that best meet the needs of these Children. The Regional Placement Team consist of:A) Centralized Placement Coordinators who are a part

of the Centralized Placement Unit (CPU) and conduct initial and subsequent placement searches for placement of all Children into a foster home, general residential operation (not including RTC) emergency shelter, when therapeutic foster care is being sought and placement of Children with primary medical needs.

B) Residential Treatment Placement Coordinators (RTPC) who seek placement for Children into an


intensive foster home, emergency shelter (when structured settings cannot be immediately located), and a Residential Treatment Center / General Residential Operation providing treatment services.

C) Developmental Disability Specialists who seek placement for Children diagnosed with Intellectual Disabilities/Developmental Disabilities (ID/DD) in a General Residential Operation, also known as a GRO serving Children with Mental Retardation, in:1. Intermediate Care Facilities for Persons with an

Intellectual Disability (ICF/ID);2. Home and Community Based Services (HCS Homes,

if eligible);and3. Nursing Homes.

Relative A person connected to a Child by blood, marriage or adoption.

Remedial Action Actions RCCL may impose if an operation is deficient in a rule, including a minimum standard, statute, specific term of a permit, or condition of evaluation, probation, or suspension. There are four types of remedial actions; corrective, adverse, judicial, and monetary actions.

Residential Child Care

The care, custody, supervision, assessment, training, education, or treatment of a Child who is not related by blood, marriage, or adoption to the owner or operator of the Operation, for all of the twenty-four (24)-hour day, regardless of whether the Operation is for profit.

Sibling Group Children originating from the same household and in DFPS conservatorship.

Stabilization Sufficient improvement in the Child's emotional and/or behavioral condition indicated by clinical evidence that the Child is no longer at risk for acute psychiatric hospitalization and does not demonstrate risk of imminent harm to self or others. The Child is ready for placement in a Less Restrictive Setting than the IPTP program.

Standard Terms and Conditions

The terms and conditions applicable to any contract resulting from this Open Enrollment.

Star Health A comprehensive managed health care system for Children in the conservatorship of DFPS and Young Adults up to age twenty-two (22) with a voluntary foster care agreement and young adults up to age twenty-one (21) who are eligible for transitional Medicaid (left foster care following their eighteenth (18th) birthday).


Substitute Care Residential care and support provided to a Child in DFPS' managing conservatorship who has been placed in a living situation outside the Child's own home in order to protect the Child from abuse or neglect.

Successful Discharge

A Child completing the program and moving to a Less Restrictive Setting.

Telecommunications

The transmission, emission or reception of voice and/or data through any medium by wire, radio, other electrical electromagnetic or optical means. Telecommunications includes all aspects of transmitting information, such as telephone, text messaging, videoconferencing and any type of communication via the internet including Voice Over Internet Protocol (VOIP), e-mail, social networking, instant messaging and wireless data exchange.

Therapy The provision of assistance and guidance in resolving personal, social or psychological problems and difficulties through a collaborative process that facilitates progress toward mutually determined treatment goals and objectives. Therapy is provided by a trained professional who demonstrates competence in the ability to appropriately use treatment modalities for individuals, families and groups.

Treatment Services A full range of mental health services that address the changing needs of Children with emotional disorders. These services must be tailored to each individual Child’s physical, emotional, social and educational needs and may include:A) Medication assessment and treatment by psychiatrists;B) Individual and group therapy;C) Specialized treatments, such as substance abuse

treatment, anger management, conflict resolution and cognitive-behavioral therapy; and

D) Incorporation of treatment with goal-oriented activities within an age-specific therapeutic milieu.


7. APPLICATION SUBMISSION AND REFERENCE DOCUMENTS

7.1 Application for Enrollment and Readiness Questionnaire

7.1.1 Application for Enrollment

The Application for Enrollment must be complete for it to be accepted by DFPS.

DFPS considers a complete answer to be a written response. Responding with “Not Applicable” is only an appropriate response when a question or form does not apply to an Applicant’s organization.

