Table of Contents
Questions and Answers – Set #2
RFR #04-8210-3080-01
IV.
PROGRAMS and SERVICES .............................................................................................. 1
IV.
APPENDIX A: JOINT STANDARDS .............................................................................. 5
IV.
APPENDIX B: RESIDENTIAL SCHOOLS WITH FOLLOW ALONG SERVICES ........ 6
IV.
APPENDIX C: STARR ....................................................................................................... 7
IV.
APPENDIX D: IRTP AND APPENDIX E: CIRT ............................................................. 10
IV.
APPENDIX F: CONTINUUM .......................................................................................... 13
IV.
APPENDIX G: GROUP HOMES ..................................................................................... 18
IV.
PRE INDEPENDENT LIVING: GROUP HOMES ........................................................... 20
IV.
INDEPENDENT LIVING: GROUP HOMES .................................................................. 20
IV.
APPENDIX H: TEEN PARENTING PROGRAM (TPP) ................................................. 22
IV.
APPENDIX I: GROUP HOME 1:4 TRANSITION TO IFC ............................................ 24
IV.
APPENDIX L: INTENSIVE GROUP HOME WITH EXPANDED NURSING (Non
Competitive) and APPENDIX M: MEDICALLY COMPLEX GROUP HOME (Competitive).. 24
IV.
APPENDIX N: INTENSIVE 1:2 GROUP HOME WITH FOLLOW ALONG ............... 24
IV.
APPENDIX O: OUTREACH INDEPENDENT LIVING ................................................ 24
IV.
APPENDIX P: STATE UNIVERSITY PREPARATORY SERVICE .............................. 25
V.
CLARIFICATION TO QUESTIONS AND ANSWERS – SET #1 ...................................... 25
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
REQUEST FOR RESPONSES:
Caring Together: Strengthening Children and Families Through
Community-Connected Residential Treatment
RFR # 04-8210-3080-01
QUESTIONS & ANSWERS – Set #2
October 31, 2012
This posting contains responses to questions about Programs and Services, including questions on
RFR Appendices A through P, which EOHHS received regarding the CARING TOGETHER RFR
dated August 14, 2012 (Original RFR), and which are considered to be of general interest and to
help clarify the Original RFR and its associated documents. The Second Restatement of the
Request for Responses (the RFR) reflects amendments to the Original RFR that were not included
in the First Restatement of the RFR, posted on Comm-PASS October 18, 2012. The First
Restatement of the Appendices reflects amendments to the Original Appendices. These are tracked
in a Revision Log #2. The Second Restatement of the RFR, First Restatement of Appendices, and
Revision Log are posted on Comm-PASS.
The questions are grouped into categories for easier reference and, where practical, the RFR or
attachment sections to which they refer are identified. Answers to Questions 1 - 52 were posted on
Comm-PASS on October 19, 2012.
IV.
PROGRAMS and SERVICES
53. What is the role of the DCF Lead Agencies in making referrals to CARING TOGETHER
Services and their interfacing with DMH? What role will the current Lead Agencies play, or
will they even continue? What is the role of the DCF Lead Agencies in making referrals of
DCF youth/families to the Continuum, and what is their role in interfacing with the
Continuum provider re: care management?
ANSWER: The Agencies will continue to initiate the determination of need for CARING
TOGETHER services at a local level. The referral process will include participation of the
CARING TOGETHER Clinical Support Team. For DCF, this local process includes Lead
Agencies. Ongoing case management for DCF will also continue to be provided at the local level,
with the support of Lead Agencies. DMH will not be using Lead Agency services.
54. Are the services and “beds” in group homes, residential, etc. only available to Massachusetts
DCF and DMH clients? In other words, may a Contractor have a client in an open bed in
that group home (or other service) that is paid for through the Local Education Authorities
or other revenue stream?
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Caring Together RFR: Questions and Answers-Set #2
ANSWER: Contractors providing services through the Approved Contractor List (NonCompetitively selected services) have the ability to sell services to other purchasers as well as to
DCF and DMH. Contractors do not need to reserve a certain number of beds when providing
services through the Approved Contractor List. Contractors selected for a program through the
Competitive process must be able to meet the capacity requirements for those DCF and DMH
clients as set forth in the RFR for the program, or, as set forth in the Agency Service Agreement.
55. Are referrals from DCF and DMH restricted to set geographic areas?
ANSWER: The Agencies are committed to utilizing services as close to the youth and family’s
community as reasonably possible. There are cases, however, in which it is not feasible or
appropriate (for safety or other reasons) to utilize services within the youth and family’s
community. While there are geographic targets, there are no actual restrictions on geography.
56. The RFR calls for Providers to use the Child and Adolescent Needs and Strengths (CANS)
tool as one of the assessment tools. To date, there are two versions of the CANS tool that
continue to be utilized: MA CANS (DMH preferred) and DCF CANS (DCF preferred). Will
the Agencies require the use of one or the other version of the CANS, preferably the
Massachusetts CANS, to eliminate duplication of effort, paperwork, etc.? Will the
Massachusetts CANS be accepted on the Virtual Gateway? Which version of the CANS will
be used: the CBHI or the DCF one?
ANSWER: EOHHS is committed to the alignment of assessment tools for CARING TOGETHER
services, but for the interim, the Agencies will continue to use separate tools.
57. Given the requirement for electronic medical records, will DCF/DMH be implementing a
requirement to use the Massachusetts Standard Documentation forms so that there can be
consistency across agencies and providers?
ANSWER: EOHHS is committed to consistency of forms as a long-term strategy for CARING
TOGETHER services, but for the interim, the Agencies will continue to use separate reporting
tools.
58. If a bidder submits an application for a service model with Add-Ones, could the proposal be
rejected because of the Add-Ons?
ANSWER: Bidders should not address Add-Ons in their responses. Add-Ons are authorized on a
case-by-case basis and are not meant to be a method to augment, enhance or otherwise change the
basic composition of a service model or the rate of reimbursement.
59. If a bidder has an idea to expend its UniFy program to provide intensive family therapeutic
services along with parenting skills, independent living skills, communicating with
teachers/services providers and more, could that be included in the proposal? If so, where
would it be included?
ANSWER: EOHHS will only consider proposals for the Service Models specified in the RFR.
60. Do subcontractors in a Continuum application need to be prequalified though a submission
of the Joint Standards? Do subcontractors need to submit separate a Service Standard
response (e.g., in the Continuum)? Does a subcontractor need to also be a residential services
provider in order to participate as a Follow Along provider? For example, if a current
residential provider would like to partner with a CSA/CBHI service provider in that region,
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Caring Together RFR: Questions and Answers-Set #2
what would the partnering CSA/CBHI provider need to submit in order to qualify as a
Follow Along service provider partnering with a group home provider? If a provider uses a
subcontractor for the Intensive Foster Care (IFC), does the subcontractor have to submit
Joint Service Standards? Are any other submissions required?
ANSWER: When Continuum Contractors propose to subcontract for residential services, they may
only subcontract with providers that are on the CTFS Contractor List for the applicable type of
Group Home. Therefore, the subcontractor would have had to file its own response to the RFR,
which would include, among other things, a Joint Service Standards Response Package and a
Group Home Service Response Package. Even if a Continuum Contractor plans to utilize its own
(not subcontracted) residential services within its Continuum, the Contractor has to file a separate
response for the residential services (a Group Home Service Model Response Package), and be
approved for such. When Continuum Contractors are offering IFC as part of their Continuum, they
may only use IFC programs approved as Contractors through the DCF Family Networks RFR.
This is true regardless of whether the Contractor intends to subcontract for this service or utilize its
own service. The IFC programs do not have to be on the CTFS Contractor List but do have to be
approved for a CTFS Service Model. Any other subcontracting arrangement (e.g., for Follow
Along) requires the approval of Agencies, but the provider does not need to be on the CTFS
Contractor List. Please see Revision Log, Item 33 and the Second Restatement of the RFR. The
Contractor is responsible for ensuring that the subcontracted services are provided in accordance
with the terms of the RFR and contract including, when applicable, the integration of Follow Along
staff within the residential program in order to ensure the required service continuity.
