RFA 67-207.pdf

Health and Human Services Building | 625 Forster Street | Harrisburg, PA 171200701 | www.health.pa.gov

June 18, 2026

Dear Potential Applicant:

You are invited to submit an application to the Pennsylvania Department of Health in accordance with the enclosed Request for Applications (RFA) #67-207.

A pre-application conference will be held via Microsoft Teams on July 16, 2026, from 10:00 AM to 12:00 PM ET. Potential applicants can join via Microsoft Teams by clicking on this link:

https://www.microsoft.com/en-us/microsoft-teams/join-a-meeting and entering the following: The meeting ID is 244 438 829 602 761, and meeting Passcode is Ce2C3d4Z; or by phone at +1 267-332- 8737; Phone Conference ID: 226889544#. If attending by phone, any content shown on Teams call screen will not be visible. Applicant attendance is optional.

All questions regarding this RFA must be directed by e-mail to danierhode@pa.gov no later than 12:00 p.m. ET on July 9, 2026. All questions must include the specific section of the RFA about which the potential applicant is requesting clarification. Answers to all questions will be posted at www.emarketplace.state.pa.us. Click on ‘Solicitations’ and search for the above RFA number.

Submit one application, (Part 2 of this RFA) by email to: RA- DHHEALTH_DEPT_DOC@pa.gov. The Department cannot accept secure or encrypted emails. Any submission via secure or encrypted email will be immediately discarded. Applications must be received no later than 1:30 p.m. ET on July 23, 2026. Applications can be submitted as soon as they are ready for submission; to prevent late submissions, applicants are encouraged to not wait until this closing date and time. The timestamp on the received application email in the RA- DHHEALTH_DEPT_DOC@pa.gov inbox is the final and only timekeeper to determine if the application was received by the deadline.

LATE APPLICATIONS WILL NOT BE ACCEPTED REGARDLESS OF THE REASON.

Type “APPLICATION ENCLOSED RFA #67-207” as the subject line of your e-mail submission.

We expect that the evaluation of applications and the selection of Grantees will be completed within eight weeks of the submission due date.

Sincerely, Office of Procurement For Agency Head Enclosure

RFA 67-207

Family Impact Initiative

CONTENTS

Part One: General Information A. Information for Applicants B. Application Procedures………………………………………………………………

1. General

2. Evaluation of Applications

3. Awards

4. Deliverables

5. Reporting Requirements

C. Application Instructions and Required Format

1. Application Instructions

2. Application Format

3. Definitions

Part Two: Title of Application

Application Forms and Attachments I. Cover Page II. BOP-2201 Worker Protection and Investment Certification Form III. BOP-1307 Lobbying Certification Form IV. Work Statement V. Budget Template is downloadable and is attached for completion of the budget request

Any Grant Agreement resulting from this RFA will include certain standard terms and conditions that will be attached as appendices and will be part of the agreement, which may either be found at http://www.health.pa.gov/vendors or are attachments to this RFA. These terms and conditions are not negotiable and are listed below:

� Payment Provisions (Rev.11/25) and Attachment 1 � Commonwealth Standard General Terms and Conditions (Grant) (Rev.

10/1/23)

� Department Standard General Terms and Conditions (Grant) (Rev. 12/24)

� Audit Requirements (Rev. 10/24) � Federal Standard Terms and Conditions (Grant) (Rev. 12/24)

PART ONE

General Information

A. Information for Applicants

The Pennsylvania Department of Health (Department) is responsible for administering the Title V Maternal and Child Health Services Block Grant (MCHSBG) for Pennsylvania. The MCHSBG was established as part of the 1935 Social Security Act and is administered at the federal level by the Health Resources and Services Administration (HRSA). The mission of the MCHSBG is to improve the health and wellbeing of the nation’s mothers, infants, children and youth, including those with special health care needs and their families.

Every five years the Department conducts a comprehensive needs and capacity assessment to gauge the strengths and needs of the state’s Maternal and Child Health population (which includes pregnant people, infants, and children, as well as children with special health care needs) and related services. As a result of the most recent needs and capacity assessment, the Department identified seven priorities on which to focus on for 2026 through 2030. The work of this RFA falls within the priority: Provider Access, Care Coordination, and Navigation for Children and Youth with Special Health Care Needs (CYSHCN).

HRSA has defined five population domains: Women/Maternal Health, Perinatal/Infant Health, Child Health, CYSHCN, and Adolescent Health. To impact the identified domains, the Department has identified National Performance Measures and State Performance Measures that must be reported annually. As a result, the Department has created a State Action Plan that demonstrates the logical relationships between the chosen priorities, performance measures, and programming strategies that address identified needs of those included in the acknowledged domains. The work of this RFA is a strategy within the CYSHCN population domain. Additional information on the Department’s administration of the Title V Block Grant, including annual reports, can be found at:

https://www.pa.gov/agencies/health/programs/maternal-health-and-infant-care/title-v HRSA notes that CYSHCN have or are at increased risk for having chronic physical, developmental, behavioral, or emotional conditions. CYSHCN have conditions, which include, but are not limited to, diagnoses such as asthma, sickle cell disease, epilepsy, anxiety, autism, and learning disorders. CYSHCN may require more specialized health and educational services to thrive, even though each child's needs may vary. According to the 2023-2024 National Survey of Children’s Health, only 15.2 percent of CYSHCN in Pennsylvania received care in a well-functioning system1.

