SAN MATEO COUNTY
HEALTH SYSTEM
REQUEST FOR PROPOSALS
FOR
HIGH SCHOOL BEHAVIORAL HEALTH
CAREER PATHWAYS PROJECT
Proposals must be submitted to:
Mary Vozikes, Contract Administration San Mateo County
Behavioral Health and Recovery Services 225 37th Avenue, 3rd Floor
San Mateo, California 94403
By 4:00 p.m. Friday, October 15, 2010
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REQUEST FOR PROPOSALS FOR HIGH SCHOOL MENTAL HEALTH CAREER PATHWAYS PROJECT
Proposals must be submitted to:
Mary Vozikes, Contract Administration San Mateo County
Behavioral Health and Recovery Services 225 37th Avenue
San Mateo, California 94403
by 4:00 p.m. Friday, October 15, 2010
This Request for Proposals (RFP) is not a commitment or contract of any kind. The San Mateo County (”County”) reserves the right to pursue any and/or all ideas generated by this request. Costs for developing the proposals are entirely the responsibility of the proposers and shall not be reimbursed. The County reserves the right to reject any and all proposals. The County reserves the right to waive any requirements of this RFP when it determines that waiving a requirement is in the best interest of the County. General Provisions Regarding Public Nature of Proposals. Government Code Section 6250 et. seq., the Public Records Act, defines a public record as any writing containing information relating to the conduct of the public's business prepared, owned, used, or retained by any state or local agency regardless of physical form or characteristics. The Public Record Act provides that public records shall be disclosed upon request and that any citizen has a right to inspect any public record, unless the document is exempted from disclosure. Proposer’s Rights regarding Confidentiality of Proposals. The County cannot represent or guarantee that any information submitted in response to the RFP will be confidential. If the County receives a request for any document submitted in response to this RFP, it will not assert any privileges that may exist on behalf of the person or business submitting the proposal. If a proposer believes that a portion of its proposal is confidential and notifies the County of such in writing, the County may, as a courtesy, attempt to notify the Proposer of any request for the proposal. However, it would be the sole responsibility of that proposer to assert any applicable privileges or reasons why the document should not be produced, and to obtain a court order prohibiting disclosure. The Proposer understands that the County is not responsible under any circumstances for any harm caused by production of a confidential proposal. County’s Rights Regarding Confidentiality of Proposals. To the extent consistent with applicable provisions of the Public Records Act and applicable case law interpreting those provisions, the County and/or its officers, agents and employees retains the discretion to release or to withhold disclosure of any information submitted in response to this RFP.
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I. INTRODUCTION
A. The County welcomes proposals from all qualified service providers. The County may, in its sole discretion, enter into contracts with multiple qualified providers.
B. Purpose
The purpose of this RFP is to solicit proposals, select a contractor or contractors, and award a contract or contracts to provide innovative solutions to the challenge of attracting and retaining a diverse workforce in Behavioral Health and Recovery Services (BHRS). This Request for Proposals (RFP) is to make available $50,000 to one or more high schools in San Mateo County to establish a High School Behavioral Health Career Pathways Project at their school(s) in partnership with BHRS, and its contracting agencies. The High School Behavioral Health Career Pathways Project has been identified as a “workforce of the future” outreach strategy by engaging youth from various ethnic, cultural and linguistic backgrounds in considering behavioral health careers. A proposer submitting a proposal shall satisfy all requirements outlined in this RFP. Proposers selected will be offered an opportunity to contract for the term February 1, 2011 through June 30, 2012, with an option to renew for 2 additional years, based on availability of funds.
C. Authority
This RFP is being issued pursuant to the San Mateo County Mental Health Services Act (MHSA) Workforce Education and Training (WET) Component of its Three-Year Program and Expenditure Plan, as approved by the MHSA Oversight and Accountability Commission and the State of California Department of Mental Health.
D. Background
This is one of several initiatives developed through an extensive planning process that resulted in the State-approved Workforce Education and Training Plan. In this plan, workforce development objectives address four priority areas: 1) hard to fill and hard to retain job positions; 2) developing a diverse workforce; 3) creating the workforce of the future, and; 4) continued consumer and family member employment development. The plan was developed with participation of representatives from un-served and underserved populations, organizations serving un-served and underserved populations, consumers and family members, educators,
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community colleges, four year and graduate programs, employment development services, as well as the community at large.
E. Qualified Providers
The County seeks a public secondary school recognized by the State of California, which has the ability to provide the services described in the Scope of Work (Exhibit A) with high school juniors and/or seniors. Agencies applying for funding must partner with a school. Schools applying for funding are encouraged to partner with other local schools in forming and operating a High School Behavioral Health Career Pathways Project.
F. As of the issuance date of this RFP and continuing until the final date for submission of proposals, all County personnel are specifically directed not to hold meetings, conferences, technical discussions, or communications of any kind with any applicant for purposes of responding to this RFP. Any attempt by an applicant, or agent thereof, to contact County personnel or a member of the Proposal Review Committee regarding the proposal process may be considered tampering and may result in the applicant being disqualified from entering into any contract that may result from this RFP.
G. The County may modify the RFP prior to the fixed date for submission of
proposals by issuance of an addendum to all parties who have received the RFP.
II. SCOPE OF WORK AND SPECIFICATIONS
A. Program Description
The High School Behavioral Health Career Pathways Project will provide junior and/or senior high school students with specific curriculum and exposure on behavioral health care theory, practice, and careers. In addition to increasing student knowledge, information and experiences will be provided to promote understanding of people with various behavioral health and substance use conditions. Students will be exposed to behavioral health careers, have opportunities to visit program sites, and interact with staff in diverse career positions and programs.