61. What is the process for obtaining prior consent from the Agencies to be a subcontractor with
a provider, and how long does that process takes?
ANSWER: If a bidder proposes in its response to use subcontractors and such subcontractors are
named, approval of the subcontractors will be part of the award and contracting process. If a
Contractor decides to subcontract after the initial contract awards and/or if there are subsequent
changes to subcontractors, the Contractor must notify the Agencies in writing of such. Review
time will vary depending on the nature of the subcontracting.
62. Can a Continuum Contractor be a subcontractor to group homes in order to provide Follow
Along or Stepping Out services if the Continuum Contractor is not a Group Homes
Contractor and the client is not in Continuum services?
ANSWER: Any other subcontracting arrangement (e.g., for Follow Along) requires the approval of
Agencies, but the provider does not need to be on the CTFS Contractor List. Please see Revision
Log, Item 33 and the Second Restatement of the RFR. The Contractor is responsible for ensuring
that the subcontracted services are provided in accordance with the terms of the RFR and contract
(including, when applicable, the integration of Follow Along staff within the residential program in
order to ensure the required service continuity).
63. Will someone from DEEC Licensing be involved in the response to relevant questions?
ANSWER: DEEC Licensing staff have reviewed and concur with the responses to all questions
related to DEEC licensing.
64. Is Occupational Therapy included in the contract and/or expected to be provided by the
Provider? If not, what is the expectation for obtaining services for children that have sensory
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Caring Together RFR: Questions and Answers-Set #2
processing and/or integration challenges, which are very common in the latency-age
population served?
ANSWER: Contractors must provide an Occupational Therapist as required by the Service Model.
Where OT is not included in the model, it would be assessed in the same way as any other
community service.
65. Do the Agencies recommend or require that a standard youth and family team planning and
implementation process be used by service providers in order to ensure that service are
family-driven, youth-partnered, strength-based, collaborative, and maintain continuity in
care by providing continuity in care planning and implementation procedures?
ANSWER: It is up to bidders to propose how they will ensure that the requirements of the RFR
are met.
66. Appendix A, 4.14 talks about linking with Family Partners. As Family Partners is not part of
this RFR, but will be issued at a later date, how can one link to Family Partners that do not
yet exist?
ANSWER: Providers will be required to meet this requirement once the Family Partner services
are implemented.
67. Will there be logistical problems with multiple service authorizations in terms of
Respite/Follow Along or Residential Schools/Follow Along?
ANSWER: The Agencies have the capacity to track service authorizations and to ensure that they
are accurately entered into its payment system in a timely manner.
68. Will the different reporting systems for DCF (i-FamilyNet) and DMH children be made
consistent?
ANSWER: The Agencies and EOHHS are actively working to make reporting systems consistent,
and expect that a technical solution will be developed within the term of the procurement.
69. Through whom will DMH referrals be made for a particular service?
ANSWER: DMH and DCF will make their respective referrals for services. The final process for
referrals is in development.
70. What is the role of the Lead Agencies in the CARING TOGETHER referral, Utilization
Management, treatment oversight and discharge planning process?
ANSWER: DCF Lead Agencies will continue to assist local offices in the determination of need
for these services, and will interface with the CARING TOGETHER Clinical Support Teams
around quality and network management activities. The operational details are still under
development and are expected to be ready for implementation when the CARING TOGETHER
system begins.
71. RFR Section 2.1, under “Providing Clinical Support to Local Treatment Teams and
Providers,” discusses ‘level of service criteria’ that will assist in determining discharges. Are
these criteria currently available for each CARING TOGETHER service?
ANSWER: No, the criteria are currently under development.
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Caring Together RFR: Questions and Answers-Set #2
72. CANS Assessment will be required, but not all provider agencies have been offered the
opportunity to be trained. How will that training be offered to all agencies?
ANSWER: The Agencies will assist providers in accessing training for the CANS assessment.
73. Page 25 of the RFR (Section 2.1, under “A Phased-In Approach”): How far in advance of
“going live” will the Agencies provide the service criteria? And once the standardized
formats are rolled out, how much transition time will providers have before having to use the
new forms/formats?
ANSWER: The Agencies are currently developing the service criteria and the standardized formats
and anticipate that they will be ready for use by providers by the start date. The Agencies will
develop a reasonable transition time for use of the new forms/formats based on their experience
with similar transitions in the past.
74. Do the Agencies have suggestions for how to include youth and families in the hiring process
when most of the staff will be hired before youth and families are seen in the first place? Is
this meant to be more of an ongoing process once the program is up and running?
ANSWER: It is up to each bidder to propose how they will ensure that the requirements of the
RFR are met.
IV.
APPENDIX A: JOINT STANDARDS
75. Are the Rehab Option definitions for DMH and DCF the same, including utilizing the same
reporting documentation?
ANSWER: Yes. The Agencies will require the same documentation, and will be using the same
definitions. The Agencies will also provide training to all CARING TOGETHER Contractors
providing rehabilitative services regarding documentation and reporting.
76. Appendix A, Section 4.04 indicates all Contractors must ensure unlicensed staff that
administer medication be certified under the Medication Administration Program (MAP)
with the expectation is that all program staff within the RFR programs/services must be
MAP trained by July 1, 2012. Does this requirement apply to residential schools? Will
EOHHS increase capacity for MAP training in the first few months of implementation of the
RFR services, particularly for training the trainer? Will providers be allowed to access DMH
training?
ANSWER: MAP, the administering of medication by unlicensed staff, is a new requirement for
children’s services by DCF and DMH. MAP applies to all CARING TOGETHER placement
services except for IRTPs, CIRTs, Residential Schools (Appendix B), Independent Living
Programs (Appendix G), Outreach Independent Living Program (Appendix O), State University
Preparatory Program (Appendix P) and Teen Parenting Programs (Appendix H) except Enhanced
Teen Parent Services. Services will begin upon start date of contract and staff must be trained and
certified in accordance with Department of Public Health regulatory requirements, at 105 CMR
700.000, which requires staff to be trained and certified within six months of the contract start date.
DCF and DMH will pay for the testing and certification of staff; however, CARING TOGETHER
Contractors are responsible for providing training to their staff. The State is paying the test vendor
to conduct the Train the Trainer sessions. Train the Trainer sessions will be held monthly through
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Caring Together RFR: Questions and Answers-Set #2
the start-up period, and the test vendor will increase testing capacity for MAP Certification
candidates commensurate with demand during this same period. Providers of IRTPs and CIRTs
must follow the requirements for medications set out in Appendix D and E respectively. Providers
of the Residential School Service Model and Teen Parenting Programs using a group home are
required to fulfill the medication administration requirements of 102 CMR 3.06(4)(k).
77. Page 15 of Appendix A requires Contractors to support and coordinate “assisting with
homework to help support academic success/re-engagement if necessary.” If a family wants
Continuum staff to assist with homework directly on a regular or temporary basis, to what
extent is the provider expected to provide “tutoring services”?
ANSWER: Continuum Contractors would be expected to provide the structure and support
necessary for youth to complete homework and establish successful study habits. In addition, the
Continuum providers are to provide the kind of homework assistance expected of a parent or
guardian on a routine basis, and where applicable, to assist the parent/guardian in developing this
skill. The Continuum Contractor is not expected to provide ongoing tutoring.
78. For CARING TOGETHER aftercare services, are the Agencies looking for a particular
modality? Can that modality be one that a Contractor creates? What are the minimum
monthly contacts required in aftercare services and in residential services both for the
youth/clinician and the clinician/family?