A. Applicant Information

Legal Name of Applicant

Office Address

City, State, Zip

Phone Fax

Contact Person Title

Contact's E-mail

Vendor ID Number

B. Additional Applicant Information

Doing Business As Name (DBA) or Parent Organization Indicate if different from Legal Name above

Attach a copy of Assumed Name Certificate.

If an Applicant has a Parent Organization, attach a copy of the agreement between the Applicant and Parent OrganizationMailing Address - If different from Office Address above

Applicant: Parent Organization: Federal ID Number – If different from Vendor ID

Applicant: Parent Organization:

Social Security Number - If applying as Individual/Sole Proprietor

Name of Person Authorized to Sign Contract

Title

Phone Number:

Email:


Name of Person Responsible for Billing

Title

Phone Number:

Email:

Type of Applicant – Check appropriate box(es) and attach documentation as indicated

Are you applying to provide services to DFPS without payment (No-Pay Contract)? Yes No

Governmental EntityDo you have taxing authority? Yes No

Private CorporationFor ProfitNon-Profit

State of Incorporation: Charter Number:

Attach a copy of Certificate of Incorporation Partnership

LimitedGeneral

Attach a list of names, addresses and Social Security numbers for each partner

If Partnership – Do you have:

Yes No Partnership AgreementYes No Signatory Assignment

If yes is checked above, attach a copy

Sole ProprietorshipFor ProfitNon-Profit

If Sole ProprietorshipProvide date of birth:

Are you a certified Texas HUB?Yes – Attach a copy of HUB certification form.No – Select all that apply if you fall into one or both of the categories below:

Minority Owned Business Woman Owned Business

Submit a valid DFPS Residential Child-Care License issued by Residential Child-Care Licensing (RCCL) for the Operation and services for which the Applicant is submitting an Application.

C. Service Area

If proposing to provide multiple IPTPs, a separate Application must be submitted for each facility that you propose to provide IPTP services.

Select only one region below for which you are submitting this Application to provide IPTP services.

Region: 1 2 3 4 5 6 7 8 9 10 11


NOTE: If proposing to provide services in Region 3*:

Select the counties within Region 3* available for enrollment.

☐ Collin ☐ Grayson☐ Cooke ☐ Hunt☐ Dallas ☐ Kaufman☐ Denton ☐ Navarro

☐ Ellis ☐ Rockwall☐ Fannin ☐ Wise

NOTE: Applicants interested in providing services in Region 3b for Erath, Hood, Johnson, Tarrant, Palo Pinto, Somervell or Parker counties should contact the Single Source Continuum Contractor (SSCC), ACH Child and Family Services of Fort Worth.

D. Readiness Questionnaire

Complete and submit the required Readiness Questionnaire in Section 7.1.2 of this Open Enrollment.

E. Insurance

Review the minimum insurance requirements in Minimum Insurance Standards, Section 2.9 of this Open Enrollment and the IPTP Contract in Section 7.3 of this Open Enrollment.

Review the Minimum Insurance Standards in Section 2.9 of this Open Enrollment and Indicate in the table below, if requirements are met:

Commercial Crime Insurance or equivalent insurance with 3rd Party endorsement & Employee Dishonesty endorsement: Yes No

Commercial General Liability or equivalent insurance: Yes No

Professional Liability Insurance or equivalent insurance if Operation intends to employ staff to provide professional services: Yes No


If "No" is checked for any insurance named above, Contractor must submit insurance coverage documentation with the signed Contract. DFPS will not execute a Contract if this documentation is not provided or is found to not meet the insurance requirements.

If “Yes” is checked for any insurance named above, Contractor must submit insurance coverage documentation with the signed contract.

F. Certification

I certify that the information provided in this Application is to the best of my knowledge, complete and accurate, that the named legal entity has authorized me, as its representative, to submit this Application, and that the legal entity complies with all requirements of this Open Enrollment. I have attached a Corporate Board of Directors Resolution or similar document authorizing me to enter into contracts on behalf of this legal entity.

By signing this Application, I certify that the Texas address shown on the Application is the Applicant's address, which qualifies the Applicant as a Texas Resident Bidder as defined in Texas Administrative Code, Title 34, Part 1, Chapter 20.Signature of Authorized Representative Date

Name of Authorized Representative (Printed)

Title of Authorized Representative (Printed)



7.1.2 READINESS QUESTIONNAIRE AND INSTRUCTIONS

Applicants must read and understand the information provided in the website links below.

