City of Chicago Request for Proposals (RFP) For Expanded HIV Testing for Disproportionately Affected Populations RFP #DA

Transcription

1 City of Chicago Request for Proposals (RFP) For Expanded HIV Testing for Disproportionately Affected Populations RFP #DA Key Dates Release Date January 13, 2014 Pre-Proposal Conference January 22, 2014 Letter of Intent Due January 24, 2014 Proposal Due February 3, 2014 Contract Start Date February 14, 2014 Submit one (1) original, four (4) complete copies, and a complete electronic copy on a CD of the proposal All proposals must be addressed and delivered to: Department of Public Health DePaul Center Room South State Street Chicago, Illinois, PROPOSALS MUST BE RECEIVED NO LATER THAN 4:00 P.M. CENTRAL ON February 3, 2014 NO PROPOSALS WILL BE ACCEPTED FOR ANY REASON AFTER THIS DEADLINE City of Chicago Department of Public Health STI/HIV Services Division Rahm Emanuel Mayor Bechara Choucair, M.D. Commissioner

2 TABLE OF CONTENTS City of Chicago Request for Proposals (RFP) For Expanded HIV Testing for Disproportionately Affected Populations RFP #DA I. Purpose. 3 II. Background.. 3 III. Eligibility Requirements for Respondents... 4 IV. Pre-Proposal Conference. 5 V. Available Funding 5 VI. Project Description... 6 VII. Instructions for Completing a Proposal... 8 A. Intent to Apply... 8 B. Proposal Guidelines... 8 VIII. Proposal Checklist IX. Submission Guidelines 14 A. Format Instructions B. Required Documentation.. 15 X. Evaluation of Proposals.. 15 XI. Reporting and Other Requirements for Successful Respondents 16 XII. Compliance with Laws, Statutes, Ordinances and Executive Orders Appendices A. Intent to Apply Form B. Title Page. 22 C. Proposal Checklist D. Budget Forms E. Program Work Plan F. Key Personnel Form. 28 2

3 I. Purpose City of Chicago Request for Proposals (RFP) For Expanded HIV Testing for Disproportionately Affected Populations RFP #DA The purpose of this Request for Proposal (RFP) is to identify one qualified Lead Organization (LO) to administer and manage all aspects of the expanded HIV testing project funded under CDC-RFA-PS Category B entitled Expanded HIV Testing for Disproportionately Affected Populations. The LO will implement expanded HIV testing efforts for populations disproportionately affected by HIV, namely, African Americans, Hispanics, men who have sex with men (MSM) and injection drug users (IDU) in healthcare settings. The expanded testing initiative aims to identify strategies for leveraging resources to maximize the yield and sustainability of routine HIV screening programs in healthcare settings that may include strategies for obtaining reimbursement for HIV screening from third party payers. In addition to promoting routine HIV screening in healthcare facilities, the LO will conduct enhanced linkage activities that includes comprehensive prevention counseling services, linkage to partner services, and integrated testing programs for HIV, sexually transmitted infections (STIs), hepatitis, and tuberculosis (TB). The successful Respondent will be expected to identify and subcontract with multiple numbers and types of community-based healthcare facilities (herein referred to as subcontracted healthcare facilities). II. Background Chicago, like other large urban areas continues to be disproportionately affected by the HIV epidemic. While Chicago accounts for 31% of Illinois population in 2012, it accounts for 63.1% (N=22,324) of those living with HIV/AIDS in the state. Chicago s prevalence rate of per 100,000 is three times the state s prevalence rate (274.6 per 100,000). Both nationally and locally there are considerable racial/ethnic disparities in HIV rates. In Chicago, non-hispanic (NH) Blacks have an AIDS case rate that is more than four times greater than that of NH Whites (36 vs. 8.2 per 100,000 respectively); an HIV infection diagnosis rate three times higher (63.4 vs per 100,000); and an HIV prevalence rate twice that of NH Whites (1,270.1 vs per 100,000, respectively). Hispanics have a considerably lower prevalence rate than NH Whites and NH Blacks and a slightly higher AIDS diagnosis rate than NH Whites. Of the 21,555 people living with HIV infection in 2011, 79% are men, 51% are NH Black, and 59% are MSM. Among NH Black men living with HIV infection, 63% were infected as a result of male-to-male sexual contact, compared with 90% of NH White, 75% of Hispanic, and 80% of NH Asian/Pacific Islander men. HIV diagnoses continue to decline and improvements in access to care result in steadily increases in the number of people living with HIV. The largest percentage decrease in the last five years is observed among people who inject drugs, attributable to needle exchange/clean works programs. However, people between the ages of have experienced an average 5% increase in HIV infections over the past 5 years. AIDS diagnoses have similarly fallen, with the exception again among those between the ages of 13 and 30. Young adults are shouldering an increasing proportion of new HIV and AIDS diagnoses. While males account for 81% of all 2011 HIV infection diagnoses, this percentage varies by race/ethnicity. Among NH Black diagnoses, 75% are males, compared to 93% for Whites, and 86% for Hispanic men. Among MSM who were diagnosed with HIV Infection in 2011, 48% were Black, 20% 3

