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APS-Medical/Mental Health Assessment ServicesProcurement Number: HHS0000022

Adult Protective Services

Provider Enrollment (PEN)

For

Medical/Mental Health Assessment Services

Procurement Number: HHS0000022

Enrollment Period Opens: June 1, 2015

Enrollment Period Closes: May 31, 2020

*HHSC may open, close or extend enrollment for DFPS Regions or counties within a Region as needs change.

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TABLE OF CONTENTS

1. GENERAL INFORMATION............................................................................................................41.1. INTRODUCTION.............................................................................................................................................41.2. POINT OF CONTACT....................................................................................................................................41.3. PROVIDER ENROLLMENT SCHEDULE.........................................................................................................51.4. AMENDMENTS AND ANNOUNCEMENTS REGARDING THIS PEN................................................................51.5. ELIGIBLE APPLICANTS.................................................................................................................................61.6. DELIVERY OF NOTICES...............................................................................................................................6

2. STATEMENT OF WORK................................................................................................................72.1. PROGRAM PURPOSE...................................................................................................................................72.2. NEED FOR SERVICE....................................................................................................................................72.3. ELIGIBLE CLIENT POPULATION AND CHARACTERISTICS...........................................................................72.4. SERVICE DELIVERY AREA(S)......................................................................................................................72.5. SERVICE DESCRIPTION...............................................................................................................................82.6. CLIENT RECORD DOCUMENTATION REQUIREMENTS..............................................................................102.7. PERSONNEL RECORDS.............................................................................................................................112.8. SERVICE AUTHORIZATION AND REFERRAL PROCESS.............................................................................112.9. CONTRACTOR QUALIFICATIONS................................................................................................................122.10. DFPS BACKGROUND CHECK POLICY......................................................................................................132.11. GENERAL REQUIREMENTS........................................................................................................................142.12. PERFORMANCE MEASURES......................................................................................................................15

3. UTILIZATION AND COMPENSATION.........................................................................................163.1. SERVICE UTILIZATION...............................................................................................................................163.2. AVAILABILITY OF FUNDS............................................................................................................................163.3. METHOD OF PAYMENT..............................................................................................................................163.4. COMPENSATION.........................................................................................................................................163.5. PROMPT PAYMENT....................................................................................................................................173.6. INVOICING PROCESS.................................................................................................................................17

4. HISTORICALLY UNDERUTILIZED BUSINESSES (HUB)..........................................................205. APPLICATION REQUIREMENTS................................................................................................21

5.1. PEN CANCELLATION/PARTIAL AWARD/NON-AWARD..............................................................................215.2. RIGHT TO REJECT RESPONSES OR PORTIONS OF REPONSES..............................................................215.3. AMENDMENTS TO RESPONSES.................................................................................................................215.4. JOINT RESPONSES....................................................................................................................................215.5. WITHDRAWAL OF RESPONSES..................................................................................................................215.6. DEBRIEFING...............................................................................................................................................215.7. PROTEST PROCEDURES...........................................................................................................................215.8. WRITTEN QUESTIONS...............................................................................................................................215.9. APPLICATION SUBMISSION INSTRUCTIONS...............................................................................................22

6. SCREENING AND AWARD.........................................................................................................256.1. SCREENING................................................................................................................................................256.2. BEST VALUE FACTORS.............................................................................................................................256.3. NON-RESPONSIVE APPLICATIONS............................................................................................................266.4. CORRECTIONS TO APPLICATION...............................................................................................................266.5. REVIEW AND VALIDATION OF APPLICATIONS...........................................................................................266.6. ADDITIONAL INFORMATION........................................................................................................................27

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1. General Information

1.1. IntroductionThe Health and Human Services Commission (HHSC) on behalf of The Department of Family and Protective Services (DFPS) Adult Protective Services (APS) solicits applications from qualified individuals and organizations to provide services in accordance with the specifications contained in this Provider Enrollment (PEN).

1.1.1. DFPS MissionThe 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.

1.1.2. Provider Enrollment (PEN) and Resulting ContractThe contracts resulting from this PEN consist of this solicitation document, the Application (Form 2280PEN, Application and Contract) and supporting documents submitted by the Applicant, any contract plans, the HHSC Uniform Terms and Conditions (UTCs), and all attachments and forms named and incorporated by reference.

1.1.3. Terms and ConditionsThe terms and conditions outlined throughout this solicitation govern the PEN andany resulting contract. Any Contract awarded under this PEN includes the:

HHSC Uniform Terms and Conditions V. 2.14, available in Package 12 on this Enrollment’s main page;

Vendor General Affirmations, available in Package 13 On this Enrollment’s main page; and

DFPS Special Attachment, Form 5622, available in Package 14 on this Enrollment’s main page.

Subcontractors must also comply with applicable Uniform Terms & Conditions.

1.1.4. Effective Date of ContractThe effective date of a contract awarded from this PEN will be no earlier than September 1, 2015 and as indicated by the date entered by DFPS, after contract award, on Form 2280PEN Application and Contract.

1.2. Point of ContactThe sole point of contact for inquiries concerning this PEN is:

Dianne EstradaDFPS-APS Regional Contracts Program DirectorPhone: (210) 834-3882Email: [email protected]

Mailing Address: Department of Family and Protective Services APS 14000 Summit Drive

Office 1105, Mail Code: 0165Austin, TX 78728

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mailto:[email protected]


Applicant must direct all communications and questions relating to this PEN to the HHSC Point of Contact named above.

1.3. Provider Enrollment ScheduleAll dates are subject to change at the discretion of HHSC and DFPS to meet the needs of the clients served by this PEN.