These links serve as reference guides for prospective applicants who are interested in applying for a License and contracting with the DFPS to provide residential child-care services to Children in DFPS foster care. a. http://www.dfps.state.tx.us/pcs/residential_contracts/

contract_forms.asp b. http://www.dfps.state.tx.us/PCS/Residential_Contracts/comparison.asp

Notes:

1. All questions must be addressed as stated below.

2. All questions in the Readiness Questionnaire must be answered completely, except as otherwise noted. A complete answer includes a written response and any required supporting documents.

3. “Not Applicable” is only an appropriate response when a given question does not apply to an Applicant’s Operation.

4. Applicants must provide electronic versions of the completed Readiness Questionnaire on flash drives or compact discs. The electronic versions must be accessible, readable and saved as Microsoft Word files (See Section 4.9 of this Open Enrollment).

5. Applicants must provide Readiness Questionnaire responses immediately following the corresponding questions.

Applicant: _______________________________________________

Facility Address: _________________________________________

1. Describe your organizational history with contracting, including:

a. Performance under government contracts and other private party contracts in Texas or any other state for the last five (5) years.

b. Your past experience working with residential child-care services for the last five (5) years.

http://www.dfps.state.tx.us/PCS/Residential_Contracts/comparison.asp




2. Have you had a contract for residential child-care services that was non-renewed by DFPS or any other private party or governmental entity within the last three (3) years?

Yes No

If yes:

a. Provide the name of the operation, date of the non-renewal, the contract number, and list the factors that contributed to DFPS or any other private party or governmental entity taking that action; and

b. Describe in detail the actions taken by your Operation to remedy each factor that contributed to that non-renewal.

3. Have you had a contract for residential child-care services terminated by DFPS or any other private party or governmental entity within the last three (3) years?

Yes No

If yes:

a. Provide the date of the termination and the contract number, and list the factors cited that contributed to DFPS or any other private party or governmental entity taking that action.

b. Describe in detail the actions taken by your Operation to remedy each factor that contributed to that termination.

4. Have you applied for a contract to provide residential child-care services, and not been awarded a contract by DFPS or any other private party or governmental entity within the last three (3) years?

Yes No

If yes:


a. List the factors that contributed to DFPS or any other private party or governmental entity taking that action; and

b. Describe in detail the actions taken by your Operation to remedy each factor that contributed to that denial.

5. Provide a list of all current contracts with DFPS or any other private or governmental entity (federal, state or county). List must at a minimum include if applicable:

a. Type of Contract (Private, federal, state or county);b. Contract number;c. Contact person at the contract entity;d. Contact phone number;e. Type of service;f. Dollar value of the contract; andg. Begin and end date of the contract.

6. For the contracts listed in question #5 above, briefly describe your compliance with program requirements, and any corrective actions put into place by the contracting agency. Include copies of monitoring reports and letters from the Contracting Entity to the Respondent during the last 3 years.

a. Identify the referral sources that make up Applicant’s Child population by estimating the percentage (%) for each placement source (for example):

Referral Source PercentageDFPS

Texas Juvenile Justice Department

Texas Youth CommissionOut of State

Other – (List Individually)Total 100%

i. Add additional rows to table, if needed, to list “Other” referral sources individually.

ii. Total should equal 100%.


7. Does your Operation place geographical limitations on accepting admissions?

Yes No

If yes, specify the following:

Specific Region/City Other

8. Does your organization have experience serving Children with a history of multiple psychiatric hospitalizations?

YES NO

If yes, describe your organization’s relevant experience providing services similar to the IPTP services being procured under this Open Enrollment.

Please also identify the following:a. License and licensing-authority under which you provided these services;b. Compliance with program requirements;c. Corrective actions required; andd. Any termination or non-renewal for cause.

Note: Experience in the last five years is considered the most relevant in assessing applications.

9. Does your organization currently operate a program capable of providing the Intensive Psychiatric Transition Program services described in Section 2 of this Open Enrollment?

