ESBD_383499_1732772949890_RFP Instructions and Guidance.pdf

SOUTH TEXAS DEVELOPMENT COUNCIL

RYAN WHITE PART B ADMINISTRATIVE AGENCY

SOUTH TEXAS HIV ADMINISTRATIVE SERVICE AREA

SOUTH TEXAS

REQUEST FOR PROPOSAL (RFP) NO. 25-01.02.03.

GUIDANCE DOCUMENT

TABLE OF CONTENTS

SECTION I: INTRODUCTION

A. Request for Proposals (RFP)

Proposals are requested from eligible entities in the South Texas HIV Administrative Service Area (HASA) to provide health and social services to eligible persons living with HIV (PLWH).

B. General Information Pertaining to Proposals

1. Ambiguity, Conflict, or Other Errors in Request for Proposals (RFP). If an applicant discovers any ambiguity, conflict, discrepancy, omission, or other error in the RFP, he/she shall immediately notify the South Texas Development Council (STDC), HIV Administrative Agency (AA) of such error in writing and request modification or clarification of the document. A modification will be made by issuing an addendum.

Written notice will be given to all parties who have been furnished the RFP without divulging the source of the request. If an applicant fails to notify STDC prior to the date and time fixed for submission of proposal of an error or ambiguity in the RFP known to the applicant, or an error or ambiguity that reasonably should have been known to the applicant, the applicant shall not be entitled to additional compensation or time by reason of the error/ambiguity or its late resolution. STDC may also modify the RFP prior to the date and time fixed for submission of proposals by issuance of an addendum to all parties who have received the RFP. All addenda will be numbered consecutively beginning with the number one (1).

2. Proposal Preparation Cost. Costs for developing proposals are entirely the responsibility of the applicants and shall not be chargeable to STDC.

3. Economy of Presentation. Proposals should not contain promotional or display materials, except as they may directly answer, in whole or in part, questions contained in the RFP. Such exhibits shall be clearly marked with the applicable reference number of the questions in the RFP. Proposals must address the requirements set forth in the RFP in a concise and clear manner. Proposals that do not address each criterion may be rejected and not considered.

4. Implied Requirements. Services not specifically mentioned in this RFP, but which are necessary to provide the functional capabilities described by the applicant, shall be included in the proposal.

5. Compliance with RFP Specifications. The applicant’s response must coincide with the format of the RFP, as instructed, beginning with page one of the RFP.

6. Status/Disposition of Proposal. All proposals become the property of STDC and will not be returned to the applicant.

7. Contractual Development. The contents of a successful proposal may become contractual obligations if a contract is awarded. Failure of the applicant’s to accept those obligations may result in the elimination of the proposal from the selection process. The contents and requirements of this RFP may be incorporated into any legally binding and duly negotiated contract between STDC and the selected vendor(s).

C. Definitions

1. Administrative Agency (AA) – An entity awarded a contract by the Texas Department of State Health Services to perform administrative, planning, evaluation, data management, and quality management functions for Ryan White Part B, HIV State Services, and Housing Opportunities for Persons with AIDS

(HOPWA) funds. The AA for the South Texas HIV Administrative Service Area is the South Texas Development Council (STDC).

2. Contract – A written document referring to promises or agreements for which the law establishes enforceable duties and remedies between a minimum of two parties.

3. Contract Period or Contract Term – The term of the contract from beginning date to end, or renewal date.

4. Contractor or Service Provider – An entity that is awarded and has entered into a contract with STDC under this RFP.

5. Cost Reimbursement – A payment mechanism in which funds are provided to carry out approved activities based on an approved eight (8) line category budget. Amounts spent in support of these activities shall be billed on a monthly basis for reimbursement. Indirect costs are a separate cost group in the budget.

6. Debarment – An exclusion from contracting or subcontracting with state agencies on the basis of cause set forth in Title I, Texas Administrative Code, 113.101-113.108, commensurate with the seriousness of the offense, performance failure, or inadequacy to perform.

7. Deliverables – Goods or services contracted for delivery or performance.

8. Fee For Service – Payment mechanism for services that are reimbursed at an agreed rate per unit of service.

9. HIV Administrative Service Area (HASA) – Texas is divided into six HASAs, with each HASA containing one or more HIV Service Delivery Areas. An administrative agency is responsible for providing administrative and planning services for the entire HASA they cover. The South Texas HASA includes the following HSDAs: Brownsville, Corpus Christi and Laredo.

10. HIV Service Delivery Area (HSDA) – Texas is divided into 27 HSDAs for the purposes of allocating direct client services funds for medical and psychosocial support services.

11. Indirect Costs – A cost not readily assignable to a particular program and is incurred for a common purpose that benefits more than one program, i.e., general administrative costs. See the Texas Grants Management Standards available online at: https://comptroller.texas.gov/purchasing/grant-management/.

12. Project – A description of the overall goal or mission of the grant or contract.

13. Project Period – The entire anticipated period of the project, including the initial contract period and each renewal contract period, until the next competitive cycle is in place.

14. Respondent (or Applicant) – Entity that submits a proposal in response to this RFP.

15. Scope of Work or Statement of Work – A statement outlining the specific services a contractor is expected to perform, indicating the type, level, and quality of service, as well as the time schedule required.