Table 2 - Procurement SchedulePEN Enrollment Period Opens1 June 1, 2015PEN Enrollment Period Closes2 May 31, 2020

Anticipated Contract Start DateApproximately Sixty days (60)

after all screening requirements are met.

1.3.1. Adjustments to Closing DateHHSC reserves the right, at its sole discretion and without additional notice, adjust the closing date for the entire PEN, a specific Region, or a specific service delivery area within a Region to meet the needs of DFPS. Any adjustment made to this solicitation will be made via a posted amendment to this PEN.

1.3.2. Re-Opening PENHHSC reserves the right, at its sole discretion and without additional notice, close or re-open the enrollment period for the entire PEN, a specific Region, or for a specific service delivery area within a region to meet the needs of DFPS. Any adjustment made to this solicitation will be made via a posted amendment to this PEN.

1.4. Amendments and Announcements Regarding this PENHHSC will post all official communication regarding this PEN on the HHS Open Enrollment Opportunities web page. HHSC reserves the right to revise and correct the PEN including minor grammatical, organizational and clerical errors at any time. Any adjustment made to this solicitation will be made via a posted amendment to this PEN. It is the responsibility of each Applicant to comply with any changes, amendments, or clarifications posted to the HHS Open Enrollment Opportunities web page. Applicants must check the HHS Open Enrollment Opportunities web page frequently for changes and notices of matters affecting the PEN.

Applicant or Contractor’s failure to periodically check the HHS Open Enrollment Opportunities web page will in no way release awarded Contractors from “addenda or additional information” resulting in additional costs to meet the requirements of the PEN.

1.5.Eligible ApplicantsDFPS is authorized to enter into contracts with entities that are:

1 HHSC accepts applications throughout the enrollment period. Award recommendations are made, as screening is completed, to DFPS. Applicants should not wait until the end of the enrollment period to submit applications.2 HHSC may adjust the enrollment period as necessary to meet the needs of DFPS/APS. If HHSC or DFPS determines that it is in their best interest to adjust the enrollment period as a whole or for a specific service delivery area, an amendment will be posted the HHS Open Enrollment Opportunities web page.

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1.5.1. Not debarred or suspended from participating in Federal contracts;

1.5.2. Not barred from participating in state contracts under Government Code § 2155.077; and

1.5.3. Meet qualifications as stated in Section 2.10 Contractor Qualifications.

1.6.Delivery of NoticesAny notice required or permitted under this Contract by one party to the other party must be in writing and correspond with the contact information noted in this section. At all times, Contractor will maintain and monitor at least one active electronic mail (email) address for the receipt of Contract-related communications from DFPS. It is The Contractor's responsibility to monitor this email address for Contract-related information.

The remainder of the page is intentionally left blank.

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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


2. Statement of Work

2.1.Program PurposeDFPS, through the APS program, protects persons age 65 or older and adults with disabilities from abuse, neglect, and exploitation by investigating and providing or arranging for services necessary to alleviate or prevent further maltreatment.

2.2.Need for ServiceThe purpose of this Contract is to improve the Adult Protective Services (APS) Division of DFPS access to professionals to conduct medical and mental health assessments. The goal of the Contract is to obtain: (1) medical and mental health assessments to support DFPS staff in making decisions about the presence/absence of abuse/neglect during investigations and (2) Court Related services by provision of expert testimony.

DFPS does not guarantee any minimum level of utilization or specific number of referrals. Utilization rate will vary according to the needs of staff, individual client needs, and regional allocations. The final decision for use, partial use, and non-use of these professional services lies within the authority of DFPS.

2.3.Eligible Client Population and CharacteristicsDFPS purchases Medical or Mental Health Assessment Services for persons in an open APS case. Clients will be alleged victims of physical and/or sexual abuse, medical, mental or physical neglect, or financial exploitation. DFPS staff will refer such individuals to selected Contractors through issuance of a service authorization.

2.3.1. Client characteristics may include:2.3.1.1. Questionable capacity to consent.2.3.1.2. Refusal to make adjustments to eliminate continued financial

exploitation.2.3.1.3. Refusal to accept assistance to alleviate abuse/neglect.2.3.1.4. Lack of mental or medical care for a long period due to:

2.3.1.4.1. no connection with a health care system or provider; or inability to see his or her own licensed healthcare provider in a timely way because of scheduling difficulties or licensed healthcare providers being unavailable; or

2.3.1.4.2. reluctance to leave home to visit a doctor's office, clinic, or hospital.

2.3.1.5. Persons suffering from a negligent act or omission.2.3.1.6. Possible misdiagnosis, over-medication, or inadequate care by an

individual responsible for providing services.

2.4.Service Delivery Area(s)

***NOTE: Only Region 10 is open for new applications, effective 3/1/2017.***

The PEN for Medical/Mental Health Assessment Services is released on a statewide basis; however, contracts are awarded on a regional basis. Contracts are for the DFPS Region specified in the map below. Regions are further divided into specific service delivery areas referred to as catchment areas. Catchment areas consist of a

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county as specified in the Service Delivery Area detail page for Region 10, available in Package 3 of this enrollment’s main page.

DFPS reserves the right to adjust the service delivery areas at any time through a formal amendment to this solicitation in order to meet the client service needs of DFPS.

It is expected that services will primarily be provided in the Client’s home (home-based) unless otherwise requested to be provided at an alternate location specified by the APS Specialist. DFPS will not reimburse for time required to travel to and from the site of service.

2.5.Service DescriptionThe Contractor will conduct, document, and submit a complete written assessment. The complete assessment must be sufficient to respond to the presenting issues and provide appropriate substantiation for the resulting conclusions. In addition, the Contractor will, at the request of DFPS, provide court related services. Court related services are not optional.