The Family Impact Initiative (FII) provides a framework for addressing systems of services for CYSHCN. The FII uses a system change approach rather than a program-based approach to address community improvements for families of CYSHCN. Systems change is the core of the

1 2023-2024. Data Resource Center for Child and Adolescent Health.

https://www.childhealthdata.org/browse/survey/results?q=12180&r=40

FII.

"Systems change" is a shift in the way that a community makes decisions about policies, practices, procedures, and the allocation of resources. To undertake systems changes, a community must build collaborative bridges among multiple agencies, community members, and other stakeholders. A system change extends beyond a single program, to multiple programs and organizations, affecting CYSHCN and families across the community. System changes rely on building partnerships and cultivating these relationships. It has been said of systems change, “if you want to change the system, get the system in the room.” Bringing the right partners to the “room” is critical and includes families and youth with CYSHCN.

System changes affecting CYSHCN and their families should always be family and youth driven.

FII focuses on policy, practice, and procedural changes which can be sustained within an organization or system. System change involves the following aspects:

a. A practice change creates a new way to do things, such as adding a new assessment to a well-child visit for CYSHCN that addresses transition to adult care.

b. A policy change is a formalized set of practices and guidelines that inform strategic decisions, day-to-day operations, and decision making. Creating a policy that all patients beginning at the age of 12 years receive a transition to adult care assessment during their well-child visit would be an example of a policy change.

c. A procedural change describes what actions to take in specific circumstances. A transition assessment might also require additional implementation guidelines to create clarity and consistency, which would be a procedural change.

While some activities, such as material development, training, or connecting to resources, lay the groundwork for system change, these activities alone are not system changes. System changes are integrated into an organization’s practices, policies, and procedures in such a way that if all current staff left an organization, the change would be sustained at the institutional level.

The FII provides funding to local communities to improve community systems to better meet the needs of CYSHCN and their families. The FII is a replication of North Carolina’s Innovative Approaches initiative that has been operating in North Carolina for 15 years and has been deemed a best practice by the Association of Maternal and Child Health Programs (AMCHP). More information about Innovative Approaches can be found here:

https://amchp.org/database_entry/innovative-approaches-community-systems-building-grants-for-children-and-youth-with-special-health-care-needs-cyshcn/

In 2021, Pennsylvania was awarded a one-year replication grant by AMCHP, which allowed the state to build capacity and pilot Innovative Approaches in Philadelphia County. The Department has funded the initiative with MCHSBG funds since 2022. Since that time the initiative, now coined Family Impact Initiative in Pennsylvania, has accomplished many system change goals, including: created and disseminated a video of important CYSHCN resources and organizations available in Philadelphia to support families; held annual resource fairs focusing on transition supports, early childhood, and parent or caregiver wellbeing and respite; established support groups in schools for parents of children who have a learning disability or special need; held Individualized Education Plan and 504 plan trainings with an educational expert for parents;

partnered with the Children’s Hospital of Philadelphia to develop and provide training for doctor’s office reception staff and medical professionals to create a more friendly and quality office visit for children with disabilities; and partnered with Philadelphia Parks & Recreation to identify outdoor parks and spaces that accommodate and are safe for individuals with disabilities to support their Rec for All plan developed to create pathways for an inclusive recreation system for Philadelphians of all abilities.

Parents and caregivers of CYSHCN often experience a complex system of uncoordinated services.

The aim of the FII is to improve community systems to better meet the needs of families of CYSHCN. A series of strategies is implemented to support the development of community based and family-focused systems of care for CYSHCN. The FII Coordinator(s) lead local efforts to identify a committee of stakeholders, which includes a parent advisory committee. The committees work together to assess community capacity to meet the needs of CYSHCN, identify areas in need of improvement, and develop strategies for addressing those areas. Implementing these strategies leads to strengthened county-level system change capacity. This increase in system change capacity leads to service delivery system improvements, which over the long-term leads to meaningful improvements in the lives of CYSHCN and their families.

