25RFP1343702B_PS.pdf

REQUEST FOR PROPOSAL 25RFP1343702B-PS

FY25 RFP for RWPA & Ending the HIV Epidemic

Project Period FY2025-FY2027: RYAN WHITE HIV/AIDS TREATMENT EXTENSION ACT

OF 2009

Project Period FY2025-FY2029: ENDING THE HIV EPIDEMIC: A PLAN FOR AMERICA

RFP ISSUANCE DATE: March 28, 2025 RFP DUE DATE AND TIME: Friday, May 2, 2025 11:00 A.M.

PRE-PROPOSAL CONFERENCE DATE: Thursday, April 10, 2025 at 10:00 A.M.

PURCHASING CONTACT: PHYLLIS STEWART at (404) 612-4215 E-MAIL: phyllis.stewart@fultoncountyga.gov

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under the Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law 111-87) via grants under H89HA00007 and UT8HA33933. This document was funded with 100% governmental sources. The information or content and conclusions are those of the Department for HIV Elimination and should not be construed as the official position or policy of, nor should any endorsements be inferred by, HRSA, HHS or the U.S.

Government.

Table of Contents

SECTION 1 – INTRODUCTION

1.1 Project Description

1.2 Service Categories Eligible for Funding

1.3 Additional Funding Information

1.4 Minimum and Desired Qualifications of Applicants

1.5 Method of Source Selection

1.6 Background

1.7 Using Data Effectively: Reporting & Integrating Data

1.8 Impact of the Changing Healthcare Landscape

1.9 County Objectives

1.10 Obtaining the RFP

1.11 Pre-Proposal Conference

1.12 Proposal Due Date

1.13 Contact Person and Inquiries

1.14 Procurement Schedule

SECTION 2 – INSTRUCTION TO PROPOSERS

2.1 Procurement Process

2.2 Contract Definitions

2.3 No Contact During Procurement Process

2.4 Clarification & Addenda

2.5 Term of Contract

2.6 RFP Submittals

2.7 Definition of a “Complete” Submission Packet

2.8 Proposal Evaluation

2.9 Disqualification of Proposers

2.10 Reserved Rights

2.11 Applicable Laws

2.12 Insurance and Risk Management Provisions

2.13 Accuracy of RFP and Related Documents

2.14 Responsibility of Proposer

2.15 Confidential Information

2.16 County Rights and Options

2.17 Cost of Proposal Preparation and Selection Process

2.18 Termination of Negotiations

2.19 Wage Clause

2.20 Additional or Supplemental Information

2.21 Reporting Responsibilities

2.22 Georgia Security and Immigration Compliance Act

2.23 Authorization to Transact Business

2.24 Right to Protest

2.25 Non-Collusion

2.26 Certificate of Acceptance of RFP Requirements

2.27 Exceptions to the Services Agreement Contract

2.28 Certification Regarding Debarment

2.29 General Requirements

2.30 Preparation and Writing Tips

2.31 Client Eligibility and Recertification

2.32 Program and Fiscal Monitoring Standards

2.33 Business Associate Agreements

2.34 Program Income

2.35 Cultural Humility and Linguistic Competence

2.36 Condom Availability

2.37 HIV Workforce

2.38 Meaningful Involvement of Persons with AIDS (MIPA)

2.39 Collaborations

2.40 Professional Licenses

2.41 Funding Exclusions

2.42 Federal Requirements

2.43 Local Policies Affecting Funding

2.44 Other Documents to be Provided Prior to Entering into Contract

SECTION 3 - PROPOSAL REQUIREMENTS

3.1 Overview of Proposal Requirements

3.2 Format & Proposal Submission Instructions

SECTION 4 – TECHNICAL PROPOSAL GUIDELINES

4.1 Overview

4.2 Technical Proposal and Cost Proposal

4.3 Service Category Plan

SECTION 5 – COST SECTION OF THE TECHNICAL PROPOSAL

5.1 Financial Management and Fiscal Procedures

5.2 C-BR Budget Request Guidance Procedures

5.3 C-BR Budget Request Guidelines for Determining Types of Costs

5.4 Principles for the Proper Allocation of Administrative/Program Costs, and Unallowable Costs . 52

5.5 C-BR Combined RFP Budget Request and Budget Tables

5.6 Cost Justification (C-J)

SECTION 6 – EVALUATION PROCESS

6.1 Evaluation Committee

6.2 Evaluation and Selection Process

6.3 Responsiveness Review

6.4 Evaluation Selection Criteria

6.5 Award Selection

6.6 Notification of Selection

SECTION 7 – NOT APPLICABLE

SECTION 8 – RISK MANAGEMENT AND INSURANCE REQUIREMENTS

SECTION 9 – CONTRACT INFORMATION AND SAMPLE CONTRACT

ATTACHMENTS

SECTION 10 – EXHIBITS

Exhibit 1: Purchasing Forms

a. Form A: Georgia Security and Immigration Contractor Affidavit and Agreement

b. Form B: Georgia Security and Immigration Subcontractor Affidavit (Not Applicable)

c. Form C: Disclosure Form & Questionnaire

d. Form D: Local Preference (Not Applicable)

e. Form E: Service Disabled Veterans (Not Applicable)

f. Exhibit A: Promise of Non-Discrimination

g. Exhibit B1: Schedule of Intended Subcontractor Utilization (Not Applicable)

h. Exhibit B2: Subcontractors & Suppliers Form (Not Applicable)