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2.5.1. Medical or Mental Health Assessments. A complete client specific Medical or Mental Health assessment includes:

2.5.1.1. Face-to-Face interview and assessment with the client conductedby a medical or mental health professional that meets the minimum qualifications in this PEN. This includes a clinical interview, an assessment of medical history, a mental status exam, and treatment recommendations; 2.5.1.2. The written completion of the applicable Exhibit A, (available in Package 11 on this Enrollment’s main page) when requested by the APS Specialist;

2.5.1.3. A written statement provided while on-site, when requested by the APS Specialist documenting an opinion as to the client’s:

2.5.1.3.1. capacity to consent, or 2.5.1.3.2. a recommendation for further testing or treatment, including

an explanation that substantiates its necessity; and2.5.1.4. A typewritten interpretation of the findings that will include:

2.5.1.4.1. The date the referral was received.2.5.1.4.2. The date, start, and end time of the assessment, and the

location and setting where it was performed;2.5.1.4.3. A description of the current and historical medical and/or

mental condition of the client;2.5.1.4.4. The name of the tests that were performed as deemed

necessary by the examiner or specified by the APS Specialists, which may include, but are not limited to, the following:

2.5.1.4.4.1. Memory Assessment,2.5.1.4.4.2. Mood Assessment,2.5.1.4.4.3. Mobility Assessment,2.5.1.4.4.4. Medication Review, or2.5.1.4.4.5. Medical history;

2.5.1.4.5. The interpretation of the test, which must include narrativedescriptions of the findings of the tests;

2.5.1.4.6. Any recommendation for further testing or treatment,including an explanation that substantiates its necessity;

2.5.1.4.7. An opinion as to the client's capacity to consent;2.5.1.4.8. The name and credentials of each provider involved in the

preparation, administration, and interpretation of the test; and

2.5.1.4.9. Dated signature of the professional who conducted theassessment. If the professional is a Registered Nurse, the assessment must also contain the signature and date (month/day/year) of the supervising Physician.

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2.5.2. Exhibit A. The APS Specialist will request the completion of the applicableExhibit A (available in Package 11 on this Enrollment’s main page) before seeking an emergency order for protective services to take necessary actions to protect a client in a life-threatening, emergency situation when the client appears to be unable or unwilling to give consent. Exhibit A is used to document the medical/mental health professional’s opinion stating whether the client lacks the capacity to consent to or refuse services. Exhibit A is considered part of a full assessment; however, it will be completed only when requested by the APS Specialist and will be submitted prior to the full assessment when requested.

2.5.3. Missed, Declined or Cancelled Appointments2.5.3.1. Missed and declined appointments are defined as services scheduled

to be conducted at an agreed upon time by both parties and attempted, but resulted in the client’s decline of services, uncooperativeness, or inability to participate at the scheduled time, or the client not being present.

2.5.3.2. Delay in beginning the Assessment session. It is possible that theClient may not be able to provide access to the home immediately upon making the service provider’s presence known. The Contractor must wait 15 minutes on site before departing. The actual time waiting (not to exceed 15 minutes) and the time spent face to face conducting the Assessment is billable as long as it does not exceed the 3 hour limit per assessment.

2.5.3.3. The Contractor will notify the APS Specialist in writing within 24hours of the missed or declined appointment.

2.5.3.3.1. The report documentation requirements are asfollows:

2.5.3.3.1.1. The circumstances that resulted in theinability to conduct the assessment,

2.5.3.3.1.2. The location, date, and time of thescheduled appointment;

2.5.3.3.1.3. The time of arrival and departure from the location of the scheduled appointment;

2.5.3.3.1.4. The signature, credential and date indicatedby the professional who attempted the assessment;

2.5.3.3.1.5. Method, date, and time notification sent to the APS Specialist.

2.5.3.4. Cancelled Appointments. Appointments in which the APS Specialisthas notified the Contractor at least twenty-four (24) hours prior to the appointment time to cancel the appointment. The notification will be by e-mail or verbal.

2.5.3.4.1. Contractor must document notifications of cancellation by APS workers in the client file.

2.5.3.4.2. Cancellations without 24 hour notification will be reimbursable.

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2.5.4. Court Related Services. The Contractor will provide expert testimony in court cases, at the Department's request. DFPS considers court related services as a required and necessary component of the total service array of this solicitation. As such, services performed under this contract are not considered complete until the court related services component has been completed or determined by APS as unnecessary.

2.5.5. Court related services include:2.5.5.1. The appearance or other appropriate mode of participation by a

licensed professional in a court setting for the purpose of testifying on behalf of DFPS; and/or,

2.5.5.2. The provision of a deposition or other testimony given outside of court while under oath to be used in court, when requested on behalf of DFPS.

2.5.6. Contractor must include the following documentation to DFPS when billing for the provision of Court Related Services:

2.5.6.1. The location, date, and time of the service;2.5.6.2. The time of arrival and departure from the location where services

were provided;2.5.6.3. The name and credential of the professional who testified.