4 were White, and 21% were Hispanic. Among females, heterosexual contact accounts for 86% of all HIV infection diagnoses in 2011 for all race/ethnicity groups. In 2011, 74% of new female HIV infections were among NH Blacks. HIV and STI infections are prevalent among similar risk groups and have been found to enhance the acquisition and transmission of one another. In Chicago in 2011, 43% of men diagnosed with primary and secondary syphilis were co-infected with HIV. Results from the 2008 and 2011 Chicago HIV Behavioral Surveillance surveys among MSM show that overall, HIV prevalence among Chicago men who have sex with men (MSM) was 20.9% in 2011; up from 18.1% in The largest increase in HIV prevalence was observed among non-hispanic White MSM (11.6% in 2008 to 16.8% in 2011) and NH Black MSM (32.2% in 2008 to 35.1% in 2011). HIV prevalence remained stable among Hispanic / Latino MSM (12.1% in 2008 to 12.5% in 2011). Among MSM youth (under 30 years of age) the only increase in HIV prevalence was observed among White MSM (1% in 2008 to 10% in 2011). No changes were observed in Black MSM youth (28% in both years) and a slight decrease was observed among Latino MSM youth (9% to 8%). Considerable decreases were observed in the number of HIV-positive MSM who were not aware of their HIV infection between the 2008 and 2011 surveys. Overall, in 2008, 52% of HIV-positive MSM were unaware of their status, in 2011, less than one-quarter (22%) were unaware of their HIV infection. These decreases were observed among all race/ethnicity groups. In 2011, 33% of HIV-infected Black MSM were not aware of their infection, compared to 67% in 2008; 9% of HIV-infected White MSM were not aware of their infection compared to 23% in 2008; 21% of HIV-infected Hispanic MSM were not aware of their infection compared to 50% in The percentage for all MSM that report ever having had an HIV test in their lifetime has increased from 94% in 2008 to 99% in Overall, 65% of MSM met the CDC HIV testing guidelines (at least one HIV test annually) in This was similar to 64% reported by MSM in Changes in regular HIV testing (at least one test annually over the last two years) varied by race/ethnicity where rates of annual HIV testing were slightly increased for Black MSM (62% in 2008 to 66% in 2011; slightly decreased for Whites (57% to 53%) and increased for Hispanic MSM (53% to 56%). Sixty-two percent of Black and 57% of Hispanic MSM were offered an HIV test at their regular doctor visit compared to 44% of White MSM. This RFP is intended to sustain the progress made in HIV testing and seeks to expand routine testing and linkage to care services in clinical settings to reach a broader array of at-risk populations. III. Eligibility Requirements for Respondents The successful Respondent must be able to meet all of the criteria below to be eligible to submit a project proposal as the LO. Any public or private for-profit or non-profit that: Is located within the City of Chicago; Can demonstrate the administrative, organizational, programmatic, and fiscal capability to plan, develop, implement, and evaluate the proposed project; and Currently provides or has provided in the past five (5) years: management of HIV testing program(s); and either HIV clinical services or linkage to HIV clinical services for people living with HIV/AIDS to one or more of the target populations. 4

5 Respondents should have substantial experience in the coordination of large scale activities through subcontract arrangements. The organization that submits the proposal will be designated as the LO to contract with the City of Chicago. Subject to prior pre-approval by CDPH, other participating organizations will be subcontractors to the LO. All subcontracted healthcare facilities must be located within the city of Chicago and all services proposed must be conducted within the City. All subcontracted healthcare facilities contracted by the LO must also demonstrate that they meet all of the eligibility criteria as stated in this RFP. If the Respondent is partnering with another organization to provide services detailed in this RFP and will have a financial or subcontracting relationship with the partnering organization, the LO is required to have an executed Memorandum of Understanding (MOU) with its partner(s) specific to the proposed services to be provided that specifically delineates the details for the relationship and the responsibilities of both parties. This MOU must be signed by the Executive Directors of each partner(s) and must be current. This MOU(s) should be included as an attachment to the LO s proposal submission. All Respondents must complete the City s electronic Economic Disclosure Statement and Affidavit which is accessed via the City s website, and typing Economic Disclosure Statement in the search button. All Respondents must submit proof of insurance with their completed proposal. The successful Respondent will be required to name the City of Chicago as additional insured. All Respondents are strongly encouraged to complete an Intent to Apply form (see Appendix A) and submit it to Tonya Hardy at Tonya.Hardy@cityofchicago.org by January 24, IV. Pre-Proposal Conference An in-person Pre-Proposal Conference has been scheduled for this RFP. The purpose of the Pre-Proposal Conference is to provide an overview of this RFP, describe the proposal review process, and answer prospective Respondents questions. Organizations planning to submit a proposal for funding are strongly encouraged to participate in a Pre-Proposal Conference. The Pre-Proposal Conference will be held at the following location and date: V. Available Funding Location January 22, :30 p.m. Chicago Department of Public Health Board Room 333 South State Street, Suite 200 Chicago, Illinois, A total of $850,000-$1,300,000 is anticipated to be available annually for this RFP using funds received through a cooperative agreement between the Center for Disease Control and Prevention (CDC) and the CDPH for an initial term of February 14, 2014 through December 31, The LO will be expected to subcontract with CBOs representing different types of clinical settings to conduct the activities as outlined in this RFP. Contract renewal is possible for up to two (2) additional periods, each period not to exceed one year, and contingent on funding availability and prior program and fiscal performance. 5