i. Exhibit C: Subcontractor Contact Form (Not Applicable)

j. Insurance and Risk Management Signature Page

Exhibit 2: T-P Technical Proposal and C-P Cost Proposal Template Exhibit 3: C-BR Combined RFP Budget Request (Excel Format) Exhibit 4: FY25-FY29 Service Category Plan Tables (Excel Format) Exhibit 5: Proposal Forms

a. Evidence of Tax-Exempt Status

b. Indirect Cost Rate Letter

SECTION 11 – APPENDICES TO REVIEW

Appendix 1: Priority Service Definitions Appendix 2: SF-424B Non-Construction Programs Appendix 3: PHS 5161 – Federal Assurances Appendix 4: Employment Report Appendix 5: OAHS Expectations Appendix 6: Compliance with Legislative Mandates Appendix 7: Agency Roles by Service Category Appendix 8: Sample Contract

25RFP1343702B-PS

SECTION 1 – INTRODUCTION

1.1 PROJECT DESCRIPTION

Fulton County, Georgia (“County”) is Fulton County is seeking proposals from qualified service providers from Barrow, Bartow, Carroll, Cherokee, Clayton, Cobb, Coweta, DeKalb, Douglas, Fayette, Forsyth, Fulton, Gwinnett, Henry, Newton, Paulding, Pickens, Rockdale, Spalding, or Walton Counties to provide core medical and support services for low-income Persons Living with HIV (PLWH) in the 20-county Atlanta Eligible Metropolitan Area (EMA) via the Ryan White Part A (RWPA) grant which includes the Minority AIDS Initiative (MAI) and from Cobb, Clayton, DeKalb, Fulton, and Gwinnett Counties for Persons Living with HIV (PLWH) regardless of income via the Ending the HIV Epidemic (EHE) grant.

The green sections are the general parts of the application that all potential agencies must complete when requesting any of the following funding.

The dark blue sections denote Ryan White Part A (RWPA) services. Applicants who are seeking RWPA funding must review this section for guidance when requesting RWPA funding.

The light blue sections denote the Minority AIDS Initiative Funding services. Applicants seeking this funding must review this section for direction when requesting MAI funding.

Note: You cannot apply for MAI without applying for RWPA funding.

The orange sections denote Ending the Epidemic (EHE) services. Applicants who are seeking EHE funding must review this section for direction when requesting EHE funding.

By applying for funding under this RFP Proposer acknowledges that, if awarded, County will determine the most appropriate funding source (RWPA/MA/EHE) and priority category.

However, applicants can apply for all three funding streams, or RWPA and EHE, or EHE only.

Through the issuance of this Request for Proposals (“RFP”), the County is soliciting proposals from qualified Proposers/Offerors for the Fulton County “HIV Emergency Relief Project Grants” hereinafter “Ryan White Part A Program” or “RWPA” and the “Ending the HIV Epidemic: A Plan for America – Ryan White HIV/AIDS Programs Parts A and B” hereinafter “Ending the HIV Epidemic” or “EHE” (for more information see:

https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview). RWPA includes Minority AIDS Initiative (MAI) funding https://ryanwhite.hrsa.gov/about/parts-and-initiatives/part-f-minority-aids-initiative. Fulton County is issuing this competitive Request for Proposal to fund programs in the Atlanta EMA that demonstrate proficiency working with PLWH to achieve positive health outcomes. As part of this RFP process, Fulton County will fund culturally competent programs offering an array of Ryan White core medical and support services that directly address the needs of EMA residents disproportionately impacted by HIV. These programs will exist within a jurisdiction-wide continuum of care network that provides services in a consistent, cost-effective manner;

coordinates effectively with other service providers; and minimizes duplication of effort. To be eligible for funding under this RFP, you must be a business, including those registered as a federal 501(C) (3), or as a nonprofit organization registered with the Secretary of State to do business in the State of Georgia, or be a Georgia state local health jurisdiction or a Tribal health jurisdiction.

Funding under this announcement is provided by the United States Department of Health and Human Services, Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB), Division of Metropolitan HIV/AIDS Programs. This program announcement is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, applications can be processed, and funds can be awarded in a timely manner.

Funds will be awarded to organizations that have demonstrated success in improving the health outcomes of clients. The amount awarded to each successful applicant will be based on the merits of the proposal. Proposals will be evaluated according to the evaluation criteria outlined in this RFP. Ranked proposals will typically be funded in order; however, proposals may be funded outside of rank order to ensure geographic coverage. Allocation of funds will be made in a fair and equitable manner that does not discriminate based on race, color, creed, national origin, gender, sexual orientation, or religion of clientele served by an agency, community-based organization or institution requesting funds. Funds will be awarded to organizations that have https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview.

https://ryanwhite.hrsa.gov/about/parts-and-initiatives/part-f-minority-aids-initiative demonstrated success in improving the health outcomes of clients. It is expected that funds will contribute to the replication, continuation, or expansion of an existing program or HIV services.

Proposals provided in response to this RFP that comply with the submittal requirements set forth in Sections 4.0 and 5.0, including all forms and certifications, will be evaluated in accordance with the criteria and procedures described in Section 6.0. Based on the results of the evaluation, the County will award the RWPA and EHE service funds to the most advantageous Proposers based on the cost and the evaluation factors set forth in the RFP. The County reserves the right to award any service in whole or in part if proposals suggest that doing so would benefit the County.

