STATE OF DELAWARE DELAWARE HEALTH AND SOCIAL SERVICES DIVISION OF MANAGEMENT SERVICES 1901 N. DuPont Highway New Castle, DE 19720 REQUEST FOR PROPOSAL NO.HSS 09 002 FOR Part A: Early intervention providers to find creative new ways to meet goals of timely service delivery and provision of services in the natural environment. AND / OR Part B: Early Intervention providers to become active members of the Individualized Family Services Plan (IFSP) team to promote recommended practices on teaming. FOR THE DEPARTMENT OF HEALTH AND SOCIAL SERVICES 1901 N. DUPONT HWY. NEW CASTLE DE 19720 Deposit Waived Performance Bond Waived Date Due: August 26, 2009 11:00 am LOCAL TIME Bids will be accepted only from current Delaware Part C providers. A mandatory pre-bid Meeting will be held on July 22, 2009 at 10:00 am at the Delaware Health and Social Services, Herman M. Holloway Sr. Campus, Procurement Branch, Main Administration Bld., Sullivan Street, First Floor, Conference Room #198, 1901 N. DuPont Highway, New Castle, DE 19720. “All bidders must be on time, at the Mandatory Pre-bidders Meeting. No proposals will be accepted from bidders who either did not attend the mandatory Pre-Bid Meeting or who are more than 15 Minutes Late”. Questions can be submitted by July 21, 2009 no later than 4:30 p.m. and responses will be summarized and posted on the DHSS Procurement Website by the close of business on July 24, 2009. Submit questions to Rosanne.Griff- Cabelli@state.de.us. REQUEST FOR PROPOSAL # HSS 09 002 Bids for Birth to Three Early Intervention System will be received by the Delaware Health and Social Services, Herman M. Holloway Sr. Campus, Procurement Branch, Main Administration Bld., Sullivan Street, Second Floor, Room #259, 1901 N. DuPont Highway, New Castle, DE 19720, until 11:00am local time , August 26, 2009. At which time the proposals will be opened and read. A mandatory pre-bid Meeting will be held on July 22, 2009 at 10:00 am at the Delaware Health and Social Services, Herman M. Holloway Sr. Campus, Procurement Branch, Main Administration Bld., Sullivan Street, First Floor, Conference Room #198, 1901 N. DuPont Highway, New Castle, DE 19720. For further information, please contact Rosanne Griff-Cabelli Via E-mail; address: Rosanne.Griff-Cabelli@state.de.us. Questions can be submitted by July 21, 2009 no later than 4:30 p.m. and responses will be summarized and posted on the DHSS Procurement Website by the close of business on July 24, 2009. Submit questions to Rosanne.Griff-Cabelli@state.de.us. In the event that state offices are closed on the day of the pre-bid meeting due to a State of Emergency declared by the Governor of Delaware, the pre-bid meeting will be cancelled or postponed. The status of the pre-bid meeting will be posted to the RFP website as soon as possible at http://www.dhss.delaware.gov/dhss/rfp/dhssrfp.htm . If the pre-bid meeting is cancelled, written questions will be accepted, in lieu of the pre-bid meeting, in accordance with the instructions presented in this document. If the pre-bid meeting is postponed, the new date and time will be posted to the RFP website. All RFP-PSCOs can be obtained online at http://www.dhss.delaware.gov/dhss/rfp/dhssrfp.htm . A brief “Letter of Interest” must be submitted with your proposal. Specifications and administration procedures must be obtained at the above office or phone (302) 255-9290. NOTE TO VENDORS: Your proposal must include the forms in Appendix G signed, and all information on the forms complete. “All bidders must be on time, at the Mandatory Pre-bidders Meeting. No proposals will be accepted from bidders who either did not attend the mandatory Pre-Bid Meeting or who are more than 15 Minutes Late”. NOTIFICATION TO BIDDERS Bidder shall list all contracts awarded to it or its predecessor firm(s) by the State of Delaware; during the last three years, by State Department, Division, Contact Person (with address/phone number)., period of performance and amount. The Evaluation/Selection Review Committee will consider these Additional references and may contact each of these sources. Information regarding bidder performance gathered from these sources may be included in the Committee’s deliberations and factored in the final scoring of the bid. Failure to list any contract as required by this paragraph may be grounds for immediate rejection of the bid.” There will be a ninety (90) day period during which the agency may extend the contract period for renewal if needed. If a bidder wishes to request a debriefing, they must submit a formal letter to the Procurement Administrator, Delaware Health and Social services, Main Administration Building, Second Floor, South Loop, 1901 North DuPont Highway, Herman M. Holloway Sr., Health and Social Services Campus, New Castle, Delaware 1901, within ten (10) days after receipt of “Notice of Award”. The letter must specify reasons for the request. If you do not intend to submit a bid you are asked to return the face sheet with “NO BID” stated on the front with your company’s name, address and signature. IMPORTANT: ALL PROPOSALS MUST HAVE OUR RFP NUMBER (HSS 09 002 ON THE OUTSIDE ENVELOPE. IF THIS NUMBER IS OMITTED YOUR PROPOSAL WILL IMMEDIATELY BE REJECTED. FOR FURTHER BIDDING INFORMATION PLEASE CONTACT: SANDRA SKELLEY, PROCUREMENT ADMINISTRATOR DELAWARE HEALTH AND SOCIAL SERVICES PROCUREMENT BRANCH MAIN ADMIN BLD. SULLIVAN STREET 2ND FLOOR –ROOM # 259 1901 NORTH DUPONT HIGHWAY HERMAN M. HOLLOWAY SR. HEALTH AND SOCIAL SERVICES CAMPUS NEW CASTLE, DE 19720 PHONE: (302) 255-9290 IMPORTANT: DELIVERY INSTRUCTIONS IT IS THE RESPONSIBILITY OF THE BIDDER TO ENSURE THAT THE PROPOSAL HAS BEEN RECEIVED BY THE DEPARTMENT OF HEALTH AND SOCIAL SERVICES BY THE DEADLINE. The issuance of this Request for Proposals (RFP) neither commits the Delaware Department of Health and Social Services, Division of Public Health, to award a contract, to pay any costs incurred in the preparation of a proposal or subsequent negotiations, nor to procure or contract for the proposed services. The Division reserves the right to reject or accept any or all proposals, or portion thereof, to cancel in part or in its entirety this Request for Proposals, or to delay implementation of any contract which may result, as may be necessary to meet the Department’s funding limitations and processing constraints. The Department and Division reserve the right to terminate any contractual agreement without prior notice in the event that the State determines that State or Federal funds are no longer available to continue the contract. I. Introduction Since 1993, Federal and state funds have been awarded to Delaware’s Division of Management Services, Birth to Three Program, to coordinate early intervention services for children ages birth to thirty-six months who have disabilities or developmental delays, as authorized in Part C of the Individuals with Disabilities Education Improvement Act of 2004 (IDEA) and 16 Del Code Sec 210 et seq. The mission of Delaware’s statewide early intervention system is to enhance the development of infants and toddlers with disabilities or developmental delays, and enhance the capacity of their families to meet the needs of their young children. See Appendix A (“A Vision to Guide the Delaware Part C Birth to Three Early Intervention System”). Early intervention services are defined as services that are designed to meet the developmental needs of each eligible child and the needs of the family related to enhancing the child's development. The services needed by each child and his/her family are selected in collaboration with the parents based on the recommendations of a multidisciplinary assessment and treatment team, and are provided under public supervision by qualified personnel. The service package is put together into an Individualized Family Service Plan (IFSP), which is to be followed by all involved with that family. To the maximum extent appropriate to the needs of the child, early intervention services must be provided in a natural environment, including the home and community setting in which children without disabilities participate. A variety of specific details about the system can be found at: http://www.dhss.delaware.gov/dhss/dms/epqc/birth3/directry.html The system functions via a network of public/private partnerships, with state agencies providing overall management and service coordination for families, and private agencies / contractors providing direct services to them. For Part A (Timely Delivery of Services), a total of $50,000 is available. Contracts will be awarded based on the criteria enumerated later in this document. For Part B (Team-based Approach), we anticipate awarding up to 8 contracts. The total amount of these awards will not exceed $75,000 per year, for a total of $150,000 for two years. II Scope of Services PART A: This RFP, managed by the Division of Management Services, is seeking bids from agencies and organizations that have open contracts with the Birth to Three Early Intervention System (Part C) to identify innovative ways to reach and maintain goals for timely service delivery and provision of services in the natural environments as part of Delaware's Birth to Three Early Intervention System (Part C). Contractors would receive incentive payments ($100 per child) when the goal of 95% timely delivery of services is achieved throughout the year. Timely delivery of services is defined based on the Delaware Part C State Performance Plan. Service delivery is timely when the child receives early intervention services within 30 calendar days from written parental consent for service to the initiation date of service. The definition includes all new early intervention services from both the initial IFSP and subsequent IFSPs. Recipients would be required to participate in the design and development of tracking reports regarding timely delivery of services. Recipients will also be expected to submit a final plan detailing how recommended practices will be maintained. The final outcome of the project is development and maintenance of procedures to prevent service delays and to formalize a mechanism to report consistent, valid and reliable service delivery data to the Birth to Three Early Intervention System (Part C). The project will include: * Receipt of incentive payments when contracted providers reach 95% compliance for timely delivery of services. If the IFSP team has identified the cause for the delay as exceptional family circumstances, i.e., child hospitalized or other extenuating family circumstances, then this would be documented and timely services adjusted according to the documentation. In other words, if the delay is due to extenuating family circumstances and documented as such on the IFSP, the timeliness standard for this particular instance may be waived. Timely delivery of services is inclusive of all new early intervention services on the IFSP, and includes meeting identified timeframe for evaluations needed for transition when requested. The end result is for early intervention providers to develop and maintain approaches that prevent delays in services. * Input on existing documentation to be utilized within the contract period to track, monitor, and verify timely delivery of services. As part of this project, information will be reviewed for effectiveness, efficiency, and impact in improving ongoing communication with the CDW regional programs for timely delivery of services. The end result is to implement statewide tracking on an ongoing basis to comprehensively monitor timely delivery of services. * Identification of barriers preventing timely delivery of service and solutions addressing these barriers. Provider agencies will contribute their plans for maintaining timely delivery of services and participate in up to three statewide meetings. The specific services for which bids are requested are described in Appendix B. PART B: This RFP, managed by the Division of Management Services, is seeking bids from agencies and organizations that have open contracts with the Birth to Three Early Intervention System (Part C) to become active members of the Individualized Family Services Plan (IFSP) team to promote recommended practices on a team-based approach to service delivery and family based practices. Current early intervention literature and research indicate that team- based approaches to early intervention are critical to support family and caregiver competence and have positive impacts on a child’s developmental progress. Recipients would be required to provide baseline and progress data, document innovative strategies used to promote recommended practices, and submit a plan detailing how recommended practices will be maintained. Using a Program Assessment Tool, Recipients will be required to demonstrate how changes in practices promoted successful team-based approaches to service delivery. The specific services for which bids are requested are described in Appendix B. Special Features: Proposals must comply with the following special features of the Early Intervention System, regardless of the funding source being used to reimburse for services: 1. Abide by all Part C requirements contained in the standard Early Intervention contract that all bidders have already signed. 2. Meet the personnel standards outlined in Appendix D, which are specific to individuals providing services to participants in the Early Intervention System. 3. Serve all children in the context of their family and their community, and involve families in all aspects of early intervention. 4. Participate in development of an Individualized Family Service Plan (IFSP) for each child, which includes goals, steps and progress reporting. (See Appendix E for an explanation of what is involved in this requirement.) 5. Meet specific reporting requirements and timelines. (See Appendix B for details on those requirements.) III. SPECIAL TERMS AND CONDITIONS Length of Contract Contract term is twelve months with the possibility of renewal on a yearly basis for up to 4 years contingent upon the agreement of all parties, the availability of funds and the absence of any additional price considerations. Bidders may bid on Part A, or Part B, or both parts of this RFP. Multiple vendors may be selected Contracts may be awarded to multiple bidders who have the needed qualifications and meet the criteria specified in this RFP. All bidders must indicate in their proposal whether they are applying for funding of Part A, Part B, or both. Subcontractors If a subcontractor is going to be used, this needs to be specified in the proposal, with an identification of the subcontractor, the service(s) to be provided and its qualifications to provide such service(s). Subcontractors will be held to the same requirements as the primary contractor. The contract with the prime contractor will bind sub or co-contractors to the prime contractor by the terms, specifications and standards of this RFP and any subsequent proposals and contracts. All such terms, specifications and standards shall preserve and protect the rights of the Agency under this RFP with respect to the services to be performed by the sub or co-contractor, and the sub or co- contractor will not prejudice such rights. Nothing in this RFP shall create any contractual relation between any sub or co-contractor and the Agency. Funding disclaimer clause The Department of Health and Social Services reserves the right to reject or accept any bid or portion thereof, as may be necessary to meet the Department's funding limitations and processing constraints. The Department reserves the right to terminate any contractual agreement without prior notice in the event the State determines that state or federal funds are no longer available to continue the contract. Reserved Rights Notwithstanding anything to the contrary, the Department reserves the right to: ? Reject any and all proposals received in response to this RFP. ? Waive or modify any information, irregularities, or inconsistencies in proposals received; ? Negotiate as to any aspect of the proposal with any bidder and negotiate with more than one bidder at the same time; ? If negotiations fail to result in an agreement within two weeks, the Department may terminate negotiations, re-advertise, prepare and release a new RFP, or take such other action as the Department may deem appropriate. Contract Termination Conditions The Department may terminate the contract(s) resulting from this request at any time that the contractor fails to carry out the provisions of the proposal or make substantial progress under the terms specified in this request and the resulting proposal. The Department shall provide the contractor with thirty days written notice of conditions endangering performance. If, after such notice, the contractor fails to remedy the conditions contained in the notice, the Department shall issue the contractor an order to stop work immediately and deliver all work in progress to the State. The Department shall be obligated only for those services rendered and accepted prior to the date of notice of termination. Upon receipt of not less than thirty days written notice, the contractor may be terminated on a date prior to the end of the contract period without penalty to either party. The contract may be terminated in whole or part: a. By the Department upon five calendar days’ written notice for cause or documented unsatisfactory performance. b. By either party without cause upon thirty calendar days’ written notice to the other party, unless a longer period is specified. c. By the Department upon fifteen calendar days’ written notice of the loss of funding or reduction of funding for the affected contractor service. Contract Monitoring The contractor will be monitored on a regular basis throughout the duration of the contract. Failure of the contractor to resolve any problem(s) identified in the monitoring may be cause for termination of the contract. Method of Payment Part A – Timely Delivery of Services: Payment will be made at the end of the contract upon submission of an invoice, accompanied by documentation of all CDW children served during the prior 12 month period. The documentation will need to identify those who met the ‘timeliness’ threshold, with dates specified. A single payment of $100/per child will be made if at least 95% compliance was achieved – the payment amount calculated based on those children for whom service delivery was timely. This special payment can only be made once for any given child. No interim payments will be made. Part B – Team-based Approach: Monthly payments will be made upon receipt of invoice from contractor. The invoice must delineate basis for payment and include a monthly report. Monthly payments can be based on 1/12 of the amount of each year of the contract. IV. FORMAT AND CONTENTS OF BIDDER RESPONSE Proposals should contain the following information, adhering to the order as shown. Title Page The Title Page shall include: ? The RFP PSC # and subject, in which county(ies) the service will be provided; ? The name of the applicant ? The applicant’s full address ? The applicant’s telephone number ? The name, title and E-Mail address of the designated contact person ? The bid opening date (state the date and time) Table of Contents The Table of Contents shall include a clear and complete identification of information presented by section and page numbers. Qualifications and Experience The bidder’s Delaware Part C Early Intervention contract number needs to be specified. This section should contain sufficient information to demonstrate the organization's experience and staff expertise, including a mechanism to provide clinical oversight for practitioners, to provide the services included in the bid. Also, a statement must be included that the organization either has a Delaware Business License prior to signing of the contract. An organizational chart showing the bidder’s administrative staff must be included. The chart should identify staff by both name and title. For sole practitioners only, please describe how you assure clinical oversight, in lieu of an organization chart. A listing must be provided that specifies the number of personnel, by discipline, that the contractor will be assigning to work on the service(s) included in the bid. The bidder must also provide an assurance that the staff who will be assigned will meet the appropriate certification or licensure requirements as set out in Appendix D. At the time of the signing of the contract, documentation (resumes/ copies of licenses, etc.) will be required, but we are not asking for those copies to be included with the bid. The bidder shall also list all contracts awarded to it or its predecessor firm(s) by the State of Delaware during the last three years, by State Department, Division, Contact Person (with address/phone number), period of performance and amount. A form is provided for this in Appendix G. The Evaluation/Selection Review Committee may contact each of these sources. Information regarding bidder performance gathered from these sources may be included in the Committee’s deliberations and factored into the final scoring of the bid. Failure to list any contract as required by this paragraph may be grounds for immediate rejection of the bid / termination of the contract (if awarded). This section should not be longer than two pages. The organizational chart, staffing and contracts listings, and any other pertinent documentation may be considered an attachment and not part of the two-page limit. Proposed Methodology This section should describe the approach that will be taken to provide the service(s) for which the bid is being submitted. A timeline as to when the bidder will be able to begin offering services once a contract is finalized is needed, along with an explanation of any delay, if anticipated. The Proposed Methodology should not exceed 5 pages. Payment for Services Part A – Please indicate understanding and acceptance of the specified payment structure. Also specify the projected number of children and their families to be served during the year. Part B – Please propose a payment methodology, based on the budget that reflects the anticipated number of children and their families to be served each year. The budget should use a line item format. The bidder should describe any factors that may have an impact on the contract cost and should provide a suggested monthly payment schedule, contingent upon completion of various project tasks/performance achieved during the prior month. Forms (to be found in Appendix G) The Bidders Signature Form must be completed and signed by the appropriate authorized representative and included in the back portion of the submitted proposal. (NOTE: Failure to provide signatures to this form may be grounds for disqualification). The Certification Sheet must be completed and signed by the appropriate authorized representative and included in the back portion of the submitted proposal. (NOTE: Failure to provide signatures to this form may be grounds for disqualification.) The Statement of Compliance Form must be signed by the appropriate authorized representative and included in the back portion of the submitted proposal, to assure that he/she will comply with all Federal and Delaware laws and regulations pertaining to equal employment opportunity and affirmative action. In addition, compliance must be assured in regard to Federal and Delaware laws and regulations relating to confidentiality and individual and family privacy in the collection and reporting of data. The State of Delaware Contracts Disclosure form must be completed and included in the back portion of the submitted proposal. (NOTE: Failure to provide this form may be grounds for disqualification.) Contract The contract for the State of Delaware, Delaware Health and Social Services can be found in Appendix C. This boilerplate contract will be used unless another boilerplate contract has previously been approved by the Attorney General’s office for specific contractors. It will take precedence over all other elements of proposals submitted, including appendices. The bidder should review the contract and specify any objections or concerns in the proposal. Appendices A. A Vision to Guide the Delaware Part C Birth to Three Early Intervention System B. Description of Services Covered in this RFP C. DHSS Contract Attachment One: Reimbursement Methodology Attachment Two: Natural Environments Attachment Three: Business Associate Agreement D. Personnel Matrix E. IFSP F. DHSS Policy Memorandum #46 G. Forms V. GENERAL INSTRUCTIONS FOR SUBMISSION OF PROPOSALS A. Number of copies Required Two (2) original CDs (Each Labeled as “Original”) and six (6) CD copies (Each labeled as “Copy”). In addition, any required confidential financial or audit information relating to the company and not specifically to the proposal may be copied separately to three (3) additional CDs (Each labeled “Corporate Confidential Information”). All CD files shall be in PDF and Microsoft Word formats. Additional file formats (i.e. .xls, .mpp) may be required as requested. It is the responsibility of the bidder to ensure all submitted CDs are machine readable, virus free and are otherwise error-free. CDs (or their component files) not in this condition may be cause for the vendor to be disqualified from bidding. Bidders will no longer be required to make hard copies. Two original CD’s and six CD copies of the proposal, in accordance with the attached request for proposals, must be received on or before August 26, 2009 at 11:00 am , and shall be submitted to: Sandra Skelley, Procurement Administrator Division of Management Services Department of Health and Social Services 1901 North DuPont Highway Main Building, Second Floor, Room 259 New Castle, DE 19720 Proposals should be typed double-spaced on 8 1/2 x 11 paper, with each page numbered. NOTE TO VENDORS: If you do not intend to submit a bid and you wish to be kept on the mailing list, you are required to return the face sheet with "NO BID" stated on the front with your company's name, address and signature. B. Closing Date All responses must be received by no later than: August 26, 2009 at 11;00am. Late submission is cause for disqualification. DO NOT RELY ON OVERNIGHT SERVICES FOR DELIVERY. C. Notification of Acceptance Notification of the Department’s intent to enter into contract negotiations will be made in writing to all bidders D. Questions All questions before the mandatory pre-bid meeting, concerning this request must be sent via email and directed only to: Rosanne Griff-Cabelli (email address: Rosanne.Griff-Cabelli@state.de.us). Such questions must be submitted no later than 4:30 pm on July 21, 2009 in order to be addressed. All responses will be posted on the DHSS website as an amendment to this RFP. E. Amendments to Proposals Amendments to proposals will not be accepted after the submission deadline for proposals has passed. The State reserves the right at any time to request clarification and/or further technical information from any or all bidders submitting proposals. F. Proposals Become State Property All proposals become the property of the State of Delaware and will not be returned to the bidder. The State will not divulge the specific content of any proposal to the extent that the bidder identities would be disclosed. The content is privileged and confidential. G. Non-Interference Clause The awarding of this contract and all aspects of the awarded bidders contractual obligations, projects, literature, books, manuals, and any other relevant materials and work will automatically become property of the State of Delaware. The awarded bidder will not in any manner interfere or retain any information in relationship to the contractual obligations of said contract, at the time of the award or in the future tense. H. Investigation of Bidding Contractor’s Qualifications DHSS may make such investigation as it deems necessary to determine the ability of the bidder to furnish the required services, and the bidder shall furnish such data as DHSS may request for this purpose. I. Request for Proposal and Final Contract The contents of the Request for Proposal will be incorporated by reference into the final contract(s) and will become binding upon the successful bidder(s). If the bidder is unwilling to comply with any of the requirements, terms and conditions of the Request for Proposal, objections must be clearly stated in the proposal. Objections will be considered and may be subject to negotiation at the discretion of the State. J. Proposal and Final Contract The content of each proposal will be considered binding on the bidder and subject to subsequent contract confirmation if selected. The contents of the successful proposal will be included by reference in the resulting contract. K. Cost of Proposal Preparation All costs of proposal preparation will be borne by the bidder agency. L. Proposed Timetable The Department’s proposed schedule for this procurement process is indicated below. The Department, in all cases, will determine the ultimate timing of events related to this procurement. EVENT DATE RFP advertisement and issuance June 29 and July 6, 20009 Mandatory Pre-bid Meeting Delaware Health and Social Services, Herman M. Holloway Sr. Campus, Procurement Brain, Main Administration Bld., Sullivan Street, First Floor, Conference Room #198, 1901 N. DuPont Highway, New Castle, DE 19720. Sign in will be required and anyone signing in after 10:15 a.m will not be authorized to submit a bid July 22, 2009 Questions about the RFP must be received by the date shown July 21, 2009 Responses to questions will be posted on the Procurement website as an addendum to the RFP no later than the date shown July 24, 2009 Bids will be publicly opened on the date shown. August 26, 2009 – at 11:00 a.m. Review of proposals August 26 – Sept. 24, 2009 Negotiations (if necessary Sept. 8 – Sept. 24, 2009 Awards made; bidders notifed of awards/rejections Sept. 25, 2009 Sign Contracts Sept. 30, 2009 Initiate work Upon receipt of purchase order M. Confidentiality and Debriefing The Procurement Administrator shall examine the proposal to determine the validity of any written requests for nondisclosure of trade secrets and other proprietary data identified in conjunction with the Attorney General’s Office. After award of the contract, all responses, documents, and materials submitted by the bidder pertaining to this RFP will be considered public information and will be made available for inspection, unless otherwise determined by the Director of Purchasing, under the laws of the State of Delaware. All data, documentation, and innovations developed as a result of these contractual services shall become the property of the State of Delaware. Based upon the public nature of these Professional Services (RFP) Proposals a bidder must inform the state in writing, of the exact materials in the offer which CANNOT be made a part of the public record in accordance with Delaware’s Freedom of Information Act, Title 29, Chapter 100 of the Delaware Code. If a bidder wishes to request a debriefing, he must submit a formal letter to the Procurement Administrator, Herman M. Holloway Campus, Delaware Health and Social Services Main Building, 2nd Floor, 1901 N. duPont Highway, New Castle, Delaware 19720 within 10 days after receipt of Notice of Award. The letter must specify reasons for the request. VI. SELECTION PROCESS All proposals submitted in response to this Request for Proposal will be reviewed by a Selection Committee composed of appropriate Department staff. The Selection Committee will review each applicant's proposal. Upon completion of its review, the Committee shall make recommendations for awards based on the review process. The final selection of CONTRACTORS will be made by the Director of the Division of Management Services, based upon the recommendations of the Selection Committee. If necessary, oral reviews/ negotiations will be requested. A. Proposal Evaluation Criteria Each proposal will be rated against review criteria corresponding to the items outlined below. In each instance, the proposal must receive a Pass in order for the bidder to be considered for a contract. CATEGORY Weight Meets Mandatory RFP Provisions PASS/FAIL Is a current Part C provider PASS/FAIL Personnel listing matches requirements PASS/FAIL Has sufficient administrative support and oversight to comprehensively meet the requirements 10% (Criterion B) Presents an appropriate Methodology 60% (Criterion B) Presents a cost-effective budget 30% (Criterion C) Proposals submitted will be objectively reviewed against the following specific scoring criteria: Criterion A Bidder’s Qualifications ? The bidder must provide its current Delaware Birth to Three (IDEA) contract number. Criterion B Proposed Methodology ? The methodology must demonstrate the ability to fulfill the RFP requirements. ? The methodology must fully and adequately address all the requirements stated in the RFP Scope of Services and in Appendix B Services / Requirements. Criterion C Rates ? The bid must contain assurances that it will accept the payment plan proposed for Part A; for Part B, an itemized budget will be submitted. The budget should use a line item format. Reminder to all Bidders Bidders shall list all contracts awarded to it or its predecessor firm(s) by the State of Delaware during the last three years, by State Department, Division, contact person (with address & telephone number), period of performance and amount of contract, using the form found in Appendix G. The Selection Committee may contact each of these sources. Information regarding bidder performance gathered from these sources will be included in the Committee's deliberations and factored in to the final scoring of the proposal. Failure to list any contract as required by this paragraph will be grounds for immediate rejection of the proposal. When a bidder is approved for participation in the Early Intervention System as a contractor, Department representative(s) will enter into discussions with the bidder to establish a contract. B. Project Costs and Scope of Service The Department reserves the right to award this project to a bidder other than the one with the lowest cost or to decide not to fund this project at all. Cost will be balanced against the score received by each bidder in the rating process. The State of Delaware reserves the right to reject, as technically unqualified, proposals that are unrealistically low if, in the judgment of the evaluation team, a lack of sufficient budgeted resources would jeopardize project success. Appendix A Statewide Early Intervention System For Families of Infants and Toddlers With Disabilities or Developmental Delays A VISION TO GUIDE THE DELAWARE PART C BIRTH TO THREE EARLY INTERVENTION SYSTEM The Mission of this statewide effort is to enhance the development of infants and toddlers with disabilities and developmental delays, and to enhance the capacity and abilities of their families to meet the special needs of these young children. A comprehensive, coordinated early intervention system that empowers families and makes available resources to enable their children to reach their maximum potential provides long term benefits to the children, their families and the Delaware community. Such an effort reflects the national and state goal that all children start school ready to learn. Principles of the program: * Family-centered focus Delaware has a commitment to strengthening and supporting families. As the primary influence in the child's life and the most knowledgeable source of information about the needs of the child and family, family members should be included in each step of service design and delivery. A key function of service providers is to enhance and build the capacity of the family to meet their own needs. Furthermore, the program will be sensitive to the family's right to privacy and to multi-cultural differences. * Integration of services The needs of infants and toddlers and their families require the perspectives of various disciplines; thus, services should be planned using a collaborative, multidisciplinary, interagency approach. Services and supports should occur in settings most natural and comfortable for the child and family. The development of a natural system of supports within a family’s community should be promoted at all times. Existing services and programs, both public and private, should be supported with appropriate linkages promoted. * Universal application Families of infants and toddlers with disabilities or developmental delays in all areas of the State should receive comprehensive, multidisciplinary assessments of their young children, newborn through 36 months, and have access to all necessary early intervention services. * Cost effectiveness The system should maximize the use of third-party payment, and avoid duplication of effort. * High quality services Services should be provided at the highest standards of quality, with providers being required to meet appropriate licensing and credentialing guidelines. Revised and Approved by Interagency Coordinating Council APPENDIX B SERVICES/REQUIREMENTS Part A – Timely Delivery of Services: The provider agrees to: 1. Within one month of start of project, provide input on tracking information that will be submitted to Child Development Watch for the tracking, monitoring, and verification of timely delivery of services. Timely delivery of service is defined according to the Part C State Performance Plan as 30 calendar days from written parental consent for service to start of service. All new services initiated during the year will be tracked in order to calculate whether a child has received timely delivery of services. If delays in service are due to exceptional family circumstances, these will be documented and agreed upon by the IFSP team. If an exceptional family circumstance does prevent timely initiation of services and it is documented on the IFSP, and if services do begin as soon as possible, it may be considered “timely”. 2. Provide recommendations through this project on data elements to track and report in the proposed case management system. The goal is to implement a tracking system for all provider agencies and CDW that will improve communication and facilitate the monitoring of required timelines, specifically, timely delivery of services. 3. Provide identification of barriers preventing timely delivery of service and solutions addressing these barriers. Provider agencies will designate one person to attend up to three meetings a year to participate in this task. 4. Develop and document approaches that prevent delays in services in a report submitted at the end of the year, with the goal of sustainability. 5. Achieve at least 95% compliance within the year for timely delivery of services. Submit quarterly data (CDW tracking form; initial assessment and service visits; etc) which verifies timely delivery of services for each service per child. The final report should be year-to-date and detail all CDW children served and their information in order to calculate the 95% compliance. Part B – Team based approach: Provider agency will agree to: 1. Identify lead interventionist for eligible children with two or more services from the provider agency. Agency may identify a lead interventionist when only one service is provided from that agency, and the duties and time would be reflected in the budget accordingly. a) Lead interventionist will participate in all IFSP meetings and will bring input from other interventionists to add to the team discussion. b) Through team discussion, family and child goals will be identified and listed on the IFSP. Intervention goals and strategies will be described under each of the family or child goals on the IFSP. Team will choose IFSP outcomes and strategies based on the interests and priorities of the child and family. c) At each IFSP update, the lead interventionist will discuss with the family and service coordinator what is working and what is challenging for the child and family. Team discussion will occur with the family to problem solve challenges, and adapt interactions, routines and the environment, in order to achieve IFSP goals. This will be documented in the IFSP. d) Lead interventionist will share strategies with other interventionists within their agency and also with community providers where the child may be during the day, with parental consent. e) Lead interventionist will maintain ongoing communication with the service coordinator and early intervention providers, including those from other agencies. f) Lead interventionist will participate in the Child Outcome Summary Form discussion to improve quality of the observations and ratings. Responsibility for completing the COSF will continue to be as is documented in Delaware Building Blocks. 2. Complete a program assessment to identify current practices that support a team based model of service delivery and opportunities for improvement. a) The program assessment tool recommended is the DEC (Division for Early Childhood) Recommended Practices Program Assessment: Improving practices for young children with special needs. Other program assessment tools will be considered and reviewed at the beginning of the project. b) Use assessment results to identify and implement strategies for team based model practices in early intervention. c) Share results and practices in regional CDW team and provider agency meetings. 3. Develop and conduct at least four joint trainings annually with the provider agency and CDW. a) Topics for the training should include: best practices for teaming, creating and integrating functional goals, and working across disciplines. b) Training content and materials will be shared with CDW regional programs and the Birth to Three office. c) Birth to Three will work with Mid South regional resource Center and National Early Childhood Technical Assistance Center to develop a guidance document on implementing and sustaining team based approach to service delivery. 4. Develop and utilize simple family feedback strategies, in conjunction with Birth to Three, to solicit input from families about their experiences with the team based service delivery model. 5. Submit monthly reports (and an annual final report) to the Birth to Three office on data such as: number of children and families participating; amount of time and number of IFSP meetings attended; amount of time, number and types of follow up contacts between IFSP meetings; number and content of trainings within agency; overall successes and challenges. Monthly expenditure reports / invoices and brief progress updates will be required. 6. Participate in quarterly regional meetings with other provider agencies and CDW to develop solutions to sustain team based approach to early intervention. Appendix C DELAWARE HEALTH AND SOCIAL SERVICES Contract# CONTRACT A) Introduction 1. This contract is entered into between the Delaware Department of Health and Social Services (the Department), Division of ______________ (Division) and _______________________(the Contractor). 2. The Contract shall commence on __________________ and terminate on _____________ unless specifically extended by an amendment, signed by all parties to the Contract. Time is of the essence. (Effective contract start date is subject to the provisions of Paragraph C 1 of this Agreement.) B) Administrative Requirements 1. Contractor recognizes that it is operating as an independent Contractor and that it is liable for any and all losses, penalties, damages, expenses, attorney's fees, judgments, and/or settlements incurred by reason of injury to or death of any and all persons, or injury to any and all property, of any nature, arising out of the Contractor's negligent performance under this Contract, and particularly without limiting the foregoing, caused by, resulting from, or arising out of any act of omission on the part of the Contractor in their negligent performance under this Contract. 2. The Contractor shall maintain such insurance as will protect against claims under Worker’s Compensation Act and from any other claims for damages for personal injury, including death, which may arise from operations under this Contract. The Contractor is an independent contractor and is not an employee of the State. 3. During the term of this Contract, the Contractor shall, at its own expense, carry insurance with minimum coverage limits as follows: a) Comprehensive General Liability $1,000,000 and b) Medical/Professional Liability $1,000,000/ $3,000,000 or c) Misc. Errors and Omissions $1,000,000/$3,000,000 or d) Product Liability $1,000,000/$3,000,000 All contractors must carry (a) and at least one of (b), (c), or (d), depending on the type of service or product being delivered. If the contractual service requires the transportation of Departmental clients or staff, the contractor shall, in addition to the above coverage, secure at its own expense the following coverage: e) Automotive Liability (Bodily Injury) $100,000/$300,000 f) Automotive Property Damage (to others) $ 25,000 4. Not withstanding the information contained above, the Contractor shall indemnify and hold harmless the State of Delaware, the Department and the Division from contingent liability to others for damages because of bodily injury, including death, that may result from the Contractor’s negligent performance under this Contract, and any other liability for damages for which the Contractor is required to indemnify the State, the Department and the Division under any provision of this Contract. 5. The policies required under Paragraph B3 must be written to include Comprehensive General Liability coverage, including Bodily Injury and Property damage insurance to protect against claims arising from the performance of the Contractor and the contractor's subcontractors under this Contract and Medical/Professional Liability coverage when applicable. 6. The Contractor shall provide a Certificate of Insurance as proof that the Contractor has the required insurance. The certificate shall identify the Department and the Division as the “Certificate Holder” and shall be valid for the contract’s period of performance as detailed in Paragraph A 2. 7. The Contractor acknowledges and accepts full responsibility for securing and maintaining all licenses and permits, including the Delaware business license, as applicable and required by law, to engage in business and provide the goods and/or services to be acquired under the terms of this Contract. The Contractor acknowledges and is aware that Delaware law provides for significant penalties associated with the conduct of business without the appropriate license. 8. The Contractor agrees to comply with all State and Federal licensing standards and all other applicable standards as required to provide services under this Contract, to assure the quality of services provided under this Contract. The Contractor shall immediately notify the Department in writing of any change in the status of any accreditations, licenses or certifications in any jurisdiction in which they provide services or conduct business. If this change in status regards the fact that its accreditation, licensure, or certification is suspended, revoked, or otherwise impaired in any jurisdiction, the Contractor understands that such action may be grounds for termination of the Contract. a) If a contractor is under the regulation of any Department entity and has been assessed Civil Money Penalties (CMPs), or a court has entered a civil judgment against a Contractor or vendor in a case in which DHSS or its agencies was a party, the Contractor or vendor is excluded from other DHSS contractual opportunities or is at risk of contract termination in whole, or in part, until penalties are paid in full or the entity is participating in a corrective action plan approved by the Department. A corrective action plan must be submitted in writing and must respond to findings of non-compliance with Federal, State, and Department requirements. Corrective action plans must include timeframes for correcting deficiencies and must be approved, in writing, by the Department. The Contractor will be afforded a thirty (30) day period to cure non-compliance with Section 8(a). If, in the sole judgment of the Department, the Contractor has not made satisfactory progress in curing the infraction(s) within the aforementioned thirty (30) days, then the Department may immediately terminate any and/or all active contracts. 9. Contractor agrees to comply with all the terms, requirements and provisions of the Civil Rights Act of 1964, the Rehabilitation Act of 1973 and any other federal, state, local or any other anti discriminatory act, law, statute, regulation or policy along with all amendments and revision of these laws, in the performance of this Contract and will not discriminate against any applicant or employee or service recipient because of race, creed, religion, age, sex, color, national or ethnic origin, disability or any other unlawful discriminatory basis or criteria. 10. The Contractor agrees to provide to the Divisional Contract Manager, on an annual basis, if requested, information regarding its client population served under this Contract by race, color, national origin or disability. 11. This Contract may be terminated in whole or part: a) by the Department upon five (5) calendar days written notice for cause or documented unsatisfactory performance, b) by the Department upon fifteen (15) calendar days written notice of the loss of funding or reduction of funding for the stated Contractor services as described in Appendix B, c) by either party without cause upon thirty (30) calendar days written notice to the other Party, unless a longer period is specified in Appendix A. In the event of termination, all finished or unfinished documents, data, studies, surveys, drawings, models, maps, photographs, and reports or other material prepared by Contractor under this contract shall, at the option of the Department, become the property of the Department. In the event of termination, the Contractor, upon receiving the termination notice, shall immediately cease work and refrain from purchasing contract related items unless otherwise instructed by the Department. The Contractor shall be entitled to receive reasonable compensation as determined by the Department in its sole discretion for any satisfactory work completed on such documents and other materials that are usable to the Department. Whether such work is satisfactory and usable is determined by the Department in its sole discretion. Should the Contractor cease conducting business, become insolvent, make a general assignment for the benefit of creditors, suffer or permit the appointment of a receiver for its business or assets, or shall avail itself of, or become subject to any proceeding under the Federal Bankruptcy Act or any other statute of any state relating to insolvency or protection of the rights of creditors, then at the option of the Department, this Contract shall terminate and be of no further force and effect. Contractor shall notify the Department immediately of such events. 12. Any notice required or permitted under this Contract shall be effective upon receipt and may be hand delivered with receipt requested or by registered or certified mail with return receipt requested to the addresses listed below. Either Party may change its address for notices and official formal correspondence upon five (5) days written notice to the other. To the Division at: _______________________________________ _______________________________________ _______________________________________ To the Contractor at: ________________________________________ ________________________________________ ________________________________________ 13. In the event of amendments to current Federal or State laws which nullify any term(s) or provision(s) of this Contract, the remainder of the Contract will remain unaffected. 14. This Contract shall not be altered, changed, modified or amended except by written consent of all Parties to the Contract. 15. The Contractor shall not enter into any subcontract for any portion of the services covered by this Contract without obtaining prior written approval of the Department. Any such subcontract shall be subject to all the conditions and provisions of this Contract. The approval requirements of this paragraph do not extend to the purchase of articles, supplies, equipment, rentals, leases and other day-to-day operational expenses in support of staff or facilities providing the services covered by this Contract. 16. This entire Contract between the Contractor and the Department is composed of these several pages and the attached: Appendix A - Divisional Requirements Appendix B - Services Description Appendix C - Contract Budget 17. This Contract shall be interpreted and any disputes resolved according to the Laws of the State of Delaware. Except as may be otherwise provided in this contract, all claims, counterclaims, disputes and other matters in question between the Department and Contractor arising out of or relating to this Contract or the breach thereof will be decided by arbitration if the parties hereto mutually agree, or in a court of competent jurisdiction within the State of Delaware. 18. In the event Contractor is successful in an action under the antitrust laws of the United States and/or the State of Delaware against a vendor, supplier, subcontractor, or other party who provides particular goods or services to the Contractor that impact the budget for this Contract, Contractor agrees to reimburse the State of Delaware, Department of Health and Social Services for the pro-rata portion of the damages awarded that are attributable to the goods or services used by the Contractor to fulfill the requirements of this Contract. In the event Contractor refuses or neglects after reasonable written notice by the Department to bring such antitrust action, Contractor shall be deemed to have assigned such action to the Department. 19. Contractor covenants that it presently has no interest and shall not acquire any interests, direct or indirect, that would conflict in any manner or degree with the performance of this Contract. Contractor further covenants that in the performance of this contract, it shall not employ any person having such interest. 20. Contractor covenants that it has not employed or retained any company or person who is working primarily for the Contractor, to solicit or secure this agreement, by improperly influencing the Department or any of its employees in any professional procurement process; and, the Contractor has not paid or agreed to pay any person, company, corporation, individual or firm, other than a bona fide employee working primarily for the Contractor, any fee, commission, percentage, gift or any other consideration contingent upon or resulting from the award or making of this agreement. For the violation of this provision, the Department shall have the right to terminate the agreement without liability and, at its discretion, to deduct from the contract price, or otherwise recover, the full amount of such fee, commission, percentage, gift or consideration. 21. The Department shall have the unrestricted authority to publish, disclose, distribute and otherwise use, in whole or in part, any reports, data, or other materials prepared under this Contract. Contractor shall have no right to copyright any material produced in whole or in part under this Contract. Upon the request of the Department, the Contractor shall execute additional documents as are required to assure the transfer of such copyrights to the Department. If the use of any services or deliverables is prohibited by court action based on a U.S. patent or copyright infringement claim, Contractor shall, at its own expense, buy for the Department the right to continue using the services or deliverables or modify or replace the product with no material loss in use, at the option of the Department. 22. Contractor agrees that no information obtained pursuant to this Contract may be released in any form except in compliance with applicable laws and policies on the confidentiality of information and except as necessary for the proper discharge of the Contractor’s obligations under this Contract. 23. Waiver of any default shall not be deemed to be a waiver of any subsequent default. Waiver or breach of any provision of this Contract shall not be deemed to be a waiver of any other or subsequent breach and shall not be construed to be a modification of the terms of the Contract unless stated to be such in writing, signed by authorized representatives of all parties and attached to the original Contract. 24. If the amount of this contract listed in Paragraph C2 is over $25,000, the Contractor, by their signature in Section E, is representing that the Firm and/or its Principals, along with its subcontractors and assignees under this agreement, are not currently subject to either suspension or debarment from Procurement and Non-Procurement activities by the Federal Government. C) Financial Requirements 1. The rights and obligations of each Party to this Contract are not effective and no Party is bound by the terms of this contract unless, and until, a validly executed Purchase Order is approved by the Secretary of Finance and received by Contractor, if required by the State of Delaware Budget and Accounting Manual, and all policies and procedures of the Department of Finance have been met. The obligations of the Department under this Contract are expressly limited to the amount of any approved Purchase Order. The State will not be liable for expenditures made or services delivered prior to Contractor's receipt of the Purchase Order. 2. Total payments under this Contract shall not exceed $ ______ in accordance with the budget presented in Appendix . Payment will be made upon receipt of an itemized invoice from the Contractor in accordance with the payment schedule, if any. The contractor or vendor must accept full payment by procurement (credit) card and or conventional check and/or other electronic means at the State’s option, without imposing any additional fees, costs or conditions. Contractor is responsible for costs incurred in excess of the total cost of this Contract and the Department is not responsible for such costs. 3. The Contractor is solely responsible for the payment of all amounts due to all subcontractors and suppliers of goods, materials or services which may have been acquired by or provided to the Contractor in the performance of this contract. The Department is not responsible for the payment of such subcontractors or suppliers. 4. The Contractor shall not assign the Contract or any portion thereof without prior written approval of the Department and subject to such conditions and revisions as the Department may deem necessary. No such approval by the Department of any assignment shall be deemed to provide for the incurrence of any obligations of the Department in addition to the total agreed upon price of the Contract. 5. Contractor shall maintain books, records, documents and other evidence directly pertinent to performance under this Contract in accordance with generally accepted accounting principles and practices. Contractor shall also maintain the financial information and data used by Contractor in the preparation of support of its bid or proposal. Contractor shall retain this information for a period of five (5) years from the date services were rendered by the Contractor. Records involving matters in litigation shall be retained for one (1) year following the termination of such litigation. The Department shall have access to such books, records, documents, and other evidence for the purpose of inspection, auditing, and copying during normal business hours of the Contractor after giving reasonable notice. Contractor will provide facilities for such access and inspection. 6. The Contractor agrees that any submission by or on behalf of the Contractor of any claim for payment by the Department shall constitute certification by the Contractor that the services or items for which payment is claimed were actually rendered by the Contractor or its agents, and that all information submitted in support of the claims is true, accurate, and complete. 7 The cost of any Contract audit disallowances resulting from the examination of the Contractor's financial records will be borne by the Contractor. Reimbursement to the Department for disallowances shall be drawn from the Contractor's own resources and not charged to Contract costs or cost pools indirectly charging Contract costs. 8. When the Department desires any addition or deletion to the deliverables or a change in the services to be provided under this Contract, it shall so notify the Contractor. The Department will develop a Contract Amendment authorizing said change. The Amendment shall state whether the change shall cause an alteration in the price or time required by the Contractor for any aspect of its performance under the Contract. Pricing of changes shall be consistent with those prices or costs established within this Contract. Such amendment shall not be effective until executed by all Parties pursuant to Paragraph B 14. D) Miscellaneous Requirements 1. If applicable, the Contractor agrees to adhere to the requirements of DHSS Policy Memorandum # 46, (PM #46, effective 4/18/08), and divisional procedures regarding the reporting and investigation of suspected abuse, neglect, mistreatment, misappropriation of property and significant injury of residents/clients receiving services, including providing testimony at any administrative proceedings arising from such investigations. The policy and procedures are included as Appendix to this Contract. It is understood that adherence to this policy includes the development of appropriate procedures to implement the policy and ensuring staff receive appropriate training on the policy requirements. The Contractor’s procedures must include the position(s) responsible for the PM46 process in the provider agency. Documentation of staff training on PM46 must be maintained by the Contractor. 2. The Contractor, including its parent company and its subsidiaries, and any subcontractor, including its parent company and subsidiaries, agree to comply with the provisions of 29 Del. Code, Chapter 58: “Laws Regulating the Conduct of Officers and Employees of the State,” and in particular with Section 5805 (d): “Post Employment Restrictions.” 3. When required by Law, Contractor shall conduct child abuse and adult abuse registry checks and obtain service letters in accordance with 19 Del. Code Section 708; and 11 Del. Code, Sections 8563 and 8564. Contractor shall not employ individuals with adverse registry findings in the performance of this contract. 4. If applicable, the Contractor agrees to adhere to the requirements of DHSS Policy Memorandum # 40 (PM #40, effective 3/10/2008), and divisional procedures regarding conducting criminal background checks and handling adverse findings of the criminal background checks. This policy and procedure are included as Appendix to this Contract. It is understood that adherence to this policy includes the development of appropriate procedures to implement the policy and ensuring staff receive appropriate training on the policy requirements. The Contractor’s procedures must include the title of the position(s) responsible for the PM40 process in the contractor’s agency. 5. If applicable, the Contractor agrees to adhere to the requirements of DHSS Policy Memorandum # 36 (PM #36, effective 9/24/2008), and divisional procedures regarding minimal requirements of contractors who are engaging in a contractual agreement to develop community based residential arrangements for those individuals served by Divisions within DHSS. This policy and procedure are included as Appendix to this Contract. It is understood that adherence to this policy includes individuals/entities that enter into a contractual arrangement (contractors) with the DHSS/Division to develop a community based residential home(s) and apartment(s). Contractors shall be responsible for their subcontractors’ adherence with this policy and related protocol(s) established by the applicable Division. 6. All Department campuses are tobacco-free. Contractors, their employees and sub- contractors are prohibited from using any tobacco products while on Department property. This prohibition extends to personal vehicles parked in Department parking lots. E) Authorized Signatures: For the Contractor: For the Department: ________________ __________________ Name Rita Landgraf Secretary ________________ ________________ Title Date ________________ For the Division: Date __________________ Valencia Beaty Director __________________ Date Attachment One REIMBURSEMENT METHODOLOGY Part A: Timely Delivery of Services: * The Division agrees to make a one-time payment of $100 per child for each child who receives timely service throughout the term of the contract when contractor reaches at least 95% compliance for timely delivery of services as defined in the scope of services section and Appendix B Services / Requirements of the RFP. This incentive payment will be made only once, at the end of the contract’s term. Also, to qualify for this payment, the contractor will be expected to participate in setting up this project for their respective agency within one month of start of project, and in contributing to the design and development of tracking information that will be implemented across all provider agencies. Recipients will also be expected to identify barriers preventing timely delivery of service and solutions to address these barriers. A final plan will be submitted detailing how recommended practices will be maintained. Provider agencies will contribute their plans for maintaining timely delivery of services and participate in up to three statewide meetings. Part B: Team-based approach: [To be inserted when budget and payment plan are approved] Attachment Two NATURAL ENVIRONMENTS GUIDELINES FOR THE DELAWARE BIRTH TO THREE EARLY INTERVENTION SYSTEM Revised October 2002 Definition: According to the federal law, Individuals with Disabilities Education Act Part C- Infants and Toddlers with Disabilities, all early intervention services will be provided in natural environments to the maximum extent appropriate to the needs of the child. Natural environments refer to settings where a peer without disabilities would participate. These may include, but are not limited to, home and/or community settings such as: child care, gymnastics programs, play groups, toy lending libraries, library story hours, swimming pools, parents- day-out programs, and Early Head Start programs. The unique characteristics of the family within the community, together with the needs of the child, should be guiding factors in this process. Vision and Standards: The Birth to Three Early Intervention System has incorporated into its vision and philosophy a belief that services and supports should occur in settings most natural and comfortable for the child and family. The development of a natural system of supports within a family’s community is promoted at all times. These settings should foster opportunities for the development of peer interactions with children without disabilities. Services should maximize the activities in the daily routine, reflecting the child’s and family’s schedule. The Child Development Watch Program (CDW), which serves children under Part C and their families, has incorporated into its standards and indicators (Standards for Early Intervention Services Delivery System as Provided by Child Development Watch, adopted Nov. 1996) that services are provided in the child’s natural environments. 1. First Contacts: When parents learn that their child has a delay or disability, they may ask about the options for intervention, including the use of natural environments. The CDW Team members then discuss community resources, supports and programs. Through this discussion, the integration of the child’s and family’s needs are assessed and the concept of natural environments is reinforced. The preference is to have the first meeting in the family’s environment. 2. Evaluations and Assessment Planning: When planning for the child’s evaluations and assessment, the team, comprised of family members, the primary care physician, providers (as appropriate), the CDW service coordinator, and other assessment staff will consider the advantages and disadvantages of various locations. Emphasis should be put on providing the assessment in the context of the child’s natural environments. When families identify resources, priorities and concerns related to enhancing the development of their child, the team will consider the family’s preference for the environment in which any personal interview may occur. The team will consider the family’s perspective of natural environments for their child as part of the identification of resources, priorities, and concerns. The CDW service coordinator will support the family to ensure resources are located, priorities are established, and concerns are addressed. 3. Development of Outcomes/Initial Individualized Family Service Plan (IFSP) Meeting: When developing and prioritizing outcomes and identifying strategies to meet outcomes, the team will consider the advantages and disadvantages of various environments in which activities may be implemented. The team will recognize that all activities and services do not have to be provided in the same location. The team will focus on identifying the child’s activity settings and learning opportunities in each of these settings. Activity settings are where the child plays and learns. Learning opportunities build on existing capabilities. Understanding a family’s routines is critical in identifying when learning opportunities occur in various settings. The IFSP team identifies the unique needs of the child and family. Based on these unique needs, the IFSP team determines the frequency, intensity and locations in which services and supports will be provided. Frequency and intensity of services may be affected by the location in which services are provided. Opportunities for informal networking with other families may also be affected by location decisions. Families need to be aware of available options in order to make informed decisions while participating as members of the IFSP team. Interventionists will discuss these options with each family. Consideration of natural environments for child and family is an on-going activity, which begins with the first contact and continues through the entire IFSP process. In almost all cases, the IFSP process will result in services and supports that are embedded in the child and family's normal daily routines. If interventions cannot take place in natural environments at the initiation of the plan, the IFSP team will pursue moving services to the natural environments as the plan is updated. Written documentation in the IFSP indicates that natural environments were discussed with the family. What constitutes a natural environment is unique to each child and family. Only when the outcomes cannot be met by providing services and supports in natural environments, then the IFSP team will consider the use of other environments. The IFSP team shall include on the IFSP a written justification of which services will not be provided in natural environments. In these cases, written documentation will indicate that the services will be provided to meet the unique needs of the child and family in another environment. 4. Periodic Review and Transition Planning: When reviewing outcomes and strategies, the team will consider whether the previously identified activities, supports, and service locations remain appropriate. The team will again focus on identifying the child’s activity settings and learning opportunities in these settings. The team will strive to adjust plans in order to engage interventions in natural environments. When developing a transition plan to Part B and other programs, the team will consider the least restrictive environments. In order to facilitate communication among school districts, families, providers, CDW service coordinators, child care, and community programs, Delaware has established Sequenced Transition to Education in the Public Schools (STEPS) Early Childhood Transition Teams. Transition planning occurs for all children, including a discussion of options for services and supports in natural environments. Recommended practice suggests the following questions be asked of families, professionals, primary care physicians, child care, and others providing services at each decision point throughout the IFSP process and during transition: * What are the child’s strengths, interests, and needs? * What are the family’s strengths interests, and needs? * What does the family identify as natural environments? * Where are the child’s activity and learning opportunities occurring? * What are the identified activities and outcomes? * What are the supports and services needed to conduct activities and attain outcomes? * Can these activities, supports, and services be provided in the identified natural environments? * If not, what are the barriers and what are the strategies to overcome these barriers? * Does documentation support how services best meet the needs of the child and family? (Including the use of natural environments or barriers to its use) 5. Provider Training Contracts: Formalized provider training will include understanding the definition of natural environments, identifying the child's activity settings and learning opportunities in these settings, strategies for securing and incorporating natural environments, including how to implement the IFSP and deliver services in natural environments. Training will be for family members, early intervention personnel, teachers, parents, child care professionals, and therapists. All provider contracts, as they are renewed, will support the options of services in natural environments and attendance reporting to allow providers to describe a broader range of settings for service delivery. The transdisciplinary model of service delivery model promotes consultation and early intervention in natural environments. Ongoing technical assistance and consultation are offered in support of training received through provider contracts. This support can occur from CDW or through mentor relationships. Data Collection and Capacity Building: As a prelude to the development of the Individualized Family Service Plan (IFSP), the CDW Service Coordinator will review “natural environments” with the family and the IFSP Team. The intent of the review is to provide full consideration for development of outcomes, which incorporate early intervention services into family and child routines and addresses the full range of options for locations, natural learning environments, and learning opportunities. Subsequently, a review of natural environments will be incorporated into Peer Review and Quality Assurance IFSP reviews. The IFSP reflects utilization of natural environments. The CDW Service Coordinator will indicate this in the IFSP. Data will be analyzed from monitoring of IFSPs. Data regarding natural environments will be obtained through the Birth to Three ongoing monitoring and evaluation activities such as surveys of families, child care professionals, service providers, and focus groups. If the data identifies geographic areas where there are limited or no options for support and services in the natural environment, the Quality Management Coordinator will work to develop new providers and partnerships within the identified communities. If the data identifies a service provider group unable to provide services or support in a natural environment, additional training and technical assistance will be delivered by a team from the Birth to Three office. The State Interagency Coordinating Council (ICC) will assist in building capacity within communities through its Transdisciplinary Committee, Building Capacity in Natural Environments Committee, and local children's advocacy groups. The State ICC will advise and assist on improving community linkages by including members such as Early Head Start, Head Start, the Early Childhood Assistance Program (ECAP), the child care community, libraries, playgroups, and the faith community who focus on services to all young children. The State ICC will advise and assist on financial barriers to providing services within natural environments, including barriers with private and public health insurance. In addition, the State ICC will assist in providing training to family service providers and early care and education providers, including child care professionals, on family-centered practices, early intervention services and natural environments. Revised by the Delaware Interagency Coordinating Council on October 22, 2002 Attachment Three BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement (“Agreement”), effective as of the _______day of __________________, 200__, is entered into by and between _________________, a ______________(“Covered Entity”) and ________________ (“Business Associate”) WHEREAS, in conjunction with the provision of certain healthcare services, Covered Entity receives and creates certain individually identifiable heath information (“Protected Health Information”) the creation, transmission, disclosure and dissemination of which must be protected as confidential information; WHEREAS, in conjunction with the provision of certain healthcare services to Covered Entity under an agreement dated the _________ day of _________________, _______, (“Original Contract”) Business Associate has access to and is involved in the creation, transmission, disclosure and dissemination of such Protect Health Information. WHEREAS, the Covered Entity and Business Associate wish to comply with the provisions of 45 C.F.R. §160.101 et seq. (“Privacy Regulations”) and 45 C.F.R. §164.308 et seq. (“Security Regulations”) regarding the appropriate use and disclosure of Protected Health Information; NOW THEREFORE, for good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, Covered Entity and Business Associate hereby agree as follows: 1. Definitions. The terms used in this Business Associate Agreement (“Agreement”) shall have the same meaning as those terms are used in HIPAA, 45 CFR § 160 et seq. and 45 CFR § 164.308 et seq. 2. Permitted uses and Disclosures of Protected Health Information. Business Associate will not use or further disclose any Protected Health Information except in the provision of services to Covered Entity as specifically authorized under the Original Contract, including without limitation any use or disclosure which would violate the provisions of the Privacy Regulations. Notwithstanding the foregoing, Business Associate may use and disclose Protected Health Information to provide data aggregation services related to the healthcare operations of Covered Entity. Business Associate may also use and disclose Protected Health Information in the proper management and administration of Business Associate and to carry out its legal responsibilities, provided that the use and disclosure is either required by law or Business Associate obtains reasonable assurances from the person to whom the information is disclosed that it will be held confidentially and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person and the person notifies Business Associate of any instances of which it is aware in which the confidentiality of information has been breached. 3. Responsibilities of Business Associate. Business Associate will: (a) Not use or further disclose Protected Health Information other than as permitted or required by the Original Contract or as required by law, including without limitation, the Privacy Regulations and any applicable State law; (b) Use appropriate safeguards to prevent use or disclosure of Protected Health Information other than as provided for in the Original Contract; (c) Implement administrative, physical, and technical safeguards that reasonably protect the confidentiality, integrity, and availability of the electronic protected health information that it creates, receives, maintains, or transmits on behalf of the Covered Entity.(d) Report to Covered Entity any use or disclosure of Protected Health Information not provided for in the Original Contract of which it becomes aware; (e) Ensure that any agents, including a subcontractor, to whom it provides Protected Health Information received from, or created or received by Business Associate on behalf of, the Covered Entity agrees to the same restrictions and conditions that apply to Business Associate with respect to Protected Health Information. Further any agent or subcontractor must agree to implement reasonable and appropriate safeguards to protect electronic protected health information. (f) Make available for inspection and copying Protected Health Information to an individual about such individual in accordance with 45 C.F.R § 164.524; (g) Make available Protected Health Information to an individual about such individual for amendment and incorporate any amendments to Protected Health Information in accordance with 45 C.F.R. § 164.526; (h) Make available Protected Health Information required to provide an accounting of disclosures in accordance with 45 C.F.R. §164.528; (i) Make its internal practices, books, and records relating to the use an disclosure of Protected Health Information received from, or created or received by Business Associate on behalf of, Covered Entity available to the Secretary of HHS to whom the authority involved has been delegated for purposes of determining the Covered Entity’s compliance with privacy Regulations; and (j) At termination of the Original Contract, if feasible, return all Protected Health Information received from, or created or received by Business Associate on behalf of, Covered Entity that Business Associates still maintains in any form and retain no copies of such Protected Health information or, if return is not feasible, extend the protections of the Original Contract and this Agreement to the information and limit further uses and disclosures to those purposes that make the return of the protected Health Information infeasible. 4. Other Arrangements (a) If a business associate is required by law to perform a function or activity on behalf of a covered entity or to provide a service described in the definition of business associate as specified in §160.103 of this subchapter to a covered entity, the covered entity may permit the business associate to create, receive, maintain or transmit electronic protected health information on its behalf to the extent necessary to comply with the legal mandate without meeting the requirements of (a) (2) (1) of §164.314, provided that the covered entity attempts in good faith to obtain satisfactory assurances as required by paragraph (a)(2)(ii)(A) of §164.314, and documents the attempt and the reasons that these assurances cannot be obtained. (b) The covered entity may omit from its other arrangements authorization of the termination of the contract by the covered entity, as required by paragraph (a)(2)(i)(D) of §164.314 if such authorization is inconsistent with the statutory obligations of the covered entity or its business associate. 5. Termination of Agreement. This Agreement and the Original Contract may be terminated by Covered Entity if Covered Entity determines that Business Associate has violated a material term of this Agreement. The provisions of Paragraphs 1 and 2 hereof shall survive any termination of this Agreement and/or the Original Contract. 6. Miscellaneous. This Agreement contains the final and entire agreement of the parties and supersedes all prior and/or contemporaneous understandings and may not be modified or amended unless such modification is in writing and signed by both parties and their successors, administrators and permitted assigns. All personal pronouns used in this Agreement whether used in masculine, feminine or neuter gender, shall include all other genders, the singular shall include the plural, and vice versa. Titles of Paragraphs are utilized for convenience only and neither limit nor amplify the provisions of this Agreement itself. If any provision of this Agreement or the application thereof to any person or circumstance shall be invalid or unenforceable to any extent, the reminder of this affected thereby and shall be enforced to the greatest extent permitted by law. IN WITNESS WHEREOF, the parties hereto have executed this Agreement to be effective as of the day and year first above written. COVERED ENTITY: BUSINESS ASSOCIATE: By: __________________________ By: __________________________ Print Name: ___________________ Print Name: ___________________ Title:_________________________ Title: _________________________ Group Health Plans Addendum Except when the only electronic protected health information disclosed to a plan sponsor is disclosed pursuant to §164.504(f)(1)(ii) or (iii), or as authorized under §164.508, a group health plan must ensure that its plan documents provide that the plan sponsor will reasonably and appropriately safeguard electronic protected health information created, received, maintained, or transmitted to or by the plan sponsor on behalf of the group health plan. The plan documents of the group health plan must be amended to incorporate provisions to require the plan sponsor to (i) implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic protected health information that it creates, receives, maintains or transmits on behalf of the group health plan; (ii) ensure that the adequate separation required by §164.504(f)(2)(iii) is supported by reasonable and appropriate security measures; (iii) ensure that any agent, including a subcontractor, to whom it provides this information agrees to implement reasonable and appropriate security measures to protect information; and (iv) report to the group health plan any security incident of which it becomes aware. IN WITNESS WHEREOF, the parties hereto have executed this Agreement to be effective as of the day and year first above written. COVERED ENTITY: BUSINESS ASSOCIATE: By: __________________________ By: __________________________ Print Name: ___________________ Print Name: ___________________ Title:_________________________ Title: _________________________ Appendix D DELAWARE PERSONNEL STANDARDS and GUIDELINES MATRIX Personnel Highest Entry-Level Academic Degree and/or Recognized Comparable Qualifications Delaware Recognized Current Standard for Practice * Guidelines for Part C Preferred Courseware/Experience for Best Practice 1. Audiologist Master Licensure, CCC-A Pediatric Experience Pediatric Coursework. Supervised Experience with infants & toddlers. 2. Nurse Advanced Practice Nurse Licensure as R.N. M.S.N. R.N. M.S.N. Nurse with MSN or BSN with 1-3 yrs NICU, PH, Peds or OB experience, training in developmental screening, infant health management. Nurse with MSN or BSN with 3-5 yrs NICU, OB, Peds, PH experience, advanced training in developmental assessment, knowledge of family dynamics, inter-agency coordination. Nurse with MSN in PH, MCH, Peds with training & experience in developmental screening, infant health management. Nurse with MSN in MCH, PH with advanced training in developmental assessment, 1-3 yrs experience in infant evaluations, developmental assessments or early intervention, knowledge of family dynamics, inter-agency coordination. 3. Nutritionist Dietitian BS in Nutrition B.S. Registered Dietitian and Dietetic Internship or Equivalent B.S. in Nutrition Registered Dietitian B.S. in Nutrition Coursework and/or experience with infants and toddlers with developmental disabilities. Masters in Nutrition Masters in Nutrition. Coursework in Pediatrics and Developmental Disabilities. Supervised experience with infants and toddlers with developmental disabilities. 4. Occupational Therapist B.S. Certification, O.T.R. Licensure, O.T.R. Pediatric coursework plus Level II pediatric field work, with supervision by an experienced birth-3 OTR during first year. Masters with pediatric coursework and 3 yrs supervised experience with specialized courses in treatment approaches. 5. Physical Therapist M.S. Licensure, L.P.T. or B.S. Licensure, L.P.T. Licensure, L.P.T. Pediatric coursework plus Pediatric Affiliation or infant and toddler experience under supervision during first year. Masters with pediatric concentration. Supervised experience in treatment with infants and toddlers. 6. Physician Licensure, M.D., D.O. M.D. or D.O. plus three- year residence. Diagnostician-based certified or board eligible in pediatrics/family practice State standard Consultation for appropriate sub-specialist: Board-eligibility or board certification in Infant and Child Psychiatry, Pediatric Neurology, Orthopedics with special interest in Pediatrics, Neonatology, Developmental Medicine, or Clinical Genetics. Personnel Highest Entry-Level Academic Degree and/or Recognized Comparable Qualifications Delaware Recognized Current Standard for Practice Guidelines for Part C Preferred Courseware/Experience for Best Practice 7. Psychologist Clinical School Ph.D. (including one-year internship) Masters (60 graduate hour minimum). Licensure and/or certification Licensure (including post- doctoral supervision) Licensure and/or Certification State standard State standard Coursework in infant assessment, child/family therapy, child psychopathology, child/clinical specialties. Supervised experience (at least 3 months) specific to infancy. Coursework in assessment, child/family intervention. Supervised experience specific to infant/toddlers/families. 8. Social Worker MSW Licensure Licensure, LCSW MSW State standard Coursework with infants/toddlers/families. Assessment and intervention with families of children with disabilities. Supervised experience with infants, toddlers and families in interagency collaboration and inter-system coordination. 9. Special Educator (Early Childhood Special Educator) Collegiate Professional Certificate with Early Childhood Special Education endorsement Collegiate Professional Certificate with Early Childhood Special Education endorsement State standard and supervised experience with infants, toddlers, and their families. Masters in Early Childhood Special Education. coursework with focus on infants/toddlers/families. Supervised experience with families with infants and toddlers with disabilities. 10. Speech and Language Pathologist Masters and Licensure Licensure, CCC-SLP State standard plus supervised experience with infants/toddlers and their families. Coursework in parent-infant interaction in context of communication, alternative service delivery model, and oral- motor development/feeding. Supervised experience with infants, toddlers, and families. 11. Family Counselor Masters and Licensure, LPC Licensure, LPC State standard Coursework in interdisciplinary family counseling with infants/toddlers. Marriage and family specialty. 12. Orientation and Mobility Specialist MS & AER Certification B.S. or M.S. and AER Certification State standard and supervised with infants and toddlers MS & AER certification, coursework and experience in interdisciplinary programming for infants and toddlers and their families. * Must be combined with highest entry-level academic degree column for Part C Birth to Three systems in Delaware. Para Professionals: Nursing Occupational Therapy Physical Therapy Education Social Work Other Licensed Practical Nurse Certified Occupational Therapy Assistant Physical Therapy Assistant Teacher Aide Social Service Specialist Child Development Specialist Nurse’s Aide Occupational Therapy Aide Physical Therapy Aide Case Manager Family Service Coordinator Appendix E – Individualized Family Service Plan (IFSP) The IFSP is a written plan for providing early intervention services to an eligible child and the child’s family. It is based on the clinical assessment of functioning in the five developmental domains and the family’s concerns, needs, priorities and resources that may influence the child to improve developmental outcomes. It is the responsibility of the professional team working with the child to share information that contributes to the IFSP process. The IFSP is designed to address the child’s developmental needs and the needs of the family as they relate to the child’s development. The plan focuses on outcomes to meet these needs. Team members share ideas on how these outcomes can be met. Ideas may include things that the family and others important in the child's life can do to encourage development. At the IFSP meetings, methods to encourage development are discussed. These would include options such as early intervention services as well as other community resources and supports. A. Purpose The purpose of the IFSP is to identify and organize formal and informal resources to facilitate families' goals for their children and themselves. The IFSP is a promise to children and families - a promise that their strengths will be recognized and built on, that their needs will be met in a way that is respectful of their beliefs and values, and that their hopes and aspirations will be encouraged and enabled. The IFSP is an evolving process of interaction, collaboration, and partnership between families and professionals. It is a living, fluid document that can be modified any time. The definition of family is an individual process, dependent upon individual family variables. The family may include, but not be limited to birth parents, adoptive parents, guardians, siblings, aunts, uncles, grandparents, and significant others. B. Preparation It is the responsibility of the Service Coordinator to assist the family in preparing for the IFSP meeting, including an orientation to the IFSP process prior to the initial IFSP team meeting. Participants in the IFSP are the family, assessment team, service provider, primary care physician, service coordinator and other persons the family may desire. The meeting will be held at a time and place convenient to the family. Written notice will be provided to the family and other participants at least 10 working days before the meeting. The family is encouraged to actively participate in the discussion and is the primary decision-maker in the process of IFSP development. Parents are responsible for the final decision in determining whether they, their child, or other family members will accept or decline services. Unique cultural characteristics and preferences of families should be taken into consideration in IFSP planning. The contents of the IFSP must be fully explained to the family and the family must sign the IFSP to indicate informed written consent before the provision of early intervention services. C. Content The IFSP is primarily the family's roadmap for addressing the needs of their child. It is written in family friendly language and addresses the family's goals for their child. While the IFSP may also serve as a document for insurance or other purposes, the focus of the document must be that it is meaningful and comprehensive to the family. The IFSP includes the following information: 1. Information about the child's status based upon professionally acceptable objective criteria including a statement of the child's present level of: a. Physical development including vision, hearing, and health status b. Cognitive development c. Communication development d. Social or emotional development e. Adaptive development (Provider agencies are responsible for completing full reports for any evaluations completed; the results are used in this section of the IFSP. The lead interventionist will bring input from all interventionists across provider agencies) 2. Family information including a statement of the family's resources, priorities, and concerns related to enhancing the development of the child 3. Outcomes including a statement of the major outcomes expected to be achieved for the child and family, and the criteria, procedures and timelines used to determine: a. The degree to which progress toward achieving the outcomes is being made b. Whether modifications or revisions of the outcomes or services are necessary (Through team discussion, family and child goals will be identified and listed on the IFSP. Intervention goals and strategies will be described under each of the family or child goals on the IFSP) 4. Early intervention services including a statement of the specific early intervention services necessary to meet the unique needs of the child and the family to achieve the stated outcomes (The lead interventionist will share strategies with other interventionists across agencies and with community providers where the child may be during the day, with written parental consent) 5. Other supports and services, to the extent appropriate, along with the steps that will be undertaken to secure those services through public or private resources There are other services that a child or family need, but are not covered under Part C. The listing of these non-covered services does not mean that these services must be provided. By listing these services the IFSP provides a comprehensive picture of the child's early intervention, medical, and health needs which is useful to both the child's family and the Service Coordinator. It is also appropriate for the Service Coordinator to assist the family in securing non-covered services. 6. Dates and duration of services include the projected dates for completed referral to provider agencies, initiation of services and the anticipated duration of those services. (Each provider is responsible for providing the first visit progress page for both evaluations and initial treatment session to the Service Coordinator. The service referral date will be the date that written family consent was obtained for a service or the date of evaluation if completed by the provider) 7. The Service Coordinator is named on the IFSP. The Service Coordinator is responsible for assuring implementation of the IFSP and coordination with other agencies and persons. 8. Transition plans to provide a smooth progression from CDW to school district or other services at age 3. The transition plan describes steps taken to facilitate the transition of the three-year-old child when exiting CDW to preschool services under Part B or other services. D. Required IFSP meetings include: 1. The initial IFSP meeting that is held after the child has been evaluated for eligibility for the first time 2. Periodic IFSP review for a child and family is conducted every six months or more frequently if conditions warrant, or if the family requests such a review. The purpose of the periodic review is to determine: • The degree to which progress towards achieving the outcomes is occurring • Whether modifications or revisions of the outcomes or services is necessary This review may be carried out by a meeting or by other means that is acceptable to the family and other participants (The Provider is required to submit on a quarterly basis, and as requested, progress summaries for each child served, to the child’s service coordinator, indicating current goals that were worked on with the child and family, a statement indicating any needs or concerns expressed by the family, a statement indicating absences/missed appointments, and a plan for the next quarter. In addition, the Provider is required to notify the child’s Service Coordinator in order to allow for multidisciplinary team review and approval if there are any provider recommendations to modify (frequency, intensity, method or location) specific services that a child is receiving PRIOR to the initiation of any changes in order to allow for an IFSP meeting to be held) 3. An annual meeting to evaluate the IFSP. The results of any current evaluations and any other information available from ongoing assessments of the child and family will be used in determining what services are needed. All IFSP meetings should be conducted: a. In a setting and at times that are convenient to families and mutually agreed upon. This could include evening meetings and might occur at the family's home or in another location that is comfortable to the family. b. In the native language of the family or other mode of communication used by the family. Parents will be informed of their right to have family members or other advocates present at the IFSP meeting. The meeting arrangements will be made and written notice provided to the family and other participants 10 days prior to the meeting. Appendix F Department of Health and Social Services DHSS Policy Memorandum 46 April 18, 2008 Subject: Injury to Clients I. PURPOSE a. To protect the right of residents/clients of Delaware Health and Social Services (DHSS) facilities to be free from abuse, neglect, mistreatment, financial exploitation or significant injury. b. To require that each Division that has, or contracts for the operation of, residential facilities establish standardized written procedures for the reporting, investigation and follow up of all incidents involving suspected resident/client abuse, neglect, mistreatment, financial exploitation, or significant injury. c. To require that all DHSS residential facilities comply with The Patient Abuse Law (Title 16, Chapter 11, section 1131, et seq.) and Title 29, Chapter 79, sections 7970 and 7971 (Attachments I and II); and that all Medicaid and/or Medicare certified long term care facilities and Intermediate Care Facilities for Mental Retardation (ICF/MR) comply with the federal regulations (42 CFR) and State Operations Manual for such facilities. d. To require that all DHSS residential facilities comply with all applicable state and federal statutes, rules and regulations pertaining to suspected abuse, neglect, mistreatment, financial exploitation, or significant injury. II. SCOPE a. This policy applies to anyone receiving services in any residential facility operated by or for any DHSS Division, excluding any facilities/programs in which the only DHSS contract is with the DHSS Division of Social Services Medicaid Program. b. This policy is not intended to replace additional obligations under federal and/or state laws, rules and regulations. III. DEFINITIONS a. Abuse shall mean: 1. Physical abuse the unnecessary infliction of pain or injury to a resident or client. This includes, but is not limited to, hitting, kicking, pinching, slapping, pulling hair or any sexual molestation. When any act constituting physical abuse has been proven, the infliction of pain shall be assumed. 2. Emotional abuse - This includes, but is not limited to, ridiculing or demeaning a resident or client, cursing or making derogatory remarks towards a resident or client, or threatening to inflict physical or emotional harm to a resident or client. b. Neglect shall mean: 1. Lack of attention to the physical needs of the resident or client including, but not limited to, toileting, bathing, meals, and safety. 2. Failure to report client or resident health problems or changes in health problems or changes in health condition to an immediate supervisor or nurse. 3. Failure to carry out a prescribed treatment plan for a resident or client. 4. A knowing failure to provide adequate staffing (where required) which results in a medical emergency to any patient or resident where there has been documented history of at least 2 prior cited instances of such inadequate staffing within the past 2 years in violation of minimum maintenance of staffing levels as required by statute or regulations promulgated by the department, all so as to evidence a willful pattern of such neglect. (Reference 16 DE Code, §1161-1169) c. Mistreatment shall mean the inappropriate use of medications, isolation, or physical or chemical restraints on or of a resident or client. d. Financial exploitation shall mean the illegal or improper use or abuse of a client's or resident's resources or financial rights by another person, whether for profit or other advantage. e. Significant Injury is one which is life threatening or causes severe disfigurement or significant impairment of bodily organ(s) or functions which cannot be justified on the basis of medical diagnosis or through internal investigation. f. Residential Facility shall include any facility operated by or for DHSS which provides supervised residential services, including Long Term Care licensed facilities, group homes, foster homes, and community living arrangements. g. Long Term Care Facility is any facility operated by or for DHSS which provides long term care residential services and the Delaware Psychiatric Center. h. High managerial agent is an officer of a facility or any other agent in a position of comparable authority with respect to the formulation of the policy of the facility or the supervision in a managerial capacity of subordinate employees. IV. RESPONSIBILITIES a. The Director, or his/her designee of each Division within the scope of this policy, is hereby designated as an official DHSS designee under the State Mandatory Patient Abuse Reporting Law. b. Each Division will develop written procedures consistent with the standards contained in this policy and which will be activated immediately upon discovery of any suspected abuse, neglect, mistreatment, financial exploitation or significant injury of or to a client of a residential or longterm care facility. These procedures must clearly outline the reporting chain from the witness to the Division Director, and other appropriate parties, to require the expedient relay of information within the required time frames. c. These standardized procedures shall also apply when the preliminary inquiry suggests that the significant injury, suspected abuse, neglect, mistreatment or financial exploitation may have been caused by a staff member of the residential facility, whether on or off the grounds of the residential facility. Suspicion of facility/program negligence (including inadequate supervision resulting in client-client altercations) and incidents involving abuse by persons who are not staff members of the residential facility shall also be reported. d. The standardized procedures shall be approved by the appropriate Division Director prior to implementation. The Division Director or designee shall forward a copy of the approved procedures to the Chief Policy Advisor, Office of the Secretary, and other appropriate agencies. e. Each Division will require that the standards established in this policy are incorporated in all residential operational procedures and all residential contracts. Each Division shall require that all residents and providers of these programs be informed of their specific rights and responsibilities as defined in the Division's written procedures. f. Each Division shall require that all levels of management understand their responsibilities and obligations for taking and documenting appropriate corrective action. g. Each Division shall require appropriate training of all staff and contract providers in the PM 46 policy and procedures. Such training shall also include the laws prohibiting intimidation of witnesses and victims (11 Del. C., sections 3532 through 3534) and tampering with a witness or physical evidence (11 Del. C., sections 1261 through 1263 and section 1269). h. Each Division shall develop quality assurance/improvement mechanisms to monitor and oversee the implementation of the PM 46 policy and procedures. i. Each Division must ensure that all employees of, or contractors for, residential facilities shall fully cooperate with PM 46 investigations. V. STANDARDS/PROCEDURES Standard and consistent implementation of this Department policy is required. Each Division's written procedures shall include the following: a. Employee(s) of the residential facility, or anyone who provides services to residents/clients of the facility, who have reasonable cause to believe that a resident/client has been abused, mistreated, neglected, subjected to financial exploitation, or has received a significant injury shall: 1. Take actions to assure that the residents/client(s) will receive all necessary medical attention immediately. 2. Take actions to protect the residents/client(s) from further harm. 3. Report immediately to the Division of Long Term Care Residents Protection (if the incident occurred in a long term care facility or if the client was a resident of a long term care facility); and to the Department of Services for Children, Youth and Their Families/Division of Family Services (if the client is a minor, as required under 16 Del. C., section 903). It is essential that the reporting person ensure that the report be made to the appropriate division designee immediately. 4. Report immediately to the facility/program director and the Division's designated recipient(s) of PM 46 reports. 5. Follow up the verbal report with a written initial incident report to the persons/ agencies named in (a) 3 and (a) 4 (above) within 48 hours. b. In addition to the above named persons, any other person may make a report to a staff person of the facility or to the Division director or his/her designee. Such a report shall trigger activities under V(a), items 1 through 5. c. Each written initial report of suspected abuse, neglect, mistreatment, financial exploitation, or significant injury (completed by the reporting employee) must include: 1. The name and gender of the resident or client. 2. The age of the resident or client, if known. 3. Name and address of the reporter and where the reporter can be contacted. 4. Any information relative to the nature and extent of the abuse, neglect, mistreatment, financial exploitation or significant injury. 5. The circumstances under which the reporter became aware of the abuse, neglect, mistreatment, financial exploitation or significant injury. 6. The action taken, if any, to treat or otherwise assist the resident or client. 7. Any other information that the reporter believes to be relevant in establishing the cause of such abuse, neglect, mistreatment, financial exploitation or significant injury. 8. A statement relative to the reporter's opinion of the perceived cause of the abuse, neglect, mistreatment, financial exploitation or significant injury (whether a staff member or facility program negligence). d. The Division's designated recipient of PM 46 reports shall report all allegations of abuse, neglect, mistreatment, financial exploitation and significant injury, to the Office of the Secretary; the Office of the Attorney General/Medicaid Fraud Control Unit (for Medicaid and/or Medicare certified long term care facilities); the appropriate state licensing agency for the program, if applicable; and the Division Director or designee, within 24 hours of receiving notification of such. e. In instances where there is immediate danger to the health or safety of a resident/client from further abuse, mistreatment or neglect; if criminal action is suspected; or if a resident/client has died because of suspected abuse, mistreatment, neglect or significant injury, the Division Director or his/her designee shall immediately notify the appropriate police agency. The Division of Long Term Care Residents Protection, and the Office of the Secretary, shall be notified if the police were contacted. Further, the Division Director or his/her designee shall notify the Office of the Attorney General/Medicaid Fraud Control Unit, the Office of the Secretary, and the Chief Medical Examiner, if a resident/client has died because of suspected abuse, mistreatment, neglect, significant injury, or as a result of any cause identified by 29 Del. C., section 4706. f. The Division Director or his/her designee shall review the initial incident report and initiate an investigation into the allegations contained in the report. The investigation, with a written report, shall be made within 24 hours, if the Division has reasonable cause to believe that the resident's/client's health or safety is in immediate danger from further abuse, neglect or mistreatment. Otherwise, the investigation and written Investigative Report, up to and including the Division Director's or designee's signed review of the report, shall be made to the Division of Long Term Care Residents Protection (DLTCRP) within 10 days. This timeframe may be extended by DLTCRP if extenuating facts warrant a longer time to complete the investigation. If the facility is a Medicaid- Medicare certified long-term care facility, or an ICF/MR facility, the report of suspected abuse, neglect, mistreatment, financial exploitation or significant injury shall be sent to the appropriate authorities, as required in the respective regulations under 42 CFR, within 5 working days of the incident. g. The investigative process shall be confidential and not subject to disclosure both pursuant to 24 Del. C., section 1768 and because it is privileged under the governmental privilege for investigative files. Each Investigative Report shall be labeled as confidential and privileged, pursuant to 24 Del. C., section 1768. Each investigation shall include the following: 1. A visit to the facility or other site of incident. 2. A private interview with the resident or client allegedly abused, neglected, mistreated, whose finances were exploited or whose injury was significant. 3. Interviews with witnesses and other appropriate individuals. 4. A determination of the nature, extent and cause of injuries, or in the case of exploited finances, the nature and value of the property. 5. The identity of the person or persons responsible. 6. All other pertinent facts. 7. An evaluation of the potential risk of any physical or emotional injury to any other resident or client of that facility, if appropriate. h. A written report (Investigative Report) containing the information identified in V (g) shall be completed within the time frames identified in V (f) and shall include a summary of the facts resulting from the investigation. (Attachment 3) i. The Investigative Report shall be sent to the facility director and to the Division Director or designee. The Facility Director and the Division Director or designee shall review the report. If the incident is serious, the Division Director must review the incident with the Department Secretary prior to the completion of the report. The Facility Director and the Division Director or designee shall indicate in writing their concurrence or non concurrence with the report. If the facts show that there is a reasonable cause to believe that a resident/client has died as a result of the abuse, neglect, mistreatment, or significant injury, the Division Director or designee shall immediately report the matter to the Office of the Attorney General/Medicaid Fraud Control Unit, the Division of Long Term Care Residents Protection, and the Office of the Secretary. j. All Investigative Reports shall be forwarded by the reporting division, forthwith, to the Division of Long Term Care Residents Protection. The Division of Long Term Care Residents Protection shall complete the investigation by making a determination of findings and documenting their conclusions. k. If a determination is made at the Division level (upon consultation with the Division of Management Services, Human Resources office) that discipline is appropriate, the Investigative Report shall be forwarded to the Human Resources office. Human Resources shall determine the appropriate level of discipline, forward their recommendations to the Office of the Secretary and to the originating division for implementation, and proceed as appropriate. l. The Office of the Secretary shall be informed by the Division of Long Term Care Residents Protection, in writing, of the results of the investigation, including the findings and recommendations, within 5 days following the completion of the investigation. m. The Division Director or designee shall notify the appropriate licensing or registration board, if the incident involved a licensed or registered professional, and the appropriate state or federal agency, including the appropriate state licensing agency of the program, if applicable, upon a finding of: 1) abuse, mistreatment, neglect, financial exploitation, or significant injury; 2) failure to report such instances by a licensed or registered professional; or 3) failure by a member of a board of directors or high managerial agent to promptly take corrective action. n. The Division Director or designee shall notify the employee, resident/client, the guardian of the resident/client, if applicable, and the incident reporter of the results of the facility-based case resolution, unless otherwise prohibited by law. They shall also advise the parties of the fact that there is a further level of review that will occur through the Division of Long Term Care Residents Protection and/or the Office of the Attorney General/Medicaid Fraud Control Unit. o. The Division of Long Term Care Residents Protection shall, at the conclusion of their review of the case, notify the DHSS employee (or the agency director for contract providers), the resident/client, or the guardian of the resident/client, if applicable, and the originating Division Director or designee, of the substantiated or unsubstantiated status of the case, unless otherwise prohibited by law. The Division of Long Term Care Residents Protection shall also notify the Office of the Attorney General/Medicaid Fraud Control Unit of all substantiated cases. VI. IMPLEMENTATION a. This policy shall be effective immediately (upon the completion of mandatory departmental training). b. In carrying out this policy, all parties must protect the confidentiality of records and persons involved in the case, and may not disclose any Investigative Report except in accordance with this policy. VII. EXHIBITS a. Attachment 1 - Delaware Code, Title 16, Chapter 11, Sections 1131-1140. b. Attachment 2 - Delaware Code, Title 29, Chapter 79, Sections 7970-7971. c. Attachment 3 - Investigative Report form Vincent P. Meconi April 18, 2008 Vincent P. Meconi, Secretary Appendix G F O R M S (To be completed, signed and included in the proposal package) ? Bidders Signature Form ? Certification Sheet ? Statement of Compliance Form ? Office of Minority and Women Business Enterprise ? Self-Certification Tracking Form ? State of Delaware Contracts Disclosure ? Checklist for Required Bid Content STATE OF DELAWARE DELAWARE HEALTH AND SOCIAL SERVICES BIDDERS SIGNATURE FORM Name of Bidder _________________________________________ Signature of Authorized Person ___________________________ Type in Name of Authorized Person ________________________ Title of Authorized Person ________________________________ Street Name/Number _____________________________________ City, State, and Zip Code _________________________________ Contact Person __________________________________________ Telephone Number _______________________________________ Fax Number _____________________________________________ Date ____________________________________________________ Bidder's Federal Employers Identification No. ________________ Delivery Day/Completion Time _____________________________ F.O.B. __________________________________________________ Terms __________________________________________________ THE FOLLOWING MUST BE COMPLETED BY THE VENDOR AS CONSIDERATION FOR THE AWARD AND EXECUTION BY DELAWARE HEALTH AND SOCIAL SERVICES OF THIS CONTRACT, THE (COMPANY NAME) _____________________________ HEREBY GRANTS, CONVEYS, SELLS, ASSIGNS, AND TRANSFERS TO THE STATE OF DELAWARE ALL OF ITS RIGHTS, TITLE AND INTEREST IN AND TO ALL KNOWN OR UNKNOWN CAUSES OF ACTION IT PRESENTLY HAS OR MAY NOW HEREAFTER ACQUIRE UNDER THE ANTITRUST LAWS OF THE UNITED STATES AND THE STATE OF DELAWARE, RELATING THE PARTICULAR GOODS OR SERVICES PURCHASES OR ACQUIRED BY THE DELAWARE HEALTH AND SOCIAL SERVICES DEPARTMENT, PURSUANT TO THIS CONTRACT. STATE OF DELAWARE DELAWARE HEALTH AND SOCIAL SERVICES Certification Sheet As the official representative for the proposer, I certify on behalf of the agency that: a. They are a regular dealer in the services being procured. b. They have the ability to fulfill all requirements specified for development within this RFP. c. They have independently determined their prices. d. They are accurately representing their type of business and affiliations. e. They will secure a Delaware Business License. f. They have acknowledged that no contingency fees have been paid to obtain award of this contract. g. The Prices in this offer have been arrived at independently, without consultation, communication, or agreement, for the purpose of restricting competition, as to any matter relating to such prices with any other contractor or with any competitor; h. Unless otherwise required by Law, the prices which have been quoted in this offer have not been knowingly disclosed by the contractor and prior to the award in the case of a negotiated procurement, directly or indirectly to any other contractor or to any competitor; and i. No attempt has been made or will be made by the contractor in part to other persons or firm to submit or not to submit an offer for the purpose of restricting competition. j. They have not employed or retained any company or person (other than a full-time bona fide employee working solely for the contractor) to solicit or secure this contract, and they have not paid or agreed to pay any company or person (other than a full-time bona fide employee working solely for the contractor) any fee, commission percentage or brokerage fee contingent upon or resulting from the award of this contract. k. They (check one) operate ___an individual; _____a Partnership ____a non-profit (501 C-3) organization; _____a not-for-profit organization; or _____for Profit Corporation, incorporated under the laws of the State of____________. l. The referenced proposer has neither directly or indirectly entered into any agreement, participated in any collusion or otherwise taken any action in restraint of free competitive bidding in connection with this bid submitted this date to Delaware Health and Social Services m. The referenced bidder agrees that the signed delivery of this bid represents the bidder’s acceptance of the terms and conditions of this invitation to bid including all specifications and special provisions. n. They (check one): _______are; _____are not owned or controlled by a parent company. If owned or controlled by a parent company, enter name and address of parent company: __________________________________________ __________________________________________ __________________________________________ __________________________________________ Violations and Penalties: Each contract entered into by an agency for professional services shall contain a prohibition against contingency fees as follows: 1. The firm offering professional services swears that it has not employed or retained any company or person working primarily for the firm offering professional services, to solicit or secure this agreement by improperly influencing the agency or any of its employees in the professional service procurement process. 2. The firm offering the professional services has not paid or agreed to pay any person, company, corporation, individual or firm other than a bona fide employee working primarily for the firm offering professional services, any fee, commission, percentage, gift, or any other consideration contingent upon or resulting from the award or making of this agreement; and 3. For the violation of this provision, the agency shall have the right to terminate the agreement without liability and at its discretion, to deduct from the contract price, or otherwise recover the full amount of such fee, commission, percentage, gift or consideration. The following conditions are understood and agreed to: a. No charges, other than those specified in the cost proposal, are to be levied upon the State as a result of a contract. b. The State will have exclusive ownership of all products of this contract unless mutually agreed to in writing at the time a binding contract is executed. Date Signature & Title of Official Representative Type Name of Official Representative STATE OF DELAWARE DELAWARE HEALTH AND SOCIAL SERVICES Statement of Compliance Form As the official representative for the CONTRACTOR, I certify on behalf of the agency that: They will comply with all Federal and Delaware laws and regulations pertaining to equal employment opportunity and affirmative action. In addition, compliance will be assured in regard to Federal and Delaware laws and regulations relating to confidentiality and individual and family privacy in the collection and reporting of data. Authorized Signature ________________________________ Title____________________________________________ Date_____________________________________________ OFFICE OF MINORITY AND WOMEN BUSINESS ENTERPRISE SELF-CERTIFICATION TRACKING FORM If your firm wishes to be considered for one of the classifications listed below, this page must be signed, notarized and returned with your proposal. COMPANY NAME_______________________________________________________ NAME OF AUTHORIZED REPRESENTATIVE (Please print) ________________________________________________________________________ SIGNATURE____________________________________________________________ COMPANY ADDRESS______________________________________________________________ TELEPHONE #__________________________________________________________ FAX #__________________________________________________________________ EMAILADDRESS________________________________________________________ FEDERAL EI# __________________________________________________________ STATE OF DE BUSINESS LIC#____________________________________________ Note: Signature of the authorized representative MUST be of an individual who legally may enter his/her organization into a formal contract with the State of Delaware, Delaware Health and Social Services. Organization Classifications (Please circle) Women Business Enterprise (WBE) Yes/No Minority Business Enterprise (MBE) Yes/No PLEASE CHECK ONE---CORPORATION ______ PARTNERSHIP______INDIVIDUAL _______ ________________________________________________________________________ For certification (WBE), (MBE), (DBE) please apply to Office of Minority & Women Business Enterprise Phone #’ (302) 739-74206 L. Jay Burks, Executive Director Fax# (302) 739-7839 Certification #____________ Certifying Agency____________ http://www.state.de.us/omwbe SWORN TO AND SUBSCRIBED BEFORE ME THIS ______________DAY OF ___________20________ NOTARY PUBLIC_________________________MY COMMISION EXPIRES ____________________ CITY OF ___________________________COUNTY OF _________________STATE OF__________________ Definitions The following definitions are from the State Office of Minority and Women Business Enterprise. Women Owned Business Enterprise (WBE): At least 51% is owned by a women, or in the case of a publicly owned enterprise, a business enterprise in which at least 51% of the voting stock is owned by women; or any business enterprise that is approved or certified as such for purposes of participation in contracts subject to women-owned business enterprise requirements involving federal programs and federal funds. Minority Business Enterprise (MBE): At least 51% is owned by minority group members; or in the case of a publicly owned enterprise, a business enterprise in which at least 51% of the voting stock is owned by minority group members; or any business enterprise that is approved or certified as such for purposes of participation in contracts subjects to minority business enterprises requirements involving federal programs and federal funds. Corporation: An artificial legal entity treated as an individual, having rights and liabilities distinct from those of the persons of its members, and vested with the capacity to transact business, within the limits of the powers granted by law to the entity. Partnership: An agreement under which two or more persons agree to carry on a business, sharing in the profit or losses, but each liable for losses to the extent of his or her personal assets. Individual: Self-explanatory For Certification in one of above bidder must contract: L.Jay Burks, Executive Director Office of Minority and Women Business Enterprise (302) 739-4206 Fax (302) 739-7839 State of Delaware Contracts Disclosure Vendor/Predecessor Firm Name State Department and Division Contact Name, Address and Phone Number Period of Performance Contract Number Amount Sample Vendor Firm Name DHSS \ DMS Contact Name 1901 N DuPont Highway New Castle, DE 19720 302.-___-____ 01/01/2002 – 12/31/2002 PSC- _____ $100,000 Bidder shall list all contracts awarded to it or its predecessor firm(s) by the State of Delaware during the last three (3) years, by State Department, Division, Contact Person (with address/phone number), period of performance, contract number and amount. The Evaluation/Selection Review Committee will consider these additional references and may contact each of these sources. Information regarding bidder performance gathered from these sources may be included in the Committee's deliberations and factored in the final scoring of the bid. Failure to list any contract as required by this paragraph may be grounds for immediate rejection of the bid. List contracts in the format specified. Include those contracts whose period of performance has been within the past three (3) years in addition to those awarded within this timeframe. Contracts with amendments only have to be listed once. If a vendor has had no contracts within this timeframe, enter “No contracts to specify” under Vendor/Predecessor Firm Name in the first row of the table. Checklist for Required Bid Content ? DHSS / DMS seven-digit PSC# on the outside envelope for each bid ? Proposal is typed double-spaced on 8 ½ x 11 paper, each page numbered. ? Proposal contains all information cited in Section IV of this RFP and in the proper order (descriptions below may not be all-inclusive): ? Title Page with required information ? Table of Contents ? Qualifications & Experience (including Bidder’s DE Part C contract number; current DE business license; organizational chart showing administrative staff with title and name; list specifying the number of personnel by discipline who will be assigned to work on the services included in the bid) ? Proposed Methodology (including approach taken to provide the services, timeline when services will begin once a contract is finalized.) ? Payment Plan for Services ? All Forms cited in this Appendix. ? Two original CD’s and six CD copies of the proposal submitted to Sandra Skelley no later than August 26, 2009 at 11:00am REMINDER: All questions before the mandatory pre-bid meeting must be directed only to Rosanne Griff-Cabelli and must be via email to: rosanne.griff-cabelli@state.de.us no later than July 21, 2009 at 4:30 pm. All responses will be posted on the DHSS website as an amendment to this RFP. The entities must enter into a memorandum of understanding with the business associate that contains terms that accomplish the objectives of paragraph (a) (2)(i) of section §164.314 or if other law contains requirements applicable to the business associate that accomplish the objectives of paragraph (a)(2)(i) of section §164.314 Specialty Standards: Clinical Nurse Specialist, School Nurse, Pediatric Nurse Practitioner, Family Nurse Practitioner, Maternal/Child Clinical Specialist, Neonatal Nurse Practitioner, and other clinical specialties pertinent to the need of the facility. Alternative Licensure as: Teacher of the Visually Impaired, Teacher of the Hearing Impaired, Educational Interpreter/Tutor for Hearing Impaired, Early Childhood Education/Child Care. MATRIX SOURCE: Standards for the Early Intervention Services Delivery System as Provided by Child Development Watch, November 2003. NOTE: Not all personnel listed in the Matrix are included in this RFP for Early Intervention Services for DHSS. Page 25 of 61 Page 1 of 61