RFP, RFV, & OPPs

ATTACHMENT A - HCBS PROPOSAL TITLE PAGE FY 24 25 ATTACHMENT B - STATEMENT OF OBLIGATION ATTACHMENT C - DS 1891 Medicaid Integrity Form

Attachment A - Winter 2025 OPP Proposal Title Page Attachment B - Statement of Obligation Attachment C - Statement of Equity and Diversity Attachment D -Service Code Listing Attachment E - Business Plan Outline Attachment F- NLACRC Cost Statement

Appendix 1 - CPP Housing Guidelines (FY 2017-18) Appendix 1A - Amendments to FY 2017-18 CPP Housing Guidelines Appendix 2 - NLACRC Catchment Area Appendix 3 - Sample CPP-CRDP Housing Agreement Appendix 4 - NLACRC Board of Trustees Service Provider Insurance Policy Appendix 5 - NLACRC Board of Trustees Request for Proposals Policy Attachment A - Proposal Title Page Attachment B - Proposal Requirements Attachment C - HDO Conflict of Interest Statement

Attachment-A-Proposal-Title-Page-NLACRC-2425-9-fillable Attachment B - DS 1891 Applicant Vendor Disclosure Statement Attachment C - Statement of Obligation Attachment D Start Up Budget Guidelines Appendix1 - Sample Service Development Agreement Appendix 2 - NLACRC Board of Trustees Request for Proposals Policy - Copy

Appendix 1 - Program Design Requirements NLACRC-2425-11 Appendix 2 - Sample Service Development Agreement NLACRC-2425-11 Appendix 3 - NLACRC Board of Trustees Service Provider Insurance Policy Appendix 4 - NLACRC Board of Trustees Request for Proposals Policy Appendix 5 - Statutes and Regulations NLACRC-2425-11 Appendix 6 - Substance Use Disorder Treatment Services Rates Attachment A - Proposal Title Page Attachment B - DS 1891 Applicant Vendor Disclosure Statement Attachment C - Statement of Obligation Attachment-D-Budget-for-Start-Up-Costs Attachment E- Cost Statement - Ongoing (NLACRC-2425-11)

Appendix 1 - Program Design Requirements Appendix 2 - Sample Service Development Agreement Appendix 3 - NLACRC Board of Trustees Service Provider Insurance Policy Appendix 4 - NLACRC Board of Trustees Request for Proposals Policy Appendix 5 - Statutes and Regulations Appendix-6-Behavioral-Day-Services-Rates-rev Attachment A - Proposal Attachment B - DS 1891 Applicant Vendor Disclosure Statement Attachment C - Statement of Obligation Attachment-D-Budget-for-Start-Up-Costs Attachment E- Cost Statement - Ongoing (NLACRC-2425-10)

Appendix-1-Program-Design-Requirements-NLACRC-2425-7-rev-1 Appendix 2 - Sample Service Development Agreement FY 24-25 Appendix 3 - NLACRC Board of Trustees Service Provider Insurance Policy Appendix 4 - NLACRC Board of Trustees Request for Proposals Policy Appendix 5 - Statutes and Regulations Appendix 6 - Median Rates for Specialized Residential Facilities Attachment A - Proposal Title Page (NLACRC-2425-12) Attachment B - DS 1891 Applicant Vendor Disclosure Statement Attachment C - Statement of Obligation Attachment-D-Budget-for-Start-Up-Costs-rev-2 Attachment E- Cost Statement - Ongoing (NLACRC-2425-12)

Appendix-1-Program-Design-Requirements-NLACRC-2425-7-rev Appendix 2 - Sample Service Development Agreement FY 24-25 Appendix 3 - NLACRC Board of Trustees Service Provider Insurance Policy Appendix 4 - NLACRC Board of Trustees Request for Proposals Policy Appendix 5 - Statutes and Regulations Appendix 6 - Median Rates for Specialized Residential Facilities Attachment A - Proposal Title Page (NLACRC-2425-7) Attachment B - DS 1891 Applicant Vendor Disclosure Statement Attachment C - Statement of Obligation Attachment-D-Budget-for-Start-Up-Costs-rev Attachment E- Cost Statement - Ongoing (NLACRC-2425-7)