The amount awarded to each successful applicant will be based on the merits of the proposal. Proposals will be evaluated according to the evaluation criteria outlined in this RFP. Ranked proposals will typically be funded in order; however, proposals may be funded outside of rank order to ensure geographic coverage.

By applying for funding under this RFP Proposer acknowledges that, if awarded, the County will determine the most appropriate funding source (RWPA/MAI/EHE) and priority category.

RWPA and EHE funds are awarded to the Chairman of the Board of Commissioners of Fulton County, who serves as the Chief Elected Official (CEO) of the Atlanta EMA and is responsible for administering the funds in accordance with applicable local laws and regulations. The Metropolitan Atlanta HIV Health Services Planning Council (Planning Council), whose members are appointed by the Chairman, prioritizes service categories, and allocates funds for RWPA and designs service directives that drive the development of RWPA programs.

Allocation of funds will be made in a fair and equitable manner that does not discriminate based on race, color, creed, national origin, gender, sexual orientation, or religion of clientele served by an agency, community-based organization or institution requesting funds.

Ryan White Part A (RWPA) (Dark Blue) RWPA funds provide direct financial assistance to EMAs that have been the most severely affected by the HIV epidemic to assist in developing or enhancing access to a comprehensive continuum of high quality, community-based care for low-income individuals and families with HIV disease. As defined by the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB), a comprehensive continuum of care consists of core medical services. Care must include access to antiretroviral and other drug therapies, including prophylaxis and treatment of opportunistic infections as well as combination antiretroviral therapies. Comprehensive HIV/AIDS care beyond core medical services must include only those essential support services that enable individuals to access and remain in primary medical care and improve their medical outcomes.

Eligibility to apply for Part A funds shall be open to not-for-profit private or public agencies/organizations that provide HIV health care and essential supportive services for individuals with HIV disease and their families in the Atlanta EMA and meet the qualifications set forth by HRSA, the Metropolitan Atlanta HIV Health Services Planning Council, and the Fulton County Ryan White Program (FCRWP). Complete Exhibit 5: Proposal Forms

a. Evidence of Tax-Exempt Status.

Eligible recipients include hospitals, community-based organizations, hospices, ambulatory care facilities, community health centers, migrant health centers, homeless health centers, substance abuse treatment and mental health programs (42USC 300ff-14(b)(2)). Private for-profit entities may apply for these funds if they can document they are the only available providers of quality HIV services for a specific service category in the geographic area they intend to serve.

To be considered for RWPA funds, applicants must have at least one-year experience in providing direct services within each category for which they apply. It is not required that the requisite experience is HIV-specific. However, applicants lacking HIV experience must demonstrate the ability to transition into this field of service and provide care (medical or non-medical) to PLWH.

Minority AIDS Initiative (MAI) (Light Blue) As a component of the Ryan White Treatment Extension Act of 2009, the Minority AIDS Initiative (MAI) provides funding for activities aimed at eliminating the disproportionate impact of HIV/AIDS on racial and ethnic minority populations. Funded activities must be designed to increase the number of minorities aware of their HIV status, facilitate access to and retention in medical care, improve health outcomes, and reduce health disparities.

Applicant organizations must document a history of working with the Atlanta EMA minority communities (program reports, journal articles, annual activity reports, other documentation); must have recognized programs located within the minority community; must document linkages with the minority communities (formal agreements of collaboration, memoranda of agreement or understanding, contracts or subcontracts with other minority organizations and/or organizations serving predominantly minority populations); must demonstrate their history of, or describe plans for, coordinating services and cooperating with other agencies providing HIV/AIDS-related services; must demonstrate history of and capacity to continue to provide services in a culturally appropriate way (other program descriptions, staff and governing board composition, etc.). All organizations applying for this funding must be linked with and aware of HIV counseling and testing sites, hospitals, clinics, and key HIV service providers.

Agencies selected for funding will be responsible for implementing innovative and effective (evidence-based/informed) interventions and service delivery models to improve HIV-related health outcomes among minority populations. These interventions should target persons out of care or unaware of their status as identified in the most recent Integrated Plan (see: https://endhivatl.org/resources/georgia-integrated-hiv-prevention-care-plan-2022-2026/ ).

HRSA has funded numerous innovative and effective interventions for minority populations. Applicants may find the following useful to assist with program implementation of initiatives.

Building Futures: Youth Living with HIV at HRSA HAB Building Futures: Supporting Youth Living with HIV |

TargetHIV The Center for Engaging Black MSM Across the Care Continuum (CEBACC) at https://targethiv.org/cebacc E2i: Using Evidence-Informed Interventions to Improve Health Outcomes among People Living with HIV at https://targethiv.org/e2i Using Community Health Workers to Improve Linkage and Retention in Care at https://targethiv.org/chw Integrating HIV Innovative Practices (IHIP) at https://targethiv.org/ihip) o Resources on the IHIP website include easy-to-use training manuals, curricula, case studies, pocket guides, monographs, and handbooks, as well as informational handouts and infographics about SPNS generally. IHIP also hosts TA training webinars designed to provide a more interactive experience with experts, and a TA help desk exists for you to submit additional questions and share your own lessons learned.

Replication Resources from the SPNS Systems Linkages and Access to Care at https://targethiv.org/library/replication-resources-spns-systems-linkages-and-access-care o There are Intervention manuals for patient navigation, care coordination, state bridge counselors, data to care, and other interventions developed for use at the state and regional levels to address specific HIV care continuum outcomes among hard-to-reach people with HIV.