The Department is seeking to award one entity that is positioned to affect change in the Northeast region of Pennsylvania and shall meet the needs of CYSHCN through implementation of FII across the following counties: Carbon, Columbia, Lackawanna, Luzerne, Monroe, Pike, Schuylkill, Susquehanna, Wayne, and Wyoming. The awarded applicant shall focus system change efforts throughout all counties identified in this region which include but are not limited to (1) health care transition from pediatric to adult care, (2) screening and identification of CYSCHN, (3) accessibility of services, (4) adequate health insurance and financing, (5) coordinated, ongoing, comprehensive care, (6) education, information and resources, (7) health and wellbeing of CYSHCN, and (8) emergency preparedness. Applicants shall develop and implement substantive, sustainable, and family driven system change activities based on needs identified within the identified region to improve community systems across multiple counties. Applicants shall develop and implement no less than five system change goals per fiscal year.

Through this RFA process, the Department is soliciting grant applications on Family Impact Initiative. The Department is interested in funding applications addressing and improving the percentage of children who receive care in a well-functioning system through implementing the system change initiative described above. The overall goal of this funding is to promote and support the development of community-based and family-focused systems of care for families of CYSHCN. The anticipated grant agreement term is January 1, 2027, to June 30, 2031, subject to the availability of funding. If the anticipated effective date is changed by the Department for the resulting grant agreement, the term is expected to remain a total of 54 months, subject to the availability of funding. The Department expects to award one grant agreement.

At the Department’s discretion and by letter notice, the Department may extend the resulting grant agreement as follows:

Extension. Upon notice to the Grantee, without the need for a formal amendment, the Department may, for any reason, exercise a 3-month extension.

Applications are welcomed from Pennsylvania based community-based organizations or health care providers that are currently providing or have the capacity to provide services to the CYSCHN community in Pennsylvania which includes, but is not limited to, local health departments, including county and municipal health departments, Federally Qualified Health Centers, and non-profit organizations are eligible to apply for funding. Applicants must be able to provide services throughout the identified service region in the following counties: Carbon, Columbia, Lackawanna, Luzerne, Monroe, Pike, Schuylkill, Susquehanna, Wayne, and Wyoming. The Department is seeking applicants with a history of commitment to serving CYSCHN and a sufficient track record to indicate a good chance of success. The awarded applicant shall provide these services to residents of Pennsylvania only. Additional information about how to apply, relevant and specific restrictions, and stated preferences regarding applicants are noted and outlined in Section B. Applicants are encouraged to be innovative and creative in their approach.

This RFA provides interested and eligible parties with information to prepare and submit applications to the Department. Questions about this RFA can be directed to the contact listed on the potential applicant letter (which is the first page of this RFA) by the date and time listed therein.

All questions must include the specific section of the RFA about which the potential applicant is requesting clarification. Answers to all questions will be posted under the RFA Solicitation at www.emarketplace.state.pa.us. Each applicant shall be responsible for monitoring the website for new or revised RFA information. The Department shall not be bound by any information that is not either contained within the RFA or formally issued as an addendum by the Department.

In order to do business with the Commonwealth of Pennsylvania providers are required to enroll in the SAP system. Applicants may enroll by selecting “Non-Procurement” at:

https://www.budget.pa.gov/Services/ForVendors/Pages/Vendor-Registration.aspx or by calling toll free at 1-877-435-7363. The PDF and MP4 embedded links next to “Non-Procurement” provide guidance on enrolling.

B. Application Procedures

1. General

a) Applications must be received by the Department by the time and date stated in the cover letter. The Department will reject any late applications. The decision of the Department with regard to timeliness of submission is final.

b) If it becomes necessary to revise any part of the application guidelines, an amendment will be posted under the RFA Solicitation at www.emarketplace.state.pa.us.

c) The decision of the Department with regard to selection of applicants is final. The Department reserves the right, in its sole and complete discretion, to reject any and all applications received as a result of this request and to negotiate separately with competing applicants.

d) The Department is not liable for any costs the applicant incurs in preparation and submission of its application, in participating in the RFA process or in anticipation of award of the resulting grant agreement.

e) The Department reserves the right to cancel the RFA at any time up until the full execution of the resulting grant agreement.

f) Awarded applicants and non-selected applicants shall not be permitted to issue news releases pertaining to this project prior to official written notification of award by the Department review committee. Any subsequent publication or media release issued by the Grantee throughout the life of the grant using funding from this grant agreement must acknowledge the Department as the granting agency and be approved in writing by the Department.

2. Evaluation of Applications

All applications meeting the stated requirements in this RFA and received by the designated date and time, will be reviewed by a committee of qualified personnel selected by the Department. The Review Committee will recommend applications that most closely meet the evaluation criteria developed by the Department. If the Review Committee determines that additional clarification of an application is needed, Division of Community Systems Development and Outreach staff and staff from the Office of Procurement will schedule an oral presentation, either in person or via a conference call, or assign a due date for the submission of a written clarification, or both.

Evaluation criteria used by the Review Committee, include:

1. Organizational Capability and Competency

2. Statement of the Problem

3. Approach to the Problem, Feasibility and Sustainability

4. Program Goals and Objectives

5. Performance Measures

6. Budget Detail and Budget Narrative

3. Awards

Grants will be administered through the Department.