2.6.Client Record and Documentation Requirements The Contractor must maintain individual client files that include, but are not limited to:

2.6.1. Form 2311 Service Authorization Form authorizing the service; 2.6.2. Any individual case information provided by DFPS, 2.6.3. Completed Assessment, 2.6.4. As applicable, Exhibit A, 2.6.5. Contractor must document the time and date that the Contractor received the

request for services consistent with the manner of receipt of the request by:2.6.5.1. Maintaining the email (with a clearly visible receipt date and time

notation), or 2.6.5.2. Utilizing a Time and Date stamp on the Form 2311, and 2.6.5.3. As applicable, documenting the date and time verbal request

received.2.6.6. Documentation of any incidents of missed, canceled, or declined

appointments to include supporting documentation of the notification to the APS Specialist, and

2.6.7. Documentation to support the delivery of court related services.

2.7.Personnel RecordsService provider records must support all Contractor Minimum requirements for Staff, Subcontractors, and Volunteers with regards to qualifications, insurance, and current background checks. DFPS reserves the right to require additional records as needed.

2.8.Service Authorization and Referral ProcessAPS Staff will authorize Assessment Services by issuing a DFPS Service Authorization, Form 2311. When seeking a protective order and requesting an

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Exhibit A, APS Staff may verbally authorize a referral; however this does not take the place of a Form 2311, written authorization, which will be forwarded within 1 business day of the verbal request.

2.8.1. Authorization FormOnly services provided as authorized on a DFPS Service Authorization, Form 2311 may be billed.

2.8.1.1. Contractor must maintain Form 2311 authorizing the service in each client's record as basis for payment from DFPS;

2.8.1.2. The following claims will be subject to non-payment or collection if payment has already been made:

2.8.1.2.1. Service types not authorized; 2.8.1.2.2. Services delivered by a person not meeting the minimum

qualifications; 2.8.1.2.3. Service claims that exceed the number of units (3) or fall

outside the timeframes specified on the Form 2311; 2.8.1.2.4. Services claimed and not provided;2.8.1.2.5. Services claimed without adequate supporting

documentation.2.8.2. Referral Information

Contractor must follow any case specific instruction provided in the Comments section of the Form 2311.

2.8.3. Initiating ServicesThe Contractor must submit the written complete assessment within three (3) business days of receipt of the referral. DFPS anticipates that emergency situations may occur requiring a need for expedited services. Expedited services may include the completion of a written opinion regarding capacity and recommendation for necessary treatment or testing, due immediately on-site; Exhibit A, due within one (1) business day unless an emergency which will require the completion at the time of conducting the assessment; followed by a full written assessment due within three (3) business days. The Contractor must work closely with DFPS to expedite service delivery when requested by the APS Specialist.

2.9.Contractor QualificationsIn order to provide services and receive payment for services rendered, each direct service provider (whether staff or subcontractor) must meet and maintain the minimum licensure and credential requirements. Medical or Mental Health professionals conducting assessment services will be appropriately licensed by the State of Texas to provide the service and perform the acts specified in this Contract. Each Professional must maintain his/her license in good standing during the term of the Contract.

2.10. Licensure and CredentialsCredentials by Region - Medical Assessments

DFPS Region

1 2 3 4 5 6 7 8 9 10 11

Physician X X X X X X X X X X X

Physician Assistant X X X X XAdvanced Practice X X X X X X X X

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Nurse

Registered Nurse* X X X X X X X

* Must be completed under the supervision of a Physician

Credentials by Region - Mental Health Assessments

DFPS Regions

1 2 3 4 5 6 7 8 9 10 11

Physician X X X X X X X X X X X

Psychiatrist X X X X X X X X X X X

Psychologist X X X X X X X X X XLicensed Clinical Social Worker X X X X X XLicensed Master Social Worker X X X XLicense Professional Counselor X X X X X

2.10.1. The person conducting the assessment must at all times be respectful of the client’s culture, lifestyle, and traditions. The person conducting the assessment must:

2.10.1.1. keep scheduled appointments; 2.10.1.2. be on time; 2.10.1.3. not be accompanied by persons not participating in the assessment;2.10.1.4. provide the Client their undivided attention while conducting the

assessment, and 2.10.1.5. be respectful of the Client’s home by not engaging in disrespectful

behavior such as smoking. 2.10.2. DFPS retains its right, as its sole discretion, to approve or disapprove the

provision of services by any licensed professional.2.10.3. Annually, the Contractor will submit a current listing of service providers to

the DFPS Contract Manager in the format requested.

2.11. DFPS Background Check PolicySection 411.114 of the Texas Government Code and agency policy, found at the link below, require DFPS to conduct Criminal and Abuse/Neglect/Exploitation Background Checks on Contractors and on each employee, subcontractor, or volunteer who will be involved in direct delivery of services to DFPS clients under a contract or will have access to personal client information. Contractor must maintain and recheck records every 24 months.

http://www.dfps.state.tx.us/PCS/Contract_Handbook/Chapter_5/5-08-back_ground_check.asp

2.11.1. Contractor must collect information necessary to run background checks via Forms 2970c and 2971c. It may be necessary for the Contractor to obtain additional information from the employee, subcontractor, or volunteer if the person does not live in Texas or has recently lived outside of Texas in another state.

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2.11.2. Contractors will submit criminal abuse and neglect history information for background checks electronically through the DFPS Automated Background Check System (ABCS) according to the instructions in the user guide located at:

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

2.11.3. SubcontractorsA subcontract is a written contract that assigns some of the obligations of a prime contractor to the subcontractor. Subcontracts are between a primary contractor and the individual or entity assuming some of the obligations of the primary contractor. The requirements in this section are in addition to requirements stated in the HHSC Uniform Terms and Conditions (UTCs).

The prime contractor remains fully responsible for compliance with and full performance of all its duties and obligations under the original contract with DFPS. All activities associated with subcontracts must go through the prime contractor.

2.12. General Requirements

2.12.1. Minimum Insurance Requirements In order to mitigate risk under this Contract, DFPS will require the Contractor to submit required verification of insurance/bond coverage that meets or exceeds current minimum DFPS insurance requirements and provide a completed Certificate of Insurance Form 4736 or equivalent for each policy currently in force and referenced within, before this Contract is finally executed.