B. The services to be delivered are described in Attachment A: Scope of Work.
C. The proposer must be able to agree to all of the terms of the County form contract included as Attachment B and be able to complete the County declaration form included as Attachment C. If the proposer cannot agree
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to each term but still wishes to respond to the RFP, the proposer must specifically identify in its proposal the terms, with which it cannot comply. D. Population to be Served
How strong is proposer leadership experience with the target population to be served? How long have key personnel been involved in similar work? Do key staff have experience with providing service needs? The High School Behavioral Health Career Pathways Project is intended to work with high school juniors and seniors who have some demonstrated interest in investigating behavioral health careers. Proposers should describe their suggested location(s) of service (taking into consideration the projected staffing, program configuration, training needs described below), the characteristics of the students in those locations, and the number of students likely to participate at each location.
E. Enrollment Process
Proposers shall describe how students will be recruited into the project and participation standards that will be expected for students to remain in the project. A description of how the program will assess a student’s interest and motivation to participate in the project is required.
F. Projected Number of Student Participants
Proposers shall describe the number of students expected to participate in the project for a full school year.
G. Curriculum Development and Staff Preparation
It is expected that from February 1, 2011 to August 1, 2011 curriculum will be developed, staff will be trained and coached, and other start up activities will transpire. Such activities will not exceed $15,000. Behavioral Health and Recovery Services staff will assist in curriculum development including development of lesson modules and arrangement of lectures and field trips to mental health care sites. Proposers must agree to administer/use survey instruments (to be determined), to measure student interest in behavioral health careers and their attitudes pertaining to behavioral health consumers prior to enrollment in the project and again at the end of the project.
H. Contract Term and Renewal Language
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The contract start date is to be negotiated with the successful proposer(s), but will be not later than February 1, 2011. It is expected that the students will be enrolled in the project commencing with the Fall 2011 school semester. The contract will be effective through June 30, 2012 with an option to renew, based on funding availability and program outcomes/performance, for up to two (2) additional years. The contract(s) may be terminated by the Contractor(s) or the Chief of the Health System or designee at any time upon sixty (60) days written notice to the other party.
I. Funding Allocations
Allocation of funds for these services is $50,000 effective January 1, 2011 for FY 2010-11. The program(s) will be funded through not-to-exceed contracts with one or multiple organizations. Funds will be distributed based on the completion of negotiated deliverables. Budget must state proposed deliverables with anticipated cost of provision of these services.
J. Workforce Development and Education Committee
The BHRS Workforce Development and Education Committee will oversee this plan. The committee meets six times a year, and provides input regarding how training and workforce development services are delivered, and monitors progress towards meeting the goals of the plan. All providers receiving funding from BHRS for workforce development activities are required to attend the WDEC meetings.
III. PROPOSAL CONTENTS
A. To be eligible for evaluation, proposers shall adhere strictly to the format set forth below. Each of the required sections identified must be addressed and must be specifically labeled.
The content and sequence of the proposal will be as follows:
Section Title 1 Cover Letter 2 Table of Contents 3 Program Summary 4 Financial Summary 5 Proof of Insurance 6 References 7 Board Authorization
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Items 1 through 8 below contain brief descriptions of material that must be included in this proposal. 1. Cover Letter: Proposer shall identify the firm’s name that will be
providing the services offered in the proposal. The name, address, telephone number, facsimile number and e-mail address of a principal contact for information regarding the proposal shall be supplied.
2. Table of Contents: Immediately following the Cover Letter, provide
a comprehensive Table of Contents of the material included in the proposal. The Table of Contents must clearly identify the proposal sections and the applicable page numbers.
3. Program Summary:
a. Service Description - Describe the overall services you
intend to provide consistent with Attachment A. Include in this section the program goals and objectives, and how this project will be embedded into the existing school structure and curriculum. As part of contract negotiations, the selected applicant(s) will work with the Behavioral Health and Recovery Services to develop specific outcome measures based on these parameters.
b. Staffing - Describe proposed staff and their duties, including disciplines and degrees, as appropriate. Describe training and experience of staff to ensure project outcomes are achieved. Identify the designated project director who will serve as the main point of contact. Provide the professional resume for the project director.
c. Work Plan and Timelines - Describe the activities necessary
during the start up, implementation and on-going phases. , Include a timeline for each of the phases.
d. Cultural Competence - Describe how you will ensure this
project is delivered in a culturally competent manner. This may include culturally relevant program features, staffing that reflect cultural and linguistic diversity, and education materials that value the cultural diversity of San Mateo County.
e. Interagency Coordination - Describe how you will ensure
effective interagency coordination.
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f. Program Evaluation - Describe your capacity to partner with
BHRS in evaluating this project. You may include other projects or programs that would indicate this capacity.
g. Organizational Background and Capacity - Describe the
school’s experience with implementing special projects including those focused on student career development. Outline prior experiences collaborating with community based organizations and local (city/county) governmental entities. Identify potential implementation challenges and strategies to address such challenges.
4. Financial Summary
Prepare a narrative of how this program will be staffed and financed. Provide a budget, including personnel, operating, and other relevant expenditures. Include information on any other resources, including in-kind, that will support the proposed project.
5. Proof of Insurance
Attach insurance certificates indicating liability insurance of a minimum of $1,000,000 for each of the following: comprehensive general, motor vehicle, professional, and worker’s compensation.
6. References
Include five references recently familiar with the quality and reliability of the school’s work. Include the name, mailing address, contact person and phone number for each reference.
7. Board Authorization
Include a letter from the school principal, or district superintendent, or school board authorizing submission of this proposal and giving signature authority to the signer of the proposal.