Attachment A - Proposal Title Page Attachment B - DS 1891 Applicant Vendor Disclosure Statement Attachment C - Statement of Obligation Attachment D Budget for Start Up Costs Attachment E - ARFPSHN Variable Cost Statement Appendix 1 - Program Design Requirements Appendix 2 - Sample Service Development Agreement (need from SM) Appendix 3 - NLACRC Board of Trustees Service Provider Insurance Policy Appendix 4 - NLACRC Board of Trustees Request for Proposals Policy Appendix 5 - Statutes and Regulations (NLACRC-2425-4)

Appendix 1 - Program Design Requirements Appendix 2 - Sample Service Development Agreement FY 24-25 Appendix 3 - NLACRC Board of Trustees Service Provider Insurance Policy Appendix 4 - NLACRC Board of Trustees Request for Proposals Policy Appendix 5 - Statutes and Regulations (NLACRC-2324-2 and 2324-3) Attachment A - Proposal Title Page (NLACRC-2425-2 and 2425-3) Attachment B - DS 1891 Applicant Vendor Disclosure Statement Attachment C - Statement of Obligation Attachment D - Budget for Start-Up Costs Attachment E - Facility Cost Statement - DS 6023

Appendix 1 - Program Design Requirements Appendix 2 - Sample Service Development Agreement FY 24-25 Appendix 3 - NLACRC Board of Trustees Service Provider Insurance Policy Appendix 4 - NLACRC Board of Trustees Request for Proposals Policy Appendix 5 - Statutes and Regulations (NLACRC-2425-1) Appendix 6 - Pool Safety Regulations (NLACRC-2425-1) Attachment A - Proposal Title Page Attachment B - DS 1891 Applicant Vendor Disclosure Statement Attachment C - Statement of Obligation Attachment D - Budget for Start-Up Costs Attachment E - Facility Cost Statement - DS 6023

Project 1- Socialization Training Program (028) Project 2- Social Recreational Programs (525) Project 3- Specialized Recreational Therapy (106) Project 4- Art Therapist (691) Project 5- Dance Therapist (692) Project 6- Music Therapist (693) Project 7- Recreation Therapist (694) Project 8- Camping Services (850) Project 9- Sports Club (008) Attachment A: Title Page Attachment B: Statement of Obligation Attachment C: Statement of Equity and Diversity Guide

SDP Standardized Vendorization Packet for Pre-Enrollment Services Person Centered Planning and Self-Directed Supports Guidance Attachment A: Vendor Packet Checklist Attachment B: General Self-Directed Supports Qualifications and Agreement Form Attachment C: Financial Management Services Self-Directed Supports Qualifications and Agreement Form Attachment D: DS 1890 Vendor Application Attachment E: DS 1891 Applicant/Vendor Disclosure Statement Attachment F: Conflict of Interest Form Attachment G: Business Associate Agreement/HIPAA Form Attachment H: Home and Community Based Services Provider Agreement Form Attachment I: W9 Request for Taxpayer Identification Number and Certification

Attachment A: Proposal Title Page Attachment B: Statement of Obligation Attachment C: Statement of Equity and Diversity Attachment D: Cost Statement Attachment E: Proposal Writing Requirements Attachment F: DDS Directive Attachment G: Business Plan Attachment H: CFS Service Code Attachment I: CFS Fact Sheet Attachment J: CFS Referral and Service Need form Attachment K: CFS Provider Quarterly Reporting Tool

Attachment A: Proposal Title Page Attachment B: Statement of Obligation Attachment C: Business Plan Attachment D: Statement of Equity and Diversity Attachment E: NLACRC Cost Statement

Attachment A: Proposal Title Page Attachment B: Statement of Obligation Enclosure C: CCP Referral and Service Need Evaluation Form Attachment F: CCP Program Design Guidance Enclosure A: CCP Service Code Description Enclosure B: Person Centered Career Plan Service Provider Fact Sheet Enclosure C: CCP Referral and Service Need Evaluation Form Enclosure D: CCP Fact Sheet for Potential Service Providers Enclosure E: CCP Fact Sheet for Individuals and Families

Attachment A: Proposal Title Page Attachment B: Statement of Obligation Attachment C: Proposal Writing Requirements Attachment D: Program Design Requirements Attachment E: DS1890 Attachment F: DS1891 Attachment G: HCBS Provider Agreement Attachment H: Sample Transportation Contract Attachment I: NLACRC Board of Trustees Service Provider Insurance Policy Attachment J: Cost Statement Attachment K: Statutes and Regulations Attachment L: W-9