Ending the HIV Epidemic (EHE) (Orange) The Ending the HIV Epidemic: A Plan for America (hereafter referred to as “EHE” or “initiative”) has four pillars, or key strategies:

https://endhivatl.org/resources/georgia-integrated-hiv-prevention-care-plan-2022-2026/ https://endhivatl.org/resources/georgia-integrated-hiv-prevention-care-plan-2022-2026/ https://targethiv.org/library/hrsa-hab-building-futures-supporting-youth-living-hiv https://targethiv.org/library/hrsa-hab-building-futures-supporting-youth-living-hiv https://targethiv.org/cebacc https://targethiv.org/e2i https://targethiv.org/chw https://targethiv.org/ihip https://targethiv.org/library/replication-resources-spns-systems-linkages-and-access-care

The Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC), along with the National Institutes of Health (NIH) Centers for AIDS Research (CFARs), the Indian Health Service (IHS), and the Substance Abuse and Mental Health Services Administration (SAMHSA) are collaborating on the implementation of each of these Pillars. At the most general level:

Pillar One is led by CDC and, among many activities, includes working with the HRSA Health Center

Program to increase testing among Health Center Program patients;

Pillar Two is led by HRSA and focuses on providing access to HIV care and treatment through the

RWHAP and the Health Center Program, including working with CDC funded organizations and/or CDC staff to link people with HIV, newly diagnosed or re-identified through testing programs, to care;

Pillar Three is co-led by CDC and HRSA with the HRSA Health Center Program focusing on providing Pre-Exposure Prophylaxis (PrEP) related outreach, care coordination, medical services and medications supported by CDC efforts to promote PrEP among populations needing PrEP services as well as other prevention activities, such as syringe services programs (SSPs); and, Pillar Four is led by CDC to rapidly detect HIV clusters and networks with support from the HRSA RWHAP and Health Center Program to provide HIV care and treatment or PrEP services through the Health Center Program, as applicable.

EHE funds provide direct financial assistance to jurisdictions that have been identified by the federal government as geographic hotspots where new HIV transmissions are highly concentrated. The purpose of EHE is to implement strategies, interventions, approaches, and core medical and support services to reduce new HIV infections in the United States.

In working toward national EHE goals, the Department for HIV Elimination (DHE) is focused on care and treatment services for PLWH to help them reach and maintain viral suppression (Pillar Two). By increasing the number of clients that maintain viral suppression, we can contain the spread of the virus and in turn, reduce the number of new HIV cases. We must find ways to adapt our systems to address HIV-related stigma, social/structural influencers of health, and barriers to make services available for all, and not just some. This will require disruptive innovation of the care system to change the way in which we respond to service needs.

Organizations funded under EHE must:

1. Augment and interact with the RWHAP Part A Continuum of CARE in place to serve eligible low-income

PLWH in the 20-county Atlanta Eligible Metropolitan Area (EMA).

2. Operate a physical site and/or deliver services with no physical site in at least one of the following jurisdictions: Cobb, Clayton, DeKalb, Fulton, or Gwinnett Counties.

3. Be governed by a Board of Directors.

4. Be a community-based organization, community health center, Federally Qualified Health Center, hospital, health department, mental health center, substance abuse treatment center, university, migrant health center, faith-based organization, housing provider, tribal government, nonprofit organization or private for-profit organization.

5. Have a functioning accounting system that is operated in accordance with generally accepted accounting principles or an agreement with a designated eligible entity that maintains such information and acts as the respondent’s fiscal agent.

6. Be Medicaid-certified if providing services that are Medicaid-eligible.

7. Have all required licenses and certifications required by appropriate government agencies to perform the proposed services and procure all permits and pay all charges, taxes and fees.

1.2 SERVICE CATEGORIES ELIGIBLE FOR FUNDING

All services must be consistent with Public Health Service (PHS) Treatment Guidelines and all other applicable professional regulations and licensure requirements. For the PHS treatment guidelines see: https://aidsinfo.nih.gov/guidelines.

The following priorities represent services eligible for funding under this RFP. Definitions of the RWPA service activities within each category and subcategory that are eligible for funding may be found in Appendix 1: Priority Service Definitions.

Applicants are encouraged to request funds for multiple service categories and to demonstrate a coordinated continuum of core medical and support services that meet the needs of the clients served.

Ryan White Part A (Dark Blue)

RWPA NON-MAI

Core Medical Services CATEGORY Anticipated Funding

Health Insurance Premium and Cost Sharing Assistance including Dental Insurance (HIPCSA)

$260,832

Medical Case Management, including Treatment Adherence Services (MCM)

$2,110,859

Medical Nutrition Therapy (MNT) $231,063 Mental Health Services (MH) $1,911,933 Oral Health Services (OH) $2,402,260 Outpatient/Ambulatory Health Services (OAHS) See Appendix 5:

OAHS Expectations

$12,908,214

OAHS ADAP Formulary Stop Gap Medications (OAHS STOP) $1,098,667 Substance Abuse Treatment Services - Outpatient (SA-O) $1,561,599

Support Services CATEGORY Anticipated Funding

Child Care Services (Child) $36,379 Emergency Financial Assistance (EFA) $28,488 Food Bank/Home-Delivered Meals (Food) $ 1,356,814 Linguistics Services (LING) $104,333 Medical Transportation (TRANSP) $196,345 Non-Medical Case Management (NMCM) $352,123 Non-Medical Case Management – Patient Navigation (NMCM NAV) $195,624 Other Professional Services (OPS - LEGAL) $93,899 Psychosocial Support (PS) $339,081 Referral for Health Care and Support Services (REF) $894,654 https://aidsinfo.nih.gov/guidelines

OAHS services may include drop-in clinics and medical street teams.