Yes No

a. If yes, what is the bed capacity of your current program?

Male__________ Female__________

b. What is the bed capacity that you would dedicate to the Intensive Psychiatric Transition Program?

Male__________ Female__________10. Describe how DFPS-referrals under this Open Enrollment will be incorporated

into Applicant’s operational capacity:


11. How will the IPTP program manage admissions and coordinate the transitioning of Children into less restrictive settings?

12. Check the appropriate box, if your Operation proposes to serve any of the listed groups of Children. N/A

Children sixteen (16) years to seventeen (17) years of age

Children eighteen (18) to twenty-two (22) years of age

13. Describe the population the IPTP will serve, including age, gender, behavior and mental health disorders.

TARGETED CHARACTERISTICS:

14. In accordance with the children’s needs that you plan to serve, check the characteristics and behaviors of Children specified for each category in the table below:

Does Applicant currently serve Children with this Characteristic?

If DFPS needed to place a Child with this characteristic, would the Child be accepted?

If answer in second column is ‘No’, and the Child later exhibited this characteristic, would the Child be discharged?Characteristic

Actively Exhibiting Psychotic Behavior Yes No Yes No Yes NoADD / ADHD Yes No Yes No Yes NoAnxiety Disorder Yes No Yes No Yes NoAssaultive Behaviors or Homicidal Yes No Yes No Yes NoCriminal acts – an act that violates the law Yes No Yes No Yes NoCruelty to Animals Yes No Yes No Yes NoDanger to Self Yes No Yes No Yes NoDanger to Others Yes No Yes No Yes NoDepression Yes No Yes No Yes No


Does Applicant currently serve Children with this

If DFPS needed to place a Child with this characteristic,

If answer in second column is ‘No’, and the Child later Characteristic

Developmental Disorders Yes No Yes No Yes NoDSM-IV Axis I & II Diagnosis Yes No Yes No Yes NoEating Disorder Yes No Yes No Yes NoEmotional Abuse Yes No Yes No Yes NoEmotional Disorders Yes No Yes No Yes NoEnuresis/Encopresis Yes No Yes No Yes NoFire Setting Yes No Yes No Yes NoFire Setting History Yes No Yes No Yes NoGang Activity / Affiliation Yes No Yes No Yes NoGender Identity Issues/ Sexual Orientation Yes No Yes No Yes NoImpulse Control Disorder Yes No Yes No Yes NoLearning Disorder Yes No Yes No Yes NoMaladaptive Behaviors Yes No Yes No Yes NoMedically Fragile Yes No Yes No Yes NoMental Retardation (also known as Intellectual Disabilities) Yes No Yes No Yes NoOppositional Defiant Yes No Yes No Yes NoPervasive Developmental Disorder Yes No Yes No Yes NoPhysically Abused Yes No Yes No Yes NoPhysically Neglected Yes No Yes No Yes NoPregnant Yes No Yes No Yes NoPrimary Medical Needs Yes No Yes No Yes NoProbation/Parole/TYC/JPC Yes No Yes No Yes NoRequires Hospitalization Yes No Yes No Yes NoRunaway History Yes No Yes No Yes NoSexual Abuse History Yes No Yes No Yes NoSexually Inappropriate / Sexualized Behaviors Yes No Yes No Yes NoSexual Perpetrator History Yes No Yes No Yes NoSpecial Needs* Yes No Yes No Yes NoSubstance Abuse / Use Yes No Yes No Yes NoSubstance Abuse or Dependence with the need for medical detoxification Yes No Yes No Yes NoSuicidal Yes No Yes No Yes NoSuicidal Gestures Yes No Yes No Yes NoSuicidal Ideation Yes No Yes No Yes No


Does Applicant currently serve Children with this

If DFPS needed to place a Child with this characteristic,

If answer in second column is ‘No’, and the Child later Characteristic

Verbal Aggression – threaten, bully or other coercing, including threats of physical harm Yes No Yes No Yes NoOther: (Specify) Yes No Yes No Yes No

*Special Needs - means a Child with medical, mental, emotional, behavioral, or educational needs that could require extra on-going attention.