16. Sliding Fee Scale - The schedule detailing the sliding fee discount (if any) for each service provided by category. Each individual who qualifies for a sliding fee discount during the registration process is assigned a category based on income and family size.

17. Subcontractor – An entity awarded funds to perform a portion of the scope of work by the entity contracting with STDC as a result of this solicitation.

18. Vendor Identification Number (ID #) – Fourteen-digit number needed for any entity to contract with the State of Texas, and which must be set up with the State Comptroller’s Office. It consists of a ten-digit vendor number (IRS number, state agency number, or social security number) + check digit + mail code.

Section II. CONTENT AND PREPARATION

A. Application Order

Applications should be organized in the following order:

* All forms must be included. If any forms are not applicable to your agency, write N/A on the forms and include the forms in your application packet. All of the following forms are available in the “FY25 RFP Narrative Forms” document (MS Word format) or in the “FY25 RFP Budget Forms” workbook (MS Excel format).

REQUIRED FORMS LOCATION OF FORM

R eq ui re d F or m s fo r A ll

A pp lic an ts

1. Form A: Face Page – Proposal for Financial Assistance 2025 RFP Narrative Forms

2. Form B: Contact Person Information 2025 RFP Narrative Forms

3. Form C: Administrative Information (including recent Audit, Financial Statements)

2025 RFP Narrative Forms

4. Form D: Organizational Capacity and Experience (including Organizational Chart)

2025 RFP Narrative Forms

5. Form H – Form P: Assurances Appendix F – Assurances eq ui re d fo r

R ya n W hi te

6. Form E-1: Performance Measures 2025 RFP Narrative Forms

7. Form E-2: Work Plan (Part 1) (Combined for Ryan White and States)

2025 RFP Narrative Forms

8. Form E-3: Work Plan (Part 2) 2025 RFP Narrative Forms

9. Categorical Budget Justification 2025 RFP Budget Forms

10. Budget Allocation Form 2025 RFP Budget Forms

11. Subcontractor Data Sheet 2025 RFP Budget Forms ui re d fo r

S ta te S er vi ce s

12. Form E-1: Performance Measures FY24 RFP Narrative Forms

13. Form E-3: Work Plan (Part 2) FY24 RFP Narrative Forms

14. Categorical Budget Justification FY24 RFP Budget Forms

15. Budget Allocation Form FY24 RFP Budget Forms

16. Subcontractor Data Sheet FY24 RFP Budget Forms ui re d fo r H

O P

W A

17. Form E-1: Performance Measures FY24 RFP Narrative Forms

18. Form E-2: Work Plan FY24 RFP Narrative Forms

19. Form E-3: HOPWA Project Sponsor Data Sheet FY24 RFP Narrative Forms

20. Form F: Certification of Categorical Exclusion FY24 RFP Narrative Forms

21. Categorical Budget Justification FY24 RFP Budget Forms

B. Instructions for Preparation

The proposal should be developed and submitted in accordance with the instructions outlined in this section.

The proposal should meet the following stylistic requirements:

− All pages clearly and consecutively numbered, including tables and support documents.

− Typed and single spaced using 12-point font.

− Margins should not be less than the margins set in the forms and documents provided.

− Blank forms provided by STDC MUST be used (INCLUDING BUDGETS)

− Include the page numbers in the Proposal Table of Contents and Checklist in the FY25 RFP Narrative Forms document – this should be used as your table of contents.

− Face page and all forms requiring a signature must be signed.

− One (1) original (clearly marked “Original”)

− Three (3) copies (clearly marked “Copy”)

− One (1) USB flash drive (electronic copy of proposal)

− Do not include photos, pamphlets, or over-sized documents.

All responses to this RFP must conform to these instructions. Failure to conform may be considered an appropriate cause for rejection of the response.

C. Blank Forms and Instructions

This section includes instructions for completing the forms required for this proposal. All blank forms are included and released as part of the RFP Packet. There are different documents that contain the forms for this proposal. The forms for the narrative portions of the proposal are in Microsoft Word format. The budget forms and Table 2 are in a Microsoft Excel format.

If applying for more than one funding source (Ryan White, State Services, and/or HOPWA), you must clearly distinguish when your response is specific to a particular funding source or service category. Also, performance measures, work plans and budgets must be submitted for each funding source separately, where required. See B above, as well as the application checklist in the forms packet, to ensure you include all required documents. Please submit any questions you have in accordance with the written inquiries’ guidelines regarding the forms or proposal preparation and content. STDC is not responsible for proposals that are submitted incorrectly or incompletely.

**The following pages include examples and instructions of required forms for this proposal. Not all forms may have separate instructions. Some forms may have short instructions included in the forms document. Please make sure you complete all of the required forms in the RFP forms document and budget forms as outlined in the proposal checklist. **

D. Guidance on RFP Forms

FORM A: INSTRUCTIONS

This form provides basic information about the applicant and the proposed project with STDC, including the signature of the authorized representative. It is the cover page of the renewal and is required to be completed. Signature affirms that the facts contained in the applicant’s response are truthful and that the applicant is in compliance with the assurances and certifications contained in the identified Competitive Request for Proposal and the original STDC contract, any renewal(s) or amendment(s). Applicant acknowledges that continued compliance is a condition for the renewal of a contract. Please follow the instructions below to complete the face page form and return with the applicant’s response.