OAHS services should also focus on testing and treatment of STIs among RWPA, MAI, EHE supported clients.

OAHS services may include Medical Adherence Specialists who will recruit and accept referrals to assist with medication adherence strategizing with newly diagnosed, persons struggling with adherence to ART and those in care not-virally suppressed.

Minority AIDS Initiative (MAI) (Light Blue)

MAI

Core Medical Services

CATEGORY Anticipated Funding

Health Insurance Premium and Cost Sharing Assistance including Dental Insurance (HIPCSA MAI)

$101,435

Medical Case Management, including Treatment Adherence Services

(MCM MAI)

$64,918

Mental Health MAI (MH MAI) $19,696 Outpatient/Ambulatory Health Services (OAHS MAI) Appendix 5:

OAHS Expectations

$2,173,598

OAHS ADAP Formulary Stop Gap Medications (OAHS STOP MAI) $289,857 Support Services

CATEGORY Anticipated Funding

Food Bank/Home-Delivered Meals (Food MAI) $67,526 Medical Transportation MAI (TRANSP MAI) $14,491 Non-Medical Case Management MAI (NMCM MAI) $127,755 Referral for Health Care and Support Services MAI (REF MAI) $38,855

Telecare services are available under RWPA and MAI.

Ending the HIV Epidemic (Orange Section) It is anticipated that the federal award will be $5 million to $6 million. Funds will be used to:

Provide access to HIV care.

Increase capacity for established programs with demonstrated outcomes to further the reach of their work in the community or to expand their services to a larger population.

Increase the number of clients able to reach and maintain viral suppression.

Increase the number of clients brought into care including reengaged clients, individuals aware of their status but never in care, and individuals newly aware of their HIV status.

Implement innovative projects to address HIV-related stigma, social/structural influencers of health, gaps in the health care delivery system and barriers to make services available for all.

Facilitate access to RWPA by allowing services to be initiated while working on meeting the RWPA eligibility requirements.

Annual funding estimates for EHE are not included. Proposer should request such sums as necessary to perform the activities described in your response to this RFP to serve the proposed number of clients with the proposed number of service units.

Arts, Media, Culture (AMC)

This category will focus on projects that blend visual art, media, and marketing with messages of empowerment and advocacy, which seek to influence social norms.

Examples of projects that could be funded in this category include but are not limited to:

Visual art and storytelling project to destigmatize HIV and encourage retention in care. Includes support for Arts Program Coordinators, and peer stipends, to support arts workshops to improve overall patient wellness and improve clinical outcomes.

Media campaigns which seek to challenge social norms or engage/re-engage clients that have been lost to care.

Marketing campaigns which increase awareness of HIV services provided in jurisdiction.

Effective Behavioral Interventions

Behavioral interventions are designed to affect the actions that individuals take about their health. Behavioral interventions can be implemented on three levels- the individual level, community level and systems level.

Individual level interventions aim to change knowledge, attitudes, beliefs, practices, and behaviors of individuals. Community level interventions seek to change community norms, community attitudes, community awareness, community practices, and community behaviors. System level interventions changes organizations, policies, laws, and power structures. The focus is not directly on individuals and communities but on the systems that impact health. Effective behavioral interventions use a continuum of integrated policies, strategies, activities, and services whose effectiveness has been proven or informed by research and evaluation.

For replication of evidence informed interventions please refer to:

Compendium of Evidence-based Interventions and Best Practices for HIV Prevention. Applicants should identify an intervention from one of the compendium chapters: Structural Interventions; Linkage to, Retention in, and Re-Engagement in HIV Care (LRC); Medication Adherence; or Risk Reduction:

https://www.cdc.gov/hiv/research/interventionresearch/compendium/index.html

Care and Treatment Interventions: https://targethiv.org/deii/deii-resources Special Projects of National Significance (SPNS): https://targethiv.org/library/hiv- care-innovations-replication-resources Examples of EBIs targeted for funding under this RFP include:

Project Strength Through Youth Livin’ Empowered (STYLE) 2.0 Enhanced Patient Navigation (EPN) for Women of Color PL Cares Viviendo Valiente Cognitive Processing Therapy Tailored Motivational Interviewing Rapid Antiretroviral Start Protocol

EFFECTIVE BEHAVIORAL INTERVENTIONS (EBI)

EBI – Linkage to HIV Care EBI – Retention in HIV Care EBI – Re-Engagement in HIV Care EBI – Medication Adherence EBI – Risk Reduction https://www.cdc.gov/hiv/research/interventionresearch/compendium/index.html https://targethiv.org/deii/deii-resources https://targethiv.org/library/hiv-care-innovations-replication-resources https://targethiv.org/library/hiv-care-innovations-replication-resources

EBI – People in care, but not Virally Suppressed

Innovative Project Support (IPS)

Innovative Project Support Initiatives will utilize novel approaches to transform the current system of care.

Innovative projects will be designed to address social determinants of health, increase quality of life, and improve health outcomes.

Projects that focus on care and treatment services for people living with HIV, to help them reach and maintain viral suppression.