B. Proposal Format Proposals may be submitted in paper format or via email. Emailed
proposals must meet all of the formatting and page length requirements of paper submission when printed. 1. Paper submissions
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a. All proposals should be written in 12 point font; have consecutively numbered pages; include any exhibits, charts, or other attachments; and be securely bound. No facsimiled or telephone proposals will be accepted.
b. Proposal must be signed by the proposer. An unsigned
proposal may be rejected. A proposal may be signed by any authorized agency representative of the applicant as described in paragraph III.7.
c. Submit one (1) original and eight (8) copies of the complete
proposal and one (1) electronic copy on a CD. d. Submit the original proposal and all copies, including the CD,
in a sealed package clearly indicating the title of this RFP in the upper left hand corner. Include name and address of the proposer.
2. Emailed Submissions
Proposals may be submitted via email. Proposals must be submitted as an attachment to an email message using either Microsoft Word® or Adobe PDF®. Attachments may be submitted using Microsoft Excel®, as appropriate. The required signature page must be submitted showing an actual signature representation, and may also be submitted separately via fax.
3. Proposals, whether paper format or emailed, must be received by
October 15, 2010 by 4:00 p.m.
a. Address or deliver paper proposals to: Attn: Mary Vozikes, Contract Administration
San Mateo County Health System Behavioral Health and Recovery Services
San Mateo County Health System 225 37th Avenue, Floor 3, Room 320
San Mateo, California 94403.
b. Address emailed proposals to: [email protected]. Fax number: (650) 573-2841 (Note: fax is for signature page only)
IV. PROPOSAL PROCESS
A. Schedule of Events
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EVENT DATE Release of RFP September 9, 2010 Deadline for Written Questions September 17, 2010 Proposers’ Conference September 27, 2010 Release Responses to Written Questions September 29, 2010 Proposal Due Date and Time October 15, 2010
4:00PM Review of Proposals October 21, 2010 Announcement of Recommendation by (Division) Director
October 27, 2010
Protest Deadline November 3, 2010 Contract Negotiations Begin November 8, 2010 Anticipated Contract Start Date February 1, 2010
B. Submittal of Questions Proposers requiring clarification of the intent or content of this RFP, or of
the competitive proposal process, may request clarification by submitting written questions no later than September 17, 2010. It is preferred that all questions are submitted through email to:
Mary Vozikes
E-Mail: [email protected]
If email is unavailable, mail or fax questions to:
Mary Vozikes, Contract Administration HIGH SCHOOL MENTAL HEALTH CAREER PATHWAYS PROJECT
Behavioral Health and Recovery Services San Mateo County Health System
225 37th Avenue, Floor 3, Room 320 San Mateo, California 94403 Facsimile: (650) 573-2841
The County shall respond to all written questions during the Non-
mandatory Proposers’ Conference, and will e-mail questions and responses to parties who register with Mary Vozikes via e-mail at [email protected]. The County may choose to provide additional information following the Non-mandatory Proposers’ Conference. The County is responsible only for what is expressly stated in this RFP and any authorized written addenda thereto. The County is not responsible for and shall not be bound by any non-authorized person acting or purporting to act on its behalf.
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D. Submission of Proposal
1. All proposals submitted in response to this RFP shall become the exclusive property of San Mateo County.
2. The proposal shall be used to determine the proposer’s ability to
render the services to be provided. The failure of a proposer to comply fully with the instructions in this RFP may eliminate its proposal from further evaluation as determined at the sole discretion of the County. The County reserves the sole right to evaluate the contents of proposals submitted in response to this RFP and to select a successful contractor, if any.
3. All proposals must remain valid for a period of not less than one
hundred twenty (120) days from the closing date for submission. V. PROPOSAL SELECTION PROCESS AND EVALUATION
A. Final Filing Date
4:00 P.M., Friday, October 15, 2010
B. Additional Information
If the County determines, in its sole discretion, that additional information is required or desirable beyond that provided in the proposal(s) of any of the proposer(s), County shall invite the proposer(s) to make oral and/or written presentations to the Evaluation Committee.
C. Late Proposals
Any proposals delivered after 4 p.m. on Friday, October 15, 2010 may be rejected by the County as not meeting the requirements of this RFP.
D. Rejection of Proposals
1. The County may reject any proposals not meeting the minimum requirements of this RFP.
2. The County reserves the right to reject any and all proposals. 3. The County reserves the right to waive any requirements of this
RFP when it determines that waiving a requirement is in the best interest of the County. The County’s waiver of an immaterial
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requirement shall not excuse the proposer from full compliance with remaining requirements and the contents of its proposal in the event it is awarded the contract.
E. Evaluation Committee
The evaluation of proposals will be made by an Evaluation Committee selected by the Director of Behavioral Health and Recovery Services and approved by the Chief of the Heath System. The Evaluation Committee will evaluate proposals and the qualifications of proposers submitting proposals. The evaluation criteria that the Evaluation Committee will use shall include those listed in Section V., PROPOSAL SELECTION PROCESS AND EVALUATION; paragraph F, Evaluation Criteria. The Evaluation Committee will submit to the Director of Behavioral Health and Recovery Services the results of the committee’s evaluation together with the committee’s recommendations. The Director of Behavioral Health and Recovery Services will recommend a proposal and applicant to the Chief of the Heath System who shall give final approval to enter into contract negotiations.
F. Evaluation Criteria
1. History and Structure of Proposer
a. Personnel: Do key staff have sufficient direct experiences, with similar projects and/or those applicable to this project that demonstrate sufficient skills, knowledge and abilities to achieve success for this project?
b. Experience: How long has the proposer been involved in
providing programs/projects of a similar nature? Has the proposer implemented a program/project via a contract with a non school governmental entity? If so what is the proposer’s track record in contract compliance, including accounting and record-keeping requirements? Has the proposer successfully managed contracts with public or private agencies? Does the proposer have expertise in serving special populations e.g. ethnic/linguistic, dual diagnosed individuals, or other?
