Procurement

Procurement

RFP Notice and RFP Document, Attachment1, Attachment2, Q&A, and Revisions RESPONSES DUE APRIL 13, 2017 at 3pm

 


THE GULF COAST CENTER – IDD Provider of Services

7000 Ave. B
Santa Fe, Texas 77510
(409) 944-4453 or (409) 944-4460 / (800) 615-4763 ext. 10358
Fax# (409) 927-4308
Attention: Deanna David, HCS/Contract Program Manager

Individual Provider

IDD CONTRACTED PROVIDER PACKET

Dear Potential Provider,

Please download the following documents and review the required information to be submitted.

GCC FORMS TO BE COMPLETED (signed/dated) AND RETURNED:

Additional Trainings may be required that are specific to the person to whom you are providing services; for example, High Blood Pressure, Diabetes, Tube Feeding, Transferring (Wheel Chair), etc.

REQUIRED DOCUMENTS TO BE SUBMITTED ANNUALLY OR AS THEY ARE RENEWED OR UPDATED :

  • Copy of Valid Auto Insurance (updated regularly)
  • Copy of Valid Driver’s License (to establish residence)
  • Copy of Social Security Card (required only at time contract is initiated)
  • Copy of High School Diploma, GED (required only at time contract is initiated)
  • Three Letters of Reference (only if no High School Diploma or GED)(required only at time contract is initiated)
  • Email/Home/Cell Phone numbers (updated regularly)
  • Copy of Homeowners/Renter’s Insurance Policy (if you provide respite in your home)
  • FY 2014 Home Insurance Waiver (if you provide services in your home and you do not have insurance)

PROVIDER POOL LIST

If you are applying to provide services to more than one person or to be listed as a provider in the provider pool, you must have the below trainings in addition to the above forms and documents;

INFORMATIONAL ITEMS

Recipient of Services/Family

***NOTE: if you are receiving more than one of the services listed, you will only need to complete each form denoted by *** ONLY ONE TIME (these forms DO NOT need to be completed separately for each service) If you are requesting Weekend Respite If you are requesting Contract respite If you are requesting Community Support If you are requesting Day Respite

(cannot be used in combination with any other service)

If you are requesting Day Habilitation
*** IDD Recipient of Services/Family Packets Respite and/or Community Supports-Serv Coordinator (rev 11/2014) *** X X X
*** IDD Recipient of Services/Family Packets Respite – Provider Services (rev 11/2014) *** X
Use this form if you do not have a service coordinator
X
Use this form if you do not have a service coordinator
X
Use this form if you do not have a service coordinator
*** IDD Recipient of Services – Cover Letter Day Hab Selection (rev 11/2014) *** X
*** IDD Individual Assessment (rev 11/2014) *** X X X X X
*** Respite Plan (rev 11/2014) *** X
Page 1 & 2 (if Serv.Coord) Page 1 & 3(if no Serv.Coord)
X
Page 1 & 2 (if Serv.Coord) Page 1 & 3(if no Serv.Coord)
X
Page 1 & 2 (if Serv.Coord) Page 1 & 3(if no Serv.Coord)
Authorization for Administration of Medication (rev 11/2013) X X
(if meds administered during day respite)
Consent for Treatment and Use of Over-the-Counter Meds checklist PRN (rev 9/2012) X
GCC Release & Waiver of Liability & Assumption of Risk Management rev 11/2011 X X
IDD Provider Services – OHR Services Program Policies (rev 11/2014) X
IDD Emergency Information Sheet (rev 2/2014) X X
All About Contract Respite (rev 10/2012) (family/providers) X
All About Community Support (rev 9/2012) family/providers) X
Verbal Consent Form X
Consent for Evaluation of Services X
Family Complaint Process rev. 2-2015 X
Acknowledgement of Receipt of Notice of Privacy 2-2015 X
Rights Acknowledgement Form X

INFORMATIONAL ITEMS

The Gulf Coast Center – IDD Provider of Services

7000 Ave. B
Santa Fe, Texas 77510
(409) 944-4460 / (800) 615-4763 ext. 19397
Fax# (409) 927-4308
Christine Bahr – Respite
Salvador Olivares – Day Hab
Odelia Benefield – Community Support

Agency Provider

The Gulf Coast Center – IDD Provider of Services

7000 Ave B
Santa Fe, TX 77510
(409) 944-4449 or (409) 944-4460 / (800) 615-4763 ext. 10088
Fax# (409) 927-4308
Attention: Barry Kusnerik/IDD Director of Provider Services

Agency staff working with GCC consumers must have following trainings:

Agency staff working with GCC consumers must have following documents:

REQUIRED DOCUMENTS TO BE SUBMITTED ANNUALLY OR AS THEY ARE RENEWED OR UPDATED:

  • Certificate of Liability – General Liability Insurance naming GCC as additional insured
  • Certificate of Liability – vehicle insurance
  • Annual safety inspection – completed by GCC safety officer
  • Annual Fire Marshall Inspection
  • Quarterly Fire Drills
  • Fire Alarm Inspection
  • Agency Emergency Procedures
  • Agency Admission/Discharge Procedures
  • HIV/Aids Workplace Guidelines
  • Historically Underutilized Business

INFORMATIONAL ITEMS

For More information, contact:

The Gulf Coast Center
Attn: Barry Kusnerik,
7000 Ave B
Santa Fe, TX 77510
(409) 944-4449
barryk@gulfcoastcenter.org

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