1. Legal Business Name: Enter the applicant’s legal name.

2. Mailing Address: Enter the applicant’s complete mailing address, city, county, state, and 9-digit zip code.

3. Payee Mailing Address: Enter the payee’s complete mailing address, city, county, state, and 9-digit zip code.

4. Unique Entity Identification (UEI) Number: Enter the applicant’s Unique Entity Identification

(UEI) number. The UEI is a 12-character, alphanumeric value. This number is required if receiving ANY federal funds and can be obtained at: https://sam.gov/content/home

5. Federal Tax ID, Texas Comptroller Vendor ID, or Social Security Number: Enter the applicant’s Federal Tax Identification Number, Texas State Comptroller Vendor Identification Number, or Social Security Number (nine, fourteen, or nine digits respectively). *The applicant acknowledges, understands, and agrees that the applicant's choice to use a Social Security number as its vendor identification number for the contract, may result in the Social Security number being made public via state open records requests.

6. Type of Entity: Check the type of entity as defined by the Secretary of State at http://www.sos.state.tx.us/corp/businessstructure.shtml and/or the Texas State Comptroller at https://fmx.cpa.state.tx.us/fmx/pubs/tins/tinsguide/2009-04/TINS_Guide_0409.pdf and check all other boxes that describe the entity.

• Historically Underutilized Business: A minority or women-owned business as defined by Texas Government Code, Title 10, Subtitle D, Chapter 2161.

(http://www.window.state.tx.us/procurement/prog/hub/)

• State Agency: an agency of the State of Texas as defined in Texas Government Code §2056.001.ii

• Institutions of higher education as defined by §61.003 of the Education Code.

• Minority Organization is defined as an organization in which the Board of Directors is made up of 50% racial or ethnic minority members.

If a Non-Profit Corporation or For-Profit Corporation, provide the 10-digit charter number assigned by the Secretary of State.

7. HIV Service Delivery Area (HSDA): Geographic service area set by DSHS to allocate federal and state funds for HIV medical and psychosocial support services.

8. Counties Served by Project: A specific region in the State of Texas for delivery of services.

Enter the proposed counties served by the project.

9. Amount of Funding Requested: Enter the amount of funding per the allocation given from STDC for proposed project activities (not including possible renewals). This amount must match Appendix A – Funding Available.

10. Projected Expenditures: If applicant’s projected federal expenditures exceed $750,000 or its projected state expenditures exceed $750,000 for applicant’s current fiscal year, applicant must arrange for a financial compliance audit (Single Audit).

11. Project Contact Person: Enter the name, title, email address, phone number, and fax number of the person responsible for the proposed project.

12. Financial Officer: Enter the name, title, email address, phone number, and fax number of the person responsible for the financial aspects of the proposed project.

13. Authorized Representative: Enter the name, title, email address, phone number, and fax number of the person authorized to represent the applicant. “Check if change” box if the authorized representative is different from previous submission to STDC.

14. Authorized Representative Signature: The person authorized to represent the applicant must sign in this blank.

15. Date: Enter the date the authorized representative signed this form.

FORM A: FACE PAGE – PROPOSAL FOR

FINANCIAL ASSISTANCE – RFP 25.01.02.03.

This form requests basic information about the respondent and project, including the signature of the authorized representative. The face page is the cover page of the renewal and shall be completed in its entirety.

RESPONDENT INFORMATION

1. Legal Business Name:

2. Mailing Address: 3. Payee Mailing Address: Check if different from 2.

Street:

City:

State:

Zip Code:

County:

Street:

City:

State:

Zip Code:

County:

4. Unique Identification Number: (Twelve Digits)

5. Federal Tax ID or State of (Nine, Fourteen, or Nine Digits Respectively) Texas Comptroller Vendor ID or Social Security Number*:

*The respondent acknowledges, understands, and agrees that the respondent's choice to use a social security number as the vendor identification number for the contract, may result in the social security number being made public via state open records requests.

6. Type of Entity:

City Nonprofit Organization* Community-Based Organization County For Profit Organization* Federally Qualified Health Center Other Political Subdivision HUB Certified State Controlled Institution of Higher Learning State Agency Minority Organization Hospital Indian Tribe Faith Based Private Individual Other (Specify):

*If incorporated, provide ten-digit charter number assigned by Secretary of State:

7. HIV Service Delivery Area (HSDA):

8. Counties Served by Project:

9. Amount of Funding Requested: Total Funds Requested

Ryan White Part B Service Delivery (RWSD) 04/01/25-03/31/26 $

HIV State Services (SS) 04/01/25-08/31/25 $

Housing Opportunities for Person with AIDS (HOPWA) 04/01/25-08/31/25 $

10. Projected Expenditures:

Do respondent’s projected federal expenditures exceed $750,000, or its projected state expenditures exceed $750,000, for respondent’s current fiscal year (excluding amount requested in line 9 above)?** Yes No

**Projected expenditures should include anticipated expenditures under all federal grants including “pass through” federal funds from all state agencies, or all anticipated expenditures under state grants, as applicable.