ANSWER: Aftercare requirements are listed in Appendix A, Section 4.20.G. Any modality
meeting these requirements would be acceptable.
79. The group homes are listed in Appendix F as a required component of Continuum services,
but they are also separately Competitively bid, according to the table on page 6 of the RFR.
What is their relationship to the Continuum? Whom is a Group Home serving if it is not
part of a Continuum?
ANSWER: Contractors may provide Group Home services in two ways through this RFR: as a
Group Home service taking referrals directly from the Agencies; or as a Group Home service as
part of a Continuum. To become a provider of Group Home services taking referrals directly from
Agencies, the bidder would need to submit a proposal and be approved for the applicable Group
Home Service Model and be on the CARING TOGETHER Contractor List for such Service
Model. In addition, to offer Group Home Services through a Continuum, the bidder would have to
have either been selected to provide a Continuum Program by the Agencies or be an approved
subcontractor of a Continuum Contractor.
IV.
APPENDIX B: RESIDENTIAL SCHOOLS WITH FOLLOW ALONG SERVICES
80. For youth actively preparing for discharge home, are Residential School and Follow Along
ever both authorized at the same time, or may only one pay source apply at a time for each
youth?
ANSWER: Once Follow Along services begin, the Residential School provider would be paid for
both the Follow Along service and the Residential School service until the youth is discharged
from the Residential School. At that point, the provider would be paid for the Follow Along
service until that service is terminated.
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Caring Together RFR: Questions and Answers-Set #2
81. For children ages 3-5 who are not in kindergarten, what are the educational programming
expectations?
ANSWER: Educational programming expectations for residential schools are established by the
Department of Elementary and Secondary Education (DESE).
82. What will be the transition process in February for children currently in “virtual CIRT” or
Residential School beds?
ANSWER: The Agencies will work closely with providers, families and the youth in care to
facilitate necessary transitions.
IV.
APPENDIX C: STARR
83. Will waivers from DEEC be required for children whose age falls outside of DEEC’s
responsibility, and what funding mechanism will be available if the waiver requires increased
costs to support the child?
ANSWER: As described in Appendix C, Section 5.02, when the Agencies seek placement for
young adults from age of 19 through age 21 in STARR programs, the Contractor is required to
request the necessary licensing variances from DEEC and make the necessary adaptations required
by DEEC. In no case will the Agencies require placement in conflict with licensing requirements.
For example, no variance may be requested to continue the placement of a resident who is 22 years
of age or older, as no resident over the age of 21 is allowed. Requests for additional funding for
Add-On services will be considered on a case-by-case basis.
84. Please confirm that the staffing ratios remain the same for all STARRs regardless of the ages
of the youth served?
ANSWER: Yes.
85. Does a provider have to bid for a minimum of six STARR beds in total or six per area office?
ANSWER: Each STARR response must be for a minimum of six beds per Program Title as
detailed in RFR Section 9, Table 2.
86. Can one person serve as both the .25 FTE Assistant Director and the .25 FTE Clinical
Director?
ANSWER: Yes, as long as the full number of FTEs with the appropriate skill sets are present for
the number of beds in the program as required by Appendix C, Section 7.01.
87. Page 8 of Appendix C states, “Clinical Case Management/Clinical Staff: Two FTEs… are
required for every twelve youth.” Is only one FTE required for six or fewer youth?
ANSWER: Yes.
88. Appendix C, Section 7.01 states that “programs with more than 12 slots must have a .5 FTE
Assistant Director and .5 FTE Supervising Professional.” Does this mean that a program
with 12 or fewer slots need not have these positions?
ANSWER: Yes.
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Caring Together RFR: Questions and Answers-Set #2
89. What is the definition of the Follow Along Service Model, and are STARR programs eligible
to apply?
ANSWER: Follow Along services provide intensive home-based family interventions and
supports to youth and families, both while a youth is preparing to return home or move to another
family setting, and after this return takes place. Follow Along service is only being purchased for
children in Residential Schools and certain Group Homes, not for children placed in a STARR
program.
90. Is DCF seeking after-school programming through this RFR for latency age children to
support children post-discharge from STARR? Could that be proposed as part of
Continuum or Follow Along?
ANSWER: No. After-school programming is not a service that is included in the Caring Together
RFR.
91. Could a STARR program propose to serve an additional number of children (three or four)
through the Intensive Group Home (1:3) model? Can programs be co-located, for example, a
STARR and a Group Home?
ANSWER: Yes, contracts can increase the number of children as long as the Contractor complies
with the staffing and programming requirements for that program model, including ratios.
Programs may be co-located as long as they are in separate spaces with separate therapeutic
milieus. Requests to site additional programs at the same site as a STARR program are subject to
review by the Agencies and DEEC.
92. Is the Southeast Region anticipating including infant/toddler capacity within the STARR
program? If so, how much capacity and in which areas? Will the Regional Office manage the
latency contracts and be the gatekeeper for admissions/utilization, etc.?
ANSWER: Contractors providing Latency STARR for the Southern region would need the
physical and licensing capacity to serve youth ages 0 to 12 (See RFR Section 9, Table 2). While
the Agencies anticipate that use of STARR programs for infants and toddlers will be rare, we are
not specifying any particular capacity or location for ages within that range. The management of
the contract will be determined prior to implementation.
93. In RFR Section 5.5, Response Package Contents, the second bullet states that “for each
Program a Bidder wants to be selected to provide, the Bidder must complete a separate
Program Response Package.” If a Bidder decides to bid on a STARR in Pittsfield and
Holyoke, are two separate submission required? Page 15 of Appendix C asks for a Site
Summary Sheet, which would indicate one submission. Which is it?
ANSWER: Two separate Program Response Packages are required in that situation. Bidders must
submit a separate Program Response Package for each of the STARR program titles the bidder is
proposing to serve. (See RFR Section 9, Table 2 for the list of STARR program titles.) Within a
specific STARR program title, a bidder may propose more than one site; for this reason, the
question on page 15 of Appendix C allows for more than one site to be listed.
94. Must an organization have the total capacity for all STARR beds described within submitted
proposals? If separate proposals are required and mixed referrals disallowed within a
singular proposal, then must an organization that has the potential for 12 STARR beds, and
submits more than one proposal to fill those beds, then have the capacity to fill all beds
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Caring Together RFR: Questions and Answers-Set #2
awarded? For example, the provider submits a proposal for 12 beds to Worcester East and
12 beds to Worcester West and is awarded both. Is the provider responsible for 24 beds?
ANSWER: The instructions at the top of the STARR section in RFR Section 9, Table 2 state that
bidders may submit a response for all or some of the capacity for each designated Program Title.
In the example given, if a bidder with the capacity to provide 12 beds proposes 12 beds for the
Worcester East Program Title and 12 beds for the Worcester West Program Title, and is notified
that it has been awarded both, the provider could refuse the award for one of the program titles and
sign a contract that only included the other site.
95. The RFR states that Contractors will be assigned a certain number of beds for STARR
programs. Does that mean that areas will choose providers to have STARR capacity and that
those are the only providers that they will use for STARR placements, but that payment will
be made only when beds are filled?
ANSWER: Yes.
96. If payment is made only when beds are filled, are providers expected to hold capacity open
without payment?
ANSWER: Providers are expected to hold capacity for the contracted STARR slots. In order to
accommodate this, the rates for STARR were established using an 80% utilization factor, which
will cover the costs of potential underutilization. The Agencies will continue to closely monitor
STARR utilization.
97. Many of the STARR beds are identified for “mixed capacity.” Does this mean that only coed programs are desired? Or can males and females be served in different buildings? Can
two providers, one that specializes in serving males and the other in serving females,
collaborate to serve a mixed population? Do the Agencies want to ensure flexible use of
beds?