Behavioral Health Services

15. Identify the name(s) of the individual(s) providing behavioral health services and state the relationship that this person has with your Organization by indicating if they are a subcontractor, employee or neither of these. All therapists are required to be STAR Health providers.

16. Identify where Children’s current and archived records will be maintained and backed-up.

ORGANIZATIONAL STRUCTURE OF PROFESSIONAL , KEY MANAGEMENT, AND DIRECT CARE STAFF:

17. Attach a copy of your Operation's Board of Directors including:a. Full names; b. Titles; c. Addresses; d. Email addresses; and e. Phone numbers.

18. Attach a copy of your Operation's professional Organizational Chart that clearly depicts lines of authority.

19. Attach a copy of your Operation's professional staffing plan, which must contain:a. Minimum qualifications for the position; and b. The primary roles of that position.

Professional and Key Management Staff


20. What is the level of experience (in months or years) with fiscal and/or programmatic components of federal or state programs? If some positions are not applicable, indicate as such.

Position Experience Position ExperiencePresident/CEO Program Director Executive Director/Administrator

Treatment / Clinical Director

Comptroller/CFO LCCA or LCPAA

21. Attach current resumes and Professional Licenses for the President/CEO, Executive Director/Administrator, Comptroller/CFO, Program Director, Clinical Director, and Licensed Child-Care Administrator of the Operation for which you are submitting an Application.

22. Attach copies of licenses for any professional licensed employee of the organization including licensed professional therapists.

23. What is the annual turnover rate for professional and key management Staff within the last twelve (12) months?

FACILITY PLANT LAYOUT:

24. Attach the floor plan that you submitted to the DFPS Licensing Division.

25. Describe your facility’s living areas (example, carpeted, tiled, painted, decorated. etc.) and on campus recreational area if applicable.

26. Types of Precautions:

a. Identify / describe the safety precautions that have been instituted to protect the Children:

Inside Cameras Outside Cameras Fencing

Alarm system on door Alarm system on window Other

i. If "Other" Explain:

ii. If applicable, identify the locations of cameras and/or alarms.


b. Identify whether your facility is considered a locked or unlocked facility:

Unlocked Locked

iii. Is your facility used for detention purposes?

Yes No

iv. If the facility is a locked facility, can Children exit the facility without barriers in the event of a fire?

Yes No N/A

v. If no, describe the barriers to Children exiting the facility.

SLEEPING AREA :

27. Describe how the Children’s bedrooms are furnished (example: bunk beds, chest of drawers, carpet, tile, windows, etc.).

ON-SITE & OFF-SITE RECREATIONAL AREAS AND OPPORTUNITIES:

28. Check all applicable on-site recreational opportunities: Basketball Swing Set Volleyball Board Games Swimming Kickball Baseball Television Movies Video Games Art & Crafts Reading/Writing Playing Outside Ride Bike/Skateboard Music Soccer Football

Other:

29. Check all applicable off-site recreational opportunities. Festival/Theme Parks Mall Swimming Camping/Hiking Concerts Sporting Events Skating Local Park Movie Theater


Eating Out Field Trips Sports ParticipationOther:

FINANCIAL CAPACITY:

30. Identify the annual Internal Revenue Service (IRS) reporting forms your operation has:

a. Form 990

Yes No

b. Form 1065

Yes No

c. Form 1120

Yes No

d. Form 1040C

Yes No

e. Form 940

Yes No

f. Form 941

Yes No

If you answer “Yes”, submit a copy of that annual Internal Revenue Service (IRS) reporting form.



7.2 Required Forms

Forms must be closely read and carefully completed. A complete answer includes a written response and any supporting documents required by the form. In addition, “Not Applicable” is only an appropriate response to a question or form does not apply to an Applicant’s organization.

Applicants must complete and submit the forms in the format and order listed in the table below.

Notes

1. The application can be accessed via the link provided in the Required Form table below (hold down the "Ctrl" key while clicking on the link). Save the form on your computer, and complete the saved form as instructed.

2. A complete answer includes a written response and any supporting documents required by the form.

3. Forms must be completed and signed.Note: Review each form in its entirety to ensure that applicable sections are completed.