Examples of projects that could be funded in this category include but are not limited to:

Viral Suppression Awards/Incentives - for clients who are medically compliant, achieve and remain in medical treatment and work on goals of becoming virally suppressed Emergency Room Patient Navigation Partner with local emergency departments to ensure individuals are tested, linked to care, and started on

ART.

Black Barbershop Physician Network Faith-Based Projects Emergency Access to Medications for Individuals with Expired Prescriptions Behavioral interventions designed to affect the actions that individuals take regarding their health.

Services to improve quality of life and overall well-being. Life skills-training including job readiness, resume building, financial planning, self-awareness, time management, interpersonal communication, decision making, and furthering education.

Special Projects of National Significance (SPNS): https://targethiv.org/library/hiv- care-innovations-replication-resources

INNOVATIVE PROJECT SUPPORT (IPS)

IPS – Linkage to HIV Care IPS – Retention in HIV Care IPS – Re-Engagement in HIV IPS – Medication Adherence IPS – Risk Reduction IPS – People in care, but not Virally Suppressed

Non-Traditional Services (NTS) Provides a means for clients to access HIV services outside of the traditional clinical setting. Non-traditional services are client centered and focus on meeting clients where they are. Services provided in this category should center on the convenience of care for clients.

Examples of projects that we are seeking to fund include but are not limited to:

Home Health Delivery Multi-Month ART Dispensing ART starter packs for new clients; ART gap packs for existing clients Online Support Group Telehealth including Client Telecare Tablets to increase clients access to care and mitigate the burden many clients have due to lack of access to video-ready devices and/or reliable internet connection.

Disease Investigation Specialists who will focus on HIV Cluster Detection and Response in furtherance of Pillar Four. This is particularly appropriate for entities who provide HIV testing services, partner services, and RWPA/MAI/EHE.

EHE Ryan White Services (RWS) EHE services under this category are those described in HRSA HAB PCN 16-02 services.

Additionally, RWS includes:

Peer staff who are important members of care teams Community Health Workers should be integrated into service teams Linkage Coordinators

Increase access to subrecipient clinics through same day appointments, extended hours, and next available appointment of fifteen days or less.

Medical street teams

Mobile health units

Spanish speaking staff Services for the deaf and hard of hearing Differentiated service delivery in underserved communities with high incidence rates

Further clarification:

HOUSING: Rapid Rehousing is an effective housing solution for people with Substance Abuse, HIV/AIDS, and Mental Health Issues. Rapid rehousing is an evidence-based housing intervention that quickly connects families and individuals at risk or literally homeless to permanent housing through a customized package of assistance that includes time-limited financial assistance and targeted supportive services. Rapid rehousing programs help unstably housed persons solve the practical and immediate challenges to obtaining permanent housing while linking to community resources that enable them to achieve healthcare access and housing stability in the long-term.

Providers will utilize a “housing is healthcare” and “housing-first” approach to provide transitional, short-term, or emergency housing assistance to enable a client or family to gain or maintain critical outpatient/ambulatory health services and treatment, including temporary assistance necessary to prevent homelessness and to gain or maintain access to medical care.

Funded organizations will be required to: 1) stabilize the client’s housing situation as the priority and 2) then address any additional client needs. Providing housing support to clients under the EHE initiative will help ensure clients’ ability to secure and/or maintain safe, decent, and affordable housing. With less concern about their housing situation, clients can focus more attention on their adherence to HIV treatment.

Numerous studies have shown that unstable housing status is independently associated with poor HIV health outcomes. By improving the housing status for people experiencing homelessness or housing instability, EHE will facilitate linkages to and retention in ongoing core medical and behavioral health services [i.e., medical care, antiretroviral medications (ARVs), medical case management, mental health counseling, substance use disorder services, etc.] available throughout the community.

Services include emergency housing, rental, and utility subsidies, moving incidentals, linkage to additional services, vocational and life skills support, and housing case management to develop and implement a plan to ensure ongoing housing stability by improving opportunities to increase client income through employment or access to benefits, securing permanent tenant based rental assistance, or placement in permanent supportive housing.

EHE Data Infrastructure Development and Systems Linkages (DID)

Associated with the development and expansion of data systems. Includes information systems capabilities, systems, and processes - bridging existing systems (interfaces with e2Fulton) to achieve data integration, improving data entry to decrease burden and increase accuracy.

Quality Management Category Anticipated Funding

QM Program Infrastructure (QM) $610,000 Performance Measurement (PM)

Quality Improvement (QI)

1.3 ADDITIONAL FUNDING INFORMATION

EXPECTATIONS:

HOURS OF OPERATION: Funded entities shall provide a reasonable level of services in early morning

(before 8:00 am), evenings and/or weekends to facilitate access by PLWH. Services must be available in early morning and/or evening (until at least 8:00 pm) two nights per week and at least one-half day every other weekend. Services hours should reflect client preferences as identified in a client survey.

RAPID ENTRY INTO CARE: It is expected that all OAHS funded entities provide care within 3 days for newly diagnosed or newly re-engaged patients. Patients must see a clinician to initiate HIV health care (meet with a medical care provider for a comprehensive physical and medical history including baseline lab testing for CD4 count and viral load and initiation of therapy as appropriate - Request may include initiation of care via clinicians on mobile HIV testing units so long as privacy can be maintained), be offered ART, receive counseling (A full discussion should occur with the patient regarding the risks and benefits of immediate ART.