ANSWER: The instructions at the top of the STARR section in RFR Section 9, Table 2
differentiate between where the Agencies are looking for “mixed capacity” and those where the
Agencies are looking for specific numbers of male and/or female slots. “Mixed capacity” means
bidders must be flexible in accepting referrals of either gender. Capacity designated by sex must
have a defined separation, such as by floor or building, and the rooms must be reserved for
referrals of the designated gender. Bidders should review the stated gender requirements for each
specific STARR program title for which they are responding, along with the
“comments/preferences” column. Collaborative and creative proposals that meet the RFR
requirements are welcome.
98. Will providers be able to place non-STARR children in open beds in STARR units?
ANSWER: No.
99. What is the rationale for requiring a full-time director for either a six- or 15-bed program
(Appendix C, Section 7.01, p. 8)?
ANSWER: The Agencies opted to require a full-time director based on historic information related
to safety and quality issues. Rates have been established to support this requirement.
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100. For youth not attending community school, is it expected that a teacher/tutor will provide
the educational services for STARR youth? Is there funding available within the contract
to support this function?
ANSWER: For those rare instances when a youth is temporarily unable to leave the STARR
program to attend school for safety, treatment or other significant reasons, the STARR Contractor
is not responsible for providing a teacher/tutor. Appendix C states that the STARR Contractor
must notify the responsible school district of its responsibility to “offer alternative academic and
therapeutic programming on site that engages the youth in age appropriate curriculum that meets
state curriculum standards and maintains grade level progress. The expectation is that the
STARR Contractor works with the school district to ensure that the youth receives credit for
academic work done in the STARR program.” The rate set by the Division of Health Care
Finance and Policy (DHCFP) incorporates this function.
IV.
APPENDIX D: IRTP AND APPENDIX E: CIRT
101. If a provider is asked to hold a bed for a client (e.g., forensic/non-forensic), will the
provider be paid for it?
ANSWER: If DMH has enrolled a youth in an IRTP service, then DMH would pay for each day
the youth was enrolled. To be considered enrolled in an IRTP, the youth will have been screened
for this level of care, determined in need of the service, and approved, authorized and placed in
the IRTP. IRTP Contractors will not be asked to set aside capacity or “hold a bed” for potential
forensic referrals.
102. What role will the host facility on-site physician play in relation to forensic admissions,
restraints, etc.?
ANSWER: The admission process is not an emergency procedure and remains the responsibility
of the admitting/attending physician for the receiving IRTP.
103. IRTP Appendix D, Section 4.03 states that the “host facility will provide after-hours on-site
doctor emergency psychiatric coverage, as needed.” What is included in after-hours
coverage? For example, are doctors to be available for restraint coverage? What about
restraint coverage during the day?
ANSWER: The host facility will provide emergency medical response, which includes restraint
authorization and face-to-face evaluation by a physician when the IRTP attending physician is
not on site, provided that the IRTP is not co-located with and operates another IRTP service that
could reasonably provide first-line emergency medical response. In the event a co-located IRTP
service operated by the same IRTP provider is unable to respond to the IRTP with the medical
emergency, the host facility must respond.
104. IRTP Appendix D, Section 4.03 states, “The host facility will provide after-hours on-site
emergency psychiatric service coverage, as needed.” Please explain this statement. Is this
an on-site qualified physician or is it more expansive and includes assistance from other
staffing locations?
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ANSWER: The host facility will provide on-site physician coverage for restraint authorization
purposes when the IRTP physician is not on-site and no first-line response from another colocated IRTP service operated by the same IRTP provider is possible. The host facility will also
provide physician and nursing staff response in the event of a medical emergency (lifethreatening circumstance). The medical emergency response does not include staff from off-site
locations or staff from other clinical disciplines. IRTP providers are expected to be able to selfmanage most of the critical incidents they experience without host facility assistance
105. IRTP Appendix D, Section 5.05 (I)(3): Listing a restraint as a sentinel event appears to
indicate that the Contractor should manage the restraint as such with the Joint
Commission – is this correct? Could DMH offer a clearer definition of the word “sentinel
event”? If the intent is for the Contractor to notify the Joint Commission for each
restraint, that would be problematic and inconsistent for other Joint Commission-licensed
IP and residential programs.
ANSWER: The Contractor is not expected to notify the Joint Commission in the event of a
restraint. The Contractor is expected to treat a restraint episode as a critical occurrence requiring
detailed post-event analysis and to update the treatment plan to prevent future occurrence because
restraint and seclusion use are contrary to trauma-sensitive treatment and the DMH goal is to
eliminate restraint and seclusion.
106. IRTP Appendix D, Section 1.02 states that “every consideration is given to placing the
adolescent in a program that is closest in proximity to his/her home/Area-of-Tie.” The
Worcester Units would then be seen as the closest IRTP program for over one-half of the
state’s geography. For example, one home visit could require allocation of five hours of
travel. How does DMH anticipate addressing extra transportation and staffing costs for
units that treat a greater proportion of youth at a greater distance? How should a bidder
plan for this?
ANSWER: The approved rate includes funding new clinical and staff support positions in part to
enhance transportation capacity.
107. IRTP Appendix D, Section 2 does not discuss historical geographic distribution of IRTP
patients. How will DMH address regional utilization patterns that, after giving
consideration for special populations, might leave certain programs underutilized?
ANSWER: DMH decreased the number of IRTPs to enhance utilization across all IRTP services.
In setting the rates, DHCFP used a 90% utilization factor.
108. IRTP Appendix D, Section 5.02(G) Standard 7 discusses a licensing agreement. Does this
imply a payment to DMH for use and maintenance?
ANSWER: No. the “Licensing Agreement” is the title of the tenant-landlord document.
109. IRTP Appendix D, Section 5.03(H): In regards to “Licensed clinical staff,” does DMH
consider LPNs, RNs, and RNCs as licensed in relation to the provision of individual, group
and family treatment, if they are supervised and can demonstrate the appropriate skill
sets?
ANSWER: Appendix D, Section 5.03(H) refers to “IRTP clinical staff who are licensed,
experienced, and have received training in providing services to adolescents with complex
emotional, behavioral, developmental and processing needs.” Licensed clinical staff are those
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Caring Together RFR: Questions and Answers-Set #2
who function within their scope of education, experience, practice and license, which is defined
by the Commonwealth’s professional licensing standards. As a general rule, nursing staff are not
trained in individual, group and family treatment and would not satisfy this requirement, unless
they had clear documented education, experience and expertise in the provision of these forms of
psychotherapy.
110. IRTP Appendix D, Section 5.03(J): This standard refers to sufficient qualified staff. Is it
correct that this RFR does not request a staffing pattern?
ANSWER: No. The CARING TOGETHER RFR requires the following standards be met: Joint
Commission accreditation, DMH licensing, Appendix A (Service Standards), and Appendix D
(IRTP service specifications). Specific positions/roles/functions were identified as well as a
specific nursing care hour formula. These requirements collectively create a specific staffing
pattern.
111. IRTP Appendix D and CIRT Appendix E, Section 5.04(B): Standard 2 requires dedicated
space for activities by the Contractor. Since the Contractor is only a licensee, is this not the
responsibility of the host facility with the programming to ensure the use of the space
resting with the Contractor?
ANSWER: If the proposed service is located in or on the grounds of a state facility, the
Commonwealth will provide dedicated outdoor space. However, this standard refers not only to
dedicated outdoor space but to indoor space as well. Contractors must ensure this standard is met
when they determine how indoor space will be used. If the proposed service is a CIRT, the
Contractor must ensure this standard for dedicated indoor and outdoor space is met.
112. IRTP Appendix D, Section 5.05(F)(3): The two forensic programs appear to operate at a
disadvantage: How would DMH address a situation where the program might have to
admit multiple forensic admissions on the same day if the need is there and the bed is
available? The Contractor is required to maintain capacity at a level higher than the actual
census would require in order to support beds that might be needed rather than beds that
are occupied.