11. Project Contact Person: 12. Financial Officer:

Name Name Title Title Phone Phone Fax Fax Email Email

The facts affirmed by me in this proposal are truthful and I warrant the respondent is in compliance with the assurances and certifications contained in Appendix H: Assurances and Certifications. I understand the truthfulness of the facts affirmed herein and the continuing compliance with these requirements are conditions precedent to the award of a contract. This document has been duly authorized by the governing body of the respondent and I am authorized to represent the respondent.

13. Authorized Representative: 14. Signature of Authorized Representative:

Name

Title

Phone 15. Date:

Fax

Email

FORM B: CONTACT PERSON INFORMATION

This form provides information about the appropriate program contacts in the applicant’s organization in addition to those on Form A: Face Page. If any of the following information changes during the project term, please notify, Program Manager, in writing within (10) ten days.

Legal Name of Applicant:

Executive Director: Mailing Address: (Street, City, State, Zip, County)

Title:

Phone: Ext.

Fax:

Email:

Project Contact: Mailing Address: (Street, City, State, Zip, County)

Title:

Phone: Ext.

Fax:

Email:

Financial Contact: Mailing Address: (Street, City, State, Zip, County)

Title:

Phone: Ext.

Fax:

Email:

Data Reporting Contact:

Mailing Address: (Street, City, State, Zip, County)

Phone: Ext.

Fax:

Email:

Clinical Services

Phone: Ext.

Fax:

Email:

Board Chairperson: Mailing Address: (Street, City, State, Zip, County)

Title:

Phone: Ext.

Fax:

Email:

Emergency Services

Phone: Ext.

Fax:

Email:

FORM C: ADMINISTRATIVE INFORMATION

This form provides information regarding identification and contract history of the respondent, executive management, project management, governing board members, and/or principal officers. Respond to each request for information or provide the required supplemental document behind this form. If responses require multiple pages, identify the supporting pages/documentation with the applicable request.

NOTE: Administrative Information may be used in screening and/or evaluating proposals.

Legal Name of Respondent:

Identifying Information

1. The respondent must attach the following information:

If a Governmental Entity

• Names (last, first, middle) and addresses for the officials who are authorized to enter into a contract on behalf of the respondent.

If a Nonprofit or For profit Corporation

• Full names (last, first, middle), addresses, telephone numbers, titles and occupation of members of the Board of Directors or any other principal officers. Indicate the office held by each member (e.g. chairperson, president, vice-president, treasurer, etc.).

• Full names (last, first, middle), and addresses for each partner, officer, and director as well as the full names and addresses for each person who owns five percent (5%) or more of the stock if respondent is a for-profit corporation.

2. Is respondent a private, nonprofit organization?

YES NO

If YES, respondent must include evidence of its nonprofit status with the proposal. Any one of the following is acceptable evidence. Check the appropriate box for the attached evidence or complete the “Previously Filed” section, whichever is applicable.

(a) A reference to the organization’s listing in the Internal Revenue Service’s (IRS’s) most recent list of tax-exempt organizations described in section 501(c)(3) of the IRS Code.

(b) A copy of a currently valid IRS exemption certificate.

(c) A statement from a State Taxing body, State Attorney General, or other appropriate State Official certifying that the respondent organization has a nonprofit status and that none of the net earnings accrue to any private shareholders or individuals.

(d) A certified copy of the organization’s certificate of incorporation or similar document if it clearly establishes the nonprofit status of the organization.

(e) Any of the above proof for a State or national parent organization, and a statement signed by the parent organization that the respondent organization is a local nonprofit affiliate.

FORM C: ADMINISTRATIVE INFORMATION Continued

Conflict of Interest and Contract History

The respondent must disclose any existing or potential conflict of interest relative to the performance of the requirements of this RFP. Examples of potential conflicts include an existing or potential business or personal relationship between the respondent, its principal, or any affiliate or subcontractor, with STDC or any other entity or person involved in any way in any project that is the subject of this RFP. Similarly, any existing or potential personal or business relationship between the respondent, the principals, or any affiliate or subcontractor, with any employee of STDC must be disclosed. Any such relationship that might be perceived, or represented as a conflict, must be disclosed. Failure to disclose any such relationship may be cause for contract termination or disqualification of the proposal. If, following a review of this information, it is determined by STDC that a conflict of interest exists the respondent may be disqualified from further consideration for the award of a contract.

Pursuant to Texas Government Code Section 2155.004, a respondent is ineligible to receive an award under this RFP if the bid includes financial participation with the respondent by a person who received compensation from STDC to participate in preparing the specifications or the RFP on which the bid is based.

1. Does anyone in the respondent organization have an existing or potential conflict of interest relative to the performance of the requirements of this RFP?

YES NO

If YES, detail any such relationship(s) that might be perceived or represented as a conflict. (Attach no more than one additional page.)

2. Will any person who received compensation from STDC for participating in the preparation of the specifications or documentation for this RFP participate financially with respondent as a result of an award under this RFP?

YES NO

If YES, indicate his/her name, social security number, job title, agency employed by, separation date, and reason for separation.

3. Has any member of respondent’s executive management, project management, governing board or principal officers been employed by the State of Texas 24 months prior to the proposal due date?

YES NO

If YES, indicate his/her name, social security number, job title, agency employed by, separation date, and reason for separation.

4. Has respondent had a contract with STDC within the past 24 months?

If YES, indicate the contract number(s):

STDC Contract Number(s)

5.