6 VI. Project Description A. Program Goals and Objectives The following are specific local-level goals and objectives for this project. Goal 1: To increase the number of persons who receive HIV testing and the number and proportion of HIV-infected persons who are aware of their infection among populations disproportionately affected by HIV primarily (1) African American and Hispanic adolescents and adults, and (2) MSM and IDUs, regardless of race or ethnicity through routine HIV screening in healthcare settings serving these populations. Objective: When the program is fully implemented, conduct 35,000 HIV tests and identify approximately 175 HIV-infected persons annually who are previously unaware of their infection among populations disproportionately affected by HIV primarily (1) African American and Hispanic men and women, and (2) MSM and IDUs, regardless of race or ethnicity. Goal 2: Promote adoption of sustainable, routine HIV screening programs in healthcare facilities, consistent with CDC's 2006 Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Healthcare Settings. Objective: Increase the number of collaborating healthcare facilities that have implemented sustainable, routine HIV screening programs consistent with CDC's 2006 guidelines in Chicago over the course of the project. Goal 3: Support the integration of prevention services for other infections such as Hepatitis C (HCV), hepatitis B (HBV), other STIs, and TB. Objective: Increase the number of clinical settings offering integrated testing programs for HIV, hepatitis, other STIs, and TB over the course of the project in Chicago. B. Funding Requirements and Priorities The successful Respondent will need to fulfill the following minimum expectations as part of the expanded HIV testing project: Ability to reach target population through subcontracted healthcare facilities to diagnose HIV infection among African-American and Hispanic men and women, and MSM and IDUs regardless of race/ethnicity;an overall program objective is to conduct 35,000 HIV tests and identify approximately 175 HIV-infected persons annually who are previously unaware of their infection. Ability to ensure that a minimum of 80% of the HIV tests performed are within the target population; Ability to carry out routine, opt-out HIV testing in healthcare settings in accordance with the CDC's revised (2006) HIV testing recommendations; Ability to integrate HIV testing into routine practices; Ability to return HIV test results to at least 85% of persons who test positive for HIV; Ability to refer at least 80% of persons who receive their HIV positive test results to partner services; HIV partner services include a set of confidential, voluntary services to help persons with HIV notify their sex and drug-injection partners of possible HIV exposure, to offer services that can 6

7 protect the health of partners, and to prevent sexually transmitted disease (STD) reinfection in persons with HIV. Ability to deliver or refer to HIV prevention counseling to 80% of persons who receive their HIV positive results; Ability to link at least 80% of persons who receive their HIV positive test results to medical care and attend their 1 st appointment within three months of test date; Ability to sustain HIV testing and to obtain reimbursement from third party payers (Medicare, Medicaid, private insurers, etc.) through subcontracted healthcare facilities; Ability to deliver integrated HIV, STI, hepatitis, TB screening and treatment services; Ability of LO to manage, support, and administer contractual and programmatic activities related to the initiative; Ability to organize, manage, and support a diverse array of subcontracted healthcare facilities [a minimum of six (6) and a maximum of twenty (20)] in a variety ofdifferent healthcare facility settings. Facilities must be located in geographic locations in high HIV incidence community areas in Chicago and in settings with a high-incidence of HIV infection. Facilities must also include at least three (3) different types of settings listed below: Emergency departments (EDs); Urgent care clinics (UCCs); Inpatient settings; Primary care facilities; Community health centers or Federally Qualified Healthcare Centers (FQHCs); Health Maintenance Organizations (HMOs); Family planning and reproductive health clinics; High school, college and university student health clinics; Pharmacy-based clinics/clinics located in pharmacy facilities; Retail clinics/clinics located in retail store facilities; STI clinics; TB clinics; Other public health clinics; Dental clinics; Correctional facility clinics; Substance abuse treatment facilities (including methadone clinics Ability to execute a quality staffing plan to support program activities; Ability to provide training, capacity building and technical assistance to subcontracted healthcare facilities to support routine opt-out HIV screening in healthcare settings, counseling, testing, and referral, and linkage and partner services; Ability to collect and report required data to CDPH for the project in a timely manner; Ability of LO and subcontracted healthcare facilities to comply with the confidential information provisions included in their agreement and at all times to ensure that project data are shared only in a secure environment, are shared in compliance with the agreement and any applicable rules and regulations, including but not limited to the HIPAA, HITECH, and the Illinois AIDS Confidentiality Act. HIPAA Business Associate Agreements will be established and authorizations for the release of information shall be obtained, if appropriate. 7