ANSWER: Forensic IRTP admission capacity augments forensic inpatient capacity. If two youth
are referred by the court on the same day and neither requires inpatient level of care, it is
expected that one youth would be admitted to each IRTP-accepting service, subject to bed
availability.
113. Will DMH limit referrals to forensic programs for non-forensic patients to allow for
reasonable access?
ANSWER: No.
114. What is the role of the physician in the development of the IRTP and CIRT initial
treatment plans?
ANSWER: IRTP and CIRT care are physician-directed care. The role of the physician is integral
to the development and implementation of the initial and master treatment plan.
115. Is the psychiatric evaluation required to be done by a child psychiatrist or a licensed
clinician?
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Caring Together RFR: Questions and Answers-Set #2
ANSWER: A psychiatric evaluation must be conducted by a psychiatrist. The required
qualifications for an IRTP and CIRT psychiatrist are identified in the DMH licensing standards
for IRTP service.
116. Would DMH define off and on hours?
ANSWER: No. These terms are not used in the RFR.
117. The referral process for IRTPs has been closed, and managed by one or two DMH staff.
Admission is also restricted due to statutory requirements regarding eligibility for
placement. Will DMH retain its gatekeeper role?
ANSWER: Yes.
118. Will Massachusetts DCF, other in-state, and out-of-state entities be able to purchase IRTP
services for eligible youth?
ANSWER: Yes. IRTP services may be purchased by other out-of-state governmental or private
entities, provided that: 1) the Contractor has additional licensed capacity; 2) the youth meets the
level of care criteria; 3) DMH reviews and approves the referral prior to placement; 4) the
Contractor retains and maintains care coordination responsibility for the youth with the
referring entity; and 5) the Contractor also provides educational service to the youth.
IV.
APPENDIX F: CONTINUUM
119. Will Continuum providers provide the Follow Along and Stepping Out-style services for
Continuum children involved with Residential Placements?
ANSWER: Neither Follow Along nor Stepping Out services are included in the Continuum. The
Continuum Core Service Team will start working with a youth and his/her family upon
enrollment in the Continuum service. If a youth requires an out-of-home placement service
during his/her enrollment in this service, it is expected the Continuum Core Service Team will
continue to follow and work with that youth/family while the youth is in that out-of-home
placement and when he/she returns back home.
120. Can 24-hour face-to-face crisis support be provided by an emergency services provider in
certain situations? Must at least one staff member be ready for 24-hour on-call service at
any given time? If a situation is deemed unsafe, can the Contractor decide not to provide
face-to-face support directly?
ANSWER: Twenty-four hour face-to-face crisis support service must be provided by the
Continuum Contractor. Crisis support service is intended to be an outreach supportive service
delivered to a youth and family to help them through behavioral crises. It is not intended to
replace a mobile crisis intervention service or other emergency service response. Continuum
Contractors must have staff available 24 hours/day, 7 days/week to fulfill this support service
requirement. In the event of an unsafe situation, Contractors must use good clinical judgment,
involve other emergency service providers as indicated, and remain available to support the
youth/family through a crisis situation.
121. Will Continuums be placing youth into Residential Beds without DCF custody? How will
that part of the service system work?
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Caring Together RFR: Questions and Answers-Set #2
ANSWER: No. Youth placed in Residential Beds through DCF will need to be in the care/
custody of DCF prior to the placement in the Residential Bed regardless of whether the youth is
being served through the Continuum.
122. Will Family Support and Stabilization services continue to exist as a separate program or
will they be part of the Continuum?
ANSWER: Family Support and Stabilization services are not part of this RFR and the DCF
Family Networks RFR will continue to be in effect.
123. For the Continuum, the Merrimack Valley and Metro-Southern Continuum slots are to be
divided among multiple providers. How many slots will be given to each provider in these
areas? Could an organization house more than one program out of the same site (for
example, an organization becomes the Contractor for both Merrimack Valley sets of slots
and houses both out of the city of Lawrence)? Merrimack Valley Continuum: RFR Section
9, Table 2 states that the Merrimack Valley Continuum will have “at least two Continuum
Core Service Teams.” Will these teams operate within a single Continuum contract or will
there be multiple contracts awarded for this Continuum?
ANSWER: The Agencies will select one Contractor for the Merrimack Valley Continuum and
one Contractor for the Metro-Southern Continuum. The Agencies have identified the preferred
locations for each continuum and expect multiple service locations for each geographic area. It is
up to the bidder to develop a response that will meet the specifications of the Continuum on
which it is bidding, which may include subcontracting.
124. Are the 51 beds designated for the Springfield area on the Continuum reserved for one
provider, or will they be split up among multiple providers?
ANSWER: The Springfield Area Continuum will be awarded to one Contractor. It is up to the
bidder to develop a response that will meet the specifications of the Continuum on which it is
bidding, which may include subcontracting.
125. Should each Continuum proposal be based on the 30-slot assumption?
ANSWER: No. Respond to the capacity for the respective programs as listed in RFR Section 9,
Table 2.
126. Continuum Appendix F, Section 9.04, Peer Mentor: What are the age and education
requirements for this new hire?
ANSWER: Peer Mentors are young adults with personal experience living in either the child
welfare or mental health service system. They are expected to be approximately 18-25 years of
age. This position is subject to the same hiring processes as other staff position (CORI, reference
check, etc.). A high school diploma or GED is preferred.
127. Will any additional flex funds be available for Continuum providers?
ANSWER: No. Flex funds are embedded in the Continuum rate.
128. Which standard Continuum staff, if any, would require MAP training?
ANSWER: Continuum staff are not required to be trained and certified in MAP, as youth
enrolled in the Continuum and living at home will have their medication administered by their
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parent/guardian. Youth enrolled in the Continuum who are placed in a group home service will
have their medication administered by the group home service staff.
129. Are Continuum providers expected to provide respite services? If so, how is an appropriate
level and frequency of respite care to be determined?
ANSWER: Yes. The level and frequency of respite service will be determined by the Continuum
Core Service Team with the youth/parent/guardian/legally authorized representative (LAR).
Consistent with Appendix A (Service Standards), Out-of-home services (Appendix F, Section
8.02(F)(1)-(4) require the approval of the referring Agency, in addition to the consent of the
parent/guardian/LAR.
130. For Continuum services, what latitude regarding case management and decision-making
does the Continuum provider have, and what remains with DCF and/or DMH? For
example, can a provider make the determination that a youth needs residential services (or
not), or is that decision only made by the DCF/DMH Clinical Team?
ANSWER: Consistent with the Wraparound approach, it is expected that day-to-day case
management decisions for youth and their families who are enrolled in the Continuum will be
made collaboratively by the Continuum Core Service Team with the youth/parent/guardian/LAR.
However, placement decisions require approval of the referring Agency and consent of the
parent/guardian/LAR as indicated in Appendix F, Section 8.02(F).
131. Continuum Appendix F, Section 9.03 states that there should be 6.5 FTEs of Direct Care III
staff. Should this state Direct Care II staff instead?
ANSWER: No.
132. Appendix F, Section 9.03, Outreach/Support, indicates 6.5 FTEs of Direct Care (DC) III
staff. According to the UFR (Uniform Financial Report), Direct Care III staff are master’slevel clinicians. Therefore, the 6.5 FTEs of Direct Care III staff indicated in Section 9.03
must be master’s-level clinicians – is this an accurate interpretation?
ANSWER: No. For purposes of Continuum service specifications, DC IIIs do not need to be
master’s-level clinicians; however, they must be senior level and experienced staff able to work
independently in the community with youth and family.
133. In Appendix F, are the “6.5 FTEs of Direct Care III staff” in addition to the four master’slevel clinicians and one independently licensed clinician indicated in Section 9.02?
ANSWER: Yes. As indicated in Appendix F, Section 9.02, the 6.5 FTEs of DCIII staff are in
addition to the 1.0 FTE independently licensed clinician and 4.0 FTE master’s-level clinicians
who are intended to provide clinical care/service coordination for 30 youth.
