AIDS Foundation of Chicago
Request for Proposals (RFP)
The Ryan White HIV/AIDS Treatment Modernization Act
For Part B Services in Cook and the Collar Counties
(DuPage, Grundy, Kane, Kendall, Lake, McHenry and Will)
of Illinois
Key Dates
RFP Release Date: October 30, 2009 Bidders’ Teleconference: November 6, 2009 10 AM-11:30AM CST Intent to Apply Letter Due: November 13, 2009 Application Due: January 4, 2010 4 PM CST Contract Start Date: April 1, 2010 Contract End Date: March 31, 2011
CONTACT PERSON
All questions and proposals (1 original, 6 printed copies and 1 copy saved to a CD-Rom) must be addressed and delivered to
Alicia Bunton Director of Care and Quality Improvement AIDS Foundation of Chicago 200 West Jackson Blvd, Suite 2200 Chicago, Il, 60606 312-334-0958 [email protected] TABLE OF CONTENTS
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 1 I. Program Authority...... 3 II. Purpose...... 3 III. Background ...... 3 A. Overview of the Cook County and Collar Counties Service Area………………………...... 3 B. Key Program Changes ...... 4 IV. Eligibility Requirements for Applicants...... 4 V. Bidders Teleconference...... 4 VI. Available Funding ...... 5 VII. Eligible Part B Program Activities and Priorities ...... 5 A. Service Category Definitions and Allowable Activities...... 9 B. Funding Requirements and Priorities...... 20 VIII. Instructions for Completing an Application...... 22 A. Intent to Apply...... 23 B. Application Preparation Guidelines ...... 23 C. Application Checklist ……………………………………………………………………………………………….30 IX. Submission Guidelines...... 30 X. Evaluation of Applications...... 31 XI. Reporting and Other Requirements for Successful Applicants ...... 34 XII. Compliance with Laws, Statutes, Ordinances and Executive Orders ...... 34 Appendices A. Intent to Apply Form...... 36 B. Face Page...... 37 C. Program Work Plan…………...... 38 D. Program Budget Forms ...... 39 E. Service Category Budget Form...... 40 F. Application Checklist……….……………………………………………………………………………………….41
I. Program Authority
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 2 The Part B program is authorized by Title XXVI of the Public Health Service Act, as amended by the Ryan White HIV/AIDS Treatment Modernization Act of 2006 (RW).
II. Purpose These funds are used to develop or enhance access to a comprehensive continuum of high quality, state-of-the-art care for low-income persons living with HIV/AIDS (PLWHA). All services must be consistent with Health and Human Service (HHS) Treatment Guidelines, performance guidelines and all other applicable professional regulations and licensure requirements. See http://hab.hrsa.gov for the HHS performance measure guidelines.
III. Background This request for proposals (RFP) identifies eligible program activities, identifies priority program activities, provides guidance in developing and submitting an application, and informs applicants of key dates. All programmatic questions regarding this RFP (i.e., objectives, review criteria, work plan, budget components, etc.) and assistance with the application guidelines should be referred to Alicia Bunton, AIDS Foundation Chicago Telephone: 312-334-0958 Email: [email protected]
A. Overview of the Cook and Collar Counties Service Area
The Collar Counties and Cook County have 8,272, 768 residents and is home to 43.3% of Illinois residents. The county is divided into thirty different townships. Geographically, the area is the fifth largest in Illinois by land area and shares the state's coast line on Lake Michigan with Lake County. 2005 Census estimates placed the non-Hispanic white population of at 45.4% of the total population of the area. Other racial groups were African-Americans at 26.4%, Latinos at 22.2% and Asians at 5.5%.
HIV/AIDS is a serious health problem greatly affecting Cook County and its surrounding Collar Counties. According to the 2008 Illinois Department of Public Health Surveillance Report for December 2008; in the Collar Counties and Cook County there were a reported 1,728 individuals with HIV (Non-AIDS), and an additional 691 individuals with of AIDS. Likewise there are 14,795 individuals reported to be living with HIV and 14,871 reported to be living with AIDS in the defined Cook and Collar counties service area. Approximately 80% of PLWHA in the defined Cook and Collar county service area are male and 20% are female. More than half (53%) of PLWHA in the same area are non- Hispanic Black; 29% are non-Hispanic White; 16% are Hispanic; and 1% are non- Hispanic/Other. Overall, 52% of people living with HIV disease acquired infection through male-to-male sexual contact (MSM); 23% were a result of injection drug use (IDU); and 16% were acquired through heterosexual contact. Among males, 57% of those living with HIV disease acquired infection through MSM.
B. Key Program Changes
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 3 This section outlines some changes that affect the Chicago EMA’s RW Part B program. The legislation previously known as the Ryan White CARE Act was amended in 2006 and renamed the Ryan White HIV/AIDS Treatment Modernization Act of 2006 (RW). The RW legislation can be obtained at: http://hab.hrsa.gov/law.htm. RW made a number of changes regarding allowable service categories and their definitions.
IV. Eligibility Requirements for Applicants Funds are available to public and private not-for-profit organizations located within or providing services to residents of Cook, Du Page, Grundy, Kane, Kendall, Lake and Mc Henry County. Eligible recipients include hospitals, community-based organizations, hospices, ambulatory care facilities, community health centers, migrant health centers, homeless health centers, currently providing Part A, B, or C dental services.
Applicants must submit the Intent to Apply form (Appendix A) that includes all the information requested by Friday, November 13, 2009. The form may be submitted via e-mail, fax or US postal system mail to:
Alicia Bunton Director of Care and Quality Improvement AIDS Foundation of Chicago 200 West Jackson Blvd, Suite 2200 Chicago, Il, 60606 Phone 312-334-0958 Fax: 312-922-2916 Email: [email protected]
The Intent to Apply form is required, as this form is used to assist AFC in notifying potential applicants of any changes that may arise with the RFP, application submission requirements as well as the planning of the proposal review process.
V. Bidders’ Teleconference
One Bidders’ Teleconference has been scheduled for this RFP. The call will take place on Friday, November 6, 2009 at 10:00 AM-11:30AM CST. The purpose of the Bidders’ Teleconference is to provide an overview of this RFP, describe the application review process, and answer prospective applicants’ questions. Organizations planning to apply for funding are strongly encouraged to participate in the Bidders’ Conference. Participants are asked to join the call 10 minutes prior to the calls start time. To receive the presentation slides for this meeting you must RSVP with Alicia Bunton via email [email protected] by 12 noon on November 4, 2009. To join the teleconference please use the number provided below
Toll Free Number: 1-866-206-0240 Participant Pin #: 783468#
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 4 VI. Available Funding
Approximately $1,658,000.00 in RW Part B funds will be available through this RFP. Awards will begin on April 1, 2010. Contracts will be for a twelve (12) month period and all funds must be expended by March 31, 2011. Based upon performance, grants are renewable annually up to three (3) contract years. Available Service Category Funding At a Glance Cook County - $ 1,339,00 Collar Counties - $319,000 Ambulatory Care - $ 558,000 Ambulatory Care - $ 113,000 Food Bank/Home delivered meals - Emergency Financial Assistance - $ 3,000 $218,000 Food bank/Home delivered meals- $ 32,000 Housing - $ 117,000 Housing - $ 45,000 Legal - $ 62,000 Medical Nutrition Therapy - $ 24,000 Outpatient Mental Health - $ 266,000 Outpatient Mental Health - $ 39,000 Outpatient Substance Abuse – Oral Health - $ 10,000 $118,000 Outpatient Substance Abuse - $ 53,000
There are non-allowable activities in this grant application.
Funds may not be used to make cash payments to recipients of services. Funds may not be used to make payment for any item or service if payment has already been made or can reasonably expected to be made under any State compensation program, any insurance policy or any Federal or State health benefits program or by an entity that provides health services on a pre-paid basis (42USC 300ff-15(a)(6)). Funds may not be used to supplement third-party reimbursement. Funds may not be used to purchase or improve land or to purchase, construct or make permanent improvement to any building. Minor remodeling is not allowed under this RFP (42USC 300ff-14(g)).
All contracts will be paid on a reimbursement basis.
VII. Eligible Part B Program Activities and Priorities
A. General Service Category Service Guidelines, Service Category Definitions and Allowable Activities
Services rendered within Cook County and its Collar Counties are the only services that will be funded under this RFP. The State of Illinois Ryan White Part B Service Guidelines that each applicant agency must comply with are listed below.