All applicants will receive official written notification of the status of their application from the Department. Unsuccessful applicants may request a debriefing. This request must be in writing and must be received by the Division of Community Systems Development and Outreach within 30 calendar days of the written official notification of the status of the application. The Division of Community Systems Development and Outreach will determine the time and place for the debriefing. If the debriefing is held via Microsoft Teams, a link, phone number, and conference ID number will be provided. The debriefing will be conducted individually by the Division of Community Systems Development and Outreach staff. Comparison of applications will not be provided. Applicants will not be given any information regarding the evaluation other than the position of their application in relation to all other applications and the strengths and weaknesses in their individual application.

4. Deliverables

a) Family Impact Initiative (FII) Administration The awarded applicant shall:

1. Collaborate with the Department to carry out all necessary activities of the FII throughout the term of the resulting grant agreement.

2. Partner with the subject matter experts and entities of system change initiatives for CYSCHN populations who shall serve as coaches and support the awarded applicant throughout the implementation of FII for up to first year of the resulting grant agreement.

3. Utilize North Carolina’s Innovative Approaches Implementation Manual, provided by the Department, to replicate the program in the service region identified. The awarded applicant shall provide FII services throughout the following counties:

Carbon, Columbia, Lackawanna, Luzerne, Monroe, Pike, Schuylkill, Susquehanna, Wayne, and Wyoming.

4. Engage community partners to serve on a Steering Committee for FII in year one of the resulting grant agreement.

a. The awarded applicant shall identified and maintain a minimum of 25 stakeholders to serve on the FII Steering Committee.

b. Members serving must be from various health and human services agencies and disciplines. The committee must include representation throughout the service region and be familiar with the families and service system of this region.

c. The awarded applicant shall maintain the steering committee throughout the term of the resulting grant agreement.

5. Engage family members and caregivers to serve on the FII Parent Advisory

Committee (PAC) in year one of the resulting grant agreement.

a. The awarded applicant shall identified and maintain a minimum of 15 family members to serve on the PAC with an emphasis on recruiting family members that is congruent to the racial diversity of CYSHCN in the service region identified. The PAC must include parents and caregivers with representation throughout the geographical location of the service region and be parents and caregivers of children with various special health care needs who serve as subject matter experts with lived experience.

b. The awarded applicant shall compensate subject matter experts who are supporting the PAC as it relates to CYSCHN and system change.

Compensation shall be tracked and documented according to the policy as established by the Department.

c. The awarded applicant shall maintain the PAC throughout the term of the resulting grant agreement.

6. Identify and provide a system change training to all program staff and individuals identified to serve on the identified committees in year one of the resulting grant agreement. This training must be available to individuals throughout the term of the resulting grant agreement if individuals were not able to attend the training provided in year one.

7. Conduct a needs assessment of local CYSHCN service systems within the service region identified (Carbon, Columbia, Lackawanna, Luzerne, Monroe, Pike, Schuylkill, Susquehanna, Wayne, and Wyoming counties) through focus groups, surveys, or interviews to gather information and data on the current services available in the community for CYSHCN in year one of the resulting grant agreement. Additional needs assessments after year one may be conducted as needed and as agreed upon by the Department.

a. Complete data collection process with families of CYSHCN and community providers.

b. Analyze data to identify gaps/barriers and priority themes from data collection process.

c. Identify and analyze root cause issues using appropriate quality improvement tools.

d. Involve Steering Committee and PAC members in reviewing and prioritizing identified system problems to address.

e. Provide training and support for FII parent representatives and steering committee to facilitate their participation and input in the planning process via presentations, webinars, system change exercises, graphics and printed materials.

f. Determine the need to develop targeted subcommittees to address action areas.

8. Develop and implement system change objectives (SCO) based on the identified system problems or gaps in the needs assessment throughout the resulting grant agreement.

a. Identify community efforts that tie in with system change objectives to leverage collaborative partnerships and increase collective impact.

b. Develop an Action Plan utilizing approved tracking tools and templates.

Action steps, objectives and goals shall be tracked and monitored for progress and success of outcomes.

c. The awarded applicant shall develop and implement a minimum of five SCOs per fiscal year.

d. Project activities and tasks identified on Action Plan must be completed and carried out to the best of the applicant’s ability and any barriers to successful implementation shall be documented.

9. Facilitate meetings to determine progress and outcomes of project activities and tasks identified in the Action Plan. Meetings may be conducted in person, virtually, or in another format as directed and agreed upon by the committee members throughout the resulting grant agreement.

a. Meetings for PAC members must be held, at a minimum, monthly.

b. Meetings for steering committee members must be held, at a minimum, on a quarterly basis.

c. Provide targeted training and workshops as needed for those directly involved in implementing Action Plan activities.

i. Trainings, orientations, meetings and ongoing communication and resources to members shall be culturally and linguistically appropriate.