4. Forms requiring an original signature must be signed and saved in the electronic (Adobe Acrobat Files (.pdf)) copies and, if requested, submit hard copies of these forms to DFPS with original signatures.

5. Some forms may include special instructions or clarification provided under the name of the form in the column titled "Name."

6. If a form does not apply to you or your organization, mark the form "N/A", include your operation's name, signature (if required) and date, and save in the electronic copies.

Required FormsNumber Name Purpose Download2031 Signature Authority

DesignationDesignation of contract signature authority

2031.doc

http://www.dfps.state.tx.us/Application/Forms/showFile.aspx?NAME=2031.doc


Required FormsNumber Name Purpose Download2970c Disclosure and

Consent to Release of Information Regarding Criminal or Abuse/Neglect History For Applicants, Employees or Volunteers of DFPS Contractors and Subcontractors

Disclosure and release for contractor's staff

http://www.dfps.state.tx.us/documents/PCS/ABCSUserGuideFY09.pdf.

Form 2970c Word Document

2971c Request for Criminal History and DFPS History Check

Criminal history and DFPS check


Form 2971c Word Document

4109x Application for Texas Identification Number and Instructions

[If currently a Contractor with DFPS and a Texas Identification Number (TIN/Vendor ID #) is already set up, entering the Applicant’s name and writing “Already Set Up” at the top of the form is an acceptable response.]

Application for identification number

4109x Word Document

https://www.dfps.state.tx.us/Application/Forms/showFile.aspx?Name=4109x.doc

http://www.dfps.state.tx.us/Application/FORMS/showFile.aspx?Name=2971c.doc











Required FormsNumber Name Purpose Download4732 Request for

Determination of Ability to Contract

To determine DFPS' ability to contract with vendor based on conflict of interest rules

4732.doc

9007RCC Internal Control Structure Questionnaire (RCC)

[Note: This form is not required of Applicants interested in providing the services described in this Open Enrollment without payment.]

Contractor's disclosure of internal controls. Instructions included. 9007RCC.doc

9025a Related Party (Building & Transportation) Leases/Rental Worksheet

Allowable cost determination to related party 9025a.doc

7.3 RCC Contract Standard Terms and Conditions

The IPTP Contract is for informational purposes and for developing contract policies and procedures. If the Contractor is awarded a contract, DFPS will execute a resulting one. This IPTP Contract is not signed or submitted as part of the Application.

The Intensive Psychiatric Transition Program Services Residential Child-Care Contract FY2015 (Form Number 2282IPTP) can be located at:

Intensive Psychiatric Transition Program Residential Child-Care Contract FY2015


http://www.dfps.state.tx.us/PCS/Residential_Contracts/contract_forms.asp

http://www.dfps.state.tx.us/PCS/Residential_Contracts/contract_forms.asp

http://www.dfps.state.tx.us/Application/Forms/showFile.aspx?Name=9025a.doc

http://www.dfps.state.tx.us/Application/Forms/showFile.aspx?NAME=9007RCC.doc

http://www.dfps.state.tx.us/Application/Forms/showFile.aspx?NAME=4732.doc


8. ORGANIZATION OF APPLICATION

This document serves as a guide for the organization of application materials to be saved on each of the flash drives or compact discs.

1. Each flash drive or compact disc must be labeled as provided in Section 4.9.3 of this Open Enrollment.

2. This guide may not contain all items requested in the Open Enrollment.

3. The Applicant is ultimately responsible to submit all required materials in the order and format requested in the Open Enrollment.

4. File Folders should be named as indicated in the column labeled “ELECTRONIC FILE NAME”.

a. Documents in each File Folder must be saved as individual subfolders.

b. Subfolders must be made for each required and applicable document that may not be listed below.