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 5 GENERAL SUBCONTRACTOR SERVICE GUIDELINES
The following statements are general service guidelines that apply to all service categories:
The Ryan White program funds must be used as a last resort when other federal/state/local resources have been exhausted. Clients who are Medicaid beneficiaries must utilize Medicaid-certified providers for their medical care. Eligible clients may access services through subcontracted providers while they are in Medicaid spend-down status. Ryan White funds may not be used for co-payments of services covered by clients who have private insurance plans. Funds may still be used, however, for allowable services not covered by client insurance plans. Payment for services must be made directly to appropriate subcontracted providers. Services are a part of the coordinated continuum of HIV/AIDS care. Services should adhere to professional, clinical, and programmatic guidelines and regulations. Services are individualized and tailored to client needs. Services are offered in a safe and secure environment. Services are offered in such a way as to overcome barriers to access and utilization. Services are culturally sensitive and competent; service providers have received cultural competency training that incorporated race/ethnicity, as well as, cultural characteristics of individuals receiving these services. Services utilize effective management practices (in areas such as cost effectiveness, human resources, and quality improvement). Providers are knowledgeable, accepting, and respectful of the needs of individuals with HIV/AIDS. Providers must demonstrate their ability to work with underserved/hard-to-reach populations, including, but not limited to, youth/adolescents, injecting drug users and other substance users, men who have sex with men (MSM), people of color, women, and rural clients. Providers uphold consumer rights. Providers offer a comprehensive set of services on-site or by referral that address consumer and family needs. Providers must demonstrate their ability to coordinate services and cooperate with other agencies providing HIV/AIDS services. Subcontractor must comply with standards of their profession. Client confidentiality is maintained at all times and client files are kept in a locked file/room and/or a secured database. Grievance procedure must be available and understandable to clients. Provider’s facilities are compliant with federal Occupational Safety and Health
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 6 Administration, Centers for Disease Control and Prevention, Environmental Protection Agency, and Americans with Disabilities Act. Subcontractor must have liability and malpractice insurance, if applicable. Subcontractor must have a client confidentiality policy. Subcontractor must have a nondiscrimination policy in place. Subcontractor must have a client record storage and access policy. Computer files must be secure from unauthorized personnel. Subcontractor must have a client rights and responsibilities policy. Client satisfaction survey must be administered on an annual basis. Subcontractor must provide documentation of services provided, costs and monthly billing to the lead agency. Providers must maintain appropriate relationships with entities in the regional area that constitute key points of access to the health care system for individuals with HIV infection for the purpose of facilitating early intervention for those newly diagnosed with HIV disease and those who are knowledgeable of their status but not in care. Providers comply with the applicable provisions of the Health Insurance Portability and Accountability Act (HIPAA). All providers and subcontractors must collect and maintain unduplicated client- level data to be used by the lead agency and the grantee to create aggregate counts for the purpose of completing required data reports. Permit quality assurance evaluations to be scheduled during regular business hours at mutually agreed upon times and to be conducted in a manner that will provide minimal disruption in the provision of services, which includes facilitating the quality assurance process by assisting the lead agency in arranging record reviews, interviews with service recipients and sub grantee site visits. When applicable, the grantee shall make all reasonable efforts to pursue third- party payments for services subject to this agreement, including Medicaid, Medicare, and private insurance. Funds provided for services pursuant to this contract are restricted for clients infected with HIV who have no other means of payment available. If a client becomes eligible for Medicaid, the grantee and its sub grantees, when applicable, shall retroactively bill Medicaid for covered services provided with Ryan White Program funding during the time in which eligibility was being determined. At a minimum, grantee must be able to demonstrate that Part B primary care, supportive services, medical, dental and mental health are consistent with Public Health Service treatment guidelines for adults, adolescents, pediatrics, perinatal exposure, non-occupational exposure, primary medical care worker exposure, opportunistic infections and tuberculosis. Current treatment guidelines are available at
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 7 The State of Illinois imposes service cost maximums per client on funded Ryan White Part B services that AFC, the lead agent must monitor. The chart below details yearly client maximum expenditures for service categories funded in the request for proposals. Client maximum expenditures are based on Federal poverty thresholds.
Part B State of Illinois SERVICES, INCOME ELIGIBILITYAND YEARLY MAXIMUM EXPENDITURES Effective 04/23/09
Income Eligibility Based on Yearly Maximum Expenditure Individual Federal Poverty Service Per Client Levels (FPL) or Household Median Income (MI) Core Services Medical Case Management N/A None Medical Nutritional Therapy $1,000 400% (FPL) Mental Health Care $2,000 400% (FPL) Oral Health Care $3,000 400% (FPL) Outpatient/Ambulatory Health Services $4,000 400% (FPL) Substance Abuse Services-Outpatient $2,000 400% (FPL) Support Services Emergency Financial Assistance: Utility Assistance $2,000 Part B 50% MI (household) (max. 7 months year*) $2,000 HOPWA (max. 21 weeks or 5 months per year*) Food Bank/Home Delivered Meals N/A 200% (FPL) Housing Assistance: Emergency Rent $1,000 Part B only 50% MI (household) (max. 2 payments year*) Rental Assistance $2,000 Part B 50% MI (household) (max. 7 months per year*, 24 months lifetime total per household) $2,000 HOPWA (max. 21 weeks or 5 months per year*) Mortgage Assistance $2,000 HOPWA only 50% MI (household) (max. 21 weeks or 5 months per year*) Legal Assistance Only covers powers of attorney, do-not- $1,000 200% (FPL) resuscitate orders, or access to eligible benefits Psychosocial Support Services $500 400% (FPL)
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 8 All objectives should be quantified using the established Units of Service. These units are defined by service category on the following pages.
Category 1: Ambulatory/Outpatient Medical Care - Cook and Collar Counties Core Medical Service Estimated amount available: $671,000 Defined Unit of services: is defined as one (1) office visit with a medical provider, (1) lab visit and/or one (1) medical assessment for service provided.
Outpatient/Ambulatory Health Services
Definition: Outpatient/ambulatory health services are the provision of professional diagnostic and therapeutic services rendered by a physician, physician's assistant, clinical nurse specialist, or nurse practitioner in an outpatient setting. Settings include clinics, medical offices, and mobile vans where clients generally do not stay overnight. Emergency room services are not outpatient settings. Services includes diagnostic testing, early intervention and risk assessment, preventive care and screening, practitioner examination, medical history taking, diagnosis and treatment of common physical and mental conditions, prescribing and managing medication therapy, education and counseling on health issues, well-baby care, continuing care and management of chronic conditions, and referral to and provision of specialty care (includes all medical subspecialties). Primary medical care for the treatment of HIV infection includes the provision of care that is consistent with the Public Health Service’s guidelines. Such care must include access to antiretroviral and other drug therapies, including prophylaxis and treatment of opportunistic infections and combination antiretroviral therapies. The services includes treatment adherence counseling when provided in by medical personnel in a clinical, outpatient setting.
Outpatient/Ambulatory Health Services Guidelines
Subcontractor must have a current state license. Subcontractors who treat Medicaid beneficiaries must have a valid Medicaid provider certification number. Access to services is available irrespective of substance use, risk behavior, stage of illness and sexual orientation. Services must meet minimal established clinical standards of comprehensive medical care. Subcontractors provide care in a manner consistent with Public Health Services guidelines for primary medical care of HIV infection. Such care includes access to antiretrovirals and other drug therapies, including prophylaxis and treatment of
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 9 opportunistic infections and combination antiretroviral therapies. Subcontractor must screen clients for Hepatitis and provide vaccinations, or documentation that the client has previously received vaccinations. Care is integrated into a multi-disciplinary continuum, available on-site or by referral. Subcontractors must comply with standards of their practice. Subcontractor must promote enrollment in clinical trials. Service plans are appropriate to circumstances. Treatment environment is safe and secure. There is a reasonable wait for clinic/office appointments. There is adequate transportation to clinic/office appointments. Subcontractor’s facility uses equipment designed for infection control. Clients must have a complete treatment plan, tailored to his/her individual needs and containing a medical history as well as current conditions; the plan should be monitored appropriately and updated as needed. It also should include an appropriate recall/follow-up schedule. Emergency services are first priority for service delivery. Subcontractor has a referral resource listing of appropriate specialists. Services may include the provision of genotype testing, phenotype testing, Trofile assay, and HLA-B 5701, in accordance with Department policy and procedure. Services may include ophthalmological care; however, services shall not include prescriptions for eyewear necessitated for vision correction conditions not associated with HIV. Services shall not include the provision of pharmaceuticals. All outpatient/ambulatory health service providers shall have in place a written protocol for screening HIV infected clients for treatable STDs, including syphilis, gonorrhea, chlamydia, and trichomoniasis. HIV care medical providers shall report STDs using their established reporting procedures.