2. Philosophy/Service Model
a. Is there a clearly articulated understanding of and commitment to the intent of this project as described in the RFP including purpose, scope, population to be served,
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major design elements, and effective organizational structure?
b. Does the proposal include a realistic plan for incorporating
the program values and principles described in the RFP into provided services?
c. Does the proposer demonstrate that it has a track record of
positive community collaboration and does it currently have good relationships in San Mateo County?
3. Staffing Patterns and Operations/Cultural Competency/Facilities
a. Is there sufficient staffing proposed to provide the services?
b. Is training and supervision sufficient to provide services?
c. Is the agency’s plan for providing culturally competent
services consistent with the principles described in the RFP? Does the agency offer multi-lingual capability? Are there other areas of particular strength in serving culturally diverse populations?
4. Quality/Program Evaluation
a. Does the proposer demonstrate the capacity to fully participate in the evaluation of the project, including the administration of student pre and post assessments, the collection of other data as mutually agreed upon, and the analysis of the data in partnership with BHRS?
5. Work Plan/Timeline
Does the proposal provide sufficient specificity to complete the start up phase and implement the project within the proposed time frame? Is the time frame realistic? Has sufficient time been allocated to address any/all challenges with implementation?
6. Budget
Is the narrative clear and realistic?
a. Are budget justifications, including administrative costs, personnel, and other expenses reasonable?
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b. Are there sufficient revenues to meet expenses? Are there other sources of revenue available for these services? (as applicable)
c. What is the total net cost to the County?
7. References
G. Errors or Changes in the Proposal If errors are found in a proposal, the County may reject the proposal; however, the County may, in its sole discretion, correct arithmetic and/or transposition errors. The proposer will be informed of the errors and corrections. If an item is described in the narrative and omitted from the cost data, the
proposal will be interpreted to mean that the proposer will provide the item at no cost. If this is a significant item, the proposer will be notified.
Clarification of and changes in proposals prior to contract award are permissible provided that each proposer is treated fairly and equally. H. Low Bid The County reserves the right to accept other than the lowest price when the best interests of the County are served by doing so. H. Local Preference
The County reserves the right to give preference to a San Mateo County based vendor if deemed in the best interest of the County. I. Notification
Notification of the announcement of award will be done by facsimile transmission and by e-mail. Please include both in your proposal.
J. Inability to Negotiate a Contract
After a proposer has been recommended by the Evaluation Committee and selected by the Director of BHRS and approved by the Chief of the Health System, the County and such proposer will negotiate a contract for submission to the County’s Board of Supervisors (or Purchasing Agent for agreement under $100,001) for consideration and possible approval. If a satisfactory contract cannot be negotiated, the County may, in its sole discretion, begin contract negotiations with one or more than one of the
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remaining proposers. The County may contract with more than one proposer if County determines, in its sole judgment, that more than one contractor is preferred to provide the specified services.
K. Protest Process
A proposer may submit a written protest to the Chief of the Health System. Such written protest must be submitted within five (5) days after receipt of the Notification informing the proposer that their proposal was not selected. The protest must be in writing. The Chief of the Health System or designee will respond to the protest within ten (10) working days of receipt of the written protest. The Chief of the Health System or designee may establish a meeting with the proposer in order to discuss the protest. The decision of the Chief of the Health System or designee is final.
L:\CLIENT\H_DEPTS\HEALTHSE\2007\Draft Health RFP Template.doc
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ATTACHMENT A: SCOPE OF WORK A. Program Description
1. High school behavioral health career pathway projects are currently in place throughout California to build interest in and guidance toward behavioral health careers for high school students. The program is designed to create interest and remove barriers to youth entering behavioral health care jobs by giving them exposure to work toward such career goals. Youth entrance into the field, most notably youth from diverse ethnic, linguistic and cultural backgrounds, is essential to diversify the behavioral healthcare workforce. According to a report released in 2003 by the Center for the Health Professions at the University of California San Francisco, The Mental Health Workforce: Who’s Meeting California’s Needs?, California will need between 73,000 to 80,000 behavioral health professionals by 2010.2. However, the current licensed behavioral health workforce totals only 63,000, leaving a gap of approximately 10,000 to 20,000 behavioral health professionals. (California Mental Health Planning Council). These statistics do not take into consideration pressures on all behavioral health care providers to maintain staff in light Health Care Reform which will demand more skilled health care workers as services expand throughout the nation.
2. In addition to workforce development needs, such high school programs
have shown to assist students with improved, attendance, participation and motivation. For instance, Manpower Demonstration Research Corporation (MDRC) conducted a rigorous large-scale multi-site random research study to evaluate the effectiveness of career academies on student success. The study found that students participating in career academies became more focused and saw a relevancy to their education. Their participation in academic courses increased and school engagement improved for both high-risk and medium-risk subgroups. The career academies increased the level of interpersonal support the students experienced, and many parents became more involved with their child’s education.
3. Overall, students participating in career academies liked school better.
The study also found that career academies improved student performance on measurable outcomes. For example, career academies substantially improved high student attendance and reduced dropout rates. (California Mental Health Planning Council).
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B. Goals of this Program
1. Attract students to jobs in behavioral health through specific career education and experience in the field.
2. Increase understanding and tolerance towards individuals with mental
health challenges and mental health conditions in general. 3. Improve academic engagement and performance of youth through
relevant, career-oriented programming. C. Values and Principles
1. BHRS seeks to build a workforce that is diverse, well prepared and sufficient to meet the needs of our communities and support the values below:
a. Person and Family Centered Care
We promote culturally responsive person-and-family centered recovery.
b. Potential
We are inspired by the individuals and families we serve, their achievements and potential for wellness and recovery.
c. Power
The people, families, and communities we serve and the members of our workforce guide the care we provide and shape policies and practices.
d. Partnerships
We can achieve our mission and progress towards our vision only through mutual and respectful partnerships that enhance our capabilities and build we use proven practices, opportunities, and technologies to prevent and/or reduce the impacts of mental illness and addiction and to promote the health of the individuals, families and communities we serve.
