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Pre-Admission Screening Resident Review (PASRR) Level II Evaluations
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SOLICITATION # DHS90961
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RSFQ EVALUATION SCORESHEET
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Vendor:
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Evaluator:Date:
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Minimum Mandatory Requirements (MMRs)Evaluation (Pass/Fail)
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1Documentation verifying each of the Offeror's staff who are to perform the required services are licensed as a mental health professional under the Utah Division of Occupational and Professional Licensing (DOPL) Mental Health Professional Practice Act.
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2Professional vitaes for each of the Offeror's staff who are to perform the required services establishing a minimum of two years’ experience working with hospitals, NFs, and local mental health authorities providing mental health treatment, geriatric care, and/or medical care:
a. Using Diagnostic and Statistical Manual (DSM) diagnostic criteria and ICD 10;
b. Recommending mental health services provided in a NF (Specialized Services); and
c. Identifying if the need for inpatient hospitalization or crisis assessment is needed.
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3If applicable, a request from the Offeror for an exception to MMR paragraph 1. may be submitted if there are no licensed mental health professionals who can perform the required services in a rural area, which may be in any county in Utah except Davis, Morgan, Salt Lake, Utah and Weber.
At the discretion of DHS, an exception may be approved with documentation establishing that each individual who can perform the required services meets the experience requirements in MMR paragraph 2., a.-c. above, and is:
a. A certified mental health professional under the Utah Division of Occupational and Professional Licensing (DOPL) Mental Health Professional Practice Act;
b. Working towards licensure; and
c. Working under the direct supervision of a licensed mental health professional.
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Score will be assigned as follows:
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0 = The proposal fails to address the requirements or criteria described in the RFP or cannot be assessed due to missing information.
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1 = Poor, the proposal inadequately addresses the requirements or criteria described in the RFP or cannot be assessed due to incomplete information.
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2 = Unsatisfactory, the proposal addresses the requirements or criteria in the RFP in an unsatisfactory manner.
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3 = Satisfactory, the proposal addresses all of the requirements or criteria described in the RFP in a minimum satisfactory manner.
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4 = Good, the proposal addresses all requirements or criteria described in the RFP and, in some respects, exceeds them.
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5 = Excellent, the proposal addresses and exceeds all of the requirements or criteria described in the RFP.
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Scoreable Technical CriteriaEvaluator Score (0-5)Criteria Weight% of Tech CriteriaPoints PossiblePoints
Earned
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1Sample evaluations. The sample shall be for a Level II SMI evaluation. If the sample is not SMI then they fail this entire section. Evaluator shall enter a score of "1" or "2".111.1%5.00.0
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1aJustification that the individual meets the medical criteria for NF services.111.1%5.00.0
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1bIndividual’s prior history in meeting criteria to justify the SMI diagnosis.111.1%5.00.0
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1cDiagnostic criteria for diagnosis of SMI.111.1%5.00.0
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1dEthnic, language and cultural circumstances taken into consideration.111.1%5.00.0
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1eParticipation by the individual and family, or legal guardian when applicable.111.1%5.00.0
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1fA review of the individual’s current psychiatric, medical, functional and psychosocial status.111.1%5.00.0
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1gWas the evaluation of minimum quality and all required fields completed?111.1%5.00.0
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2Defined process for documenting and maintaining information111.1%5.00.0
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Totals:100.0%45.00.0
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Required Technical Point ThresholdMin PercentMin Points RequiredPoints EarnedPercent EarnedStatus
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60270.00%
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