8 VII. Instruction for Completing a Proposal A. Intent to Apply All Respondents are encouraged to complete and submit the Intent to Apply Form (Appendix A) by 4:00 p.m., Friday, January 24, This form is for informational purposes only and will not be used to determine eligibility or funding. The form may be ed or delivered to: B. Proposal Guidelines Tonya Hardy Chicago Department of Public Health 333 South State Street Chicago, IL Tonya.Hardy@cityofchicago.org This section provides information on proposal requirements and submission guidelines. Each proposal must be complete and narrative responses should be self-explanatory. Include a table of contents reflecting major categories and corresponding page numbers. Use headings and subheadings to ensure that your proposal covers all the required elements. Use the Proposal Checklist in Appendix C to create the Table of Contents and to ensure that your proposal is complete. Only documents requested in this RFP or directly related to the RFP should be submitted. Any unsolicited material submitted with a proposal will not be considered. Title Page (see Appendix B) This page must be the first page of your proposal. Project Abstract (No more than one page) The Project Abstract provides a brief description of your organization and its experience relevant to this proposal and category. The Project Abstract should include the following information: Name of organization and address(es) Description of the project for which funds are being requested Description of the organization s experience working with the target populations Organization Experience and Target Population (No more than four pages) Provide a narrative describing your organization s experience coordinating a network of healthcare facility settings. Describe experience selecting, coordinating and convening partners representing various types of clinical settings. Describe the Respondent s experience with routine HIV screening programs in healthcare settings, including experience providing or supporting similar programs in the past or currently, and for what length of time. If the Respondent has previous or current experience with such programs, please address the following: 8

9 The types of healthcare facilities and settings where such programs have been, or will be, provided and supported. The yield of these programs in terms of number of tests conducted and number of persons with newly diagnosed HIV infection. Experience with training and technical assistance needs associated with such programs. Include experience providing and/or facilitating HIV testing and treatment to African-American and Hispanic men and women, and MSM and IDUs regardless of race/ethnicity. Describe the target populations that the Respondent plans to reach through the proposed program for routine HIV screening in healthcare settings (for example, demographic and risk behavior characteristics, geographic location). Include an explanation of the rationale behind the selection of the target populations. Cultural and Linguistic Capacity (No more than one page) Describe Respondent s ability to meet the cultural and linguistic needs of the diverse targeted communities. Describe any innovative or successful activities Respondent has undertaken in order to improve its cultural and linguistic capacity. Facility Recruitment, Staffing and Management (No more than six pages) Describe the method in which the Respondent shall recruit and select highly subcontracted healthcare facilities settings that serve the target populations to conduct the activities outlined in this RFP. The description should include the following information: The proposed number of subcontracted healthcare facilities and types of healthcare settings (for example, emergency departments, primary care clinics, STI clinics, correctional facility clinics) in which routine HIV screening activities will be supported. How the Respondent will decide which subcontracted healthcare facilities to recruit for this program. If subcontracted healthcare facilities that will be recruited for this program have already been identified, please include that information, along with the rationale for selecting them and information about their experience with routine HIV screening. If agreements to participate in the program have already been established with any healthcare facilities, provide copies of the agreements or Memoranda of Understanding (MOUs) as attachments to Respondent s proposal. Describe how the project will be staffed to successfully carry out the program. If staff are in place, complete the Key Personnel Form in Appendix F.The staffing plan should list all positions that will support the program and, for each position, the associated responsibilities, whether the position will be supported by funds from this RFP or by other funding sources, and the percentage of time that will be spent on this program. This information should be included in Appendix D: Budget Forms. Examples of possible staffing needs include, but are not limited to, the following: Planning and overseeing all components of the program (including contract monitoring). Marketing and promotion of the program to subcontracted healthcare facilities. Providing testing services (unless services will be provided by staff of the healthcare facility). Collecting, entering, managing, and ensuring the security of required data for reporting to CDPH. Conducting local-level monitoring and evaluation, including collecting, entering, managing (including ensuring security), analyzing, reviewing and using, and disseminating data. Conducting quality assurance for the program. Describe how all aspects of the project will be planned, managed, and overseen. 9

10 Program Implementation (No more than 22 pages) 1. Program Services (No more than 16 pages) A. HIV Screening, Linkage, and Referral (No more than 12 pages) Describe of how the Respondent will work with administrators, managers, and clinical directors of subcontracted healthcare facilities that agree to participate in the program (that is, participating healthcare facilities) to develop and implement detailed plans for conducting routine HIV screening programs. Describe how the Respondent proposes to address each of the following: Promoting the program to staff, educating providers and other appropriate staff about routine HIV screening, and gaining their support for the program; Promoting HIV screening to patients/clients; Providing routine, voluntary screening to patients/clients; Using test technologies and strategies that will maximize the proportion of persons tested who receive their results; and Delivering all services in a manner consistent with applicable CDC guidelines and recommendations. Describe the type(s) of consent procedure(s) that will be used (for example, opt out, opt-in) for screening in healthcare settings, and the rationale and effectiveness of this approach to increase routine HIV testing. A focus of the program is to encourage the use of opt-out consent procedures, where allowable and appropriate. Include a description of any state or local laws or regulations regarding consent for HIV screening and testing. Describe the activities to be conducted to achieve the following performance standards: At least 85% of persons who test positive for HIV receive their test results; At least 80% of persons who receive their HIV-positive test results are linked to medical care and attend their first appointment within 3 months of test date; At least 80% of persons who receive their HIV-positive test results are referred and linked to partner services; and At least 80% of persons who receive their HIV-positive test results receive prevention counseling or are referred to prevention services. Describe how opportunities will be explored to integrate HIV screening into other screening programs conducted at subcontracted healthcare facilities (for example, screening programs for blood pressure, diabetes, and cholesterol). Describe the Respondent s plan to increase over the course of the project, the number of subcontracted healthcare facilities that can implement sustainable, routine HIV testing programs B. Service Integration (No more than two pages) Describe the methods and the data sources that will be used for integrating screening and testing for other STIs (for example, syphilis, gonorrhea, chlamydia infection), hepatitis B, hepatitis C, and TB into the HIV screening programs funded under this RFP. In the response please address the following: Collaboration with subcontracted healthcare facilities administrators, managers, and clinical directors to plan, develop, and implement service integration activities; Collaboration with STI, hepatitis, and TB programs to design, develop, and implement the activities; Use of all available mechanisms to obtain reimbursement for these integrated screening activities from third party payers; Process for initiating partner services as soon as possible after diagnosis for patients/clients who test 10