Category 2: Emergency Financial Assistance (EFA) - Collar Counties Only Non-Core Medical Service Estimated amount available is $3,000 Defined Unit of services: One (1) month’s emergency assistance payment or voucher provided and one (1) eligibility/assessment for service provided.
Emergency Financial Assistance Services
Definition: Emergency financial assistance is the provision of short-term payments to agencies or establishment of voucher programs to assist with emergency expenses related to essential utilities and housing when other resources are not available.
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 10 The use of funds for emergency financial assistance must be linked to a client’s ability to gain or maintain access to HIV-related medical care or treatment. Emergency Financial Assistance Services Guidelines
Utility assistance includes heating and cooling, water, and sewage. Funds may be used for installation fees and deposits, monthly assistance and outstanding bills for utility services that must be paid prior to initiation or continuation of services. Utility assistance excludes cable TV, internet, long distance telephone, and cellular telephones. Utility assistance checks must be mailed, in a timely manner, to utility companies for clients deemed eligible. Payments may not be made directly to the client.
Category 3: Food Bank/Home Delivered Meals - Cook and Collar Counties Non-Core Medical Service Estimated amount available is $250,000 Defined Unit of services: is defined as one meal for food pantry services, one meal for home delivered meals, one package for non-food items and one (1) eligibility/assessment for service provided.
Food Bank/Home-Delivered Meal Services
Definition: Food bank/home-delivered meals include the provision of actual food or meals. It does not include finances to purchase food or meals. The provision of essential household supplies such as hygiene items and household cleaning supplies should be included in this item. It includes vouchers to purchase food.
Food Bank/Home-Delivered Meal Services Guidelines
Services must be part of the coordinated continuum of HIV/AIDS services. Subcontractor must store, prepare, serve, and/or deliver/dispense food consistent with applicable food safety standards, where applicable. Where applicable, proper temperature is maintained at the point of delivery and during storage, based on food service standards. Food inventory is updated and rotated as appropriate on a first-in, first-out basis, and shelf life standards are observed. Facilities and equipment have capacity for proper food storage and handling. A procedure for rejecting/discarding unsafe foods exists, and food handlers are knowledgeable and trained, if appropriate. Subcontractor and vendors maintain proper licensure. Different levels and types of nutritional services are available and based on client economic need, functional ability, disease progression, age, and culture.
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 11 All services are menu driven based on HIV/AIDS nutritionally sound menu plans. (Donated food may play a role in menu planning, but does not drive it.) Documented menus, where appropriate, must reflect the nutritional needs of HIV/AIDS clients. Menu offerings include special diets and appropriate supplements that meet client nutritional needs. Nutrition services are based on factors such as client input, availability, and variety. Food vouchers may be provided, but need to specify “only for the purchase of foods.” Subcontractor must have in place ways to assess utilization of services (including return rate and discontinuation of services) for planning purposes.
Category 4: Housing - Cook and Collar Counties Non-Core Medical Service Estimated amount available is $162,000 Defined Unit of services: One (1) emergency assistance payment for utility or rental services and one (1) eligibility/assessment for service provided.
Housing Services
Definition: Housing services are the provision of short-term assistance to support emergency, temporary, or transitional housing to enable an individual or family to gain or maintain medical care. Housing-related referral services include assessment, search, placement, advocacy, and the fees associated with them. Eligible housing can include both housing that does not provide direct medical or supportive services and housing that provides some type of medical or supportive services such as residential mental health services, foster care, or assisted living residential services. The use of funds for short-term or emergency housing must be linked to a client’s ability to gain or maintain access to HIV-related medical care or treatment. The use of Ryan White funds for housing rent assistance is limited to a lifetime cap of 24 months per household effective March 27, 2008.
Rent/Mortgage Assistance Subcontractor Guidelines
Rent assistance or emergency rent assistance checks must be mailed, in a timely manner, to landlords for clients determined eligible by the lead agency. Mortgage assistance checks must be mailed, in a timely manner, to the lending institution holding the mortgage on client’s primary residence. Payments may not be made directly to the client.
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 12 Subcontractor must maintain accurate and up-to-date records on all account activity. Emergency rent assistance may provide a maximum of two payments per grant year for a total of $1,000 per grant year. The Ryan White grant year is April 1 – March 31.
Emergency Housing Subcontractor Guidelines
Subcontractor’s facility must comply with appropriate building, zoning, health and safety codes, and be clean, safe, secure, well ventilated, properly lighted, and heated. Subcontractor must not discriminate on the basis of age, race, sex, health status, disability, sexual orientation, gender, or religious preference. Subcontractor must treat all clients with dignity and respect. Subcontractor must accommodate a culturally diverse client population.
Congregate Living Facilities Guidelines
Subcontractor’s facility must comply with appropriate building, zoning, health and safety codes, and be clean, safe, secure, well ventilated, properly lighted, and heated. Facility design must be conducive to fostering resident independence. Occupants must have the opportunity to take care of themselves by doing their own meal preparation, housekeeping, and other activities of daily living. Subcontractor must ensure that maintenance procedures follow sanitary code and guidelines for livable housing. Emergency procedures for illness, accident, and fire are written and posted in a prominent and accessible place and included in orientation for new residents and staff immediately upon taking up residence or employment. Emergency telephone numbers for police, fire, ambulance, medical services, and the appropriate program supervisor for the agency are posted in a convenient and accessible place. Subcontractor has a written policy regarding tuberculosis and other infectious disease testing of staff, volunteers, and residents. In congregate living facilities housing more than eight persons, at least one supervisory staff person trained to handle emergencies is on call and available 24-hours-a-day, and at least one staff person is on-site during nighttime hours for security and emergency response. That staff person should be trained to understand and recognize domestic violence issues. The facility will take appropriate safety measures to ensure that individuals in domestic violence situations will have a safe dwelling while at the facility. Each housing unit has a written policy on hours of visitation, overnight guests,
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 13 substance use, smoking in common areas and other issues related to tenants’ comfort and security. Written admission criteria are established. Statement of client rights and responsibilities is given to client and included in client handbook or housing contract. Housing contract defines length of residence, conditions regarding behavior and other factors related to residence. Subcontractor must treat all clients with dignity and respect. Client privacy is ensured. Staff and volunteers are trained in consumer policies of the agency. Subcontractor must accommodate a culturally diverse client population. Staff of housing facility is culturally appropriate and of appropriate sexual orientation or is trained to be sensitive to these factors in the population being served. Services and staff address client needs and those of significant others. Subcontractor must fully inform clients of types and limits of services it can provide. Subcontractor must have linkage agreements providing access to existing continuum of housing services. Subcontractor must provide case management or linkages to case management.
Category 5: Legal Services - Cook County Only Non-Core Medical Service Estimated amount available is $62,000 Defined Unit of services: One (1) case for in-person services and one(1) call for telephone consultations. All cases, phone or in-person must have an eligibility/assessment for service provided.
Legal Services
Definition: Legal services are the provision of services to individuals with respect to powers of attorney, do-not-resuscitate orders, and interventions necessary to ensure access to eligible benefits, including discrimination or breach of confidentiality litigation as it relates to services eligible for funding under the Ryan White Program. It does not include any legal services that arrange for guardianship or adoption of children after the death of their normal caregiver.
Legal Service Guidelines
Part B cannot pay for adoption/foster care assistance, regardless if the client is living or deceased. Part B cannot pay for wills or trusts. Subcontractor must have a current state license.
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 14 The services are easily accessible to persons with HIV/AIDS. Services are provided at a reasonable or no cost to the client. Intake process is flexible and responsive, accommodating disabilities, cultural diversity, and health conditions. Clients are kept informed and work together with staff to determine the objective of the representation, to make decisions regarding the case and to achieve goals in a timely fashion. Services must be professional and effective. Paralegal work is supervised to ensure services are delivered correctly and in a timely manner. Subcontractor makes appropriate referrals when necessary. Subcontractor will develop trustful relationships wherein personal, social issues related to seeking, and receiving HIV care may be successfully resolved. Services must be provided in a sensitive, compassionate, nonjudgmental, and comprehensive manner. Staff are trained and knowledgeable in the law and has HIV/AIDS awareness. All information disclosed by client is confidential. It will not be released to anyone without client permission except as permitted or required by rules of professional conduct or by law.