2.12.2. 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.

2.12.3. All required insurance policies will include an endorsement stating that the Department will be given thirty (30) calendar days written notice of policy or bond cancellation or a material change in the policy or bond. If a Contractor is unable to obtain applicable coverage after completing good faith efforts that have been documented in the contract file, the Contractor will bear the cost of any losses during the entire term of the agreement.

2.12.4. If the coverage will be provided through a Self-Insurance Plan, then the plan submitted has to demonstrate that it meets or exceeds these requirements.

2.12.5. 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.

2.12.6. The Contractor will provide DFPS with documentation that meet these requirements; DFPS reserves sole discretion to determine whether a document provided to DFPS meets the current minimum insurance requirements, coverage and/or limits.

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


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

2.12.7.1. 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 $1,000,000 per occurrence, and $2,000,000 aggregate.

2.12.7.2. 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. Sole Proprietors, with no employees are exempt from this insurance requirement.

2.12.7.3. Professional Liability insurance or equivalent insurance coverage to cover losses from errors and omissions during professional services with a minimum limit of $1,000,000 per occurrence, and $2,000,000 aggregate.

2.12.8. Contractor Notice to DFPS of Any Material ChangesContractor 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.

2.12.9. Renewals or New Coverage during Contract PeriodContractor 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.

2.12.10.Request for DocumentsContractor will provide any required documents under this Subsection without expense or delay to DFPS.

2.13. Performance Measure

The Contractor will achieve the measure, as stated below, for the term of the Contract. Measures, indicators, targets, data sources, or methodologies are subject to change during the Contract period or at renewal.

DFPS will track Contractor performance throughout the term of the Contract.

Performance measure data may be used by DFPS to make decisions about Contract status, to adjust the nature and intensity of DFPS' Contract monitoring and quality assurance activities, and to keep stakeholders informed about the success of the contracting effort. The Contract Performance measure is:

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OUTCOME #1: Contractor delivers quality services in a professional and respectful manner.PERFORMANCE PERIOD: Contractor performance for this outcome is determined for one or more of the following semi-annual performance periods, wholly or partially, depending on the contract start and end dates: September 1 through February 28/29; March 1 through August 31.INDICATOR: Percentage of unduplicated clients served without validated complaintsTARGET: 90%PURPOSE: To evaluate the Contractor’s approach in service deliveryDATA SOURCE: DFPS Contracts Complaint Data; DFPS IMPACT DataMETHODOLOGY: The numerator is the total number of unduplicated clients served during the performance period minus the total number of validated complaints reported during the performance period. The denominator is the total number of unduplicated clients served during the performance period. Divide the numerator by the denominator, multiply by 100 and state as a percentage.


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3. Utilization and Compensation

3.1. Service UtilizationActual level of utilization or specific number of clients referred will vary. DFPS does not guarantee utilization or any level of utilization to any specific Contractor.

3.2. Availability of FundsFunding is not guaranteed at any level. Payment is based on utilization and will fluctuate throughout the term of the contract.

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

3.3. SequestrationSequestration refers to automatic spending cuts required under the Federal 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 are set to begin January 2, 2013, and continue for the next 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 service has the potential to be impacted by these budget cuts.

3.4. Method of PaymentPayment will be a Fee-for-Service payment methodology based on unit rates accepted by DFPS. The Contractor agrees to this basis for payment and to adhere to the fiscal and billing policies and procedures of the Department. DFPS is not obligated to pay more than the contracted rates for delivery of services. The Contractor must not claim for services not provided.

3.5. CompensationContractor will be compensated according to the Fee Schedule found in Attachment A. Service Delivery Area Detail and under the following circumstances:

3.5.1. Billing RequirementsThe unit of service for an assessment and court testimony is hourly, billed at fifteen (15) minute increments. The maximum number of units that can be claimed for a complete assessment is three (3) hours.

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3.5.2. Unit of Service Payment is based on a unit rate for each “unit of service" The time and expense of travel to and from the site of service delivery or court related services are included in the unit rate.

Unit of Service Additional InformationMedical/Mental Health Assessment

Per hour or any part of an hour billed in 15 minute increments.

Per Client Per Complete Assessment.

Completion of the applicable Exhibit A, when requested by the

APS Specialist

Actual time to complete the client interview/assessment and the written interpretation of findings.

Not to exceed 3 hours.

*Missed, Declined or Cancelled Appointments

Flat Fee Claimable cancelled appointments are those cancelled without a 24 hour notice. The service provider must remain on site for 15 minutes.

Court Related Services

Per hour or any part of an hour billed in 15 minute increments.

Allowable and billable only when it is at the request of DFPS

Claimable time is actual time spent testifying or participating in mediation activities.

Any non-billable service or billable services not supported by documentation in the client’s record, such as notations of the session beginning and ending times, location, full dates, or signature of performing provider, are subject to recoupment.

3.1. Prompt Payment

Pursuant to Texas Government Code, Subtitle F, §2251.021, the DFPS will make payments within thirty (30) days of receipt of a correct invoice and any required support information. In addition, DFPS will pay any interest due on overdue payments according to the provisions of Texas Government Code, Subtitle F, §2251.026.

3.2. DFPS will not provide cash advances to Contractors.

3.3. Invoicing ProcessThe Contractor will submit to DFPS a total bill each month in the format prescribed by the Department, and will accept as payment in full the contracted unit rate.