11 positive for other STIs; and Process for referring or linking patients/clients who are candidates for hepatitis A or B vaccination to these services. C. Sustainability (No more than two pages) Describe how the Respondent will maximize the likelihood that the programs developed will be sustainable. In the response, please include the following: How and under what circumstances the Respondent plans to use funds from this RFP to cover the cost of HIV screening; and A plan on how to obtain reimbursement for HIV screening from third party payers (for example, Medicare, Medicaid, private insurance, HMO programs) to demonstrate program sustainability. 2. Program Support (No more than six pages) Respondents must provide technical assistance to subcontracted healthcare facilities to carryout activities under this RFP; conduct quality assurance activities; collect, manage and report data; and conduct monitoring and evaluation activities as described below. A. Training and Technical Assistance (No more than two pages) Describe how the training and capacity building needs of subcontracted healthcare facilities will be identified. Describe how training will be provided, coordinated and tracked for LO and subcontracted healthcare facilities staff for their respective job responsibilities under this program, including training on applicable confidentiality and privacy laws. Describe how technical assistance will be provided or coordinated for subcontracted healthcare facilities and CBOs or other service organizations. Describe how a referral network will be developed and how staff at subcontracted healthcare facilities and CBOs or other service organizations will be educated on use of the network. Include a description of existing referral networks. Describe how exchange of information and peer-to-peer consultation and technical assistance among subcontracted healthcare facilities will be facilitated (for example, convening jurisdiction-level workshops, development of collaborations). Describe how provision of technical assistance to staff of subcontracted healthcare facilities and CBOs or other service organizations will be tracked and documented. B. Data Collection and Reporting (No more than two pages) Describe how the Respondent will ensure that positive test results are reported to the appropriate local or state surveillance and partner services programs, in accordance with applicable laws and regulations. Describe the methods that will be used to distinguish newly diagnosed cases of HIV from previously diagnosed cases. Describe the planned process for collecting client-level data to monitor screening, linkage and referral objectives. Describe what mechanisms will be used for collecting data to track screening of syphilis, gonorrhea, chlamydia infection, hepatitis B, hepatitis C, and/or TB and how these data will be submitted to CDPH. 11

12 Describe how program data will be managed at subcontracted healthcare facilities, including assuring patient/client confidentiality and adhering to policies and practices for data security. Describe the process the Respondent will use to ensure that data collection, entry, management (including quality assurance activities), submission, analysis, utilization, dissemination, and data security and confidentiality are consistent with applicable state and federal regulations, including but not limited to HIPAA, HITECH, and the Illinois AIDS Confidentiality Act. This description should address data collection, entry, and management at the testing facilities or settings. C. Monitoring and Evaluation (No more than two pages) Funded grantees will work with CDPH to develop and implement a detailed monitoring and evaluation (M&E) plan. Describe the actions that will be taken and the timeframe needed to develop a comprehensive monitoring and evaluation plan as well as a description of how the monitoring and evaluation data will be used, by whom, and when (e.g., how frequently) to measure progress toward meeting program objectives and to improve program performance. Program Work Plan (see Appendix E) Budget and Justification (No more than two pages for justification, no page limit for Budget Forms) Provide a narrative description of the proposed project budget and complete all forms in Appendix D. Your narrative must address the following questions: Describe your organization s fiscal capacity and stability to manage the proposed project. All contracts will be paid on a reimbursement basis. Describe your organization s demonstrated capacity to operate on a reimbursement basis. Describe and justify all costs proposed in the budget. The budget and narrative must meet all requirements set forth in this section. This section provides the format for the required 12-month item budget explaining how each line item will be expended and recorded on the budget forms in Appendix D. Respondents may request funds through this RFP to support the following costs directly associated with this program: Personnel Salaries and Fringe Benefits Operating Costs Professional/Technical Costs Transportation and Travel Expenses Materials and Supplies Equipment Administrative Expenses A description of each expense category is presented below. Personnel: For these costs, provide the following information: the name of the employee and job title, number of positions, salary, number of pay periods, percent of time to be charged to this project, and the amount of the CDPH share and other share, and the total cost. Provide a brief budget justification explaining the duties of each employee assigned to the project. If the Respondent has not yet identified individuals to fill salaried positions, indicate that these individuals are yet to be hired (TBD). In the 12