134. According to Appendix F, Section 9.07, the Continuum occupational therapist (OT) does
not provide assessments or planning. Who does OT assessments, and who plans for
cognitive and sensory processing and integration?
ANSWER: For youth within the Continuum, the occupational therapist provides consultation to
the Continuum Core Service Team, community providers and the youth’s school. The
occupational therapist may also provide consultation/coaching to the youth’s family. When
indicated and available, OT assessments and intervention may be accessed through resources
such as outpatient providers or the youth’s school.
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Caring Together RFR: Questions and Answers-Set #2
135. Appendix F, Section 9.01 indicates one FTE independently licensed clinician to supervise
the staff providing the clinical and outreach services. Would this be the same independently
licensed clinician as referenced in Section 9.02, or would it be in addition to the one FTE
independently licensed clinician indicated in Section 9.02?
ANSWER: The one FTE independently licensed clinician identified in Appendix F, Section 9.01
(Program Management) is in addition to the independently licensed clinician identified in Section
9.02 (Clinical Care/Service Coordination).
136. For the Continuum, there is significant risk due to the high fixed costs associated with
required staff and the high variable costs associated with Residential placements. If the
Agencies do not utilize enough slots, or if referrals are such that a higher than predicted
proportion of clients ends up requiring Residential services, a Continuum program may be
financially distressed. Do the Agencies have a plan to protect Contractors from this risk?
ANSWER: The Agencies will meet with Continuum Contractors on a regular basis to monitor
implementation and utilization of this service.
137. The assumption is that each Continuum has 30 youth. Does this mean that a Continuum
with 13 slots (like Oxford) will require 33% of the full quota that a 30-youth Continuum
would have?
ANSWER: The Continuum model and staffing pattern were developed based on a 30-slot
prototype. A Continuum of a different size would prorate its staffing pattern accordingly.
138. Can group living environments that are on an approved Contractor list also provide
services within a Continuum?
ANSWER: Group living environments must be on the CARING TOGETHER approved
Contractor list to provide services within a Continuum.
139. Do the identified locations of out-of-home placements within a Continuum need to be in the
same geographic area as identified in the RFR Section 9, Estimates of Capacity? For
example, within the North County Continuum, do the out-of-home placements need to be
available only in the Fitchburg and Gardner areas, or could they be accessed in other areas
such as Worcester?
ANSWER: The intent of Continuum service is to support youth and families in their home
communities. Out-of-home placement for youth enrolled in the Continuum will be provided as
close to the youth/family’s home as reasonably possible.
140. Is it expected that a Continuum youth placed in a Group Home will receive the same array
of services as in a non-Continuum Group Home?
ANSWER: Youth enrolled in the Continuum placed in a Group Home receive all services
provided by the Group Home as well as the full array of services provided by the Continuum
Core Service Team.
141. When Continuum children require out-of-home care, who makes the decision? Is it correct
that the Continuum makes the referral and pays the subcontractor at the “adjusted rate”?
ANSWER: The Continuum Provider, with the family and/or Legally Authorized Representative,
and with consultation from the Agency, determines the level of service and or program. If there is
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Caring Together RFR: Questions and Answers-Set #2
disagreement, the Agency will make the final determination. When a youth enrolled in the
Continuum requires an out-of-home placement, the Continuum Contractor will make the referral to
that Group Home or Intensive Foster Care service and be responsible for paying the service
provider. The subcontractor must be paid for the placement at the rate the Continuum would be
paid for the placement if not subcontracted.
142. In the Continuum, must Contractors be able to provide all services listed in the model?
ANSWER: Yes.
143. Are there Add-Ons for the Continuum?
ANSWER: Yes. Add-Ons will be subject to a review and approval by the Agencies.
144. Are Pre-Independent Living (IL) and Independent Living (IL) services part of the
Continuum? If so, are they being considered as in-home or out-of-home placements, and
how do these services figure into the percentages of out-of-home placements?
ANSWER: Pre-IL and IL services are part of the Continuum design and will be implemented in
future years of the contract.
145. We understand that DCF IFC providers will be getting referrals from DMH; however, we
also understand that DCF will not allow DCF and DMH youth to reside in the same home.
Does that mean that IFC providers will be required to recruit DMH-specific homes? If so,
can existing foster homes be designated for that purpose?
ANSWER: At this time, DMH-referred youth will need to be placed in IFC homes where there
is not already a DCF youth. There is no requirement to “designate” a home in advance as serving
only one population.
146. What is the expected duration of stay in the Continuum?
ANSWER: The expected duration for all CARING TOGETHER services is individualized and
will vary based on youth/family circumstances.
147. Within the Appendix F index, there is a Section 10 – Continuous Learning and Quality
Improvement; however, there is no corresponding text within the RFR addressing this.
Will this section be added as an amendment or should Providers disregard the section?
ANSWER: This was an error in the index to Appendix F. Please see Revision Log, Item 28 and
the First Restatement of Appendix F.
148. Appendix F, Section 8.02(C)(3) states, “Contractor staff are available for face-to-face crisis
support for youth and families seven (7) days per week; twenty-four (24) hours per day
wherever these supports are needed.” How have these services been estimated for staffing?
For pricing? How is it envisioned that staff doing this work will collaborate with and
involve staff of Child Mobile Crisis Teams?
ANSWER: Bidders should refer to the rates for these services that have been established by
DHCFP. Bidders are encouraged to develop collaborative relationships with Mobile Crisis
Teams to ensure that situations requiring that level of intervention are accessed in a timely
manner.
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Caring Together RFR: Questions and Answers-Set #2
149. Why is the rate for a Continuum youth placed in a Group Home different from the nonContinuum youth rate? Specifically, what Group Home services should be provided by the
Continuum program that do not have to be provided by the Group Home program? This
clarification is especially important when the two programs are with two different
providers.
ANSWER: Some of the functions normally performed by Group Home staff will be the
responsibility of the Continuum Core Service Team as negotiated between the Continuum Core
Service Team and the Group Home. The rates for the placement portion of the Continuum were
adjusted to reflect the reduced level of services provided by the group home staff rather than the
Continuum Core Service Team.
150. If a Continuum child is in need of residential services for an extended period of time such
that Continuum services are no longer beneficial to a child, what would the process be for
transferring the child out of Continuum care and into standard Group Home care? Are
there any criteria to guide the decision to transfer?
ANSWER: Such determinations are made in conjunction with the family, the Agency case
managers and the Caring Together Clinical Support Teams.
151. Who has the authority to discharge a client from the Continuum?
ANSWER: Determinations to discharge or transfer a child/youth are made in conjunction with
the family, the Agency case managers, and the applicable CARING TOGETHER Clinical
Support Teams.
IV.
APPENDIX G: GROUP HOMES
152. Please provide the latency versus adolescent age breakdown for each of the Group Homes
solicited in the procurement.
ANSWER: Available data is in the RFR document titled “CCAnalysisthruJan12rev1” (Excel
file), which can be found under the Specifications Tab of the RFR’s Comm-PASS file.
153. Who makes referrals to Group Homes outside the Continuum?
ANSWER: The Agencies will make the referrals to Group Homes outside the Continuum.
154. At what point are youth eligible for Follow Along while in placement?
ANSWER: Youth receiving Intensive Group Home 1:3 or Group Home 1:4 services are eligible
for Follow Along when the Agency determines, in collaboration with the Contractor and the
youth and family, that the youth and his/her family are ready to begin in-home treatment in
preparation for a return home.
155. Is there a limit to the number of Follow Along and/or Continuum clients a Group Home
can have?
ANSWER: No. The only limit on the number of clients a Group Home may have is based on the
applicable license of the Group Home.
156. Is there a weighting system for the Follow Along questions to which bidders must respond?
They are not broken down per question, as with the other questions.