Category 6: Medical Nutrition Therapy - Collar Counties Only Core Medical Service Estimated amount available is $24,000 Defined Unit of services: One (1) visit with a licensed provider, one (1) issuance of a nutritional supplement , one (1) nutritional plan developed by a licensed registered dietician and one (1) eligibility/assessment for service provided.
Medical Nutritional Therapy
Definition: Medical nutrition therapy is provided by a licensed registered dietitian outside of a primary care visit and includes the provision of nutritional supplements. Medical nutrition therapy provided by someone other than a licensed/registered dietitian should be recorded under psychosocial support services. The provision of food, nutritional services, and nutritional supplements may be provided pursuant to a physician's recommendation and a nutritional plan developed by a licensed, registered dietician.
Medical Nutritional Therapy Services Guidelines
These services include the purchase and distribution of nutritional supplements, as well as the licensed registered dietitian’s services. Services are provided by a licensed registered dietitian. Services must be part of the coordinated continuum of HIV/AIDS services.
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 15 Subcontractor must store, prepare, serve, and/or deliver/dispense food consistent with applicable food safety standards, where applicable. Where applicable, proper temperature is maintained at the point of delivery and during storage, based on food service standards. Food inventory is updated and rotated as appropriate on a first-in, first-out basis, and shelf life standards are observed. Facilities and equipment have capacity for proper food storage and handling. A procedure for rejecting/discarding unsafe foods exists, and food handlers are knowledgeable and trained, if appropriate. Subcontractor and vendors maintain proper licensure. Different levels and types of nutritional services are available and based on client economic need, functional ability, disease progression, age, and culture. All services are menu driven based on HIV/AIDS nutritionally sound menu plans. (Donated food may play a role in menu planning, but does not drive it.) Documented menus, where appropriate, must reflect the nutritional needs of HIV/AIDS clients. Menu offerings include special diets and appropriate supplements that meet client nutritional needs. Nutrition services are based on factors such as client input, availability, and variety. Subcontractor must have in place ways to assess utilization of services (including return rate and discontinuation of services) for planning purposes. A written prescription, updated annually at minimum, is required for the provision of nutritional supplements through medical nutritional therapy.
Category 7: Mental Health Services -Outpatient - Cook and Collar Counties Core Medical Service Estimated amount available is $305,000 Defined Unit of services: One (1) visit (group or individual) with a licensed provider and one (1) mental health assessment for service provided.
Mental Health Services
Definition: Mental health services are psychological and psychiatric treatment and counseling services offered to individuals with a diagnosed mental illness, conducted in a group or individual setting, and provided by a mental health professional licensed or authorized within the State to render such services. This typically includes psychiatrists, psychologists, and licensed clinical social workers.
Mental Health Service Guidelines
Services are conducted using language and methods sensitive to the communities served and provide opportunities for clients to assist in identifying
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 16 issues related to culture, such as primary language, spirituality needs, sexual orientation or practices, family needs and customs. Staff members are competent at serving target populations. Services are located where people are or can/will go. Confidentiality is maintained and respected by agency staff and between clients in the agency. Service site is physically accessible to persons living with HIV/AIDS and disabilities. Services are offered in a timely fashion, both in terms of available office hours and in terms of reasonable length of time between request for service and service delivery. Environment is safe and secure, both physically and emotionally. Subcontractor policies reflect inclusive mental health services for spectrum of mental health needs or provide linkages with other services. Subcontractor has a basic level of medical knowledge about HIV, both in general, and about specific populations at risk. Services available are clearly defined and allow for a continuum of approaches based on client need and staff expertise. Services include clients and families/significant others, where appropriate, as partners in determining needs and appropriate services. Subcontractor, staff, and consultants meet state licensure requirements and credentialed where applicable. Written criteria of qualifications for hiring staff and consultants are in place and adhered to. Subcontractors who treat Medicaid beneficiaries must have a valid Medicaid provider certification number. Internal quality review procedures are present. Subcontractors must comply with standards of their practices. Continuing education is provided to staff. A system of supervision emphasizing accountability and skill building is in place for all levels of staff, volunteers, and peer workers. Subcontractor has a referral resource listing of appropriate specialists.
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 17 Category 8: Oral Health – Collar Counties Only Core Medical Service Estimated amount available is $10,000 Defined Unit of services: One (1) visit with an oral health provider and one (1) oral health assessment.
Oral Health Care Services
Definition: Oral health care includes diagnostic, preventive, and therapeutic services provided by general dental practitioners, dental specialists, dental hygienists and auxiliaries, and other trained primary care providers.
Oral Health Care Service Guidelines
Clients must have a complete treatment plan, which is tailored to the client’s needs, past dental experience and medical conditions and is appropriately monitored and updated as needed. The treatment plan should include an appropriate recall/follow-up schedule. Client’s initial non-emergency visit should include a thorough exam with radiographs and treatment plan. Initial visit includes – Comprehensive head and neck exam; Complete intraoral exam, including evaluation for HIV-associated lesions; Full medical status information from medical provider, including medications and stage of illness, as needed; and Dental risk assessment and prevention strategy, including home care and oral self-exam instruction. Services encompass dental screenings, cleanings and other prophylaxes, fillings and simple extractions, as well as periodontal and other advanced treatments. Subcontractor has a referral resource listing of appropriate specialists. Emergency services are first priority for service delivery. Subcontractor must have a current state license. Subcontractors who treat Medicaid beneficiaries must have a valid Medicaid provider certification number. There is a reasonable wait for clinic/office appointments. Subcontractor’s facility uses equipment designed for infection control. There is 24-hour follow-up emergency coverage.
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 18 Category 9: Substance Abuse - Outpatient: - Cook and Collar Counties Core Medical Service Estimated amount available is $171,000 Defined Unit of services: defined as one (1) slot for methadone treatment, one (1) visit for all other outpatient services (individual or group) and one (1) substance abuse assessment.
Substance Abuse Services (Outpatient)
Definition: Substance abuse services (outpatient) is the provision of medical or other treatment and/or counseling to address substance abuse problems (i.e., alcohol and/or legal and illegal drugs) in an outpatient setting, rendered by a physician or under the supervision of a physician, or by other qualified personnel.
Substance Abuse Services Guidelines
Subcontractor is licensed by the appropriate federal, state, and local regulatory bodies, with staff appropriately qualified in their areas of expertise. Subcontractor must comply with professional standards. Subcontractor must have liability and malpractice insurance, if applicable. Subcontractor screens/assesses all referred clients for appropriateness of admission to substance abuse services. Referrals are made for emergency/crisis situations and appropriate interim services are offered. HIV education, prevention information, risk and harm reduction counseling, and referral for psychological evaluation is provided when needed. Services are offered and delivered according to a current treatment plan. Subcontractor must use universal precautions. Subcontractor has a referral resource listing of appropriate specialists. Services may include detoxification, methadone maintenance, and individual/group counseling.
For agencies that propose to provide Outpatient Substance Abuse services, Buprenorphine is one option for treating opiate addiction. Buprenorphine services are encouraged, but not required. These services must be prescribed and managed by a physician, with appropriate licensure, in a clinical setting. To learn more about these services and how to obtain the necessary licensure go to: http://buprenorphine.samhsa.gov/.
Funds may not be used for hospital in-patient treatment or to purchase injection equipment or syringes. B. Funding Requirements and Priorities
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 19 Throughout the narrative all applicants must describe how they will ensure and document the following requirements.
Standards of Care Applicants must describe how they ensure the care they provide is consistent with the most current Health and Human Service (HHS) standards of care and treatment guidelines and all other applicable professional standards. The RW Standards of Care as presented in this document for services delivered in the Chicago EMA have been established by the HRSA and the Part B Cook and Collar Counties Consortia.
Data Collection and Reporting All Part B providers must be able to track and report unduplicated client-level demographic, medical and other service data. Beginning January 1, 2009, all Ryan White HIV/AIDS Program grantees and service providers began client level data collection for HRSA’s HIV/AIDS Bureau using the new Ryan White Services Report (RSR). The RSR is a data collection and reporting system for reporting information on programs and clients served (Client Level Data). Over time, the RSR will replace the Ryan White Data Report (RDR), which is an aggregate data report.