2. This behavioral healthcare workforce is expected to understand and train in the following priorities of the San Mateo County BHRS systems of care:
a. Accept and promote a consumer and family-wellness oriented
health care system; b. Treatment of co-occurring substance use and mental health issues;
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c. Reduce stigma; d. Recognize, honor and effectively work with issues of culture,
ethnicity and linguistic abilities; e. Address and understand impact of trauma; f. Identify strengths and believe in choice, empowerment and
recovery. D. Service Model
1. Education will be provided on basics of behavioral health care, including
the values above, and may also include subject matters such as: a. Human development b. Family development c. Types of behavioral health conditions d. Assessment and treatment of mental health conditions e. Assessment and treatment of substance use conditions f. Cross cultural skills g. Recognizing and addressing stigma h. Career paths for mental health jobs
The actual topics of the program will be created in collaboration with
BHRS staff during designated program set-up time.
2. The above behavioral health education will be provided in:
a. Classroom BHRS and its service providers will partner to provide speakers and career pathway information. It is anticipated that the project will be embedded into an existing complementary course (psychology, human services, health, counseling, or sociology are preferred locations to embed the curriculum) and that students will meet daily, or during a typical “block” period of time. Such a course will be taught by credentialed secondary school faculty.
b. Field experiences School staff will work with BHRS staff to develop enriching activities for students. It is anticipated these activities will consist of visits to mental health care sites, after which students will have opportunity to engage in activities which allow them to integrate the knowledge of their observation and discussions with mental health care staff.
E. Policies and Procedures
Policy and procedures will be designed to:
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1. Reinforce collaboration with BHRS and its contracted providers in the design and implementation of the program.
2. Facilitate coordination and communication with parents regarding their
child’s participation in the program; meet with parents as needed, provide information and education to parents regarding program, and obtain parental consent for participation in program activities.
3. School and program staff will work with BHRS to create policies which
ensure safety and privacy for the students, and for the consumers and families of BHRS. Such policies will include, but not be limited to, confidentiality policies, behavioral expectations at health care sites, and steps to ensure personal safety.
F. Evaluation
1. Tracking logs and use of tools will be part of the contractual responsibilities of the schools delivering services.
2. BHRS will work with agency representatives early in the planning process
to develop an evaluation plan. This group will be responsible for final selection of the tools to be used, the key elements of the tracking logs, and the timetable for the submission of documentation, at the County’s discretion.
G. Other attachments to be included:
Attachment B: Standard Contract Language Attachment C: Contractor’s Declaration Form Attachment D: Site Certification Attachment E: Budget Worksheet
ATTACHMENT B: STANDARD CONTRACT LANGUAGE
1
COUNTY OF SAN MATEO AGREEMENT WITH INDEPENDENT CONTRACTOR
Agreement No. __________________________
CONTRACTOR NAME AND ADDRESS:
CONTRACTOR: Upon completion of work or agreed-upon work periods, mail invoice with above Agreement Number to: Department: Health System/Behavioral Health and Recovery Services Attention: Address: 225 37th Avenue City, State, Zip: San Mateo, CA 94403
It is agreed between the County of San Mateo, California, and Contractor as follows: 1. Services to be performed by Contractor In consideration of the payments hereinafter set forth, Contractor shall perform services for
County in accordance with the terms, conditions and specifications set forth herein and in Exhibit "A" attached hereto for the COUNTY OF SAN MATEO HEALTH SYSTEM, BEHAVIORAL HEALTH AND RECOVERY SERVICES DIVISION.
2. Contract Term The term of this Agreement shall be from (DATE) to (DATE) unless terminated earlier by the County. 3. Payments In consideration of the services rendered in accordance with all terms, conditions and specifications set forth herein and any
Exhibit(s) or attachment(s) attached hereto, County shall make payment to Contractor in the manner specified herein and in Exhibit "A". In the event that the County makes any advance payments, Contractor agrees to refund any amounts in excess of the amount owed by the County at the time of contract termination. The County reserves the right to withhold payment if the County determines that the quantity or quality of the work performed is unacceptable. In no event shall total payment for services under this Agreement exceed DOLLARS ($).
4. Relationship of the Parties Contractor agrees and understands that the work/services performed under this Agreement are performed as
an Independent Contractor and not as an employee of the County and that Contractor acquires none of the rights, privileges, powers or advantages of County employees.
5. Workers’ Compensation Insurance The Contractor shall have in effect, during the entire life of this Agreement, Worker’s
Compensation and Employer Liability Insurance providing full statutory coverage. In signing this Agreement, Contractor certifies awareness of the provisions of section 3700 of the California Labor Code which requires every employer to be insured against liability for Worker’s Compensation or to undertake self-insurance in accordance with the provisions of the Code, and certifies compliance with such provisions before commencing the performance of this work of the Agreement as set forth in California Labor Code section 1861.
6. Insurance The Contractor shall take out and maintain during the life of this Agreement such Bodily Injury Liability and Property
Damage Liability Insurance as shall protect him/her while performing work covered by this Agreement from any and all claims for damages for bodily injury, including accidental death, as well as any and all operations under this Agreement, whether such operations be by himself/herself or by any Subcontractor or by anyone directly or indirectly employed by either of them. Such insurance shall be combined single limit bodily injury and property damage for each occurrence and shall not be less than the amount specified by Risk Management.