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3.3.1. Instructions for Invoicing DFPSNo payment whatsoever shall be made under this Contract without the prior submission of detailed, correct invoices mailed to the regional Contract office. All billing documents must be developed specific to the month of service which includes a completed and signed/dated Pre-bill For Delivered Services Report, Form 4116 (Purchase Voucher), and when applicable a Delivered Services Input (Form 2016) and any other supporting documentation requested by the Department.

3.3.1.1. Pre-BillEach month, The Contractor will receive a DFPS pre-bill. This report lists all authorizations active during the previous month of service (applicable month shown in the upper right corner).

3.3.1.1.1. The Contractor will enter the following information on the pre-bill next to the name of each client that received services:

3.3.1.1.1.1. Appropriate Rate for type of service provided (refer to Fee Schedule) NOTE: If the client is listed more than once on the pre-bill, make the entry on the line consistent with the begin/end dates that cover the dates of service being billed;

3.3.1.1.1.2. Quantity (# of units provided: Assessments - not to exceed 3 units, claimed in quarter unit increments; Court Related Services - actual # of hours spent testifying or waiting to testify, in quarter unit increments; 1 unit for missed/declined/applicable cancelled appointments);

3.3.1.1.1.3. Fee Paid (leave blank);3.3.1.1.1.4. Amount: (total of “Applicable Rate” x “Quantity”)

3.3.1.2. VoucherThe Contractor must complete State of Texas Purchase Voucher, Form 4116X by entering:

3.3.1.2.1. Service Month and Year (#19), 3.3.1.2.2. Total Amount being claimed (#13 & #23), and3.3.1.2.3. Name and Phone Number of person that prepared the billing

(#24). 3.3.1.3. Supplemental Claims

Claims for services provided in a prior month and not yet billed or for Clients who received services but the name does not appear on the pre-bill The Contractor follows the process for submitting a supplemental claim. The Contractor completes a Form 4116X see above, attaches a copy of the Form 2311 for each service being claimed, and completes a Delivered Services Input (Form 2016) entering the following information:

3.3.1.3.1. Service Month/Year (in upper right);3.3.1.3.2. Client Last Name;3.3.1.3.3. Client First Name;3.3.1.3.4. Client Number (Same as Person I.D. on Form 2311);3.3.1.3.5. Service Code;3.3.1.3.6. Applicable Rate (from Fee Schedule);

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3.3.1.3.7. Quantity (# of units provided: Assessments - not to exceed 3 units, claimed in quarter unit increments; Court Related Services - actual # of hours spent testifying or waiting to testify, in quarter unit increments; 1 unit for missed/declined/applicable cancelled appointments);

3.3.1.3.8. Amount (total of “Applicable Rate” x “Quantity”)3.3.1.3.9. County;3.3.1.3.10. Form 2311 Begin Date; and3.3.1.3.11. Form 2311 Term Date.

3.3.2. Due DateInvoices must be received at the designated DFPS contract office. Failure to submit invoices on time may be considered a contract compliance issue and may result in contract action up to terminating the contract. The Contractor must submit the following forms with original signature and date by the 15th of the month following the month of service delivery:

3.3.2.1. Form 4116X (sign in box labeled “Vendor Certification”);3.3.2.2. Pre-bill (sign and date last page); and 3.3.2.3. When a supplemental is necessary, the Form 2016 (sign and date

bottom of page).

3.3.3. Provider StatementThe Contractor will receive a Provider Statement that identifies each client and the applicable service and dollar amount paid by DFPS for each specific payment issued to The Contractor. The Contractor is encouraged to review the following information on the Provider Statement to reconcile their claim:

3.3.3.1. “Invoice Number” on Pre-bill (in the upper right corner); and3.3.3.2. The services claimed and compensated.

To view payments made to your Financial Institution for direct deposit or warrants issued proceed to the State Comptroller website: https://ecpa.cpa.state.tx.us/vip/MainMenu.jsp


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https://ecpa.cpa.state.tx.us/vip/MainMenu.jsp


4. Historically Underutilized Businesses (HUB)

DFPS adheres to the administrative rules, policies, and forms developed by the Health and Human Services Commission relating to Historically Underutilized Businesses (HUBs). This PEN does not require Respondents to complete a HUB Subcontracting Plan.

The estimated value of the individual contract under this PEN is not expected to reach $100,000; therefore, applicants are not required to submit a HUB Subcontracting Plan (HSP) with their application. If subcontractors are used in the delivery of the services, the awarded contractor 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.

In the event the contract resulting from this PEN meets or exceeds the $100,000 threshold DFPS will require The Contractor to make a “Good Faith Effort” to comply with the HUB requirements through the development and submission of the HSP.

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.


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5. Application Requirements

5.1.PEN Cancellation/Partial Award/Non-AwardAt its sole discretion, HHSC may cancel this entire PEN make partial award or no awards.

5.2.Right to Reject Responses or Portions of ReponsesAt its sole discretion, HHSC may reject any and all responses or portions thereof.

5.3.Amendments to ResponsesApplicants have the right to amend their responses at any time prior to contract award by submitting a written amendment to the Point of Contact, as designated in §1.2 that is prior to:

5.3.1. The date of contract award notification; and

5.3.2. The closing of the enrollment period, as designated in §1.3.

5.4.Joint ResponsesHHSC will not consider joint or collaborative responses that require it to contract with more than one Applicant.

5.5.Withdrawal of ResponsesApplicants have the right to withdraw their Application from consideration at any time prior to contract award, by submitting a written request for withdrawal to the Point of Contact, as designated in §1.2.

5.6.DebriefingAn unsuccessful Applicant may request a debriefing which is an informal review of a non-award during which DFPS provides information concerning the strengths and weaknesses of a response application. Although an unsuccessful applicant may request an oral debriefing, the written debriefing serves as the official response.