Is respondent or any member of respondent’s executive management, project management, board members or principal officers:

• Delinquent on any state, federal or other debt;

• Affiliated with an organization which is delinquent on any state, federal or other debt; or

• In default on an agreed repayment schedule with any funding organization?

YES NO

If YES, please explain. (Attach no more than one additional page.)

6. Has the respondent had a contract suspended or terminated prior to expiration of contract or not been renewed under an optional renewal by any local, state, or federal department or agency or non-profit entity?

YES NO

If YES, indicate the reason for such action that includes the name and contact information of the local, state, or federal department or agency, the date of the contract and a contract reference number, and provide copies of any and all decisions or orders related to the suspension, termination, or non-renewal by the contracting entity.

Additional Information for Non-Profit Agencies

Non-profit applicants must be able to demonstrate fiscal solvency. Applicants shall submit a copy of the organization’s most recent audited balance sheet with management letters and audit notes, and a statement of income and expenses. If the applicant does not have an audited balance sheet and statement of income and expenses, the applicant must attach the most recent unaudited balance sheet and statement of income and expenses and explain why audited documents are not available (Attach no more than one additional page). The STDC will evaluate the financial statements and may, at its sole discretion, reject the proposal on the grounds of the applicant’s financial capability.

1. Are required financial statements attached?

YES NO

2. Does the applicant have personnel policies approved by the governing body which address essential issues of personnel management?

YES NO

3. Does the applicant contract with or employ the services of a CPA, accountant, bookkeeping service or trained financial manager other than the Executive Director?

If the applicant is a nonprofit entity, respond to the following:

a. Applicant has active, involved board as demonstrated by bylaws, regular meetings with sufficient attendance, minutes, and clear definition of role?

YES NO

b. Board membership includes diverse community representation?

YES NO

c. Board membership includes diverse skills?

YES NO

d. Applicant maintains Directors and Officers insurance?

YES NO

e. Applicant has a Board policy and procedures manual?

YES NO

f. Applicant provides orientation and training on board member responsibilities to new members?

YES NO

g. What date did the applicant’s Board of Directors adopt the current operating budget of the agency?

h. Applicant must attach a copy of the Board minutes for the meeting in which the operating budget was adopted. Are the minutes attached?

Signature of Authorized Official

Title

Typed Name of Authorized Representative

Date

FORM D: ORGANIZATIONAL CAPACITY AND EXPERIENCE

Respondents must provide a narrative description answering the questions below. Respondents should leave the section headings and numbered questions in their response, exactly as shown below, inserting their responses below each question.

Respondents should answer each question completely, but succinctly, without adding any additional or unnecessary information.

A maximum of twenty (20) pages may be used for this section.

A. Statement of Intent

1. What is respondent’s mission statement, and how does becoming an HIV service provider fit with the respondent’s mission?

B. Historical Background

1. Describe the history of respondent organization and the types of services or activities in which the organization has participated.

2. Has the respondent been under sanction from any funding source during the twenty-four months prior to issuance of this RFP? If there has been a sanction placed on the respondent since this date, provide details and the current status of sanctions.

3. Describe respondent’s experience, training, certifications, and licensures that promotes high quality HIV care in accordance with the criteria developed by HIVMA for qualified providers available at https://www.hivma.org/clinical-practice/defining-hiv-expertise

4. Describe respondent’s relationship to other organizations within the HIV Service Delivery Area.

Specifically describe respondent’s linkages to health and social service agencies, including those that serve people living with HIV or those who are at risk for contracting HIV. Include experience respondent has working with local medical providers.

C. Program Background

1. Describe respondent’s current programs and activities that are relevant to fulfillment of the functions required by this RFP. Discuss how the current structure of the agency is suited to carrying out the duties of an HIV Service Provider.

2. Describe what resources your agency has to perform the project, who will deliver the services and how they will be delivered; include a description of the infrastructure available to achieve service delivery and policy-making activities, as well as a description of the workforce you have or plan to have to perform these duties. Also describe the types of training agency staff will receive on a regular basis (including annual trainings, case management, HOPWA, etc.)

3. Describe respondent’s organizational structure, such as board of directors, officers, advisory councils or committees. Attach a current organizational chart showing proposed positions for this project.

4. Describe respondent’s experience in handling and protecting confidential client information.

5. How does your agency involve clients, customers, or stakeholders in the decision-making processes?

6. Describe how your agency has used program data to improve program functioning.

https://www.hivma.org/clinical-practice/defining-hiv-expertise

7. What is respondent’s experience in submitting progress program reports for delivery of services?

Describe staff position(s) responsible for reporting program activities and progress to funding sources.

8. Describe respondent’s experience and ability to provide HIV services to the entire geographic area that you are proposing to serve.

9. Describe the current or proposed plan for the following goals and objectives within the HIV Service Delivery Area.

• Increase timely linkage to treatment for those newly diagnosed with HIV.

• Increase Viral Suppression among PLWH.

• Reduce Health Disparities and Health Inequities.

• Cultivate a Stigma-Free environment for PLWH.

D. Financial Capacity of Respondent

1. What is respondent’s current total operating budget?

2. What experience and expertise does respondent have in grants and contracts management? Provide a list of current grants and contracts respondent manages, including project periods for each.