The Part B Consortia use Provide software to accomplish client level data reporting. Agencies within the Cook County and Collar Counties Part B Region report data using Client Track to the lead agent, The AIDS Foundation of Chicago (AFC). AFC uploads data into Provide for its Part B grantees.
Quality Management AFC expects all Ryan White Part B Program grantees to implement ongoing quality management activities. All applicants are expected to submit a quality management plan for each category of service Part B funding is requested. Applicants are expected to adopt quality indicators they intend to track for the assessment and delivery of the proposed services. These indicators must be linked to the HIV AIDS Bureau’s performance measures and revised standards of care. (http://hab.hrsa.gov/special/habmeasures.htm). Below are possible indicators that should be used within the scope of your quality management program and incorporated into the proposed work plan.
Access-related indicators • Increase the proportion of clients who utilize health services (HP2010.21- 10). • Percent of urgent care patients seen within 24 hours. • Percent of established patients seen for routine care within ___ business days. • Percent of new patients seen within ___ business days. • Decrease in no show rates for health services. Patient satisfaction indicators
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 20 • Percent of patients reporting they are satisfied or very satisfied with ease of access, professionalism/friendliness, and respectfulness of the medical provider. Treatment-related indicators • Percent of charts that include written treatment/housing plans. • Percent of treatment/housing plans legibly signed by both the provider and patient. • Percent of charts that include signed and dated consent to treat. • Percent of patients’ receiving care and treatment that is congruent with their Diagnosis (needs to be assessed by clinician). • Percent of charts documenting patient education. • Percent of patients completing active phase of treatment within 12 months.
HRSA also offers technical assistance in selecting appropriate service and client-level outcomes which is available online at: http://hab.hrsa.gov/tools.htm or http://careacttarget.org.
Payer of Last Resort/Use of Sliding Fee Scale Part B funds must be used as the payer of last resort. All Medicaid eligible providers must be certified as a Medicaid provider. For more information on how a provider can enroll in Medicaid go to: http://www.hfs.illinois.gov/enrollment/. Handbooks have been prepared for the information and guidance of providers who participate in the Illinois Medical Assistance Program and other health care programs funded or administered by the Illinois Department of Public Aid. These handbooks provide guidelines to enable providers to: know which services provided to eligible participants are covered; submit proper billings for services rendered; and make inquiries to the proper source when it is necessary to obtain clarification and interpretation of department policy and coverage. The handbooks can be obtained from: http://www.hfs.illinois.gov/handbooks/ or by calling 217-782-0538 or 217-524-7306. Applicants (Outpatient /Ambulatory Care, Outpatient Mental Health and Substance Abuse) must also adhere to Ryan White legislative mandates regarding the provision of services to individuals regardless of their ability to pay and require the payment of co-pays based on the approved sliding fee scale by individuals that live 100% above the federal poverty level where necessary. Applicants must establish an annual service utilization cap on services per client and develop policies and procedures that are inclusive of reviews and modifications of these caps on a case-by-case basis based on clinical needs that arise.
Cultural and Linguistic Competence Applicants are advised that all service providers should deliver services in a manner that is culturally and linguistically competent, which includes addressing the limited English proficiency (LEP) and health literacy needs of clients. HRSA defines cultural and linguistic competence as “a set of congruent behaviors, attitudes, and policies that come together in a system or agency or among professionals and enable that system, agency, or those professionals to work effectively in cross-cultural and linguistically diverse situations.”
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 21 Health care providers funded via HRSA grants need to be alert to the importance of cross-cultural and language appropriate communications and general health literacy issues. HRSA supports and promotes a unified health communication perspective that addresses cultural competency, limited English proficiency and health literacy in an integrated approach in order to develop the skills and abilities needed by HRSA-funded providers and staff to deliver the best quality health care effectively to the diverse populations they serve.
Partnerships and Memorandum of Understanding
All subcontractors must demonstrate that they meet all of the eligibility criteria as stated in this RFP. If an agency is partnering with another organization to provide services detailed in the RFP and will have a financial arrangement or subcontracting relationship with the partnering organization, the lead applicant is required to have an executed Memorandum of Understanding (MOU) with its partner(s) specific to the proposed services to be provided that specifically delineates the details for the relationship and the responsibilities of both parties. This MOU must be signed by the Executive Directors of all partner(s) and must be current. MOU(s) should be included as an attachment to the application. An organization that submits a proposal as the lead agency on behalf of multiple providers must not submit another proposal under this same service category. An organization that is included as a secondary partner or non- lead participant in a multi-provider proposal must also not submit a proposal as a lead or sole applicant in this same service category.
Other Important Requirements
All providers must document the residence, HIV status and financial eligibility of all Part B clients who receive services under this funding. In addition, all Part B clients that receive services must be linked to or currently receiving ambulatory HIV care. The applicant must ensure and document coordination as well as communication with the client’s Primary Care Provider and Case Manager.
VIII. Instructions for Completing an Application
This section provides information on application requirements and submission guidelines. Each application must be complete and narrative responses should be self- explanatory. If an applicant is proposing multiple sites one narrative is required but a separate and complete budget must be submitted for each site.
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 22 A. Intent to Apply All applicants are required to complete and submit the Intent to Apply form by 4:00 PM on Friday, November 13, 2009. (See Appendix A, page 36). This form is for informational purposes only and will not be used to determine eligibility or funding.
B. Application Preparation Guidelines This section outlines requirements for application narrative and supporting documents. Applicants are asked to describe their ability to provide services in the category in which they are applying, accordance with program requirements and in response to the needs of PLWHA in Cook County and the Collar Counties. Page limits for each section are included. Follow these instructions and outline when preparing and submitting an application.
Follow these instructions in completing your application Use single line spacing and a minimum of 11-point font size. Applications should have margins of at least ¾ inch on all sides. Submit only unbound applications (i.e., no staples, ring binders, covers) All documents should be on 8 ½”x11” paper. You may print the document double sided. Include a table of contents reflecting major categories and corresponding page numbers. Attach only supporting documentation requested or directly related to the application. Sequentially number the entire application including all the attachments Include a table of contents reflecting major categories and corresponding page numbers. Use headings and subheadings to ensure that your application covers all the required elements. Use the Application Checklist in Appendix E, page 40 to ensure that your application is complete. Please note that successful applicants will be required to report on progress in achieving goals outlined in this application.
Face Page (1 Page)
Use Appendix B (page 37) to complete the Face Page. This page must be the first page of your application.
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 23 Project Abstract (Limit Your Response to 1 Page) The Project Abstract provides a brief description of the applicant organization and its experience relevant to this application. The Project Abstract should include the following information:
Name of Organization; Description of the organization’s history and experience, and how it is applicable to the proposed project(s); Description of the target population’s and the related service needs; and Description of the project’s major goals for which funds are being requested.
Application Narrative (Limit Your Response to 16 Pages Total)
Agency Experience and Capacity (Limit Your Response to 5 Pages)
This section of the narrative should describe your agency’s experience providing services and its capacity to carry out the proposed activities. This section should include the following information:
A brief discussion of your agency, the experience you have providing services to PLWHA, and how this experience is applicable to the proposed project. A brief description of the physical location of service provision and the location’s benefits of accessibility (e.g., handicap accommodations, transportation and hours of operation). Briefly describe the geographic area to be served by the proposed project and linkages the agency has within the targeted geographic area. Briefly discuss the demographic, social and behavioral characteristics of the special sub-populations of PLWHA your agency has previously served. Describe the coordination and collaborations your agency has established in order to ensure comprehensive services. o Discuss how the agency will link with clients that are receiving ambulatory/outpatient medical primary care, case management and other HIV/AIDS health care services. o Discuss how your agency documents that all clients are linked to or receiving ambulatory/outpatient medical care o Discuss the mechanisms your agency will use to coordinate and communicate with the clients’ primary care provider and case manager regarding established treatment plans and delivered services. o Describe how your agency will track patients at increased risk of being lost to follow-up (e.g., homeless, mentally ill and substance using patients).
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 24 Describe how your agency assures the confidentiality of all client information and records. Describe how your agency ensures the proposed service is consistent with HHS guidelines and all other applicable professional standards and requirements. o Attach relevant certifications and licenses to your application. Describe the agency’s plan for administrative and clinical supervision of the proposed project. o Include supporting documentation that supports the agency’s programmatic and administrative abilities described in the narrative such as management staff resumes, certifications, licenses, in-house training, or other evidence. Describe how your agency assures the quality of its services including how the proposed services will be incorporated into your agencies continuous quality management plan. Describe the agency’s information technology (IT) capabilities and the practice management software that is utilized to manage the program. o Briefly describe what kind of reports can be generated, e.g., by procedure code, no shows and productivity. o Briefly describe your agency’s ability to comply with AFC’s data reporting requirements as outlined on page 7 of this RFP. Describe the agency’s fiscal capacity and stability to manage the proposed project as well as your demonstrated capacity to operate on a reimbursement basis.