10. Utilize tools and strategies to facilitate communication, engagement and continued participation among committee members throughout the resulting grant agreement.

a. Strategies for ongoing communication with FII members must be culturally and linguistically appropriate.

b. Tools for tracking results of team member responsibilities on specific projects or work groups must be utilized outside of formal meetings.

11. Leverage community resources to implement the Action Plan SCO and engage additional community partners on FII Steering Committee as needed as additional SCOs are identified throughout the resulting grant agreement.

12. Designate and employ a Program Manager who shall be responsible for ensuring tasks and activities for the FII initiative are carried out throughout the resulting grant agreement.

a. This position shall be responsible for maintaining the Steering Committee of community agencies and parents and caregivers on the PAC, to assess system issues affecting families of CYSHCN, facilitate the development of an Action Plan driven by parent and provider data, facilitate the completion of action items, and assist with all evaluation efforts.

b. This person shall serve as the primary point of contact for the program, oversee internal documentation of progress, and disseminate information from the Department within the program.

13. Employ a Family Advocate who shall work collaboratively with parents, primary care providers and community agencies to improve the system of care and assists with carrying out action plan projects for FII which address education and support needs for parents and caregivers of CYSHCN throughout the resulting grant agreement.

a. The Family Advocate shall be a parent, caregiver, or have lived experience and have a significant, personal relationship to a CYSCHN.

14. Designate a Fiscal Coordinator who shall serve as the point of contact for budget and funding communication regarding the FII Program throughout the resulting grant agreement.

15. Designate key personnel for all components of the FII Program throughout the resulting grant agreement.

a. Key personnel are defined as any personnel the applicant deems necessary to accomplish the deliverables.

b. Key personnel shall include personnel titles, position descriptions, and percentage of effort related to achieving the FII Program.

16. Designate staff and personnel within 30 calendar days of the effective date of the resulting grant agreement. Written approval must be requested from the Department prior to any changes in key personnel throughout the resulting grant agreement.

17. Implement other tasks to support FII as determined by the Department.

18. Serve as a FII coach to other grantees in Pennsylvania who may choose to replicate this initiative through a grant agreement with the Department and support them through the first year of implementation.

19. Address identified needs for local data on CYSHCN by working with identified partners, including but not limited to local health departments, local government organizations, and schools to ensure inclusion of CYSHCN in ongoing assessments that measure system of care improvement throughout the resulting grant agreement.

b) Client Satisfaction Data Collection The awarded applicant shall:

1. Participate in client satisfaction data collection and reporting activities as established by the Department throughout the term of the resulting grant agreement, which shall include feedback from the awarded applicant and the awarded applicant’s clients to improve the services for Pennsylvania’s maternal, infant, child, and adolescent population.

d) Program Monitoring

1. Participate in all monitoring activities as directed by the Department’s Project

Officer. Such monitoring may be completed onsite, by telephone or through another method of communication identified by the Project Officer, such as electronic mail, video, and web-based platforms. Monitoring will be conducted by the Project Officer twice per fiscal year. Monitoring activities may include:

a. File audits;

b. Interviews with employees, subcontractors, consultants, partners, and stakeholders to obtain pertinent information;

c. Interviews with clients, families, and social supports that participated in programming; and,

d. Supporting documentation review for monthly invoices.

e) Sustainability Planning and Actions

1. Create a sustainability plan with the expectation that FII will continue once the resulting grant agreement is concluded.

2. Demonstrate in the plan the identification and procurement of alternate resources, the development of policies and procedures necessary to continue services, and the implementation of these policies and procedures. The awarded applicant shall submit the sustainability plan for review and written approval within 180 calendar days of the start of year two of the resulting grant agreement.

5. Reporting Requirements

a) The awarded applicant shall be required to submit written quarterly reports to the Department within 30 calendar days of each quarter ending throughout the resulting grant agreement. Reports must include a narrative detailing the activities that have been completed with grant agreement funding along with data for outcome measures developed by the Department for the program.

b) The awarded applicant shall submit a written annual report of progress to the Department within 45 calendar days following the end of each fiscal year. The annual report must, at a minimum, identify if activities are proceeding according to the project plan and explain any deviations from the project plan.

c) The awarded applicant shall submit a final written report to the Department within 60 calendar days following the termination of the resulting grant agreement. The final report must summarize progress in accomplishing proposed tasks, obstacles to achieving goals and actions taken to overcome obstacles. Specific guidance for the final report will be issued by the Department prior to the end of the project period.

d) The awarded applicant shall submit to the Department’s Project Officer an annual assessment report once per calendar year throughout the term of the grant agreement, using the “CLAS Self-Assessment Tool for Grantees” template that can be found at the following link: https://www.pa.gov/en/agencies/health/resources/contractor-grantee.html. The annual report shall summarize in detail how the awarded applicant has met the Health Equity requirements contained in paragraph 11 of Exhibit E, Department Standard General Terms and Conditions.