13 summary section, make sure to show your calculations, indicate if staff is paid hourly, weekly, biweekly, monthly. Fringe Benefits: For these costs, provide the following information: the amount of fringe benefits requested (which should also isolate FICA and Medicare costs at 7.65%); medical insurance including dental and vision coverage, if applicable; worker's compensation and disability insurance; life insurance, if applicable; vacation time; and sick pay benefits, etc. Please include elements that are included in the fringe benefit amount. Fringe benefits must be based on the Respondent's established personnel policies. Show all calculations (formula used to determine final cost). Note: If a fringe benefit is not listed, you cannot be reimbursed for it. Operating Expenses: Respondents must delineate expenditures for items related to any programmatic activities integral to this project (e.g., telephone, advertising, printing, duplication, equipment leasing/maintenance, messenger services, facility maintenance, technical meeting costs and postage). Professional/Technical Services: List and justify all fees to be paid to consultants and subcontractors, such as the healthcare facility clinical settings for this project, noting the number of hours to be devoted to the project and specific responsibilities. Consultant fees will be allowed on a limited basis only, and should not to be used in place of staff support. Note: The City of Chicago will require all successful Respondents to identify any consultants and subcontractors, that will be part of the proposed program. If they have not yet been identified indicate that in the budget and budget justification. They must be identified and pre-approved by the project officer before they begin any services to be funded through this proposal. Transportation and Travel Expenses: Funding for transportation should be requested only as appropriate for program needs. Program-specific transportation expenses may include travel vouchers, or expenses incurred in operating organization-leased/owned vehicles. Out-of-town travel is not an allowable expense. Local Travel: Delineate amounts for public transportation and mileage reimbursement at the current federal rate available at Include here the expenses to operate agency-owned vehicles that are used in program delivery. All drivers and vehicles used for this program must have valid licenses and insurance. If an employee would like to request reimbursement for mileage, then the City of Chicago must be listed as an additional insured. Materials and Supplies: Itemize and justify programmatic materials, include office supplies that will be used by program staff in service delivery. Equipment: Itemize and justify programmatic equipment (e.g., desks, chairs, computers, file cabinets) that is $5,000 or more and/or whose normal life expectancy of more than one year. Equipment purchased with Program funds may need to be surrendered to CDPH upon expiration or termination of the agreement. Note: CDPH must pre-approve and catalogue all equipment purchases of $5,000 or greater. Note: The purchase and use of laptop computers or tablets must follow Health Insurance Portability and Accountability Act (HIPAA) and Health Information Technology for Economic and Clinical Health (HITECH) Act requirements. 13

14 Administrative/Indirect Costs: Administrative/indirect costs must be specifically delineated and justified in the proposal. The Respondent must provide a brief narrative justification for the amount requested. Examples of administrative and indirect costs include: rental costs for administrative office space, office utilities, insurance, payroll, personnel, voucher processing and financial reporting, costs to bill Medicaid including billing services and audit expenses. Administrative costs may also include partial salaries of administrative staff (e.g., executive director or office manager). Respondents must retain records of the expenses actually charged against any contract that is awarded as a result of the RFP. Note: Agencies funded through this RFP will be required to comply with various insurance specifications established by the City of Chicago. These include workers' compensation, auto liability, commercial liability and professional liability. These requirements also apply to all subcontractors and consultants. VIII. Proposal Checklist The Proposal Checklist (see Appendix C) should be used to ensure that the proposal is complete. Include the Checklist with the proposal. Proposals that do not contain each of the items indicated in the checklist will be considered incomplete and will not be reviewed. IX. Submission Guidelines Failure to follow any of the instructions related to content will result in the proposal being eliminated from consideration. Other than late delivery, the most common reasons that proposals are rejected include: inadequate number of copies, missing sections of the proposal, and failure to include requested documents. It is the responsibility of the Respondent to ensure delivery of the proposal to CDPH by the designated deadline. All proposals will be date and time stamped upon receipt and the receipt will be given to the person delivering the package at the time of receipt. Respondents using a messenger service to deliver their proposals should advise the messenger service of the 4:00 pm deadline and make sure the messenger knows to wait for a receipt. Respondents wishing to drop off completed proposals prior to the deadline of February 3, 2014 should contact Tonya Hardy to arrange for a drop off time. Ms. Hardy can be reached via at Tonya.Hardy@cityofchicago.org. All programmatic questions regarding this RFP (i.e., objectives, review criteria, work plan, budget components, etc.), and assistance with the proposal guidelines should be referred to: Debra Janiszewski Chicago Department of Public Health Telephone: Debra.Janiszewski@cityofchicago.org Submit one (1) original and four (4) complete copies, five (5) in total, and a CD with an electronic version of the proposal to: Department of Public Health DePaul Center Room South State Street Chicago, Illinois,