3. What is respondent’s experience in submitting financial reports to funding sources? Describe staff position(s) responsible for reporting financial activities and progress to funding sources.

4. Describe the financial management staff, including any financial management performed by volunteers and outside accountants.

5. What accounting software does respondent utilize and how well suited is it to fund accounting for multiple funding sources?

6. If your organization is a nonprofit agency, describe the role your Board of Directors takes in approving an annual agency budget, in approving grant application budgets, in monitoring agency expenditures compared to the budget, in approving budget amendments and variances, and in determining appropriate salary levels for the Executive Director.

7. If respondent is a nonprofit agency, describe the role of the Board of Directors in examining agency financial statements, in addressing financial concerns, and in raising funds for the respondent agency.

8. For both nonprofit and government agency respondents, describe the mechanisms and procedures in place to ensure that respondent is capable of submitting vouchers on a monthly basis to STDC for contract expenditures.

9. Describe the mechanisms in place to ensure that the respondent is capable of reimbursing subcontractors or fee-for-service providers rapidly after receipt of acceptable invoices or vouchers from those providers.

10. Describe the current and anticipated status of cash flow of respondent agency.

11. Does the respondent receive program income? What is respondent’s experience with the additive method of grant accounting in relation to program income?

FORM E-1: PERFORMANCE MEASURES – INSTRUCTIONS

Respondent will implement the required performance measures listed for each funding source and report progress to the Administrative Agency on the Semi-Annual and Annual Program Reports. Respondent agrees that required performance measures will be used to assess, in part, the applicant’s effectiveness in providing the services described in each form.

► Ryan White Performance Measures (See form) ► State Services Performance Measures (See form) ► HOPWA Performance Measures (See form)

FORM E-1: RYAN WHITE PERFORMANCE MEASURES

In the event a contract is awarded respondent agrees that performance measures will be used to assess, in part, the respondent’s effectiveness in providing the services described. Address all the requirements (see Performance Measures Guidelines) associated with the services proposed in this proposal. A maximum of one (1) page may be used this form.

Performance Measure 1: The (Respondent’s name) shall use Ryan White funds to provide at least one service to (insert #) unduplicated clients and (insert #) units to be delivered during FY25 (04/01/25-03/31/26).

Objectives related to the # of persons and units to be provided must be reflected on Table 1: Services Priorities, Allocations, and Objectives.

Performance Measure 2: The (Respondent’s name) shall engage (insert #) people living with HIV (PLWH) that know their HIV status and are not in care, bring them into care and to keep them in care to ensure that all efforts are being made to engage, bring, and keep them in care during FY25. The (Respondent’s name) shall revise the proposed Strategic Plan annually and provide updates to STDC.

Performance Measure 3: The (Respondent’s name) shall deliver and monitor services to clients as negotiated on Table 1 and contract in TCT. The (Respondent’s name) shall adequately complete and report progress on required Program Reports explaining allocations or services that exceeded or fell short of projections.

Performance Measure 4: The (Respondent’s name) shall submit completed semi-annual and annual reports according to the Reporting Due Dates listed in the contract for this RFP.

Performance Measure 5: The (Respondent’s name) shall ensure that no more than ten percent of the Ryan White allocation is expended by service provider for administrative costs.

Performance Measure 6: The (Respondent’s name) shall increase enrollment in Health Plans of eligible persons in the (name of HSDA) HSDA by no less than 10% for persons that fall between 100% and 200% of the federal poverty level (FPL). This measure is a minimum required for enrollment and FPL levels locally.

Performance Measure 7: The (Respondent’s name) shall submit a program income allocation plan for Ryan White Part B in the (name of HSDA) HSDA by no later than March 15, 2025, to the STDC Fiscal Monitor.

Performance Measure 8: The (Respondent’s name) ADAP Enrollment Worker’s (AEWs) shall accomplish or surpass all required performance measures:

1. ≥ 90% of new enrollee and recertification ADAP applications are accepted by the Texas HIV Medication Program (THMP) as complete upon initial submission.

2. ≥90% of ADAP eligibility recertifications and self-attestations are completed on or before the lapse of ADAP program benefits.

3. >90% of applications submitted by AEW as Expedite were correctly identified as Expedite.

4. >90% of application entries in the “about you” demographic, relationship, household, client financial, insurance, and case notes in TCT are correct and complete.

AEWS must adhere to these performance measures:

• Review all THMP applications in TCT.

▪ Communicate with clients, as needed, to support a timely, complete, and correct application submission to

THMP. Clients that only require THMP application assistance will be assigned to subgrantees by an algorithm based on client residence. All THMP applications assigned to a subgrantee must undergo quality assurance by an AEW before submission.

• Submit THMP-ADAP Application Monthly Tracking Sheets (THMP-ADAP Tracker Revised 2024).

• Work on Incomplete Applications. Review new list sent by the ADAP Liaison.

• Notify ADAP Liaison of any staff that leaves your organization or any new staff submitting any type of application that should be added to the contact sheet.

• All new staff who submit applications must meet with the ADAP Liaison for training before submitting any applications.

• Attend required regional calls, meetings, and trainings.

FORM E-1: STATE SERVICES PERFORMANCE MEASURES

In the event a contract is awarded respondent agrees that performance measures will be used to assess, in part, the respondent’s effectiveness in providing the services described. Address all the requirements (see Performance Measures Guidelines) associated with the services proposed in this proposal. A maximum of one (1) page may be used this form.