Target Population(s) (Limit Your Response to 1-2 Pages) Identify and describe in detail the characteristics of the target population(s) this project will serve Describe the agency’s involvement and relationship with its target population(s) and within its geographic area. Describe the unique health needs identified for each population. At a minimum, this should include race and ethnicity, gender, sexual orientation, age, homelessness and chemical dependency. Describe how your agency assesses the needs of this population. Describe how unmet needs and barriers will be addressed by the proposed project (e.g., bilingual staff, extended and weekend hours of service, child care and transportation).
Cultural and Linguistic Capacity (Limit Your Response to 1 Page)
Discuss the extent to which the target population(s) or consumer advisory group was involved in developing the proposed program or providing meaningful input into its development and how they will be involved in the evaluation of the proposed services.
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 25 Describe the extent to which the demographic comprises the agency’s frontline staff, management and the board of directors is reflective of the target population(s). Describe how you will make your services known to the target population(s) and other service providers. This may include advertisements, newsletters, brochures and other printed materials, as well as individual or community outreach activities. Describe any innovative or successful activities your agency has undertaken in order to improve its cultural and linguistic capacity.
Client Eligibility (Limit Your Response to 2 Pages)
Describe the agency’s intake/eligibility assessment process. Describe all criteria used or to be used to determine eligibility for this service category including but not limited to confirmation of residence, HIV status and financial eligibility o Eligible beneficiaries of Part B services under this RFP are individuals with HIV/AIDS living in urban Cook County, the Part B Cook County Region and the Collar Counties. Services are to be provided to eligible individuals regardless of their ability to pay for services, their current or past health condition or their residence (as long as they live within the defined service area). Note: Successful applicants must obtain approval from AFC prior to limiting services to a subset of eligible clients.
Describe your agency’s rationale for the eligibility criteria. Describe the methods used to screen clients for financial eligibility. Describe how your agency will cap or limit services provided through this request to maximize resources for the greatest number of persons in need.
Payer of Last Resort (Limit Your Response to 1-2 Pages) Explain your agency’s procedures for utilizing third party reimbursement and assuring that Part B funds are the payer of last resort. o State whether or not your agency is a Medicaid certified provider. If your agency is certified please list the services that are billed to Medicaid. If your agency is not certified please explain why not. List all other public and private sources of payment the applicant’s organization bills or otherwise utilizes. Describe how your agency assures that clients are enrolled in all possible public and private insurance or benefit programs. Attach a copy of your agency’s relevant policies and procedures for assuring the Part B funds are the payer or last resort. Describe any other efforts your agency undertakes to assure Part B funds are the payer of last resort including leveraging other funds including but not limited to RW Part A, B and C.
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 26 Program Work Plan (Limit Your Response to 3 Pages for the Narrative, No Page Limit for the Program Work Plan Form)
*SPECIAL NOTE* A separate work plan narrative and work plan form should be completed per service category for which you are applying.
Describe the overall goal of the program and the basis used for designing the proposed program(s). Describe the objectives of the proposed program and how it will be implemented with clearly defined activities that will be used to achieve the objectives. o Activities indicate the tasks that must be completed to achieve the objectives and must be specific, measurable, attainable, realistic and time-phased. The activities serve as the operating steps for the project. Define and use allowable units of service detailed within this RFP to quantify all objectives and activities. o The objectives must indicate the number of clients to be served and specify the number of service units to be provided (e.g., A unit of service is defined as one visit with a medical health provider; a provider might develop an objective to "provide 1500 visits to 1,000 Part B eligible clients by March 31, 2010”). A Work Plan must be completed for all proposed scope(s) of service. Refer to Appendix C on page 38 for a sample Program Work Plan. Describe the approach you will take for data collection, monitoring and reporting.
Budget and Justification (Limit Your Response to 2 Pages for Justification, No Limit for Budget Forms)
*SPECIAL NOTE* A separate budget narrative and budget form should be completed per each service category for which you are applying.
Provide a narrative description of the proposed project budget. Your narrative must address the following questions: Describe and justify all costs proposed in the budget. The budget and narrative must meet all requirements set forth in this section. This section provides the format for the required 12 (12) month item budget explaining how each line item will be expended. Refer to Appendix D (page 39) for required budget forms.
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 27 The policies, guidelines and requirements of 45 CFR part 74 and 45 CFR part 92 as applicable and applicable OMB Circulars A- 21, A-87, A-110, A-122 and A-133 apply with respect to the acceptance and use of funds under this program. In general, applicants may request funds through this RFP to support the following costs: Personnel salaries and Fringe Benefits, Operating Costs, Professional/Technical Costs, Materials and Supplies, Administrative Expenses.
A description of each expense category is presented below.
Personnel: For these costs, provide the following information: the name of the employee and job title, number of positions, monthly salary and percent of time to be charged to this project, the amount of the Part B share, other share, and in-kind share, and the total cost. Provide a brief budget justification explaining the duties of each employee assigned to the project. If the applicant has not yet identified individuals to fill salaried positions, indicate that these individuals are yet to be hired. Example Position or Title and Name # Positions Annual Salary % FTE Part B Share
Fringe Benefits: For these costs, provide the following information: the amount of fringe benefits requested (which should also include the percentage rate for FICA); medical insurance; including dental and vision coverage, if applicable; worker's compensation and disability insurance; life insurance, if applicable; and, vacation and sick pay benefits, etc. Fringe benefits must be based on the applicant's established personnel policies.
Operating Costs: Applicants must delineate expenditures for items related to any programmatic activities integral to this project (e.g., telephone, advertising, printing, duplication, equipment leasing/maintenance, insurance premiums, dues, subscriptions, memberships, messenger services, facility maintenance, technical meeting costs and postage). AFC will allow funding for rent and utilities related to program space if these expenses are required for this particular program and are sufficiently justified. Delineate expenditures for furniture, furnishings, materials and supplies, justifying these costs in terms of the proposed program. Note: Agencies funded through this RFP will be required to comply with various insurance specifications established by the Cook County: these include workers' compensation, auto liability, commercial liability and professional liability. These requirements also apply to all subcontractors and consultants.
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 28 Unit Costs: Indicate the per-unit cost to provide the proposed services, and explain how this figure is derived. At a minimum, show roughly how quantified program goals and anticipated costs are used. For example: 1 health service unit = 1 visit. If there are 30 health visits proposed for each of ten clients, this totals 300 units of service. The total cost for this program is $24,000: $24,000 divided by 300 days yields a cost of $80 per visit (unit of service).
Professional/Technical Costs: List and justify all fees to be paid to consultants and subcontractors, noting the number of hours to be devoted to the project and specific responsibilities. Consultant fees will be allowed on a limited basis only, and should not to be used in place of staff support. This category may include sub contractual services that facilitate program delivery, as well as services that increase client access or to assess client satisfaction. Note: AFC will require all successful applicants to identify any consultants and subcontractors that will be part of the proposed program.
Materials and Supplies: Itemize and justify programmatic materials (e.g., brochures, videos) essential to the project. Be certain to request sufficient funding for educational materials (e.g., non-English or ethnic-specific brochures or audiovisual items). Include office supplies that will be used by program staff in service delivery. This category also includes treatment costs such as laboratory tests and medical supplies.
Administrative Expenses: Administrative expenses of up to 10% of direct costs are allowable in every category, but these must be specifically delineated and justified in the application. Funds may be used to support specific HIV staff training that enhances an individual's or an organization's ability to improve the quality of services to affected clients. These dollars, however, are considered to be administrative in nature and are subject to the aggregate 10% administrative cost cap
C. Required Attachment Documentation Internal Revenue Service 501(c)3 tax exempt determination letter; Copy of applicant’s Articles of Incorporation; Copy of the applicant’s most recent Financial Statement and OMB Circular A-133 Audit; List of Board of Directors (must include place of employment for each member) Memoranda of Understanding/existing contract with medical and ancillary care providers. Either document should specifically state the nature of the agreement. Agreements must be time-phased, project specific and provide details of the arrangement. Documentation of these agreements should be on agency letterhead and signed by representatives of both agencies who are authorized to commit their agency to provide services. These documents should specify the services(s) to be provided, the number of participants to be served, the period in which the services(s) will be provided, and, if known, the monetary value of the services.