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Caring Together RFR: Questions and Answers-Set #2
ANSWER: All Follow Along questions carry equal weight.
157. Should the responses for the Follow Along immediately follow on the same pages with the
Group Home response, or should it be separate and labeled separately?
ANSWER: The response for Follow Along should be separate from the Group Home response
and labeled separately.
158. At what point are youth eligible for Follow Along while in placement?
ANSWER: The determination for Follow Along is made in conjunction with the family, the
Agency case managers, and the applicable CARING TOGETHER Clinical Support Team. Once
Follow Along services begin, the Group Home provider would be paid for both the Follow Along
service and the Group Home service until the youth is discharged from the Group Home. At that
point, the provider would be paid for the Follow Along service until that service is terminated.
159. May the same clinicians providing care for Group Home services provide Follow Along
services? When a youth transitions from the Group Home to Follow Along care, will the
Agencies expect the same clinician to provide care? What about when a youth transitions
from Independent Living to Stepping Out?
ANSWER: Continuity of Services is a critical component of both Follow Along and Stepping
Out services. Yes, the Agencies would generally expect the same clinician to provide care to
maintain continuity when a youth transitions from the Group Home to Follow Along care.
Similarly, we would generally expect the same care management staff who worked with a youth
in a Pre-IL or IL program to follow the youth through Stepping Out.
160. In Appendix G, Section 8.02(A)(2), Group Home 1:4, the specifications indicate that
providers must coordinate access to individual and group therapy, but then state that 1.5
FTEs of master’s-level clinicians should be able to provide individual and group therapy.
Given that the rate is lower for Group Home 1:4, can bidders assume that if program staff
provide clinical services that are not included in the rate, we are allowed to do third-party
billing for these services?
ANSWER: While most of the clinical services for youth in Group Home 1:4 would be accessed
from community providers; the staffing does include a clinician to provide the family work
preparatory to Follow Along services. Additional services beyond those required and paid for
under the RFR should be discussed with the youth, family/LAR and Agency. It is expected that
the Contractor will access services not included in the contract thorough community resources,
which may be paid for through third-party billing. Contracted staff may not bill third parties for
services rendered during the hours that their time is paid for by the contract.
161. Regarding Capacity for Group Home programs, will bidders be limited to the number of
beds they bid on? If bidders have additional capacity beyond what they bid on and are able
to meet all specifications (including increased staffing), could they exceed that number if
DMH or DCF wanted to make additional referrals?
ANSWER: Bidders are not limited on the specific location(s) or the number of beds being
proposed for Non-Competitive services.
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Caring Together RFR: Questions and Answers-Set #2
162. Is it permitted to have Residential School and Intensive Group Home 1:3 children in the
same house as long as both require the same direct care ratios (even though rates are
different as clinical and educational service delivery is different)?
ANSWER: Each Service Model is required to have its own separate management staff as
specified in the Appendix for that Service Model. In addition, Contractors will need to ensure
fidelity to the Model as specified, including staff-to-child ratio, as well as components such as
occupational therapy, rehabilitation services and other components or services which may vary
from Model to Model. Within these requirements, a Contractor may locate more than one
Service Model at a particular site address. Residential School providers will need to consult with
DESE prior to making any change to a DESE-approved program.
163. Regarding [Intensive] Group Home 1:3, is it acceptable for the psychiatric consultation to
be provided by a Psychiatric Mental Health Clinical Nurse Specialist? Also, can the
consultation be provided by phone? If Contractors are able to provide direct psychiatric
services to children in the program, are they allowed to do third-party billing for these
services?
ANSWER: Psychiatric Consultation service may be provided by a Psychiatric Mental Health
Clinical Nurse Specialist, provided that person is functioning within his/her scope of practice and
meets necessary licensure, education, and supervision requirements. However, this consultation
role is intended to be a liaison with other medical professionals (e.g., pediatricians) and is not
intended exclusively for the mental health professionals. Therefore, it is possible the function
will exceed the Clinical Nurse Specialist’s expertise and competence. Psychiatric consultation
must be delivered on a face-to-face to basis and is embedded in the Intensive Group Home 1:3
service rate. For this reason, third-party billing for psychiatric consultation is not allowed.
IV.
PRE INDEPENDENT LIVING: GROUP HOMES
164. Appendix G, Section 5.02(C) references a 1:10 overnight ratio, and in another place also
mentions a minimum of two staff per night. Can you clarify if it is 1:10 or minimum of
two?
ANSWER: A minimum of two staff are required at night. If a program exceeds 20 people, then
the 1:10 overnight ratio rule applies in determining the required overnight staffing.
IV.
INDEPENDENT LIVING: GROUP HOMES
165. The Independent Living (IL) service model indicates that young adults (under the age of
18) can/will be served. How does the placement of youth under the age of 18 in an
apartment meet DEEC licensing requirements, which specify that youth of this age be in a
licensed program? What are the DEEC licensing requirements for youth in apartments
who are A) age 17, and B) ages 18+?
ANSWER: The Pre-Independent Living model included in this RFR falls under the DEEC
licensing definition of “Transition to Independent Living Programs”. DEEC does not regulate
Independent Living programs such as the Independent Living model included in this RFR.
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The decision to place a young adult under the age of 18 in an unstaffed independent living
program rests solely with the Agencies, who will consult with DEEC as necessary.
166. May system-involved and non-system-involved (supported outside of this bid) youth live
together in a centralized apartment?
ANSWER: Yes, as long as the services provided to the youth referred by the Agencies remain
consistent with those specified in the Joint Standards and Service Model Specifications.
167. Can DMH-involved youth and DCF-involved youth be housed in the same apartment?
ANSWER: Yes.
168. Can a DCF/DMH-involved youth (age 18+) in a scattered site apartment have a roommate
who is non-supported (self-pay)?
ANSWER: Yes.
169. What is meant by “cannot be served in a family setting due to clinical needs” in Appendix
G, Section 3.01(D)?
ANSWER: The Agencies recognize the benefit of providing services to youth in their own
family home, a kinship setting or, alternately, another family setting. Before referring a youth to
Residential services, the Agencies will rule out the possibility of that youth being served in a
family setting.
170. Are all Independent Living participants automatically enrolled in Stepping Out at
discharge?
ANSWER: No. This decision will be made on a case-by-case basis, but the expectation is that
Stepping Out would be offered to all youth discharging into the community.
171. Can Stepping Out services be provided to a youth who did not discharge according to
service plan?
ANSWER: Yes, where the treatment team recommends this service.
172. Will youth in Independent Living and/or Stepping Out be recipients of their own vendor
payments?
ANSWER: Youth would not receive Young Adult Support Payments from DCF while they were
in an Independent Living Program. After discharge from the IL program, if a youth meets the
requirements for Young Adult Support Payment and this is supported by the tasks identified in
the youth's service plan, the Department may authorize the payments for a specific period of
time. This could occur at the same time the youth is receiving Stepping Out services.
173. If a Contractor is approved to provide IL and Stepping Out services, is it possible that this
Contractor would receive referrals from other Pre-IL and IL programs (e.g., for
community continuity)?
ANSWER: A Contractor who is approved to provide IL and Stepping Out services would only
provide them for another approved program through a subcontracting arrangement which was
approved by the Agencies. Since continuity of relationships is a primary consideration of the
integrated system, any bidder proposing a subcontract arrangement would need to establish how
the proposed model would ensure this continuity.
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IV.
APPENDIX H: TEEN PARENTING PROGRAM (TPP)
174. Appendix H, Section 14.04(G), Flexible Funds indicates that “the bidder will have the
ability to utilize a small portion of the funding available to assist residents in their
transition into the STEP and upon discharge from the program into permanent housing....”
Please clarify how bidders access these “Flexible Funds.”
ANSWER: Flexible Funds are included in the daily rate that providers of Teen Parenting
services are paid for such services.
