Consultation, Research, Training

State of Maine Procurement Justification Form PJF Page 1 of 2 Rev. 3/3/2020 PART I: OVERVIEW Department Office/Division/Program: DHHS/OADS/DD/Consultation -Lori Harding Department Contract Administrator or Grant Coordinator: Nancy Tan/ Stacy Martin (If applicable) Department Reference #: ADS-21-9714 Amount: (Contract/Amendment/Grant) $47,464.00 Advantage CT #: 20210304000000002386 CONTRACT Proposed Start Date: 3/1/2021 Proposed End Date: 10/31/2021 AMENDMENT Original Start Date: Effective Date: Previous End Date: New End Date: GRANT Project Start Date: Grant Start Date: Project End Date: Grant End Date: Vendor/Provider/Grantee Name, City, State: Human Services Research Institute (HSRI) Cambridge, Massachusetts Brief Description of Goods/Services/Grant: Consultation, Research, Training PART II: JUSTIFICATION FOR VENDOR SELECTION Mark an “X” before the justification(s) that applies to this request. (Check all that apply.) A. Competitive Process G. Grant B. Amendment H. State

Statute/Agency Directed X C. Single Source/Unique Vendor I. Federal Agency Directed D. Proprietary/Copyright/Patents J. Willing and Qualified E. Emergency K. Client Choice F. University Cooperative Project L. Other Authorization PART III: SUPPLEMENTAL INFORMATION Please respond to ALL of the following: 1. Provide a more detailed description and explain the need for the goods, services or grant to supplement the response in Part I. The Department seeks to adopt a standardized needs assessment tool to determine eligibility for individuals eighteen (18) years and older with intellectual and developmental disabilities (IDD) or Autism Spectrum Disorder (ASD) to receive Home and Community Based Services (HCBS) from the Department. These services are Medicaid financed waiver services offered pursuant to MaineCare Benefits Manual Section 21 (serving individuals with ASD or IDD); Section 29 (serving individuals with ASD or IDD who live with their families or on their own); Section 18 (serving those with other related conditions); and Section 20 (serving those with brain injury). Consultation and research services are required to ensure that the Department selects an appropriate needs assessment tool that adequately addresses current Mainecare waiver services eligibility criteria. 4/22/2021Kathy Paquette 2021-04-22T06:29:35-0700 Digitally verifiable PDF exported from www.docusign.com