15 The proposal must be received by 4:00 p.m. Central Standard Time on February 3, No extension will be permitted. No late proposals will be accepted. A. Format Instructions Follow these instructions in completing your proposal. Use at least 1.5 line spacing and at 11-point font size Proposals should have margins of at least ¾ inch on all sides Submit only unbound proposals (i.e., no staples, ring binders, covers) All documents should be on 8 ½ x11 paper Print double-sided Include a table of contents reflecting major categories and corresponding page numbers Attach only supporting documentation requested or directly related to the proposal Sequentially number the entire proposal including all the attachments No faxes will be accepted B. Required Documentation Please submit the following as attachments in the completed proposal. Clearly mark each as separate appendices. Program Work Plan (see Appendix E) Key Personnel Form (see Appendix F) Internal Revenue Service 501c(3) tax exempt determination letter, if applicable. Copy of Respondent s Articles of Incorporation. Copy of the Respondent s most recent financial statement. If Respondent received $500,000 or more in federal funds during fiscal year, submit a copy of an audit conducted in accordance with OMB Circular A-133. Copy of the completed City of Chicago Economic Disclosure Statement. List of Board of Directors (must include place of employment for each), as applicable. Proof of insurance. Proof of Medicaid billing authority. MOUs or subcontracts from potential partners and subcontractors, if applicable. X. Evaluation of Proposals All proposals that are received on time will undergo a technical review to determine whether all required components have been addressed and included. Proposals that are determined by the CDPH to be incomplete will not be further considered. CDPH reserves the right to waive irregularities that, within its sole discretion the CDPH determines to be minor. If such irregularities are waived, similar irregularities in all proposals will be waived. Proposals that are determined to be complete will be forwarded to a Review Panel. The Review Panel will evaluate and rate all remaining proposals based on the Evaluation Criteria listed below. The Review Panel forwards its recommendations and comments to the CDPH Program Director and Deputy Commissioner for HIV/STI. Final funding decisions are made by the CDPH program and Commissioner of Public Health. All Respondents will be notified of the results in writing. 15

16 Evaluation Criteria Respondent s relevant experience in providing the proposed service and reaching the target population; Respondent s ability to properly staff and recruit healthcare facility settings; Soundness of proposed plan to conduct HIV screening, linkage to care, and referral to preventive services and partner services to meet the project goals, objectives and performance standards; Soundness of proposed plan to integrate screening of other disease; Soundness of proposed plan to increase over the course of the project, the number of healthcare facilities that can implement sustainable, routine HIV testing programs; Soundness of proposed plan to develop a sustainable system of HIV screening and linkage to care activities; Respondent s ability to provide training and technical support to sub-grantees to conduct project activities; Respondent s ability to routinely provide data to CDPH in the required time-frame and in accordance privacy and confidentiality laws; Soundness of proposed monitoring and evaluation activities; and Soundness of proposed budget and delegate agency s financial capacity and stability to manage a program of the size and scopes contemplated. The CDPH reserves the right to recommend qualified funding proposals out of rank in order to ensure adequate geographic distribution. If an insufficient number of qualified proposals are submitted, the CDPH reserves the right to directly solicit and select an appropriate organization to fill in the gaps. XI. Reporting and Other Requirements for Successful Respondents All successful Respondents will be required to submit monthly program reports, monthly vouchers and participate in all CDPH-sponsored or other City-sponsored site visits, evaluations and quality assurance activities. Note: Vouchers must be accompanied by appropriate documentation and contain adequate details for all expenses for which reimbursement is requested. XII. Compliance with Laws, Statutes, Ordinances and Executive Orders Grant awards will not be final until the City and the respondent have fully negotiated and executed a grant agreement. All payments under grant agreements are subject to annual appropriation and availability of funds. The City assumes no liability for costs incurred in responding to this RFP or for costs incurred by the respondent in anticipation of a grant agreement. As a condition of a grant award, respondents must comply with the following and with each provision of the grant agreement: 1. Conflict of Interest Clause: No member of the governing body of the City of Chicago or other unit of government and no other officer, employee, or agent of the City of Chicago or other government unit who exercises any functions or responsibilities in connection with the carrying out of the project shall have any personal interest, direct or indirect, in the grant agreement. The Respondent covenants that he/she presently has no interest, and shall not acquire any interest, direct, or indirect, in the project to which the grant agreement pertains which would conflict in any 16

17 manner or degree with the performance of his/her work hereunder. The respondent further covenants that in the performance of the grant agreement no person having any such interest shall be employed. 2. Governmental Ethics Ordinance, Chapter 2-156: All respondents agree to comply with the Governmental Ethics Ordinance, Chapter which includes the following provisions: a) a representation by the respondent that he/she has not procured the grant agreement in violation of this order; and b) a provision that any grant agreement which the respondent has negotiated, entered into, or performed in violation of any of the provisions of this Ordinance shall be voidable by the City. 3. Selected respondents shall establish procedures and policies to promote a Drug-free Workplace. The selected respondent shall notify employees of its policy for maintaining a drug-free workplace, and the penalties that may be imposed for drug abuse violations occurring in the workplace. The selected respondent shall notify the City if any of its employees are convicted of a criminal offense in the workplace no later than ten days after such conviction. 4. Business Relationships with Elected Officials - Pursuant to Section (b) of the Municipal Code of Chicago, as amended (the "Municipal Code") it is illegal for any elected official of the City, or any person acting at the direction of such official, to contact, either orally or in writing, any other City official or employee with respect to any matter involving any person with whom the elected official has a business relationship, or to participate in any discussion in any City Council committee hearing or in any City Council meeting or to vote on any matter involving the person with whom an elected official has a business relationship. Violation of Section (b) by any elected official with respect to the grant agreement shall be grounds for termination of the grant agreement. The term business relationship is defined as set forth in Section of the Municipal Code. Section defines a business relationship as any contractual or other private business dealing of an official, or his or her spouse or domestic partner, or of any entity in which an official or his or her spouse or domestic partner has a financial interest, with a person or entity which entitles an official to compensation or payment in the amount of $2,500 or more in a calendar year; provided, however, a financial interest shall not include: (i) any ownership through purchase at fair market value or inheritance of less than one percent of the share of a corporation, or any corporate subsidiary, parent or affiliate thereof, regardless of the value of or dividends on such shares, if such shares are registered on a securities exchange pursuant to the Securities Exchange Act of 1934, as amended; (ii) the authorized compensation paid to an official or employee for his office or employment; (iii) any economic benefit provided equally to all residents of the City; (iv) a time or demand deposit in a financial institution; or (v) an endowment or insurance policy or annuity contract purchased from an insurance company. A contractual or other private business dealing shall not include any employment relationship of an official s spouse or domestic partner with an entity when such spouse or domestic partner has no discretion concerning or input relating to the relationship between that entity and the City. 5. Compliance with Federal, State of Illinois and City of Chicago regulations, ordinances, policies, procedures, rules, executive orders and requirements, including Disclosure of Ownership Interests Ordinance (Chapter of the Municipal Code); the State of Illinois - Certification Affidavit Statute (Illinois Criminal Code); State Tax Delinquencies (65ILCS 5/ ); Governmental Ethics Ordinance (Chapter of the Municipal Code); Office of the Inspector General Ordinance (Chapter 2-56 of the Municipal Code); Child Support Arrearage Ordinance (Section of the Municipal Code); and Landscape Ordinance (Chapters 32 and 194A of the Municipal Code). 17