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 29 Proof of service area and location. Policies and Procedures for client service utilization caps. The Sliding scale fee and the agency policies and procedures related to caps on client service use for high need users (for ambulatory medical care, oral health mental health and substance abuse service categories). Quality Management Plan for every category of service funding is sought.
D. Application Checklist The Application Checklist should be used to ensure that the application is complete. Include the Checklist with the application. Applications that do not contain each of the items indicated in the checklist will be considered incomplete and will not be reviewed. (See Appendix E; page 40 for a copy of the Checklist).
IX. Submission Guidelines
If an applicant is proposing multiple service categories one program narrative is required but a separate and complete work plan and budget must be submitted for each service category. Failure to follow any of the instructions related to content will result in the application being eliminated from consideration. Other than late delivery, the most common reasons that applications are rejected include: inadequate number of copies, missing sections of the application, and failure to include requested documents.
It is the responsibility of the applicant to insure delivery of the proposal to AFC by the designated deadline. All proposal will be date and time stamped upon receipt and the receipt with be given to the person delivering the package at the time of receipts. Applicants using a messenger service to deliver their proposals should advise the messenger service of the 4:00 PM deadline and make sure the messenger knows to wait for a receipt. The application must be received by 4:00 PM Central Standard Time on Monday, January 4, 2010. No extension will be permitted. No late applications will be accepted. Applicants wishing to drop off completed proposals prior to Monday, January 4, 2010 should contact Alicia Bunton to arrange for a drop off time. Faxed or emailed proposals will not be accepted.
Submit one (1) original and five (5) complete copies per service category applying for (six (6) in total per service category) and a CD with an electronic version of the application to: Alicia Bunton Director of Care and Quality Improvement AIDS Foundation of Chicago 200 West Jackson Blvd, Suite 2200 Chicago, Il, 60606 312-334-0958
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 30 X. Evaluation of Applications All proposals that are received on time will undergo a technical review to determine whether all required components have been addressed and included. Proposals that are determined by AFC to be incomplete will not be further considered. AFC reserves the right to waive irregularities that it, within its sole discretion, determines to be minor. If such irregularities are waived, similar irregularities in all proposals will be waived. Proposals that are determined to be complete will be forwarded to a Review Panel. The Review Panel will evaluate and rate all remaining proposals based on the Evaluation Criteria listed below. The Review Panel forwards its recommendations and comments to the AFC. Past contractual performance may also be considered for applicants that have previously received funding from AFC. Final funding decisions are made by the AFC. All applicants will be notified of the results in writing.
Evaluation Criteria: Criterion 1: Need – 15 points 1. Applicant describes the service area for the proposed services, 2. Applicant clearly describes the target population for the proposed service, including: Unique demographic characteristics including race, ethnicity, age, gender, primary languages, income distribution and medical insurance coverage rates. The information should identify the estimated number of persons in need of services and how the estimation was derived. Any special populations that will be served by the proposed services. The treatment/service needs of the target population (e.g., individuals experiencing homelessness, methamphetamine or other substance use, mental health, caries rate, edentulism, periodontal disease and oral cancer). 3. Applicant identifies all providers, resources, and/or services of other public and private organizations within the proposed service area that provide supportive care to the target population. 4. Applicant identifies and describes the most significant barriers to accessing the proposed services, gaps in services, significant health disparities, and major health problems in the community (e.g., cultural or language issues, geographic barriers, transportation, limited number of providers, access issues related to managed care, reimbursement, unreasonable wait times). 5. Applicant demonstrates a thorough understanding of the health care environment and its impact on the target population’s access to services.
Criterion 2: Response – 35 points 1. Applicant describes the proposed services, including:
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 31 All services to be provided; Location of site(s) where services will be provided; Any linkages, collaborations, partnerships, and/or leveraging of other community resources (e.g., linkages with medical schools, State/City/County health programs). If services are provided through contracts and the contract(s) is in place, a signed copy of the contract(s) must be attached to the application. If a contract(s) is not in place, a letter of agreement or memorandum of understanding with the proposed agency must be attached. 2. Applicant describes how the proposed services will be provided and demonstrates the appropriateness of these arrangements for optimal accessibility by the target population. The description should include: Applicant addresses identified needs of the target population. Applicant proposes goals and objectives that include increasing access to treatment and improved the patients’ health outcomes. Applicant proposes service goals and objectives that are relevant goals and objectives of the Healthy People 2010 initiative, specifically by 1) increasing the quality and years of a healthy life, and 2) eliminating health disparities. 3. Applicant describes how the target population(s) to be served will be informed about the services available, identified and referred to the health center or off-site location(s), and educated about the importance of HIV/AIDS prevention and treatment. 4. Applicant demonstrates how the proposed services will be integrated with other primary health care services (e.g., collaboration and communication with medical providers to ensure continuity of comprehensive primary health care). 5. Applicant demonstrates how the proposed services will take into account the needs of culturally and linguistically diverse patients. 6. Applicant describes any applicable cost-savings activities such as joint purchasing, and leveraging of other funding including RW Part A, Part A capacity building, Part B and Part C supplemental or expansion funding.
Criterion 3: Evaluative Measures - 10 Points 1. Applicant describes the proposed quality management (QM) program for the services proposed, including: Data elements to be included in the QM plan; The process for problem identification and resolution; Use of program monitoring data to continually assess and improve program performance and measure progress toward meeting objectives and
How these reports would be used for program improvement.
2. Applicant describes a plan for tracking the success of the proposed services, including:
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 32 Identified goals/objectives and key action steps for providing the proposed services; Staff responsible for the activities; and A timeline for carrying out the evaluation activities. 3. Applicant describes a plan for tracking patients at increased risk of being lost to follow-up (e.g., homeless, mental health and substance abuse patients).
Criterion 4: Impact - 5 Points 1. Applicant describes how existing barriers to services will be reduced or eliminated for the target population(s). 2. Applicant describes how the proposed services will increase access for the target population(s). 3. Applicant identifies factors that may affect progress of goal attainment in either a positive or negative way.
Criterion 5: Format – 5 points 1. Applicant adheres to the required format for submission of the application, attachments and certifications.
Criterion 6: Resources/Capabilities - 20 Points 1. Applicant describes prior experiences and expertise in working with the target population(s); and developing and implementing appropriate systems and services to meet the needs of the community. 2. Applicant describes their information technology systems as well as their plan for administrative, clinical and fiscal oversight of the proposed services. 3. Applicant describes sound and adequate client program eligibility requirements and has policies in place that work to ensure that RW Part B is the payer of last resort and that service utilization caps are employed to maximize the number of individuals that are served with the requested funds. 4. Applicant demonstrates the appropriateness of the organization’s existing clinical/ service sites where services will be located. 5. Applicant demonstrates that the proposed staffing is appropriate for the level and type of care/ services to be provided and the applicant has the cultural capability and linguistic capacity to serve the proposed target population. 6. Applicant demonstrates readiness to initiate the proposed services within 30 days of the grant award. Specifically, the applicant demonstrates that within 30 days: 1) proposed staff/providers will be recruited and/or hired, 2) the existing or proposed facility will be operational, and 3) proposed services for the target population/community will be initiated. 6. Applicants demonstrates the ability to track and report client level information.
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 33 Criterion 6: Support Requested (10 Points) 1. Applicant demonstrates that the proposed budget is appropriate and reasonable in terms of: The total resources required to achieve the goals and objectives of the applicant’s proposed service delivery plan (i.e., total project budget); The number of proposed clients and encounters; The total cost per user and encounter;
2. Applicant describes how the proposed service is a cost-effective approach to meeting the needs of the target population given the current level of health care resources available to the community. 3. The applicant describes the soundness of proposed budget and the applicant’s financial capacity and stability to manage the scope of proposed services. 4. The application includes a line item budget and budget justification.
XI. Reporting and Other Requirements for Successful Applicants All successful applicants will be required to submit provide monthly service utilization data, quarterly program reports, voucher on a monthly basis, and participate in all AFC sponsored site visits, evaluation and quality assurance activities. In addition, agencies must be Medicaid certified (if applicable) and document a system to ensure that Part B is the payer of last resort.
