Year 1 Budget Request - DHMH - Maryland.gov

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and prior to contract award. If the State finds an Offeror to be not responsible and/or an Offeror’s technical proposal to be not reasonably susceptible of being selected for award that Offeror’s financial proposal will be returned if still unopened. Proposals are usually evaluated by a committee, which then makes a recommendation for award to the Procurement Officer. However, the Procurement Officer may evaluate proposals without a committee and recommend an Offeror for award. In either case, the Procurement Officer, with the concurrence of the agency head or designee, will make the final determination for award. 5.5.2 Selection Process Sequence 5.5.2.1 Technical proposals are evaluated for technical merit and ranked. During this review, oral presentations and discussions may be held. The purpose of such discussions will be to assure a full understanding of the State’s requirements and the Offeror’s ability to perform and to facilitate arrival at a Contract that is most advantageous to the State. For scheduling purposes, Offerors should be prepared to make an oral presentation and participate in discussions within two weeks of the delivery of proposals to the State. Qualified Offerors will be contacted by the State as soon as discussions are scheduled. 5.5.2.2 Offerors must confirm in writing any substantive oral clarification of, or change in, their proposals made in the course of discussions. Any such written clarification or change then becomes part of the Offeror’s proposal. Proposals are given a final review and ranked. 5.5.2.3 The financial proposal of each qualified Offeror will be evaluated separately from the technical evaluation. After a review of the financial proposals of qualified Offerors, the evaluation committee or Procurement Officer may again conduct discussions to further evaluate the Offeror’s entire proposal. 5.5.2.4 When in the best interest of the State, the Procurement Officer may permit Offerors who have submitted acceptable proposals to revise their initial proposals and submit, in writing, best and final offers (BAFOs). However, the State may make an award without issuing a BAFO. 5.5.3 Award Determination Upon completion of all discussions and negotiations, reference checks, and site visits (if any), the Procurement Officer will recommend award of the Contract to the responsible Offeror(s) whose proposal(s) is determined to be the most advantageous to the State considering technical evaluation factors and price factors as set forth in this RFP. THE REMAINDER OF THIS PAGE IS BLANK 42
SECTION 6 - ATTACHMENTS ATTACHMENT A – STATE CONTRACT This is the contract used by <strong>DHMH</strong>. It is provided with the RFP for informational purposes and is not required at proposal submission time. Upon notification of recommendation for award, a completed contract will be sent to the selected Offeror for signature. ATTACHMENT B – BID/PROPOSAL AFFIDAVIT This form must be completed and submitted with the Offeror’s technical proposal. ATTACHMENT C – CONTRACT AFFIDAVIT This form is not required at proposals submission time. It must be submitted by the selected Offeror to the Procurement Officer with the Standard Contract (see Attachment A). ATTACHMENT D – PRE-PROPOSAL CONFERENCE RESPONSE FORM It is requested that this form be completed and submitted as described in RFP section 1.7 by those potential Offerors who plan on attending the conference. ATTACHMENT E – FINANCIAL PROPOSAL INSTRUCTIONS AND FORMS Financial Proposal forms must be completed and submitted as the Financial Proposal. ATTACHMENT F – LIVING WAGE REQUIREMENTS FOR SERVICE CONTRACTS ATTACHMENT F-1 – MARYLAND LIVING WAGE AFFIDAVIT OF AGREEMENT This document must be completed and submitted with the Technical Proposal. ATTACHMENT G – FEDERAL FUNDING REQUIREMENTS AND CERTIFICATIONS Certifications must be completed and submitted with the Technical Proposal. ATTACHMENT H – CONFLICT OF INTEREST AFFIDAVIT This document must be completed and submitted with the Technical Proposal. ATTACHMENT I – BUSINESS ASSOCIATE AGREEMENT FORM (HIPAA) This document must be completed and submitted with the Technical Proposal, if applicable. ATTACHMENT I-1 – BREACH OF UNSECURED PROTECTED HEALTH INFORMATION This document must be completed and submitted only in the event of a breach. ATTACHMENT J – BCCP CASE MANAGEMENT CARE PLAN ATTACHMENT K – BCCP DATA ENTRY FORM ATTACHMENT L – BCCP CONSENT FORM ATTACHMENT M – PROVIDER CONTRACTS ATTACHMENT N – MINIMUM STANDARDS FOR FOLLOW-UP AND RECALL ATTACHMENT O – BCCP PERFORMANCE MEASURES ATTACHMENT P– REPORTING SCHEDULE 43
Page 1 and 2: Request for Proposals Calvert Count
Page 3 and 4: STATE OF MARYLAND DEPARTMENT OF HEA
Page 5 and 6: 4.3 DELIVERY ......................