7. Hold Harmless Contractor agrees to indemnify and defend the County, its employees and agents from any and all claims, damages and
liability in any way occasioned by or arising out of the negligence of the contractor in the performance of this agreement, including any sanctions, penalties or claims of damages resulting from Contractor’s failure to comply with the requirements set forth in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and all Federal regulations promulgated thereunder, as amended.
8. Confidentiality All data produced or compiled by Contractor shall be considered confidential unless it can be obtained as public record
and shall not be shared with a third party without the prior written consent of County. All financial, statistical, personal, technical, and other data and information relating to the County's operations which is made available to the Contractor in order to carry out this Agreement shall be presumed to be confidential. Contractor shall protect said data and information from unauthorized use and disclosure by the observance of the same or more effective procedures as the County requires of its own personnel. The Contractor shall not, however, be required by this paragraph to keep confidential any data or information which is or becomes publicly available, is already rightfully in the Contractor’s possession, is independently developed by the Contractor outside the scope of the Agreement or is rightfully obtained from third parties.
9. Non-Assignability Contractor shall not assign this Agreement or any portion thereof to a third party without the prior written consent of
County, and any attempted assignment without such prior written consent in violation of this Section shall automatically terminate this Agreement.
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10. Termination of Agreement The County Purchasing Agent may, at any time from execution of Agreement, terminate this Agreement, in whole or in part, for the convenience of the County, by giving written notice specifying the effective date and scope of such termination. Termination shall be effective on a date not less than thirty days from notice. In the event of termination, all finished or unfinished documents, data, studies, maps, photographs, reports, and materials (hereafter referred to as materials) prepared by Contractor under this Agreement shall become the property of the County and shall be promptly delivered to the County. In the event of termination, Contractor shall be paid for all work satisfactorily performed until termination, except where the contracting department determines the quality or quantity of the work performed is unacceptable. Such payment shall be that portion of the full payment, which is determined by comparing the work/services completed to the work/services required by the Agreement.
11. Payment of Permits/Licenses It shall be the Contractor’s responsibility to obtain any license, permit or approval required from any
agency for work/services to be performed at his/her own expense, prior to commencement of said work/services or forfeit any right to compensation under this Agreement.
12. Non-Discrimination No person shall be excluded from participation in, denied benefits of, or be subject to discrimination under this
Agreement on the basis of their race, color, religion, national origin, age, sex, sexual orientation, pregnancy, childbirth or related conditions, medical condition, mental or physical disability or veteran’s status. Contractor shall ensure full compliance with federal, state and local laws, directives and executive orders regarding non-discrimination for all employees and Subcontractors under this Agreement. The Contractor shall comply fully with the non-discrimination requirements required by 41 CFR 60-741.5(a), which is incorporated herein as if fully set forth.
Violation of the non-discrimination provisions of this Agreement shall be considered a breach of this Agreement and subject the Contractor to penalties, to be determined by the County Manager, including but not limited to: i) termination of this Agreement; ii) disqualification of the Contractor from bidding on or being awarded a County contract for a period of up to 3 years; iii) liquidated damages of $2,500 per violation; iv) imposition of other appropriate contractual and civil remedies and sanctions, as determined by the County Manager. To effectuate the provisions of this paragraph, the County Manager shall have the authority to: i) examine Contractor’s employment records with respect to compliance with this paragraph; ii) set off all or any portion of the amount described in this paragraph against amounts due to Contractor under the Contract or any other Contract between Contractor and County. Contractor shall report to the County Manager the filing by any person in any court of any complaint of discrimination or the filing by any person of any and all charges with the Equal Employment Opportunity Commission, the Fair Employment and Housing Commission or any other entity charged with the investigation of allegations within 30 days of such filing, provided that within such 30 days such entity has not notified Contractor that such charges are dismissed or otherwise unfounded. Such notification shall include the name of the complainant, a copy of such complaint and a description of the circumstance. Contractor shall provide County with a copy of its response to the Complaint when filed. Section 504 applies only to contractors who are providing services to member of the public. Contractor shall comply with Section 504 of the Rehabilitation Act of 1973, which provides that no otherwise qualified handicapped individual shall, solely by reason of a disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination in the performance of this contract.
13. Equal Benefits With respect to the provision of employee benefits, Contractor shall comply with the County Ordinance which prohibits
contractors from discriminating in the provision of employee benefits between an employee with a domestic partner and an employee with a spouse.
14. Retention of Records Contractor shall maintain all records related to this Agreement for no less than three years after the County
makes final payment or after termination of this contract and all other pending matters are closed. All records shall be subject to the examination and/or audit by agents of the County, the State of California and/or Federal grantor agencies.
15. Compliance with State, Federal, and Local Laws, regulations, and Ordinances. Contractor and all subcontractors shall ensure
compliance with all state, federal and local laws or rules applicable to performance of the work required under this contract, and shall execute all necessary certifications of compliance therewith. Contractor certifies that the Contractor and all of its subcontractors will adhere to and certify compliance with all applicable provisions of San Mateo County Ordinance Code, including without limitation, Chapter 4.106, which regulates the use of disposable food service ware, and Chapter 2.84, which addresses equal benefits.
16. Merger Clause This Agreement, including Exhibit "A" attached hereto and incorporated herein by reference, constitutes the sole
Agreement of the parties hereto and correctly states the rights, duties, and obligations of each party as of this document's date. Any prior agreement, promises, negotiations, or representations between the parties not expressly stated in this document are not binding. All subsequent modifications shall be in writing and signed by the County Purchasing Agent. In the event that any term, condition, provision, requirement or specification set forth in this body of the agreement conflicts with or is inconsistent with any term, condition, provision, requirement or specification in any exhibit and/or attachment to this agreement, the provisions of this body of the agreement shall prevail. This Agreement, or facsimile proposal of the Agreement, constitutes the entire Agreement between County and Contractor. Further, liability referenced to in section 6 is limited to Contractor’s negligence during the Contractor's performance under this contract.