C. Application Instructions and Required Format

1. Application Instructions

The following is a list of requirements.

a) The applicant must submit one application (Part Two of this RFA), by email to

RA-DHHEALTH_DEPT_DOC@pa.gov. The Department cannot accept secure or encrypted emails. Any submission via secure or encrypted email will be immediately discarded.

b) The application must be received by the date and time specified in the cover letter.

Applicants should consider that technical difficulties could arise and allow sufficient time to ensure timely email receipt. (Late applications will be rejected, regardless of the reason). The application can be submitted as soon as it is ready for submission; to prevent late submissions, applicants are encouraged to not wait until the closing date and time in the cover letter.

c) Please note there is a 10MB size limitation per email. If the application exceeds 10MB, zip the file to reduce the size or submit multiple emails so the entire application is able to be received.

d) The application must be submitted using the format described in subsection 2, below – Application Format.

Applicants are strongly encouraged to be brief and clear in the presentation of ideas.

2. Application Format

Applicants must follow the format as described below to complete Part Two of this RFA.

Applications must be typewritten on 8 ½” by 11” paper, with a font size no smaller than 10 point and margins of at least ½ inch.

a) Cover Page – Complete the form. This form must be signed by an official authorized to bind the applicant/organization to the application.

b) Worker Protection and Investment Certification Form (BOP-2201) – BOP-2201 must be completed and signed by an official authorized to execute the certification on behalf of the applicant.

c) Lobbying Certification Form (BOP-1307) – BOP-1307 must be completed and signed by an official authorized to execute the certification on behalf of the applicant.

d) Work Statement – The work statement narrative must not exceed 20 pages. Provide a narrative description of the proposed methodology addressing the following topics:

i. Organizational Capability and Competency: Applicants shall include a description of the characteristics and qualifications of the organization that will be implementing the program. Applicants shall demonstrate their experience in working with the CYSHCN population and CYSHCN family needs throughout the identified service region, which includes Carbon, Columbia, Lackawanna, Luzerne, Monroe, Pike, Schuylkill, Susquehanna, Wayne, and Wyoming counties. Applicants shall demonstrate the ability to replicate and implement evidence-based practices.

Applicants shall provide a description of any identified key staff involved in the project and their qualifications. Applicants shall describe existing partnerships or collaborations with local health providers and community organizations that serve CYSHCN including but not limited to schools, social services, mental health, and early education. Applicants shall describe experience and readiness in assembling effective community coalitions or committees. Applicants shall describe experience and readiness in gathering qualitative community data. Applicants shall describe training and experience in the systems approach to community change. Applicants shall describe any successes in systems changes spearheaded by the organization in the past five years.

ii. Statement of the Problem: Applicants shall demonstrate an understanding of the communities served throughout the identified service region (Carbon, Columbia, Lackawanna, Luzerne, Monroe, Pike, Schuylkill, Susquehanna, Wayne, and Wyoming counties). Applicants shall demonstrate an understanding of CYSHCN and the impact the system of care has on this population throughout the identified service region. Applicants shall describe the needs and the challenges faced by families of CYSHCN in the identified service region, including any known or identified service gaps. Applicants shall demonstrate an understanding of inequities within the health system and health disparities among the CYSHCN population.

iii. Approach to the Problem, Feasibility and Sustainability: Applicants shall describe a plan to meet the goals and deliverables implementing FII through replication of North Carolina’s Innovative Approaches model throughout the identified service region (Carbon, Columbia, Lackawanna, Luzerne, Monroe, Pike, Schuylkill, Susquehanna, Wayne, and Wyoming counties). Applicants shall include a timeline for implementation of the proposed program. The timeline shall be a feasible plan and describe the major tasks associated with the goals of this project, assign responsibility for each, and plot completion of each task by month or quarter for the duration of the award. Applicants shall describe a plan to recruit, engage and retain Steering Committee members throughout the identified service region and convene this committee to meet the program deliverables. The plan shall include a description of possible partners and steps that may be needed to engage external partners to achieve desired outcomes. Applicants shall describe a plan to recruit, engage and retain Parent Advisory Committee members throughout the identified serviced region and convene this committee to meet the program deliverables. The plan shall describe how to maintain genuine and meaningful family leadership, participation, and input in planning process. Applicants shall describe a plan to identify and provide a system change training to all program staff and individuals identified to serve on the stakeholder committees. Applicants shall describe a plan to conduct a needs assessment of local CYSHCN service systems within the service region identified (Carbon, Columbia, Lackawanna, Luzerne, Monroe, Pike, Schuylkill, Susquehanna, Wayne, and Wyoming counties). Applicants shall describe a plan to develop and implement system change objectives (SCO) based on the identified system problems or gaps in the needs assessment. Applicants shall describe a plan to facilitate meetings to determine progress and outcomes of project activities and tasks identified in the Action Plan. Applicants shall describe a plan to utilize tools and strategies to facilitate communication, engagement and continued participation among committee members. Applicants shall describe a plan to leverage community resources to implement the Action Plan SCOs and engage additional community partners for FII as needed. Applicants shall describe a plan for hiring key personnel for all components of the FII Program, including a Program Manager and Family Advocate. Applicants shall describe a plan to serve as a FII coach to other Grantees in Pennsylvania who may choose to replicate this initiative through a grant agreement with the Department. Applicants shall describe any identified challenges or barriers to anticipated implementation and how to overcome them. Applicants shall describe a plan to ensure SCOs implemented will be sustainable beyond the termination of the resulting grant agreement. Applicants shall describe a sustainability plan for the FII project beyond the 54-month grant period. The sustainability plan shall describe capacity and staff development efforts that will support continued system change beyond the grant project.