Page 7 and 8: n. Normal State Business Hours - No
Page 9 and 10: 1.9 Questions Written questions fro
Page 11 and 12: 1.19 Access to Public Information A
Page 13 and 14: Howard, Anne Arundel, and Baltimore
Page 15 and 16: 2. Filing of protests; 3. Filing of
Page 17 and 18: Purpose SECTION 3 - SCOPE OF WORK 3
Page 19 and 20: 3.2.2.3 Priority Populations The ta
Page 21 and 22: Services to Be Performed by the Con
Page 23 and 24: 3.2.3.2 Follow-Up Services 10. Moni
Page 25 and 26: 14. Use staff to carry out responsi
Page 27 and 28: detection and treatment of breast a
Page 29 and 30: 3.3.3 Criminal Background Check The
Page 31 and 32: circumstance which changes the Proc
Page 33 and 34: work under the Contract, or the rep
Page 35 and 36: 4.3.2 Hand-delivery includes delive
Page 37 and 38: DHMH reserves the right to request
Page 39 and 40: contractor has committed, including
Page 41: SECTION 5- EVALUATION CRITERIA AND
Page 45 and 46: ATTACHMENT A - STANDARD CONTRACT TI
Page 47 and 48: 5.2 The Contractor agrees that at a
Page 49 and 50: 13.3 Any and all references to the
Page 51 and 52: a. That pursuant to 42 Code of Fede
Page 53 and 54: 31.1 If the Contractor withholds pa
Page 55 and 56: 33 Federal Department of Health and
Page 57 and 58: A. AUTHORITY I HEREBY AFFIRM THAT:
Page 59 and 60: (9) Admitted in writing or under oa
Page 61 and 62: I DO SOLEMNLY DECLARE AND AFFIRM UN
Page 63 and 64: in the aggregate $100,000 or more s
Page 65 and 66: ATTACHMENT D - PRE-PROPOSAL CONFERE
Page 67 and 68: vi. Data entry and data entry super
Page 69 and 70: ATTACHMENT E-1 BUDGET JUSTIFICATION
Page 71 and 72: Justification: Postage costs relate
Page 73 and 74: Offeror’s Name: Year 2 Budget Req
Page 75 and 76: Offeror’s Name: Year 4 Budget Req
Page 77 and 78: Row # Offeror’s Name ____________
Page 79 and 80: imposition of any of the requiremen
Page 81 and 82: The employee(s) proposed to work on
Page 83 and 84: Page two This clause must appear in
Page 85 and 86: CERTIFICATION REGARDING ENVIRONMENT
Page 87 and 88: 1. Type of Federal Action: a. Contr
Page 89 and 90: SUMMARY OF ADDITIONAL FEDERAL FUND
Page 91 and 92: ATTACHMENT I - BUSINESS ASSOCIATE A
Page 93 and 94:
after an incident even if Business
Page 95 and 96:
C. Effect of Termination. 1. Except
Page 97 and 98:
IN WITNESS WHEREOF and acknowledgin
Page 99 and 100:
ATTACHMENT J - BCCP CASE MANAGEMENT
Page 101 and 102:
Initials Case Manager Signature Ini
Page 103 and 104:
ATTACHMENT K - BCCP DATA ENTRY FORM
Page 105 and 106:
BREAST CANCER SCREENING INFORMATION
Page 107 and 108:
CaST ID: LAST NAME: FIRST NAME: ___
Page 109 and 110:
CaST ID: LAST NAME: FIRST NAME: BRE
Page 111 and 112:
BREAST CANCER DIAGNOSTIC AND TREATM
Page 113 and 114:
CERVICAL CANCER DIAGNOSTIC AND TREA
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
ATTACHMENT L - BCCP CONSENT FORM Br
Page 121 and 122:
Part I. The Contractor agrees to: C
Page 123 and 124:
Qualifications and Insurance O. Hav
Page 125 and 126:
45 CFR Parts 160 and 164, (“HIPAA
Page 127 and 128:
L. The following attached documents
Page 129 and 130:
Part I. The Contractor agrees to: R
Page 131 and 132:
K. Obtain and maintain appropriate
Page 133 and 134:
F. 1. The activities covered by thi
Page 135 and 136:
Preamble Laboratory Service Contrac
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H. Send patient results as follows:
Page 139 and 140:
Other W. Not be in arrears with res
Page 141 and 142:
K. The Contract Monitor for the Con
Page 143 and 144:
Hospital Service Contract Maryland
Page 145 and 146:
Billing F. ** Submit all claims for
Page 147 and 148:
provided by the contractor after fu
Page 149 and 150:
In witness whereof, these authorize
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Billing B. ** Submit all claims for
Page 153 and 154:
H. Regarding HIPAA: 5. The activiti
Page 155 and 156:
Preamble Anesthesia Service Contrac
Page 157 and 158:
N. Not bill a patient for any charg
Page 159 and 160:
previously executed grant agreement
Page 161 and 162:
Preamble Colposcopy Service Contrac
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H. See patients referred by the LHD
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AA. Comply with the Health Insuranc
Page 167 and 168:
non-federal funds using Standard Fo
Page 169 and 170:
Part I. The Contractor agrees to: C
Page 171 and 172:
R. Not bill the LHD for any service
Page 173 and 174:
H. The Contract Monitor for the Con
Page 175 and 176:
ATTACHMENT N - MINIMUM STANDARDS FO
Page 177 and 178:
9. Send a copy of the certified let
Page 179 and 180:
6. If patient is contacted and refu
Page 181 and 182:
ATTACHMENT O - BCCP PERFORMANCE MEA
Page 183 and 184:
ATTACHMENT P - REPORTING SCHEDULE B
Page 185 and 186:
DHMH 437 INSTRUCTIONS (continued) Q
Page 187 and 188:
DHMH 437 INSTRUCTIONS (continued) *
Page 189 and 190:
DHMH 438 Instructions (continued) T
Page 191 and 192:
ATTACHMENT S - CONDITIONS OF AWARD
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23. As stipulated in the “Nationa
Page 195:
Work Plan Calvert County Breast and
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Year 1 Budget Request - DHMH - Maryland.gov

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