All Part B funded agencies will be required to complete HRSA’s annual RW Data Report form online. All agencies will be required to house and manage a client-level data system and demonstrate the following minimum information system capacity at all (non-mobile) programmatic and administrative sites: Computer hardware with 750 MHz or faster with a memory of at least 128 MB The hard drive should be no less than 1 GHz Computer software that can maintain client-level data Internet access and an email system The use of CAREWare, HRSA’s free client-level software package, or the use of Client Track, will fulfill all client-level data collection requirements.
XII. Compliance with Laws, Statutes, Ordinances and Executive Orders Grant awards will not be final until AFC and the respondent have fully negotiated and executed a grant agreement. All payments under grant agreements are subject to annual appropriation and availability of funds. AFC assumes no liability for costs incurred in responding to this RFP or for costs incurred by the respondent in anticipation of a grant agreement. As a condition of a grant award, respondents must comply with the following and with each provision of the grant agreement: 1. Selected respondents shall establish procedures and policies to promote a Drug-free Workplace. The selected respondent shall notify employees of its policy for maintaining a drug-free workplace, and the penalties that may be imposed for drug abuse violations occurring in the workplace. The selected respondent shall notify the City if any of its
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 34 employees are convicted of a criminal offense in the workplace no later than ten days after such conviction. 2. Compliance with Federal, State of Illinois and City of Chicago regulations, ordinances, policies, procedures, regulations, rules, executive orders and requirements, including Disclosure of Ownership Interests Ordinance (Chapter 2-154 of the Municipal Code of Chicago); the State of Illinois – Certification Affidavit Statute (Illinois Criminal Code); State Tax Delinquencies (65ILCS 5/11-42.1-1); Governmental Ethics Ordinance (Chapter 2-156 of the Municipal Code of Chicago); Office of the Inspector General Ordinance (Chapter 2-56 of the Municipal Code of Chicago); Child Support Arrearage Ordinance (Section 2-92-380 of the Municipal Code of Chicago); and Landscape Ordinance (Chapters 32 and 194A of the Chicago Municipal Code). 3. False Statements (a) 1-21-010 False Statements Any person who knowingly makes a false statement of material fact to the city in violation of any statute, ordinance or regulation, or who knowingly falsifies any statement of material fact made in connection with an application, report, affidavit, oath, or attestation, including a statement of material fact made in connection with a bid, proposal, contract or economic disclosure statement or affidavit, is liable to the city for a civil penalty of not less than $500.00 and not more than $1,000.00, plus up to three times the amount of damages which the city sustains because of the person's violation of this section. A person who violates this section shall also be liable for the city's litigation and collection costs and attorney's fees. The penalties imposed by this section shall be in addition to any other penalty provided for in the municipal code. (Added Coun. J. 12-15-04, p. 39915, § 1) (b) 1-21-020 Aiding and Abetting. Any person who aids, abets, incites, compels or coerces the doing of any act prohibited by this chapter shall be liable to the city for the same penalties for the violation.(Added Coun. J. 12-15-04, p. 39915, § 1) (c) 1-21-030 Enforcement. In addition to any other means authorized by law, the corporation counsel may enforce this chapter by instituting an action with the department of administrative hearings. (Added Coun. J. 12-15-04, p. 39915, § 1) 21
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 35 Appendix A
INTENT TO APPLY FOR FUNDING AIDS Foundation of Chicago: Part B of the Ryan White HIV/AIDS Treatment Modernization Act
Agencies interested in applying for funding under this RFP are asked to complete and submit this form by 4:00 pm on Friday, November 13, 2009. The form may be e-mailed, mailed, faxed or delivered to: Alicia Bunton, Director of Care and Quality Improvement AIDS Foundation of Chicago 200 West Jackson Blvd, Suite 2200 Chicago, Il, 60606 Phone: 312-334-0958 email: [email protected]
Agency Name
Site Address
Executive Director
Contact Person
Telephone Number
Fax Number
Email Address
Please Check All Categories In Which You Plan To Apply For Funding Cook County Collar Counties Ambulatory Care Ambulatory Care Outpatient Mental Health Medical Nutrition Therapy Outpatient Substance Oral Health Abuse Food Outpatient Mental Health Housing EFA Legal Food Housing Outpatient Substance Abuse
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 36 Appendix B FACE PAGE AIDS Foundation of Chicago Part B of the Ryan White HIV/AIDS Treatment Modernization Act
Agency Name: Agency Tax Identification Number:
Agency Administrative Mailing Address: Agency Service Site Address:
Name of Board of Directors President: Name of Executive Director: Executive Director/CEO’s Phone Number: Executive Director/CEO’s Email Address: Primary Program Contact Person: Primary Program Contact’s Phone Number: Primary Program Contact’s Fax Number: Primary Program Contact’s Email Address: Fiscal Agent Name (if applicable): Fiscal Organization Mailing Address: Fiscal Agent/Contact’s Phone Number: Fiscal Agent/Contact’s Fax Number: Fiscal Agent’s/Contact’s Email Address: Please Check Which Category You Are Applying For Funding In This Application Cook County Collar Counties Ambulatory Care Ambulatory Care Outpatient Mental Health Medical Nutrition Therapy Outpatient Substance Abuse Oral Health Food Outpatient Mental Health Housing Outpatient Substance Abuse Legal EFA Food Housing
Cook Co Requested Amount Collar Counties Requested Amount Core Medical Services: Core Medical Services: Non Core Services: Non Core Services: Total Amount: Total Amount:
Signature of the Executive Director/CEO Date
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 37 Appendix C PROGRAM WORK PLAN AIDS Foundation of Chicago Part B of the Ryan White HIV/AIDS Treatment Modernization Act
Agency Name : Service Category:
Problem/Need:
Goal:
Objective Action Steps Completion Date Person Responsible Evaluation Method
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 38 Appendix D
SAMPLE – PROPOSED PROGRAM BUDGET AIDS Foundation of Chicago Part B of the Ryan White HIV/AIDS Treatment Modernization Act
Agency Name: Service Category: Counties proposed to Serve: Core Medical Non Core Services Services Personnel Cost Salaries and Wages
Fringe Benefits Total Personnel Cost Other Program Cost Consultant Cost
Equipment Supplies Travel Other
Total Other Program Cost Total Budget Request
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 39 Appendix E
SAMPLE - PROPOSED SERVICE CATEGORY BUDGET AIDS Foundation of Chicago Part B of the Ryan White HIV/AIDS Treatment Modernization Act Agency: Person Completing Request: Date: Total amount Requested: $ Amount requested by Core Medical Service Category: Amount requested by Non-Core Service Category:
Service Amount Number of Number of units of service to be Requested clients to provided (define units) be served Cook County Core Medical Services Ambulatory Care
Outpatient Mental Health Outpatient Substance Abuse Non Core Services Food Housing Legal Collar Counties Core Medical Services Ambulatory Care Medical Nutrition Therapy Oral Health Outpatient Mental Health Outpatient Substance Abuse Non Core Services EFA Food Housing
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 40 Appendix F APPLICATION CHECKLIST AIDS Foundation of Chicago Part B Oral Health of the Ryan White HIV/AIDS Treatment Modernization Act
The application checklist should be used to ensure that the application is complete. Include the checklist with the application. Applications that do not contain each of the items below will be considered and incomplete and will not be reviewed.
Face Page Table Of Contents Project Abstract Application Narrative Program Work Plan Budget Justification Budget Required Documentation Internal Revenue Service 501(C)3 Tax Exempt Determination Letter Copy Of Articles Of Incorporation Copy Of The Most Recent Financial Statement And OMB Circular A-133 Audit Board Of Directors List (Must Include Place Of Employment & Telephone number) Memorandum Of Understanding Resumes And Credentials Of Key Providers Sliding Fee Scale Policies And Procedures For Client Service Utilization Caps Quality Management Plan for each service category funding is requested One (1) Original, Five (5) Complete Copies And One (1) Electronic Copy Of The Proposal Are Submitted
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 41 RFP Addendum Regarding Applications for Ambulatory Care Services
Since 1991, the Ruth M. Rothstein CORE Center has led the Primary Care Consortia (PCC), which coordinates Part B ambulatory care services in Cook County. Successful applicants in this RFP process will become members of the PCC, will attend planning meetings, and will participate in collaborative effort to strengthen linkage to care, data management, and progress toward other quality indicators. Representatives from the PCC will serve on the proposal review committee that identifies successful respondents. AFC estimates that $350,000 will be made available in this funding cycle for direct ambulatory care services.
AIDS Foundation of Chicago – RW Part B – for FY 2010 -2011 Page 42