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17. Governing Law This Agreement, including any exhibits, shall for all purposes be deemed subject to the laws of the State of California, and in the event of a lawsuit concerning this Agreement shall be venued in the County of San Mateo.
THIS CONTRACT IS NOT VALID UNTIL SIGNED BY ALL PARTIES Contractor's Signature Date Contractor's Name (Please Print) I hereby certify that the services requested are necessary, that the selection process documentation is accurate, that all insurance certificates including Worker's Compensation are on file in this office, that Risk Management has approved any reductions in Contractor's insurance limits below $1,000,000, and that no work will commence until this document is signed by the County Purchasing Agent. Purchasing Agent, County of San Mateo Date Department or Division Head Approval Date Jean S. Fraser, Chief, Health System Department or Division Head Name (Please Print) Budget Unit Distribution – 1 copy to each: Purchasing Agent, County Manager’s Office, Controller, Contractor and Department v8/19/08 Short Form Agreement/Non Business Associate
8-7-06 Page 1 of 1
ATTACHMENT C County of San Mateo
Contractor’s Declaration Form
I. CONTRACTOR INFORMATION
Contractor Name: Phone: Contact Person: Fax:
Address:
II. EQUAL BENEFITS (check one or more boxes) Contractors with contracts in excess of $5,000 must treat spouses and domestic partners equally as to employee benefits.
Contractor complies with the County’s Equal Benefits Ordinance by:
offering equal benefits to employees with spouses and employees with domestic partners.
offering a cash equivalent payment to eligible employees in lieu of equal benefits.
Contractor does not comply with the County’s Equal Benefits Ordinance.
Contractor is exempt from this requirement because:
Contractor has no employees, does not provide benefits to employees’ spouses, or the contract is for $5,000 or less.
Contractor is a party to a collective bargaining agreement that began on (date) and expires on (date), and intends to offer equal benefits when said agreement expires.
III. NON-DISCRIMINATION (check appropriate box)
Finding(s) of discrimination have been issued against Contractor within the past year by the Equal Employment Opportunity Commission, Fair Employment and Housing Commission, or other investigative entity. Please see attached sheet of paper explaining the outcome(s) or remedy for the discrimination.
No finding of discrimination has been issued in the past year against the Contractor by the Equal Employment Opportunity Commission, Fair Employment and Housing Commission, or any other entity.
IV. EMPLOYEE JURY SERVICE (check one or more boxes) Contractors with original or amended contracts in excess of $100,000 must have and adhere to a written policy that provides its employees living in San Mateo County up to five days regular pay for actual jury service in the County.
Contractor complies with the County’s Employee Jury Service Ordinance.
Contractor does not comply with the County’s Employee Jury Service Ordinance.
Contractor is exempt from this requirement because: the contract is for $100,000 or less.
Contractor is a party to a collective bargaining agreement that began on (date) and expires on (date), and intends to comply when the collective bargaining agreement expires.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that I am authorized to bind this entity contractually.
Signature Name Date Title
ATTACHMENT D SAN MATEO COUNTY HEALTH SYSTEM
BEHAVIORAL HEALTH & RECOVERY SERVICES QUALITY MANAGEMENT
MEDI-CAL SITE RE/CERTIFICATION TOOL AND SUMMARY
Review Date:
Report Date:
Medi-Cal Provider Number: Provider Name: Address: Tel: Fax: Contact Person: Hours Of Operation: Contact Email:
SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY
Y N COMMENTS
Hours of operation and services provided to Medi-Cal beneficiaries are comparable to those for non-Medi-Cal clients.
TYPE OF REVIEW COMMENTS
Initial Certification Recertification
COUNTY REVIEWER AGENCY REPRESENTATIVE
SERVICES PROVIDED
Psychiatric Health Facility 05/20
Day Treatment Intensive (half day) 10/81
Targeted Case Management 15/01
Adult Crisis Residential 05/40 Day Treatment Intensive (full day) 10/85
Mental Health Services 15/10-19, 30-59
Adult Residential 05/65 Day Treatment Rehabilitation (half day) 10/91
Therapeutic Behavioral Services (TBS) 15/58
Crisis Stabilization Emergency Room 10/20
Day Treatment Rehabilitation (full day) 10/95
Medication Support 15/60
Crisis Stabilization Urgent Care 10/25
Crisis Intervention 15/70
List the name, address, phone number, and hours of operation of any school and satellite sites and indicate which sites store medications or provide day treatment.
1. POSTED BROCHURES AND NOTICES EVALUATION CRITERIA Y N N/A COMMENTS
Beneficiary brochures (Medi-Cal Guide) are available to clients in both English and Spanish.
Aware that clients who ask for current provider list can obtain from the Access Team (800-686-0101).
Notices explaining the grievance, appeal, and fair hearing processes are posted in English and Spanish.
Grievance and appeal forms (English and Spanish), with self-addressed return, are available to clients without having to request them from a staff member.
Provider’s Notices of Privacy Practices are posted in English and Spanish.
2. PHYSICAL PLANT/FACILITIES
EVALUATION CRITERIA Y N N/A COMMENTS Facility is clean, sanitary, in good repair.
Agency provides or contracts for routine building maintenance.
Exit doors are clearly marked and unlocked on the inside.
Evacuation route maps that guide people to exit doors are clearly posted.
Fire extinguishers installed throughout the facility are inspected annually.
Individuals with handicaps or disabilities can access agency by ramp or elevator if services are not provided on street level.
Handicapped parking is clearly marked and available.