Performance Measure 1: The (Respondent’s name) shall use State Services funds to provide at least one service to (insert #) unduplicated clients and (insert #) units to be delivered during FY25 (04/01/25-08/31/25).

Objectives related to the # of persons and units to be provided must be reflected on Table 1: Services Priorities, Allocations, and Objectives.

Performance Measure 2: The (Respondent’s name) shall engage (insert #) people living with HIV (PLWH) that know their HIV status and are not in care, bring them into care and to keep them in care to ensure that all efforts are being made to engage, bring, and keep them in care during FY25. The (Respondent’s name) shall revise the proposed Strategic Plan annually and provide updates to STDC.

Performance Measure 3: The (Respondent’s name) shall deliver and monitor services to clients as negotiated on Table 1 and contract in TCT. The (Respondent’s name) shall adequately complete and report progress on required Program Reports explaining allocations or services that exceeded or fell short of projections.

Performance Measure 4: The (Respondent’s name) shall submit completed semi-annual and annual reports according to the Reporting Due Dates listed in the contract for this RFP.

Performance Measure 5: The (Respondent’s name) shall ensure that no more than ten percent of the State Services allocation is expended by service provider for administrative costs.

Performance Measure 6: The (Respondent’s name) shall increase enrollment in Health Plans of eligible persons in the (name of HSDA) HSDA by no less than 10% for persons that fall between 100% and 200% of the federal poverty level (FPL). This measure is a minimum required for enrollment and FPL levels locally.

Performance Measure 7: The (Respondent’s name) shall submit a program income allocation plan for State Services in the (name of HSDA) HSDA by no later than March 15, 2025, to the STDC Fiscal Monitor.

Performance Measure 8: The (Respondent’s name) ADAP Enrollment Worker’s (AEWs) shall accomplish or surpass all required performance measures:

1. ≥ 90% of new enrollee and recertification ADAP applications are accepted by the Texas HIV Medication Program (THMP) as complete upon initial submission.

2. ≥90% of ADAP eligibility recertifications and self-attestations are completed on or before the lapse of ADAP program benefits.

3. >90% of applications submitted by AEW as Expedite were correctly identified as Expedite.

4. >90% of application entries in the “about you” demographic, relationship, household, client financial, insurance, and case notes in TCT are correct and complete.

AEWS must adhere to these performance measures:

• Review all THMP applications in TCT.

▪ Communicate with clients, as needed, to support a timely, complete, and correct application submission to

THMP. Clients that only require THMP application assistance will be assigned to subgrantees by an algorithm based on client residence. All THMP applications assigned to a subgrantee must undergo quality assurance by an AEW before submission.

• Submit THMP-ADAP Application Monthly Tracking Sheets (THMP-ADAP Tracker Revised 2024).

• Work on Incomplete Applications. Review new list sent by the ADAP Liaison.

• Notify ADAP Liaison of any staff that leaves your organization or any new staff submitting any type of application that should be added to the contact sheet.

• All new staff who submit applications must meet with the ADAP Liaison for training before submitting any applications.

• Attend required regional calls, meetings, and trainings.

FORM E-2: WORK PLANS – INSTRUCTIONS

Ryan White and State Services:

The purpose of the Ryan White Service Delivery and State Services Programs is to improve the quality, availability, and organization of health care and support services for individuals and families living with or affected by HIV. Eligible services to be provided include comprehensive outpatient health and support services for persons living with HIV (PLWH).

In awarding grant funds for these activities, the AA will strive to:

• Complement existing services programs,

• Prevent unnecessary duplication of services, and

• Initiate needed HIV services programs where none exist.

The respondent’s work plan should describe how the funds will be used to deliver comprehensive outpatient health and support services to eligible individuals. The eligible services to be provided with these funds are defined in the DSHS’s Standards of Care available at https://www.dshs.texas.gov/hivstd/taxonomy. The work plan should emphasize the objectives for HIV Services in the HIV Service Delivery Area (HSDA).

Applicants seeking Ryan White Part B and HIV State Services funds should actively collaborate with other community organizations to ensure comprehensive HIV care for eligible individuals, maximize access to needed services, coordinate care and support services by leveraging the strengths of different organizations within the community. This includes partnering with Federal Qualified Health Centers, Local Health Departments, and other Community Organizations in the service area to meet client’s needs, make successful referrals to one another, and avoid gaps in care. Collaboration helps avoid duplication of services and ensures that funding is used effectively by identifying which agency is best suited to provide specific services. By working with other organizations, applicants ensure clients receive a holistic approach to HIV Care and Support Services.

HOPWA:

The purpose of the HOPWA Program is to help eligible persons living with HIV and their households establish or maintain affordable housing, reduce the risk of homelessness, and improve their access to health care and supportive services. Stable housing helps PLWH access comprehensive healthcare, adhere to HIV treatment, and achieve viral suppression.

https://www.dshs.texas.gov/hivstd/taxonomy

FORM E-2: RYAN WHITE AND STATE SERVICES WORK PLAN (PART 1)

Applicant shall describe its plan for service delivery to the population in the proposed service area(s) and include timelines for accomplishments. Respondents should leave the numbered questions in their response, exactly as shown, below, inserting the responses below each question. Respondents should answer each question completely, but succinctly, without adding any additional or unnecessary information. If applying for Ryan White and State Services, just submit one work plan for both. A maximum of fifteen (15) pages may be used for this work plan.