5.7.Protest ProceduresThe 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.

5.8.Written Questions

5.8.1. FormatAll questions and comments regarding this PEN must:

5.8.1.1. Be submitted electronically to the HHSC Point of Contact identified in §1.2;

5.8.1.2. Reference the appropriate PEN page and section number;5.8.1.3. Be received no later than thirty (30) days prior to the PEN enrollment

period closing date set forth in the Procurement Schedule in §1.3.

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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


5.8.2. Response to QuestionsHHSC may post responses to written questions on HHS Open Enrollment Opportunities web page. website. Once posted on HHS Open Enrollment Opportunities web page. website, responses are binding on HHSC, DFPS and any Applicants.

5.8.2.1. All questions received may not be answered.5.8.2.2. Similar questions may be combined prior to response.5.8.2.3. Answers may be amended at any time prior to the PEN enrollment

period closing date.5.8.2.4. HHSC reserves the right to review questions, and determine

applicability prior to inclusion on the posted Question and Answer document.

5.8.2.5. Questions received after the due date may be reviewed by HHSC but will not receive a response.

5.8.2.6. Prior to inclusion and posting of questions HHSC considers the following factors:

5.8.2.6.1. Applicability to the PEN;5.8.2.6.2. Applicability to other possible Applicants to the PEN; and5.8.2.6.3. Impact on Applicants’ approach to providing deliverables.

It is the responsibility of interested parties to periodically check the HHS Open Enrollment Opportunities web page for updates to the procurement prior to submitting an application. The Applicant’s failure to periodically check the HHS Open Enrollment Opportunities web page. will in no way release the Applicant from “addenda or additional information” resulting in additional costs to meet the requirements of the PEN.

5.9.Application Submission InstructionsIt is Applicant’s responsibility to appropriately mark and deliver the application and related materials in response to this PEN by the response due date. Submission of an application does not execute a contract.

DO NOT submit an Application by both email and regular mail or delivery service.

5.9.1. Electronic SubmissionPreferred method of application submission is by email sent to:

[email protected]

5.9.1.1. Subject LineWhen submitted via email the electronically submission subject line should include: “PEN HHS0000022 - Legal Name of Entity”

5.9.1.2. Organization of Electronic ResponseApplicant must organize and submit electronically scanned and signed copy of its application in the following order and format.

5.9.1.2.1. Application and Contract, and Service Delivery Area FormAll information must be provided as requested by the application form. Incomplete/partial applications may not be accepted. Application MUST BE SIGNED.

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mailto:[email protected]

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

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


5.9.1.2.1.1. The Form 2280PEN, Application and Contract will be its own attachment named “Application”,

5.9.1.2.1.2. Service Delivery Area Form.5.9.1.2.2. Supporting Documentation

Supporting documentation will be its own attachment, such as credentials, insurance, and other requested documentation in the same order as requested in Form 2280PEN, Application and Contract

5.9.1.2.2.1. Scan in the same order as the request appears in the Form 2280PEN and Service Delivery Area Information.

5.9.1.2.2.2. Name this attachment “Supporting Documentation”.

5.9.1.2.3. Required Forms 5.9.1.2.3.1. Applicant must return all required forms with the

application response, as listed in Table 5 below;5.9.1.2.3.2. Forms must be signed where applicable; and 5.9.1.2.3.3. Scanned in the same order as requested in the

Required Forms list in Table 5 below;5.9.1.2.3.4. Name this attachment “Required Forms”.

5.9.1.3. Additional Requirements5.9.1.3.1. Each document, as appropriate must bear original

signatures where indicated.5.9.1.3.2. The name of the Applicant must appear at the top right hand

corner of each page;5.9.1.3.3. The solicitation number must appear at the top right hand

corner of each page under the Applicant's name;5.9.1.3.4. All pages must be collated;5.9.1.3.5. All pages must be sequentially numbered.

5.9.2. Alternate Submission Regular Mail (Paper Copy PLUS Flash Drive)

DO NOT submit an Application by both email and regular mail or delivery service.

Regular U.S. Mail, delivery service, or courier submission may be used to submit the completed Application, supporting documentation, and attachments as per the guidelines in this section.

5.9.2.1. One (1) original set of the application, related documentation and forms. Documents must be placed in a package and correctly identified with the PEN number and follow the additional guidelines in §5.9.1.1 – §5.9.1.3.5. It is Applicant’s responsibility to appropriately mark and deliver the application and related materials in response to this PEN.

5.9.2.1.1. The entire application package must be packaged in one or more Letter Size folders.

5.9.2.1.2. Label the folders as follows:

Line 1: Applicant/Organization NameLine 2: HHS0000022 – APS Medical/Mental Health Assessment Services

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For each set, include the following labeled dividers and place response items behind the appropriate divider:

Table 5 - Dividers Within Expandable FoldersDivider Label Items

Application -Form 2280PEN, Application and Contract; -Service Delivery Area Form

Supporting Documentation Supporting documents required by Form 2280PEN

Required Forms

- 1513 Disclosure of Ownership and Control Interest Statement- 2970c Disclosure and Consent to Release of Information Regarding Criminal or Abuse/Neglect- 2971c Request for Criminal History and DFPS History Check- 4108x Vendor Direct Deposit Authorization- 4109x Application for Texas Identification Number/Additional Mailing Address, as applicable- 4736 Certificate of Insurance- 9007FFS Internal Control Structure Questionnaire (ICSQ) for Fee for Service Contracts-Other supporting documents as required by any of the Forms

Digital Copies Digital media as appropriate, see §5.9.2. for additional detail related to digital copies

5.9.2.1.3. Digital CopyApplicant is required to submit with the paper copy a flash drive with a copy of the complete application in the same file format as the electronic response submission in §5.9.1.