iv. Program Goals and Objectives: Applicants shall describe how the proposed project meets the needs and improves the system of care of CYSHCN and their families in Pennsylvania. Applicants shall describe strategies for data collection methods used to identify needs and gaps in system issues for CYSHCN and their families.

Applicants shall describe how needs will be identified, and how SCOs and activities will be prioritized and developed in the Action Plan. The plan must demonstrate readiness to undertake system change activities and successfully carry out objectives. Applicants shall describe a plan that anticipated system changes will have significant reach, including all areas of the identified service region, which includes Carbon, Columbia, Lackawanna, Luzerne, Monroe, Pike, Schuylkill, Susquehanna, Wayne, and Wyoming counties. Applicants shall describe how system changes will have substantial impact on CYSHCN and families. Applicants shall describe how deliverables and activities will be provided in a linguistically and culturally appropriate manner. Applicants shall describe any existing assessment processes in the chosen service region and propose strategies to address needs for local data on CYSHCN by working with local health departments and associated partners to ensure inclusion of CYSHCN in ongoing assessments that measure system of care improvement.

v. Performance Measures: Applicants shall describe how output measures will be reported. The Department shall determine specific measures collected which will include, but not be limited to: number of individuals and their disciplines serving on the Steering Committee; number of parents or caregivers and their demographics serving on the Parent Advisory Committee; number of meetings held and individual attendance; activities identified and carried out successfully in Action Plan; number of trainings or events held and attendance; survey results and feedback of events held; and number of partnerships established to support system change objectives in the Action Plan. Applicants shall describe how the program evaluates the successful completion of goals and objectives. This program evaluation of goals and objectives shall include ongoing strategies for monitoring program performance to identify and solve problems that could impact success that is, continuous quality improvement. Applicants shall demonstrate how they will measure committee member engagement and identify strategies for improvement if engagement is determined not successful. Applicants shall describe how they will identify that the system change objective was successful and the anticipated impact occurred. Applicants shall describe how to track the number of policies, procedures, or practice changes, as evidenced by reporting.

e) Budget Detail and Budget Narrative – Use the downloadable format to present your budget request. Instructions regarding completion of the budget can be found in the last worksheet of the downloadable excel budget file. The anticipated grant agreement term is January 1, 2027, through June 30, 2031. The overall 54-month budget for the application shall not exceed $825,000.00. The budget must contain an Overall Summary in addition to a Summary with Budget Details for each year.

Overall Summary January 1, 2027 to June 30, 2031 $825,000 Year 1 Summary January 1, 2027 to June 30, 2027 $165,000 Year 2 Summary July 1, 2027 to June 30, 2028 $165,000 Year 3 Summary July 1, 2028 to June 30, 2029 $165,000 Year 4 Summary July 1, 2029 to June 30, 2030 $165,000 Year 5 Summary July 1, 2030 to June 30, 2031 $165,000

Applicants shall include a narrative which justifies the need to allocate funds for items in the spreadsheet of the itemized budget and demonstrates how they will maximize cost effectiveness of grant expenditures. Applicants shall also explain how all costs are calculated, how they are relevant to the completion of the proposed project, and how they correspond to the information and figures provided in the Budget Detail Summary.

See the Budget Definitions section below for more information.

f) Redacted Copy- Applicants may provide a redacted copy of the full application that they submit for this RFA, which redacts confidential, proprietary information, or trade secrets, or some combination thereof. Follow the process as outlined in Paragraph 26 (Confidentiality) of Department Standard General Terms and Conditions (Grant) (Rev.

12/24), which can be found at http://www.health.pa.gov/vendors.

3. Budget Definitions

This budget category is not applicable and must not be utilized.

Personnel: This budget category shall identify each position by job title, hourly rate, and the number of hours per year allocated to the project. Fringe benefits are to be shown as a separate line-item by percentage and shall include a detailed listing of the benefits being covered.

Consultant Services: This budget category shall identify the services to be provided by each consultant including hourly rate and number of hours to be utilized under this grant agreement.