Restroom is wheelchair accessible.
Building is within reasonable walking distance of public transportation.
3. FIRE SAFETY CLEARANCE
EVALUATION CRITERIA Y N N/A COMMENTS Provider has a current, valid fire safety clearance that certifies compliance with local fire codes. (Copy for BHRS.)
Provider has evidence of efforts to have the facility re-inspected prior to tri-anneal recert. (If no fire clearance obtained prior to visit.)
4. STAFF QUALIFICATIONS
EVALUATION CRITERIA Y N N/A COMMENTS The provider has a Head of Service that meets the requirements of CCR, Title 9, and Sections 622-630.
5. LICENSES/CERTIFICATIONS EVALUATION CRITERIA Y N N/A COMMENTS
ADULT AND CRISIS RESIDENTIAL TREATMENT FACILITIES ONLY – Is the provider currently licensed by the State Department of Social Services as a Social Rehabilitation Facility or Community Care Facility and currently certified as a Social Rehabilitation Program by the State Department of Mental Health?
6. POLICIES AND PROCEDURES
EVALUATION CRITERIA Y N N/A COMMENTS Provider has Policies and Procedures that are current, available, and include policies on:
General operating procedures.
Service delivery policies.
Confidentiality of client information.
Logging and reporting or unusual occurrences/ serious incidents relating to health and safety issues.
Bring/give copy of Policy 93-11.
Referring beneficiaries to a psychiatrist when necessary, or to a physician who is not a psychiatrist, if a psychiatrist is not available.
Mandatory reporting requirements.
Secure storage of client records.
Retention and destruction of client records that meets the requirement that records be retained for a minimum of seven years, or one year past the client’s 18th birthday, whichever is longer.
Requirement that clients be informed of the Grievance and Appeal process.
Written description of the specific programs and service activities provided by the agency.
COUNTY OWNED and/or OPERATED SITES: Clients are given, at admission and upon request, a copy of Informing Materials (maintained by the ACCESS Team).
Provider has a Personnel Policies and Procedures that is current, available, and include policies on:
Hiring, discipline and termination.
Sexual Harassment.
Employment non-discrimination.
Credentialing of employees.
7. PHARMACEUTICAL SERVICES POLICY PRACTICE
EVALUATION CRITERIA Y N N/A Y N N/A COMMENTS There are policies and procedures in place for dispensing, administering, and storing medications for each of the following, and practices match policies and procedures:
All medications obtained by prescription are labeled in compliance with federal and state laws.
IM multi-dose vials are dated and initialed when opened.
Medication labels are altered only by persons legally authorized to do so.
Medications intended for external-use-only are stored separately.
Medications are stored separately from foodstuffs and clearly labeled.
Medications are stored at proper temperatures. Room temperature medications at 59-86
degrees Fahrenheit. Refrigerated medications at 36-46
degrees Fahrenheit.
Temperature log for refrigerator is present and complete.
All medications are stored in a locked area with access limited to those medical personnel authorized to prescribe, dispense or administer medication.
Medications are appropriately disposed of after the expiration date.
Medications are disposed of when contaminated, deteriorated or abandoned, in a manner consistent with federal and state laws.
A medication log is maintained to document when the provider disposes of expired, contaminated, deteriorated and abandoned medications in a manner consistent with federal and state laws.
Medications are dispensed only by persons lawfully authorized to do so within the scope of practice of their license/registration/waiver.
Medication errors are reported and logged and logs are securely stored.
8. ACTION
Reviewer: If there are deficiencies, discuss them at the time of identification or upon completion of the re/certification. Decide whether to make a recommendation/s or to require a plan/s of correction within a specified time.
Y N COMMENTS Plan of Correction required? Date due (30 days from review date):
Plan of Correction received? Date received:
Plan of Correction approved? Date approved:
Follow-up site visit required? Date scheduled:
Transmittal submitted to Medi-Cal? Date faxed:
RE/CERTIFICATION APPROVAL DATE: (Certification date is the latest date all of the following are in place: a) certification application is received by San Mateo County, Behavioral Health and Recovery Services, Quality Management; b) date of fire clearance; c) date provider was operational.) _____________________. Certification is valid for 3 years from the Re/Certification Approval Date above. A provider’s certification is contingent upon compliance with all Federal, State and Local laws and regulations pertaining to the provision of services to persons with mental illness. Additional certification review will be necessary following changes in ownership, site location, organizational and/or corporate structure, programs and/or services provided. It is the responsibility of the designated Head of Service to report any such changes to the Deputy Director of the Department of Health and Social Services, Mental Health Division 60 days in advance of such changes occurring. Additional certification review may be necessary following significant staff changes (including high turnover or any change in the person designated as Head of Services), as well as following any unusual occurrences/special incidents. COMPLETED BY Signature, BHRS On-Site Reviewer Date CERTIFICATION APPROVED BY Supervisor, BHRS Quality Management Date
ATTACHMENT E
Date:
Project Name: Seeking Safety
Project Budget
FY 10-11
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$0Total In-Kind Contributions (if any)
Total Revenue
Total Funding Requested
BUDGET WORKSHEET
Proposed Total Number of Individuals to be served:
Months of Operation:
Total Start-up Costs
Proposed Total Number of Families to be served:
Proposed Expenses and Revenues
A. Expenditure
1. Personnel (list classifications and FTEs)
Total Personnel Expenditures
2. Operating Expenditures (please specify below)
b. Benefits and Taxes @ %
Total Subcontracts
5. Total Proposed Project Budget
B. Revenues (list/itemize by funding source)
4. Subcontracts/Professional Services (list/itemize all subcontracts)
Proposer's Name:
Total Operating Expenses
3. Start-up Costs (if any, please specify below)
a. Salaries, Wages:
