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					                                “Meeting community needs…one person at a time”



                                REQUEST FOR PROPOSALS

              Multidisciplinary Evaluations and Forensic Evaluations

Important Dates:
RFP Issue                                               February 2, 2011
Bidders Meeting                                         February 23, 2011 at 1:00PM
Final Deadline for Receipt of Proposals                 March 9, 2011
Award Notification                                      March 15, 2011
Anticipated Program Commencement                        July 1, 2011 or sooner (to be determined with
                                                        successful bidder)



I.       OVERVIEW

Smoky Mountain Center (SMC) is issuing this Request for Proposals (RFP) for one comprehensive
provider, preferably a Critical Access Behavioral Health Agency (CABHA), to render Multidisciplinary
Evaluations (MDE) and Forensic Evaluations (FE) for individuals who are residents of SMC’s Southern
Region which is comprised of the following counties: Cherokee, Clay, Graham, Haywood, Jackson, Macon,
and Swain.


II.      SCOPE OF WORK

A.       Purpose

Multidisciplinary Evaluations are conducted to determine the need for guardianship of an individual. A
multidisciplinary evaluation may be requested by the clerk of court, respondent, counsel or guardian to
determine issues of competency and guardianship. Minimally, a multidisciplinary evaluation team must
contain a physician, psychologist (PhD, PsyD, LPA, HSP-PA), and social worker (LCSW, LCSW-P).
However, professionals from other disciplines may participate in the evaluation at the request of the
multidisciplinary evaluation team, clerk, or respondent. The evaluation addresses the nature of the
disability.
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Per N.C.G.S. 35A-1111(b), if a multidisciplinary evaluation is ordered, the clerk shall name a designated
agency and order it to prepare, cause to be prepared or assemble a current multidisciplinary evaluation of the
respondent. Any order requesting a multidisciplinary evaluation will be sent to SMC’s Administrative
Office and SMC Service Management staff will contact the contracted Provider to advise of receipt of order
and fax or email a copy of the order for screening within 24 hours of receipt. The agency shall file the
evaluation with the clerk no later than 30 days after the agency receives the clerk's order. Unless otherwise
ordered by the clerk, the agency shall send copies of the evaluation to the petitioner and the counsel or
guardian ad litem for the respondent not later than 30 days after the agency receives the clerk's order. A
copy of the multidisciplinary evaluation must also be submitted to the LME for payment.


Forensic Evaluations are conducted to determine an individual’s capacity to participate in court
proceedings. Forensic Screenings are to be performed by a licensed or provisionally licensed clinician. A
Forensic Screening must be ordered by a Judge. A Forensic Screening will be completed for individuals
within SMC’s Southern Region catchment upon receipt of an executed Motion and Order Appointing Local
Certified Forensic Examiner. Any order requesting a Forensic Screener will be sent to SMC’s
Administrative Office and SMC Service Management staff will contact the contracted Provider to advise of
receipt of order and fax or email a copy of the order for screening within 24 hours of receipt. A Forensic
Screening must be completed and submitted to the court within seven (7) calendar days upon receipt of
order. A copy of the forensic evaluation must also be submitted to the LME for payment.


B.       Services to be provided

I.       MULTIDISCIPLINARY EVALUATIONS

The guidelines, described in Appendix A, are for a two-part multidisciplinary evaluation.
   a) The first part shall consist of separate evaluations by the physician, psychologist, and social worker.
       These evaluations reflect the expertise of the discipline. Hence, the physician would determine the
       client's physical and neurological status. Intellectual functioning, adaptive behavior, and emotional
       status shall be assessed by the psychologist. The social worker shall focus on environmental
       conditions, social relations, and community resources.
   b) The second part of the evaluation procedure would consist of a conference, preferably in person, but
       if necessary by telephone, among the three evaluators. Based upon the findings of the discipline
       evaluations, the conference participants as a group shall identify areas of competence and
       incompetence, as well as develop recommendations for general or limited guardianship. A summary
       of the conference recommendations shall be written by one of the three participants. This summary
       as well as the reports of the three discipline evaluations shall be forwarded to the clerk, petitioner,
       and respondent.

The guidelines for the discipline evaluations and for the multidiscipline conference are described in
Appendix A.




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II.      FORENSIC EVALUATIONS

A Forensic Evaluation shall include the following elements:
      A. Structured interview as defined by Certified Forensic Screener Training Manual, Revised 2003
          by David Hattem, PhD, or other NC Division of MH/DD/SAS qualified trainer, that covers the
          following areas:
              1. Factual understanding of legal system;
              2. Appreciation of own legal situation;
              3. Ability to work rationally with a lawyer.
      B. A typewritten cover letter to the Clerk of Superior Court that includes or meets the following
          requirements:
              1. Typed on agency letterhead;
              2. Addressed to Clerk of Superior or District Court from order;
              3. Defendant name and court record number(s) from order;
              4. Evaluation date and location in response to order;
              5. Date order was signed;
              6. Date order was received;
              7. Opinion of the Forensic Screener;
              8. Signature line;
              9. Typed name of Forensic Screener with “Certified Forensic Screener” typed underneath
                  name.
      C. A typewritten letter to the Judge who initiated the order that includes or meets the following
          requirements:
              1. Typed on agency letterhead;
              2. Addressed to Judge identified on order;
              3. Defendant name and court record number(s) from order;
              4. Evaluation date and location in response to order;
              5. Date order was signed;
              6. Date order was received;
              7. List the sources of information relied on for screener’s opinion;
              8. State that the defendant agreed to be evaluated after being advised report will be shared
                  with the court;
              9. Opinion of the credibility the defendant’s self-report;
              10. Summary of information related to individual’s mental health including diagnosis and
                  service needs;
              11. Responses to capacity questions;
              12. Opinion regarding whether the defendant is capable to proceed, not capable to proceed or
                  the screener is unable to determine whether the defendant is capable to proceed;
              13. Recommendations;
              14. Signature line;
              15. Typed name of Forensic Screener with “Certified Forensic Screener” typed underneath
                  name.

Screener Responsibilities:
   1.     The screener will document all attempts to contact the defendant in the defendant’s record.
   2.     If the defendant cannot be reached, the screener will notify the Clerk of Courts and Judge in
          writing of the efforts made to comply with the order including the dates and number of attempts
          made to contact and schedule the defendant.
   3.     If the defendant is in a local jail, the screener will see and assess the consumer in jail.

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      4.      Any defendant receiving a Forensic Screening shall receive admission paperwork and be
              registered in SMC’s system. The screener shall contact SMC’s Access Center at 1-800-849-
              6127 to complete the Screening, Triage, and Referral (STR) and Registration.


C.         Provider Requirements

The successful bidder:

           1. Will be required to comply with all state and federal requirements around the provision and
              reporting of Multidisciplinary Evaluations and Forensic Evaluations;
           2. Will attend, at their own expense, the required Forensic Screening training prior to July 1, 2011;
           3. Will serve any individual named by court order within SMC’s Southern Region catchment; and
           4. Will meet, at a minimum, the following utilization expectations, based on FY09-10 data:
                 a. 51 multidisciplinary evaluations
                 b. 21 forensic evaluations



III. SERVICE AREA

Smoky Mountain Center (SMC) is a Local Management Entity (LME) with a population of approximately
519,000 persons that currently serves fifteen of the westernmost counties in the state (Alexander, Alleghany,
Ashe, Avery, Caldwell, Cherokee, Clay, Graham, Haywood, Jackson, Macon, McDowell, Swain, Watauga,
and Wilkes counties). This RFP is to serve consumers who reside in one of the following SMC counties:
Cherokee, Clay, Graham, Haywood, Jackson, Macon, and Swain.


IV.        FINANCIAL

      A. Multidisciplinary Evaluations will be paid at the rate of $150.00 per hour per section, up to a
         maximum of $600.00 per section.
      B. Forensic Evaluations will be paid at the rate of $100.00 per screening.
      C. SMC will fund all evaluations referred by the LME to the contracted Provider, regardless of whether
         SMC receives reimbursement from the state for these services.
      D. Any bidder that is not a CABHA must submit their most recent financial statement and evidence of
         how long the provider has been in business.


V.         RFP NOTICE

The RFP is being posted on the SMC website: www.smokymountaincenter.com.




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VI.      BIDDER REQUIREMENTS

Any proposal not in full compliance with these requirements may be rejected without additional
cause.

      1. Each bidder must meet all time and content requirements of the RFP in order to be considered an
         acceptable candidate.

      2. The bidder is responsible for understanding and complying with all details and requirements of the
         RFP.

      3. Each bidder must be willing to enter into a State Contract and comply with all State reporting and
         documentation requirements in order to receive payment for consumers referred to the program.

      4. Each bidder must submit the proposal, and all attachments, electronically within the required
         submission timelines.

      5. Proposals must specifically address each of the following components:

         a)        Description of how required timelines will be met for multidisciplinary evaluations (MDE)
                   and forensic evaluations (FE).

         b)        Description of staffing pattern to meet staffing requirements of MDEs and FEs, including
                   each evaluator’s name, licensure/credential(s), and brief summary of each evaluator’s
                   experience providing MDEs and/or FEs, if applicable, as well as evaluators’ flexibility in
                   meeting with an individual in jail (FE) or home (MDE), if needed. If staff have not been
                   identified, thoroughly describe process for identifying and selecting qualified staff.
                   Description shall include how provider will meet, at a minimum, the following utilization
                   expectations, based on FY09-10 data:
                         i.      51 multidisciplinary evaluations
                         ii.     21 forensic evaluations

         c)        Description of bidder’s approach to be able to provide a thoughtful, comprehensive
                   multidisciplinary evaluation that clearly and respectfully evaluates an individual’s capacity to
                   manage his or her life.

         d)        Any bidder that is not a CABHA must submit their most recent financial statement and
                   evidence of how long the provider has been in business.


Bidders must submit all required information electronically to:
Becki Woolf at becki@smokymountaincenter.com.




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VII.     BIDDERS MEETING

A Bidders Meeting will be held February 23, 2011 at 1:00PM at Smoky Mountain Center’s
Administrative Office (44 Bonnie Lane, Sylva, NC). This meeting is mandatory for all those interested
in submitting a proposal. The purpose is to create an interactive dialogue and technical assistance
opportunity between the prospective bidders and the LME. It is the intent of SMC to offer specific technical
assistance to the bidders to ensure that all questions regarding the RFP are answered adequately in order to
enhance the applicant’s responses to the RFP. While questions will be permitted at the Bidders Meeting,
bidders are encouraged to submit written questions prior to the Bidders Meeting to Becki Woolf at
becki@smokymountaincenter.com. All questions and answers will be provided in writing by email
following the Bidders Meeting to those providers who attend the Bidders Meeting. No questions will be
answered prior to or following the Bidders Meeting. If you plan to attend the Bidders Meeting, RSVP to
Becki Woolf at becki@smokymountaincenter.com.



VIII. EVALUATION AND AWARD OF PROPOSALS

A review panel, consisting of SMC staff and a member of SMC’s Consumer and Family Advisory Council
(CFAC), will review all proposals that meet all of the specification and deadlines described in this RFP.
The committee will evaluate and make a recommendation based on the following:

    1. Bidder must meet all requirements and deadlines of the RFP.

    2. Proposals’ required components will be scored in the following manner:

         a)        Description of how required timelines will be met for multidisciplinary evaluations (MDE)
                   and forensic evaluations (FE).                                                    (25 points)

         b)        Description of staffing pattern to meet requirements of MDEs and FEs, including each
                   evaluator’s name, licensure/credential(s), and brief summary of evaluator’s experience
                   providing MDEs and/or FEs, if applicable, as well as evaluators’ flexibility in meeting with
                   an individual in jail (FE) or home (MDE), if needed. If staff have not been identified,
                   describe process for identifying and selecting qualified staff. Description shall include how
                   provider will meet, at a minimum, the following utilization expectations, based on FY09-10
                   data:
                         i.     51 multidisciplinary evaluations
                         ii.    21 forensic evaluations                                                 (50 points)

         c)        Description of bidder’s approach to be able to provide a thoughtful, comprehensive
                   multidisciplinary evaluation that clearly and respectfully evaluates an individual’s capacity to
                   manage his or her life.                                                              (25 points)

         d)        Any bidder that is not a CABHA must submit their most recent financial statement and
                   evidence of how long the provider has been in business to demonstrate financial viability in
                   providing these services.




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IX.      NOTIFICATION

SMC will notify all bidders by email and/or phone no later than three business days following the award
date.


X.       REQUIRED PROVIDER INFORMATION

      Provider Agency Name:

      Contact Person Name:

      Phone:

      Email Address:

      Mailing address:

      Signature:                                                          Date:




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APPENDIX A - MULTIDISCIPLINARY EVALUATION GUIDELINES


                                    MEDICAL EVALUATION GUIDELINES

                   Name, Date of Birth, Date of Evaluation

         1.        History

                   Character of deficit (mental illness, mental retardation, cerebral palsy, epilepsy, autism,
                   inebriety, senility, disease injury):

                   Etiology (if known or presumed)

                   Contributory medical family history:

                   Present medical status (degree of disability, other relevant data):

                   Chronic medical problems other than above:

                   Previous hospitalizations for significant medical problems and/or operations (include hospital
                   and dates):

                   Previous hospitalizations for treatment of mental illness (include hospital and dates):

                   Hearing (by history): Vision (by history):

                   Medications taken regularly or frequently (give dosage):

                   Current physician(s) or involved health agencies, with frequency of contact:

                   Evidence of alcoholism or drug abuse:

                   Other relevant information:

         2.        Examination

                   General appearance (note unusual findings):

                   Height: Weight: Pulse: B. P.

                   Skin Hair:

                   Head (include circumference, if contributory):

                   Eyes: Funduscopy:

                   Ears (include gross hearing to voice and whisper):

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                   Nose, mouth, and oropharynx:

                   Teeth: Neck (include thyroid):

                   Heart (and peripheral circulation when appropriate):

                   Chest and lungs:

                   Abdomen: Genitalia (also R/O Herniae):

                   Spine, hips, and extremities (include symmetry):

                   Rectal (if appropriate): Other:

         Neurological:

                   Cranial nerves (extraocular movements, nystagmus, pupillary responses, smile, gritting teeth,
                   gag, shoulder shrug):

                   Motor strength, tone and coordination (spasticity, athetoid movements, tremor, fine motor
                   functioning, etc.; include finger-to-nose, hand squeeze, rapid thumb to consecutive finger
                   approximation, gait):

                   Sensory (Romberg; touch, pin and vibration when indicated):

                   DTR's (symmetry and intensity): Plantar responses:

                   Gross vision (letter or symbol chart)

                                Without glasses: R L

                                With glasses, if worn: R L

                   Unusual behaviors:

                   Pertinent laboratory test results (CBC, urinalysis, possibly others):

         3.        Impression

                   Summary of abnormal findings and medical impression:

                   Assessment of mental competency (with reasons for this assessment):

                   Estimate of medical prognosis, when possible and appropriate (i.e., is the deficit one which is
                   apt to result in a change in the level of competency with time?):

         Examiner:                            Address:



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                                PSYCHOLOGICAL EVALUATION GUIDELINES

         I.        Intellectual Assessment - This shall be done with a standard evaluation instrument
                   appropriate to the individual’s level of functioning.



         II.       Behavioral Assessment - A standard evaluation instrument shall also be used for this
                   assessment. Assess adaptive and maladaptive behaviors. Domains include communication,
                   socialization, and daily living skills.

                   It is expected in cases where the petitioner is also a current care provider that the
                   psychologist will conduct an independent assessment of the individual’s adaptive level of
                   functioning in addition to receiving information from the care provider.



         III.      General Interview - In addition to the formal assessments, the psychologist should conduct
                   a personal interview, lasting from 20-40 minutes. The following general areas should be
                   assessed during the interview:

                   A. Ability to relate, to answer direct questions and to respond to the interviewer.

                   B. Activity level, distractibility.

                   C. General coordination, posture and balance.

                   D. Orientation to other persons, time and place.

                   E. Speech and language.

                   F. Thought processes organized or not, rigid or flexible, perseveration?

                   G. Affect and mood.

                   H. Self-concept.

                   I. Strengths and coping strategies.

                   J. Friends and other support systems.

                   K. Leisure interests and activities.




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                                      SOCIAL WORK EVALUATION GUIDELINES

         The social work evaluation addresses the social and environmental aspects of the individual's life.
         The evaluation report provides a description and assessment of living arrangements, interpersonal
         relationships, community resources, and potential guardians. A comprehensive evaluation
         necessitates an observation of the individual in his usual environment, that is, place of employment
         and/or residence. In addition, it may be essential to interview, in person or by telephone, significant
         persons in the individual's social network such as parents, relative, friends, supervisors, potential
         guardians, and staff members of various agencies. Guidelines for the social work evaluations are
         below.

         I.        Environmental Aspects

         A. Residence

                   1.           Current Residence - (i.e., location; type; supervision; household members, length of
                                residence; household responsibilities; appropriateness of physical facilities and
                                supervision; adjustment to environment).