FILE FOLDER 1: "Application" (Section 7.1.1 of this Open Enrollment)

ELECTRONIC FILE

NAMEDocument Is Document

Required Yes/No

Application Application for Enrollment Yes

FILE FOLDER 2: "Supporting Documentation" (Sections 7.1.1 and 7.1.2 of this Open Enrollment)

ELECTRONIC FILE


Required Yes/No

01-License DFPS License Yes10-Readiness Readiness Questionnaire Yes10.A-Board Board of Directors Yes, if

applicable.10.B-Org Chart Professional Organizational

ChartYes

10.C-Staffing Plan Professional Staffing Plan Yes10.D-Resume/

Professional LicensesResumes and Professional Licenses for Key

Yes


Management Staff

(Label applicable additional resumes accordingly, e.g. 10.H, 10.I, etc.)

10.E-Resume/ Professional Licenses

Yes, if applicable.

10.F-Resume/ Professional Licenses

Yes, if applicable.

10.G-Resume/ Professional Licenses

Yes, if applicable.

10.H-Floor Plan Operation’s Floor Plan Yes11-Balance Sheet Balance Sheet

(If in operation for one (1) or more years)

Yes

See Section 2.9.3

11.A-Income and Expense

Statement of Income and Expense


Yes

See Section 2.9.3

11.B-Changes in Financial Position

Statement of Changes in Financial Position


Yes

See Section 2.9.3

11.C-Cash Flows Cash Flows


Yes

See Section 2.9.3

11.D-Expenditures Capital Expenditures

(If available and in operation for one (1) or more years)

Yes

See Section 2.9.3

11.E-Audit Annual Audit


Yes, if available.

See subsection 2.9.3

11.F-Budget 12-Month Budget of Income and Expenses

(If in operation for less than one (1) year)

Yes


11.G-Funds Reserve Funds or Available Credit for Three (3) Months of Operation

(If in operation for less than one (1) year)

Yes


11.H-IRS Reporting Forms

Annual Internal Revenue Service (IRS) reporting

Yes, if Applicable.


Forms 990; 1065; 1120; and 1040C; 940; and 941 See subsection

2.9.311.I-Change Impacting

OwnershipChange impacting ownership within twelve (12) months prior to Application submission or is anticipated during the twelve (12) months following submission

Yes, if Applicable.


FILE FOLDER 3: "Required Forms" (Section 7.2 of this Open Enrollment)

ELECTRONIC FILE


Required Yes/No

01-Form 2031 Signature Authority Designation

Yes

02-2970c Release of Information Regarding Criminal or Abuse/Neglect History

Yes

02.A-2970c Executive Director Yes, if applicable.

02.B-2970c Chief Executive Officer Yes, if applicable.

02.C-2970c Comptroller Yes, if applicable.

02.D-2970c Chief Financial Officer Yes, if applicable.

03-2971c Request for Criminal History and DFPS History Check

Yes

03.A-2971c Executive Director Yes, if applicable.

03.B-2971c Chief Executive Officer Yes, if applicable.

03.C-2971c Comptroller Yes, if applicable.

03.D-2971c Chief Financial Officer Yes, if applicable.

04-Form 4109x Application for Texas Identification Number

Yes

05-Form 4732 Request for Determination of Ability to Contract

Yes

06-Form 9007RCC Internal Control Structure Questionnaire (ICSQ) for Residential Child Care

Yes

06.A-Attachment I-2 If yes, submit most current Yes


financial statement; or If no, submit current financial position

06.B-Attachment I-2C If yes, submit most recent tax return

Yes, if applicable.

06.C-Attachment I-3 If yes, submit current Audit; and Management letter (Only applicable to operations that have conducted annual audits)

Yes, if applicable.

06.D-Attachment I-7A If yes, submit copy of IRS Audit Report; and Related IRS correspondence

Yes, if applicable.

06.E-Attachment I-7D Description of IRS discrepancies or liens impacting operation’s financial position

Yes, if applicable.

06.F-Attachment I-8 If yes, submit a description of discrepancies and/or unresolved issues with the State Auditor’s Office (SAO)

Yes, if applicable.

06.F-Attachment I-9 If yes, submit procedures describing your process for safeguarding and securing confidential information

Yes, if applicable.

07-Form 9025A Related Party (Building & Transportation - Leases/Rental Worksheet)

Yes


Download - PEN Template - bidnet.com · Web viewThe electronic versions must be accessible, readable and saved as Microsoft Word files (See Section 4.9 of this Open Enrollment). Applicants

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