S-44300-00000483 OHA-RFA-5064 Fillable Application.docx
DOCX document 54 KB Posted
- Attached to
- RFA for Technical Assistance Consultants
- Solicitation number
- S-44300-00000483
- Issued by
- Marion County, Oregon
About this file
This document is a Request for Applications (RFA) issued by the Oregon Health Authority (OHA) seeking qualified firms, nonprofits, governmental agencies, coalitions, or individuals to provide technical assistance (TA) to Coordinated Care Organizations (CCOs) across Oregon, as well as assist other publicly funded health programs, tribal health programs, OHA contracted health systems, or other OHA program areas involved in health systems transformation. The RFA outlines the required areas of expertise, including analytic modeling, behavioral health integration, community health assessment, early learning systems, health information technology, payment strategies, and more. Applicants must demonstrate at least 5 years of experience in each claimed area of expertise and 3 years of experience providing technical assistance. Applicants are required to submit resumes, references, and hourly rates for the proposed services.
The RFA does not constitute a public contract, but rather establishes a Price Agreement, which, when combined with a subsequent Work Order Contract, will form the public contract. The RFA is open to qualified applicants, and the final rates will be negotiated between OHA and the selected Applicants. Travel-related expenses will be reimbursed at GSA-approved rates upon submission of required receipts.
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Other files
| File | Type | Posted |
|---|---|---|
| SexOffenderEvaluationFinal~5.doc | DOC document | |
| 5064 Addendum 1 final.pdf | ||
| S-44300-00000483 OHA-RFA-5064 Final.pdf | ||
| S-44300-00000483 OHA-RFA-5064-Addendum 1 Final.pdf | ||
| 5064 Addendum 2 final.pdf |
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Text version
ATTACHMENT 1 – OHA TA CONSULTANT APPLICATION
OregonBuys Number S-44300-00000483/OHA-RFA-5064 A. APPLICANT INFORMATION. Please print or type the requested information.
Applicant’s Business Name (As filed with the IRS):Click or tap here to enter text.
| Contact Name:Click or tap here to enter text. |
| FEIN/SSN #:Click or tap here to enter text. |
| Email:Click or tap here to enter text. |
| Phone #:Click or tap here to enter text. |
Mailing Address:Click or tap here to enter text.
B. APPLICATION FOR THE FOLLOWING AREAS OF EXPERTISE. Please check all that apply.
| ☐Analytic modeling |
| ☐Health systems leadership |
| ☐Project management |
| ☐Behavioral health integration |
| ☐Health systems research, including program evaluation |
| ☐Public health integration |
| ☐Community health and assessment improvement plan, review, implementation, and evaluation |
| ☐Improving health equity |
| ☐Public policy facilitation |
| ☐Early learning systems and strategies to improve children’s health |
| ☐Incentive metrics |
| ☐Quality improvement science |
| ☐Economic and financial modeling |
| ☐Oral health integration |
| ☐Strategies to address rising pharmaceutical costs |
| ☐Engagement strategies for person and family‐centered health care systems |
| ☐Organizational development |
| ☐Strategies to address the social determinants of health |
| ☐Health information technology |
| ☐ Primary care transformation, including patient‐centered primary care homes |
| ☐ Value‐based payment and payment strategies |
2021 Incentive Metrics. Applicant must check all subcategories that apply.
| ☐Assessments for children in DHS custody | |
| ☐Depression screening and follow-up plan (EHR) |
☐Initiation and engagement of alcohol or other drug treatment
| ☐Child and adolescent well-care visits | |
| ☐Disparity measure: ED utilization among members with mental illness |
☐Oral evaluation for adults with diabetes
| ☐Childhood immunization status |
| ☐Drug or alcohol misuse screening (SBIRT)(EHR) |
| ☐Prenatal and postpartum care |
| ☐Cigarette smoking prevalence (EHR) |
| ☐Health Equity: Meaningful language access to culturally responsive health care services |
| ☐ Preventative dental visits, ages 1-5 (kindergarten readiness) & 6-14 |
| ☐Comprehensive diabetes care: HbA1c poor control (EHR) |
| ☐Immunization for adolescents |
C. WORK EXPERIENCE SUMMARY (in addition to checking the applicable boxes above) Per Section 2 – Minimum Requirements, Applicant must submit supporting materials to show proof of 5 years’ experience and/or qualifications for each area of expertise checked above. Proof of experience and qualifications includes but is not limited to project descriptions with clear timeframes, resumes or curricula vitae. Applicant shall submit a summary of no more than 2 pages for each subject area of expertise.
Per Section 2 – Minimum Requirements, Applicant must submit supporting materials to show proof of 3 years’ experience providing technical assistance in any category.
D. HOURLY RATES
Applicant must provide a document that specifies hourly rates. Rates must be fully loaded, and details of fringe benefits should not be included. If an Applicant has multiple rates, depending on job position, please specify each rate and associated position. The final rates will be negotiated and established between OHA and Applicant when the Price Agreement is issued.
Time spent in travel status may be paid at 50% of the hourly rates and travel must be pre‐approved, in writing, by OHA. Travel related expenses will be reimbursed at GSA approved rates (http://www.gsa.gov/portal/category/100120) upon submission of required receipt(s).
E. REFERENCES
Provide at least two references with telephone numbers (please verify numbers). References will be contacted to verify the quality of Applicant’s previous work in the proposed areas of expertise. Poor references or lack of response from references will affect the Application approval process.
REFERENCE No. 1:
| Organization Name: Click or tap here to enter text. |
| Telephone: Click or tap here to enter text. |
| Contact Person: Click or tap here to enter text. |
| Fax: Click or tap here to enter text. |
| Project Title: Click or tap here to enter text. |
| Email: Click or tap here to enter text. |
REFERENCE No. 2:
| Organization Name: Click or tap here to enter text. |
| Telephone: Click or tap here to enter text. |
| Contact Person: Click or tap here to enter text. |
| Fax: Click or tap here to enter text. |
| Project Title: Click or tap here to enter text. |
| Email: Click or tap here to enter text. |
F. RESUME
Applicant shall submit resumes of Key Personnel, which demonstrate that they meet the Minimum Requirements listed in Section 2.
G. CERTIFICATION
By signing and submitting this Application to OHA, Applicant attests that Applicant has read and understands this RFA and the Sample Price Agreement. Applicant understands that this RFA and the Price Agreement are not, by themselves, a public contract, and do not constitute a promise or commitment by OHA to issue a Work Order Contract. The RFA, Price Agreement, and the Work Order Contract comprise a public contract when a Work Order Contract is issued to a Contractor, who is party to a Price Agreement. The undersigned hereby certifies under penalty of perjury that:
1. The undersigned is authorized to act on behalf of Applicant.
2. The information shown in section A of the TA Consultant Application, “Applicant Information” above, is true and accurate. If FEIN or SSN provided changes, Applicant agrees to update OHA with new FEIN or SSN within 10 days.
3. Applicant meets “Independent Contractor” status as defined in ORS 670.600 or Applicant is a governmental agency.
Applicant’s Signature
| Signature | Title | Date | |
| OregonBuys Number S-44300-00000483/OHA-RFA-5064/dap | Page 2 of 2 | ||
| OregonBuys Number S-44300-00000483/OHA-RFA-5064/dap | Page 2 of 2 |
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