                   2.           Previous Residences - if less than 1 year in current residence (i.e., brief history; see
                                item above).

         B. Employment

                   1.           Current Employment - (i.e., location, employer, supervision; supervisor; job
                                responsibilities; salary; work behavior; length of employment; appropriateness of job;
                                facility and supervision).

                   2.           Previous Employment - (i.e., brief history, see item above).

         C. Training and Education

                   1.           Current Training and Education - (i.e., program, location, supervisor or teacher; skills
                                developed; behavior; achievements; length of program; appropriateness of training
                                program).

                   2.           Previous Training and Education - (i.e., brief history; see item above).

         D. Transportation

                   1.           Current Transportation - (i.e., primary means of transportation, frequency, limitations,
                                needs, appropriateness of transportation means).

                   2.           Previous Transportation - (i.e., brief history; see item above).




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         II.       Financial Aspects

         A. Current Finances - (i.e., sources and amount of income, expenses, debts, major assets; personal
         money management; supervised money management, bank and credit utilization, insurance
         utilization).

         B. Previous Finances - (i.e., brief history; see item above).

         C. Other - (i.e., pertinent information-related living arrangements and environmental situation).

         III.      Social Aspects

         A. Immediate Family - (i.e., parents, spouse, children-names; residence; frequency of contact: type
         of interaction; supervision; appropriateness of activities).

         B. Extended Family - (i.e., siblings; cousins; see item above).

         C. Friends - (see item III-A).

         D. Group Activities - (i.e., clubs, church groups, teams-type of activity; frequency; skills,
         participants; types of interaction; supervision; appropriateness of activities).

         E. Avocational Interests - (i.e., hobbies, personal interests; see item above).

         F. Other - (i.e., pertinent information concerning interpersonal relationships and social context).

         IV.       Community Aspects

         A. Health - (i.e., physicians, dentist, health care agencies-name of personnel and agencies; services
         provided; availability of services; frequency of contact; utilization of service; appropriateness of
         service and of utilization).

         B. Economic - (i.e., Dept. of Social Services; see item above).

         C. Vocational/Education - (i.e., Vocational Rehabilitation, School System; see item IV-A).

         D. Mental Health - (i.e., Mental Health Services; see item IV-A).

         E. Legal - (i.e., attorney, courts, probation or parole officer; see item IV-A).

         F. Other - (i.e., pertinent information related to community resources and interaction).

         V.       Potential Guardian - (i.e., name; relation; frequency of contact; history of contact; interest;
         abilities; limitations; concerns).




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         VI.       Summary of Impression

         A. Summary and Impression concerning environmental, social and community assessment (i.e.,
         living arrangements, interpersonal relationships, community interaction; specific strengths and
         limitations; availability of environmental, social and community resources; ability and limitations
         concerning utilization of resources).

         B. Summary and Impression concerning potential guardian.




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                        MULTIDISCIPLINARY EVALUATION CONFERENCE GUIDELINES

         Following the discipline evaluations, the three evaluators shall conference to discuss the issues of
         disability, competency and guardianship. A report of the multidiscipline conference shall be written
         by one of the participants and forwarded to the clerk, respondent and petitioner. This report shall
         present the final impressions and recommendations of the multidisciplinary evaluation team
         concerning competency and guardianship. It is essential that the report contain references to specific
         evaluation findings and information which influenced the impressions and recommendations.

         Guidelines for the multidisciplinary evaluation conference and report are below.

         I. Competency - Describe the competency of the individual, including specific areas of competency
         (i.e., individual can decide and/or perform autonomously) and incompetency (i.e., individual cannot
         decide and/or perform autonomously). For areas of incompetency, describe the extent to which the
         client can decide and/or perform and the amount of assistance needed. Description of areas of
         competency and incompetency should address the following categories: (1) self-care (2) residence
         (3) employment (4) financial management (5) medical and health care (6) mental health and social
         services (7) education and training (8) legal assistance.

         II. Guardianship - Describe appropriate guardianship-either complete, person, estate or limited. If
         limited guardianship, describe specific power and limits of guardian in each specific category
         identified in item II. Describe specific duties of the guardian and specific issues to be reviewed in
         six months. Describe impressions of potential guardians.

         These guidelines have been adapted from NC DHHS Manuals, Chapter VIII: Guardianship,
         Appendix G: Social Work Guidelines for Multidisciplinary Evaluations.




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