The role of viral load monitoring should be included in this discussion to introduce the concept and therapy goals. Clients must be counseled on the importance of being in close contact with the health system during early months of treatment should any complications arise related to medication or HIV disease and agree on a sustainable care plan on the day of their diagnosis or re-engagement, or within 2-3 days if same-day initiation is not possible. Refer to Appendix 5: OAHS Expectations.

USE OF e2Fulton: All RWPA/MAI/EHE-funded agencies must utilize e2Fulton. This will require that agencies utilize e2Fulton to upload documents that shows eligibility status determination for clients, enter service utilization (including client demographic, client stage of illness and co-morbidity data), clinical quality management, budget and invoicing, client referrals, and HRSA/HAB Clinical Performance Measurement data.

o All DHE agencies referring to other DHE funded agencies for DHE funded services must use the e2Fulton referrals module. Referrals must be processed following PPPN-075: Referral Timelines.

ANTIRETROVIRAL THERAPY (ART): Increase the immediate administering of Antiretroviral Therapy (ART); monitor and track data to ensure all rapid entry providers review patient plans for immediate, long-term care, follow-up, and documentation of patient outcomes.

OAHS STOP-GAP MEDICATIONS: The expectation is that individuals new to care or returning to care will be provided with a prescription for ART and enough medications to cover the individual for 30 days. OAHS Stop Gap Medications may be used for the following:

i. For the immediate initiation of ART (also see OAHS Expectations

ii. For the provision of sufficient medications to cover the period between initiation of ART and the beginning of coverage by the AIDS Drug Assistance Program or a Patient Assistance Program

iii. To prevent the interruption of ART in situations where a client has, or is about to, run out of medications Stop Gap Medications can be provided until the client is able to secure on-going medication provision

TIME & EFFORT AND COST ALLOCATION: The proposer must have financial control procedures in place, including Cost Allocation Plan, and Time and Effort reporting system to verify the actual work performed by staff charged to RWPA/MAI/EHE. The proposer must have a process in place used by program and fiscal staff to ensure adequate reporting, reconciliation, and tracking of program expenditure by funding source and program income. The proposer must have a process for reimbursing subcontractors, from the time an invoice is received to payment.

SPANISH-SPEAKING PROVIDERS: To the greatest extent possible, funded subrecipients must have available during regular business hours at least one staff member who is fluent in both English and Spanish. Agencies serving Hispanic/Latino clients must have sufficient bilingual (English/Spanish) staff.

PROPOSED STAFF QUALIFICATIONS: Proposers should state job responsibilities, workload, and lines of supervision. An organizational chart identifying individuals and their job titles and major job duties will be submitted to DHE should proposal be funded. Proposers are required to have one full time employee in the Data Management/Analysis Coordinator role if they plan to serve more than 300 clients. Proposers with fewer than 300 clients are required to have 0.5 FTE Data Management/Analysis Coordinator.

WARM-HAND OFF FOR LINKAGE TO CARE: Funded organizations will be expected to provide a warm hand-off for newly identified / referred clients to be connected (i.e., directly transported by agency staff;

Case Managers should communicate specific client needs; client should be informed of all steps of the care transition; and Case Managers must follow up on care) immediately or timely to ongoing HIV medical care and treatment.

PERFORMANCE MEASURES: All agencies should monitor performance measures (including Viral Load Suppression, Annual Retention in Care, and Prescription of Antiretroviral Therapy) at least quarterly.

Agencies must be prepared to discuss their performance during site visits and quarterly PO calls. Data in e2Fulton should be entered timely and accurately reflect all labs, medications, and visits (see PPPN- 008).

ELIGIBILITY: – If an individual presents for service without proof of HIV status, the person should not be turned away but should immediately be offered a rapid HIV test (reactive tests should be confirmed using a different test). Many applicants for funding under this RFP also receive HIV prevention dollars for HIV testing and that source should be utilized first. If an applicant agency does not receive HIV funding from another source, the applicant should request funds under this RFP for a limited number of tests for eligibility.

• When PLWH are identified as being out of care, their eligibility for various support services and programs will be assessed. EHE resources will be used before Part A/MAI resources, where applicable

QUALITY MANAGEMENT: Per Title XXVI of the Public Health Service Act, legislation mandates RWHAP Part A to establish a Quality Management Program to:

• Assess the extent to which HIV health services provided to patients under the grant are consistent with the most recent Public Health Service guidelines, (otherwise known as the HHS guidelines) for the treatment of HIV disease and related opportunistic infections; and

• Develop strategies for ensuring that such services are consistent with the guidelines for improvement in the access to, and quality of HIV services.

See HRSA PCN 15-02: Clinical Quality Management https://hab.hrsa.gov/sites/default/files/hab/Global/HAB-PCN-15-02-CQM.pdf

All services must be consistent with Public Health Service (PHS) Treatment Guidelines, local service standards and all other applicable professional regulations and licensure requirements. For the PHS treatment guidelines see: https://aidsinfo.nih.gov/guidelines.

For the local service standards by service category see www.endhivatleatl.org for the Atlanta EMA standards of care.