Subcontract Services: This budget category shall identify the services to be provided by each subcontractor under this grant agreement.

Patient Services: This budget category is not applicable and must not be utilized.

Equipment: This budget category shall reflect the actual or projected cost of any equipment $5,000 or greater. Justification for the purchase of any equipment must be included.

Purchase of equipment is not a priority of the Department.

Supplies: This budget category shall reflect expected costs for general office supplies including personal computers and facsimile machines valued at less than $5,000, needed to support this project.

Travel: This budget category shall include anticipated expenditures for travel including mileage, hotels and meals.

Other: This budget category shall be used for anticipated expenditures that do not fit into any of the other budget categories such as telephone, printing, postage, and indirect costs (overhead, general, and administrative). Indirect rates cannot exceed the provider’s federally approved indirect cost rate schedule. In the description area under OTHER COSTS include the % that the rate reflects, identify the budget categories to which the rate was applied, and list the specific items that the indirect is paying for.

PART TWO

Pennsylvania Department of Health

Bureau of Family Health Division of Community Systems Development and Outreach

Request for Applications (RFA) #67-207

RFA# 67-207

Attachment I

COVER PAGE

RFA #67-207

Applicant Name: ___________________________________________________________________ (Organization or Institution) Type of Legal Entity_________________________________________________________________ (Corporation, Partnership, Professional Corporation, Sole Proprietorship, etc.)

Federal I.D.#: ___________________ Grant Amount: $____________________

SAP Vendor #:___________________

Address:___________________________________________________________________________

City_______________________County__________________State________Zip Code___________

Application Contact Person:__________________________________________________________

Title:______________________________________________________________________________

Telephone No.: __________________ Fax: _______________ E-mail:________________

Region: Northeast Region of Pennsylvania which includes the following counties: Carbon, Columbia, Lackawanna, Luzerne, Monroe, Pike, Schuylkill, Susquehanna, Wayne, and Wyoming._________________________________________

Applications/proposals/bids received shall remain valid, unless deemed unresponsive, until such time that final award(s) is or are made.

BY SIGNING BELOW, THE APPLICANT, BY ITS AUTHORIZED SIGNATORY, IS BINDING ITSELF

TO THE APPLICATION AND REPRESENTING THAT ALL THE INFORMATION SUBMITTED IS

TRUE AND CORRECT TO THEIR BEST KNOWLEDGE, INFORMATION AND BELIEF.

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL

TITLE

DATE

Attachment II

WORKER PROTECTION AND INVESTMENT CERTIFICATION FORM

A. Pursuant to Executive Order 2021-06, Worker Protection and Investment (October 21, 2021), the Commonwealth is responsible for ensuring that every worker in Pennsylvania has a safe and healthy work environment and the protections afforded them through labor laws. To that end, contractors and grantees of the Commonwealth must certify that they are in compliance with Pennsylvania’s Unemployment Compensation Law, Workers’ Compensation Law, and all applicable Pennsylvania state labor and workforce safety laws including, but not limited to:

1. Construction Workplace Misclassification Act

2. Employment of Minors Child Labor Act

3. Minimum Wage Act

4. Prevailing Wage Act

5. Equal Pay Law

6. Employer to Pay Employment Medical Examination Fee Act

7. Seasonal Farm Labor Act

8. Wage Payment and Collection Law

9. Industrial Homework Law

10. Construction Industry Employee Verification Act

11. Act 102: Prohibition on Excessive Overtime in Healthcare

12. Apprenticeship and Training Act

13. Inspection of Employment Records Law

B. Pennsylvania law establishes penalties for providing false certifications, including contract termination; and three-year ineligibility to bid on contracts under 62 Pa. C.S. § 531 (Debarment or suspension).

CERTIFICATION

I, the official named below, certify I am duly authorized to execute this certification on behalf of the contractor/grantee identified below, and certify that the contractor/grantee identified below is compliant with applicable Pennsylvania state labor and workplace safety laws, including, but not limited to, those listed in Paragraph A, above. I understand that I must report any change in the contractor/grantee’s compliance status to the Purchasing Agency immediately. I further confirm and understand that this Certification is subject to the provisions and penalties of 18 Pa. C.S. § 4904 (Unsworn falsification to authorities).

Signature Date

Name (Printed)

Title of Certifying Official (Printed)

Contractor/Grantee Name (Printed)

BOP-2201

Published: 02/07/2022

Attachment III

BOP-1307

Revised 11/7/2013

LOBBYING CERTIFICATION FORM

Certification for Contracts, Grants, Loans, and Cooperative Agreements

The undersigned certifies, to the best of his or her knowledge and belief, that:

(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of

Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement.

(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard

Form-LLL, Disclosure of Lobbying Activities, which can be found at:

http://www.whitehouse.gov/sites/default/files/omb/assets/omb/gra…