1. Summarize the proposed services, population to be served, location (counties to be served), etc.

Describe what resources your agency will utilize to perform the project; who will deliver services and how they will be delivered; include a description of the infrastructure available to achieve service delivery and policy-making activities, as well as a description of the workforce you have or plan to have in place to perform these services.

2. Describe how services will be coordinated with other health and human services providers in the area

(FQHCs, local health departments, etc.),

• How availability is maximized, and duplication reduced or avoided.

• Describe respondent’s linkages to non-Ryan White funded community support services.

• Describe respondent’s current referral system.

• Describe any strategies you have for collaboration within the HIV service delivery area to standardize client eligibility.

• Describe how you will ensure other community agencies are aware of the services you provide, including what types of outreach activities you will implement to ensure community agencies know what you do, how to contact you, and how to refer clients for your services.

• Describe specific barriers to providing services within the counties served by the agency.

3. Include your organization’s policies and procedures for implementing the DSHS Third Party Payor policy

590.001 (http://www.dshs.texas.gov/hivstd/policy/policies/590-001.shtm?terms=DSHS%20policy%

20590.001 ).

• Describe your organization’s experience or capacity for billing third party payors (e.g., Medicaid, Medicare, private health insurance) for medical services, or for working directly with medical providers who bill third party payors.

• Outline your agency’s plan for maximizing Ryan White and State Services funds by either billing third party payors or contracting with a provider who has that capacity.

• Discuss your agency’s experience or plan/capacity to collect fees from clients for medical care.

4. How will your agency collect and assess HIV client-level data? Ensure your response includes the following information:

• Discuss who is responsible for the data collection entry and reporting as well as who is responsible for quality assurance of the data.

• Include the frequency of data collection and data quality measures that will be integrated into your overall quality improvement activities.

• If any data policies have been developed by the agency, please list them.

• Lastly, please ensure that you discuss how your agency will ensure physical and electronic data security.

http://www.dshs.texas.gov/hivstd/policy/policies/590-001.shtm?terms=DSHS%20policy%25%2020590.001 http://www.dshs.texas.gov/hivstd/policy/policies/590-001.shtm?terms=DSHS%20policy%25%2020590.001

5. To address the goals and objectives of the South Texas Development Council’s HIV Comprehensive Services Plan, please respond to the following:

a. Describe respondent’s plan to increase viral suppression. Include plan to reduce any gaps to achieving viral suppression and focusing on adherence that includes clients, clinicians and supportive service providers.

b. Describe respondent’s plan to increase retention in care. Include plan to reduce any barriers including engagement in care, ensuring treatment systems are included and access to supportive services, especially mental health and substance use treatment. Discuss the integration of innovative technologies and telehealth services which enhance service delivery and engagement, particularly in remote or underserved areas.

c. Describe respondent’s plan that addresses the ongoing aim to improve quality of care, access to care and needed services, and elimination of barriers. Include the following in your response.

• Collaboration between service providers, healthcare providers, community organizations, and government agencies to create a more integrated and efficient service delivery system that addresses the multifaceted needs of PLWH.

• Expansion of core services such as medical care, mental health support, health insurance and housing assistance.

• Address social determinants of health, such as poverty, education, and social stigma, which significantly impact HIV outcomes.

6. Describe respondent’s internal Quality Assurance/Quality Improvement/Quality Management

(QA/QI/QM) plan or process utilized to assess performance and monitor services. Identify staff who use them and who are responsible for ensuring they are updated. The description shall include the following:

• The role of the QA/QI/QM Committee.

• Activities utilized to identify trends of needed improvement and the frequency of those activities.

• Activities to ensure correction and follow-up to findings identified. In all cases, the respondent must participate in the resolution of quality issues and corrective action requirements.

• Process for documenting progress and completion of goals outlined in the plan.

• Process for identifying and reporting outcome measures.

• Participation in quality improvement projects.

• Utilization and frequency of client satisfaction surveys.

• System utilized to identify, report, and monitor adverse outcomes.

FORM E-3: RYAN WHITE WORK PLAN (PART 2)

Address the required elements (see WORK PLAN Guidelines) associated with the services proposed in this RFP. A maximum of five (5) pages may be used for this work plan.

Service Category Allocation from Table 1

Total Number of Units to be Provided

Total Number of

Clients to be Served

Outpatient/Ambulatory Health Services $0 0 0 Narrative:

Early Intervention Services $0 0 0

Health Insurance Premium/Cost Sharing Assistance

$0 0 0

Home and Community-Based Health Services $0 0 0

Home Health Care $0 0 0

Hospice Services $0 0 0

Local AIDS Pharmaceutical Assistance $0 0 0

Medical Case Management $0 0 0

Medical Nutritional Therapy $0 0 0

Mental Health Services $0 0 0

Oral Health Care $0 0 0

Substance Abuse Outpatient Care $0 0 0

Child Care Services $0 0 0

Emergency Financial Assistance $0 0 0

Food Bank/Home-Delivered Meals $0 0 0

Health…