In addition, all subrecipients applying for the funding must ensure the following service expectations are addressed:

QUALITY IMPROVEMENT (QI) PROJECT/ACTIVITY: QI is a process of analyzing performance measure data and implementing activities to improve performance which is required regardless of the size and scope of the RWHAP Part A program. As such, sub-recipients are expected to implement at minimum one (1) QI project annually, in addition to any system-wide QI project. A quality improvement project may also be required if a performance measure for a particular subrecipient is off by more than 5%, has declined by 5%, or if a sub-recipient measured as one of the lowest five performers for a service funded category. In some instances, a corrective action plan will need to be implemented. However, if a sub-recipient is performing at goal for all service funded categories, it may select a QI project on any other measure of interest. Recipient CQM division will monitor the progress of the quality improvement project and/or corrective action plan.

QUALITY MANAGEMENT PLAN: The QM Plan outlines all aspects of a QM program, including an action plan with a timeline and responsible parties. It documents the necessary information required to effectively manage project quality from project planning to delivery. As such all subrecipients are required to submit a QM plan annually that evaluates the effectiveness of the QM program to ensure that the QM activities are making changes that positively affect outcomes.

QUALITY MANAGEMENT PROGRAM EVALUATION: The evaluation of the QM program includes assessing whether QM program activities have been implemented as prescribed by the quality management plan (including the action plan). Subrecipients should regularly evaluate their QM activities to maximize the impact of the program. Evaluation provides the opportunity to learn the processes and resources needed in implementing CQM activities through the collection of detailed information. Part of the evaluation should include identifying factors (i.e., staff acceptance of change, improved clinical performance) that affect the quality improvement activities. Evaluation also identifies effective improvement strategies that can be scaled up or implemented in other facets within a system of care.

Additional elements of an evaluation include effectiveness of the team and its ability to meet timelines and deliverables as described in the action plan to determine the success of the planned process.

DHE Department for HIV Elimination expects each RWPA/MAI/EHE subrecipient to have a robust quality management program. If resources are needed to support quality management activities such funds should be requested.

IMPLEMENTATION: Funded agencies (subrecipients) will be expected to have programs fully staffed and trained within three months of receipt of funding.

TELECARE: Telecare services should be woven throughout the services provided. Telehealth refers broadly to electronic, and telecommunications technologies and services used to provide care and services at-a-distance. Telecare refers to the idea of enabling people to remain independent in their own homes by providing person-centered technologies to support the individual or their caregivers. services are envisioned to be a comprehensive, multi-disciplinary team approach to provide holistic HIV/AIDS care, treatment adherence, retention in care, and wellness. Telecare is a proven strategy to improve health outcomes, but it is only effective if it is accessible. Telehealth simplifies follow-up care and helps remove barriers to treatment adherence. Improved treatment adherence will lead to improved viral suppression. This component reaches new, out of care, and non-adherent people with HIV under EHE Pillar Two. Services include computer hardware and software needed to provide telehealth services in a secure, confidential format compliant with the Health Insurance Portability and Accountability Act (HIPAA).

1.4 MINIMUM AND DESIRED QUALIFICATIONS OF APPLICANTS

Minimum To be eligible for funding under this RFP, you must be licensed to do business in the state of Georgia, or able to become licensed to do so. You must also meet these minimum criteria:

Be a business, including those registered as a federal 501(C) (3), or as a nonprofit organization registered with the Secretary of State to do business in the State of Georgia, or be a Georgia state local health jurisdiction or a Tribal health jurisdiction.

Eligibility to apply for funds shall be open to not-for-profit private or public agencies/organizations that provide HIV health care and essential supportive services for individuals with HIV and their families in the Atlanta EMA and meet the qualifications set forth by HRSA, the Metropolitan Atlanta HIV Health Services Planning Council as appropriate, and the Fulton County Department for HIV Elimination.

Be a community-based organization, community health center, Federally Qualified Health Center, hospital, health department, mental health center, substance abuse treatment center, university, migrant health center, faith-based organization, housing provider, tribal government, nonprofit organization, or private for-profit organization.

Must be governed by a Board of Directors.

Have a functioning accounting system that is operated in accordance with generally accepted accounting principles or an agreement with a designated eligible entity that maintains such information and acts as the respondent’s fiscal agent.

Be Medicaid-certified if providing services that are Medicaid-eligible.

Have all required licenses and certifications required by appropriate government agencies to perform the proposed services and procure all permits and pay all charges, taxes, and fees.

Organizations applying for EHE funds must augment and interact with the RWHAP Part A Continuum of

CARE in place to serve eligible low-income PLWH in the 20-county Atlanta EMA.

Organizations applying for EHE funds must operate a physical site and/or deliver services with no physical site in at least one of the following jurisdictions: Cobb, Clayton, DeKalb, Fulton, or Gwinnett Counties.

Organizations applying for MAI funds must document a history of working with the Atlanta EMA minority communities (program reports, journal articles, annual activity reports, other documentation); must have recognized programs located within the minority community; must document linkages with the minority communities (formal agreements of collaboration, memoranda of agreement or understanding, contracts or subcontracts).

Organizations applying for MAI funds must demonstrate their history of, or describe plans for, coordinating services and cooperating with other agencies providing HIV/AIDS-related services; must demonstrate history of and capacity to continue to provide services in a culturally appropriate way (other program descriptions, staff, and governing board composition, etc.). All organizations applying for this funding must be linked with and aware of HIV counseling and testing sites, hospitals, clinics, and key HIV service providers.

Desired Have a demonstrated history of developing and implementing culturally specific services for PLWH.

Be well-embedded and respected within their community.

Articulate a commitment and willingness to provide HIV services that are culturally relevant, and…