5.9.2.1.3.1. Label the Digital Media DeviceEach device must be labeled with the:

5.9.2.1.3.1.1. Name of the Applicant; and5.9.2.1.3.1.2. Procurement number.

5.9.2.2. Delivery of ApplicationsApplications must be submitted to Single Point of Contact as designated in §1.2.

5.9.3. Transmission via FaxApplications submitted via fax will not be accepted.

5.9.4. Costs IncurredApplicants understand that issuance of this PEN 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 a response to this PEN. 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

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responsibility of the Applicant, and will not be reimbursed in any manner by the State of Texas.


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6. Screening and Award

6.1.ScreeningHHSC and DFPS will screen all Applications in accordance with the process described in this section.

6.2.Best Value FactorsIn accordance with 1 TAC §391.131, the following best value factors will be considered in making contract award:

Table 6 - Best Value FactorsBest Value

Factor Criterion Considered

6.2.1.Delivery Terms & Conditions

A signed application indicates acceptance of the terms and conditions outlined within the:

PEN Statement of Work; All other terms in the PEN solicitation document; HHSC Uniform Terms and Conditions (UTCs) at

http://www.hhsc.state.tx.us/about_hhsc/Contracting/rfp_attch/Vendor-UTC.pdf ;

Vendor General Affirmations; and DFPS Special Attachment, Form 5622

Any terms and conditions attached to the response application will not be considered unless specifically referred to in this PEN and may result in disqualification of the response.

6.2.2.Price

Submission of a response to this PEN will constitute acceptance of the rates specified in the Fee Schedule.

6.2.3.Qualifications

Applicant must clearly meet The Contractor qualifications. Contractor Qualifications §2.10.

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http://intranet.dfps.state.tx.us/Application/FORMS/Admin/showFile.aspx?Name=5622.docx

http://www.hhsc.state.tx.us/about_hhsc/Contracting/rfp_attch/Vendor-General-Affirmations.pdf

http://www.hhsc.state.tx.us/about_hhsc/Contracting/rfp_attch/Vendor-UTC.pdf

http://www.hhsc.state.tx.us/about_hhsc/Contracting/rfp_attch/Vendor-UTC.pdf

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


Table 6 - Best Value FactorsBest Value

Factor Criterion Considered

6.2.4.Probable Performance Based on Past Contracts3

Past performance based upon Texas Comptroller's Vendor Performance System:

An acceptable score, if available; Not on a Corrective Action Plan; Not having repeated negative Performance Reports for the same

reason; or Not having purchase orders that have been cancelled in the previous

twelve (12) months for non-performance (i.e. late delivery, etc.).Contractor performance information can be located on the Comptroller's web site at:

http://www.window.state.tx.us/procurement/prog/vendor_performance/

Documented past performance based upon DFPS experience with the Applicant.

Documented past performance based upon HHSC Enterprise Agency experience with the Applicant.

Documented past performance based upon experience with any other governmental entity.

Note: Applicant may be denied a contract or a contract already in existence may be terminated if negative information becomes known to HHSC or DFPS at a later date or during the contract term.

In compliance with the provisions of Texas Government Code, Title 10, Subtitle D, Section 2155.074, Section 2155.075, Section 2156.007, Section 2157.003 and Section 2157.125, and Texas Administrative Code, Title 1, Chapter 113.6, information obtained from the Texas Procurement and Support Services Vendor Performance Tracking System will be used in screening Applications submitted in response to this PEN to determine the best value for the State.

6.3.Non-Responsive ApplicationsUnless subject to §6.4, an application will be considered non-responsive and will not be considered further when any of the following conditions occurs:

6.3.1. The Applicant fails to meet major PEN specifications;6.3.2. The Applicant is not eligible under §1.5;

6.3.3. Opportunity to ReapplyIf an application is determined to be non-responsive while the procurement is still open, the Applicant may submit another complete application prior to the application deadline as long as the Applicant meets eligibility criteria as provided in §1.5 of this solicitation.

6.3.4. No Responsive Applications

3 DFPS is required by rule (34 TAC §20.108(b)) to report vendor performance through the Vendor Performance

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http://www.window.state.tx.us/procurement/prog/vendor_performance/


If no responsive applications are received, DFPS reserves the right to award a contract based on noncompetitive negotiations in compliance with DFPS procurement policy.

6.4.Corrections to Application40 TAC §§732.215-217 describe when DFPS may allow for corrections to a Response during the screening process. Allowable corrections include but are not limited to:

6.4.1. The application is not signed.6.4.2. The Applicant’s response is not clearly legible. Typewritten is preferred.6.4.3. The Applicant fails to submit required supporting documentation or forms.

Corrections allowed to the Application must be made within the timeframes set by DFPS and meet any additional requirements specified by DFPS.

6.5.Review and Validation of ApplicationsThe Applicant must provide full, accurate, and complete information as required by this solicitation. As part of the review process, HHSC or DFPS staff may validate any aspect of the Response. Validation may consist of on-site visits, review of records, and confirmation of the information submitted by the Applicant with the Applicant and third parties.

6.6.Additional InformationBy submitting a Response, the Applicant grants HHSC and DFPS the right to obtain information from any lawful source regarding the Applicant’s and its directors’, officers’, and employees’:6.6.1. Past business history, practices, and conduct,6.6.2. Ability to supply the goods and services, and6.6.3. Ability to comply with contract requirements.

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


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