175. In the Appendix H Response Requirement Chart, there is a listing for “Emergency
Placement (for TLP Bidders).” Please explain what “TLP” stands for.
ANSWER: This is a typographical error. It should read “Emergency Placement for Teen Living
Service (TLS group home only) bidders.” Please see Revision Log, Item 26 and the First
Restatement of Appendix H.
176. Is the expectation that the TPP Houseparent model will be licensed by DEEC, given that
the RFR language identifies “some” 16- and 17-year-olds will be served?
ANSWER: Yes, all TPPs serving youth under the age of 18 are required to be licensed by
DEEC.
177. Appendix H, Section 3.01 states that TPPs serve clients between the ages of 13 and 19, and
then later states in the discharge Section 8.01 that a client is to be discharged on his/her 20th
birthday. Can Contractors take in residents over the age of 20 or only age 19?
ANSWER: Contractors for a Teen Parenting Program may only take in residents up to and
including age 19. Residents can remain through their 19th year. DCF will not refer consumers
age 20 or older to a Teen Parenting Program.
178. Appendix H, Section 5.11 states that residents are required to “be enrolled in high school, a
GED program, college, job training program, or be employed;” for how many hours per
week are these activities required? What about for those in emergency beds (Section 6.03)?
ANSWER: Any teen parent receiving TAFDC must participate in an education or training
program or be employed for a minimum of 20 hours per week. Teens placed in emergency beds
are not required to participate in education or training programs, but are encouraged to continue
to attend such programs if they were enrolled in them prior to placement.
179. Appendix H, Section 13 seems to have a misprint on page 14. The second sentence says,
“Outcome data shall be maintained on ing visits.” Please clarify.
ANSWER: This is a typographical error. It should read, “Outcome data shall be maintained on
monitoring visits.” Please see Revision Log, Item 26 and the First Restatement of Appendix H.
180. Are the Peer Advocates described in Appendix H, Section 5.08 volunteers, or are they
considered hired staff? They are not mentioned in the prescribed staffing pattern. Is there
a minimum number of hours that Peer Advocates need to be in the program? If Peer
Advocates are considered hired staff, are they included in the child-to-staff ratio?
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Caring Together RFR: Questions and Answers-Set #2
ANSWER: Peer Advocates are considered hired staff. They are not included in the child-to-staff
ratio. The number of hours the Peer Advocate works will be dependent on the size of the TPP.
181. Are the Father’s Parent Programming services (Appendix H, Section 5.12) wrapped into
the rate, or can Contractors use third-party revenue in support of fathers’ services?
ANSWER: Yes, services to fathers are built into the rate and all TPPs are required to provide
services to fathers.
182. For the Teen Parenting Houseparent services described in Appendix H, Section 14.02 (B),
does the contract require an overnight awake when the houseparent is on site? The
language says programs must ensure that the houseparent is on site overnight OR there is a
requirement of one awake overnight staff on site at all times. We interpret this to mean
that a house parent AND awake staff are not both required. Is that correct?
ANSWER: The Houseparent model does not require an awake overnight staff member in
addition to the houseparent when the houseparent is on site.
183. Does the requirement of an “FTE Program Director” for the Teen Parenting Houseparent
Model apply regardless of the number of beds provided? If a site has fewer than six beds
supported with CARING TOGETHER funding, does it still require a FTE Program
Director, or can a proportional FTE be used?
ANSWER: One FTE Program Director is required regardless of the number of beds. A
proportional FTE does not meet the requirement.
184. Can Pre-Independent Living and Teen Parenting youth be served in the same
house/program site?
ANSWER: No.
185. At the bidders’ conference, it was stated that the TPPs are subject to Competitive bids
within Regions. Does this have any impact on a program’s ability to accept referrals from
other parts of the state?
ANSWER: TPPs are to accept referrals on a statewide basis.
186. Previously, DCF has not required Teen Parenting Programs to complete a CANS
assessment. Is it correct to conclude this is a new requirement?
ANSWER: TPP Providers will not be required to complete a CANS on any client who does not
have an open case with DCF or DMH.
187. Currently, is there a pre-independent living program for teen moms? Why is it not
included?
ANSWER: All programs for teen parents are included in Appendix H. Several options are
available and individual bidders need to determine the best model for the services they wish to
provide.
188. Can Teen Parenting programs apply for Stepping Out and Follow Along?
ANSWER: The Enhanced Teen Parent model is the only Teen Parent Program service that
includes Stepping Out. No Teen Parent Program Services include Follow Along.
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Caring Together RFR: Questions and Answers-Set #2
IV.
APPENDIX I: GROUP HOME 1:4 TRANSITION TO IFC
189. What is the rationale for not being able to use OT for assessment and training?
ANSWER: The Group Home 1:4 Transition to IFC model was based on the Group Home 1:4
model, which does not include Occupational Therapy.
IV.
APPENDIX L: INTENSIVE GROUP HOME WITH EXPANDED NURSING (Non
Competitive) and APPENDIX M: MEDICALLY COMPLEX GROUP HOME
(Competitive)
190. What is the difference between Intensive Group Home with Expanded Nursing and
Medically Complex Group Home? Please give a more detailed description of the medical
issues associated with the Group Home with Expanded Nursing program?
ANSWER: The Intensive Group Home with Expanded Nursing was based on the Intensive
Group Home 1:3 model and includes all the staffing, programming and requirements of this
model with additional nursing staff. Youth referred typically have complex mental health,
medical, cognitive, and behavioral challenges. The Medically Complex Group Home is not
based on any of the Group Home Models. The Medically Complex Group Home has its own
staffing pattern, program requirements and staff to child ratio (1:2). It does not include Follow
Along services. Youth referred typically have a variety of special medical needs and conditions
such as: use of G-Tubes, seizure disorders, cardiac conditions, breathing conditions, neurological
disorders and the need for special diets or feeding plans.
191. For the Intensive Group Home with Expanded Nursing, what is/are the referring region(s),
and what is the total number of slots?
ANSWER: Any region would be able to refer individuals to Intensive Group Home with
Expanded Nursing. No slot number was set for this Non-Competitive model; a bidder may
propose any number of slots in its response.
IV.
APPENDIX N: INTENSIVE 1:2 GROUP HOME WITH FOLLOW ALONG
192. What is the projected number of beds for purchase for the 1:2 Intensive Group Homes?
ANSWER: The Agencies are not projecting bed numbers for Non-Competitive selections.
IV.
APPENDIX O: OUTREACH INDEPENDENT LIVING
193. Will more “Moving to Work” vouchers be available?
ANSWER: The vouchers referenced in Appendix O are Community Development Mass Rental
Voucher Program (MRVP) vouchers. We are not anticipating additional MRVP vouchers at this
time. This program is not part of the Moving to Work demonstration program.
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Caring Together RFR: Questions and Answers-Set #2
194. Would the Agencies consider purchasing additional slots or accept applications for
approved Contractors for Outreach Independent Living at the stated rate without the use
of vouchers, in Boston as well as areas outside of Boston?
ANSWER: As stated in RFR Section 9, Table 2, the Agencies intend to purchase three slots at
this time; however, the Agencies reserve the right to purchase additional slots from the winning
bidder in the future, depending on the capacity on the part of the bidder and the Agencies’
analysis.
IV.
APPENDIX P: STATE UNIVERSITY PREPARATORY SERVICE
195. Can the State College Preparatory program include state community colleges?
ANSWER: Yes. Any university, college or community college operated by the state that is
qualified to receive tuition waiver payments for DCF youth may be a partner for the service.
CLARIFICATION TO QUESTIONS AND ANSWERS – SET #1
V.
196. The answers to Questions #41 and #42 in the Questions and Answers – Set #1, refer to the
response to question #39. Is this correct?
ANSWER: No, the answers to questions #41 and #42 refer to the answer to question #40.
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Caring Together RFR: Questions and Answers-Set #2