18 6. If selected for grant award, respondents are required to (a) execute the Economic Disclosure Statement and Affidavit, and (b) indemnify the City as described in the grant agreement between the City and the successful respondents. 7. Prohibition on Certain Contributions, Mayoral Executive Order Neither you nor any person or entity who directly or indirectly has an ownership or beneficial interest in you of more than 7.5% ("Owners"), spouses and domestic partners of such Owners, your Subcontractors, any person or entity who directly or indirectly has an ownership or beneficial interest in any Subcontractor of more than 7.5% ("Sub-owners") and spouses and domestic partners of such Sub-owners (you and all the other preceding classes of persons and entities are together, the "Identified Parties"), shall make a contribution of any amount to the Mayor of the City of Chicago (the "Mayor") or to his political fundraising committee during (i) the bid or other solicitation process for the grant agreement or Other Contract, including while the grant agreement or Other Contract is executory, (ii) the term of the grant agreement or any Other Contract between City and you, and/or (iii) any period in which an extension of the grant agreement or Other Contract with the City is being sought or negotiated. You represent and warrant that since the date of public advertisement of the specification, request for qualifications, request for proposals or request for information (or any combination of those requests) or, if not competitively procured, from the date the City approached you or the date you approached the City, as applicable, regarding the formulation of the grant agreement, no Identified Parties have made a contribution of any amount to the Mayor or to his political fundraising committee. You shall not: (a) coerce, compel or intimidate your employees to make a contribution of any amount to the Mayor or to the Mayor s political fundraising committee; (b) reimburse your employees for a contribution of any amount made to the Mayor or to the Mayor s political fundraising committee; or (c) bundle or solicit others to bundle contributions to the Mayor or to his political fundraising committee. The Identified Parties must not engage in any conduct whatsoever designed to intentionally violate this provision or Mayoral Executive Order No or to entice, direct or solicit others to intentionally violate this provision or Mayoral Executive Order No Violation of, non-compliance with, misrepresentation with respect to, or breach of any covenant or warranty under this provision or violation of Mayoral Executive Order No constitutes a breach and default under the grant agreement, and under any Other Contract for which no opportunity to cure will be granted. Such breach and default entitles the City to all remedies (including without limitation termination for default) under the grant agreement, under any Other Contract, at law and in equity. This provision amends any Other Contract and supersedes any inconsistent provision contained therein. If you violate this provision or Mayoral Executive Order No prior to award of the Agreement resulting from this specification, the Commissioner may reject your bid. For purposes of this provision: "Other Contract" means any agreement entered into between you and the City that is (i) formed under the authority of Municipal Code Ch. 2-92; (ii) for the purchase, sale or lease of real or personal property; or (iii) for materials, supplies, equipment or services which are approved and/or authorized by the City Council. "Contribution" means a "political contribution" as defined in Municipal Code Ch , as amended. 18

19 "Political fundraising committee" means a "political fundraising committee" as defined in Municipal Code Ch , as amended. 8. (a) The City is subject to the May 31, 2007 Order entitled "Agreed Settlement Order and Accord" (the "Shakman Accord") and the June 24, 2011 "City of Chicago Hiring Plan" (the "City Hiring Plan") entered in Shakman v. Democratic Organization of Cook County, Case No 69 C 2145 (United States District Court for the Northern District of Illinois). Among other things, the Shakman Accord and the City Hiring Plan prohibit the City from hiring persons as governmental employees in non-exempt positions on the basis of political reasons or factors. (b) You are aware that City policy prohibits City employees from directing any individual to apply for a position with you, either as an employee or as a subcontractor, and from directing you to hire an individual as an employee or as a subcontractor. Accordingly, you must follow your own hiring and contracting procedures, without being influenced by City employees. Any and all personnel provided by you under the grant agreement are employees or subcontractors of you, not employees of the City of Chicago. The grant agreement is not intended to and does not constitute, create, give rise to, or otherwise recognize an employer-employee relationship of any kind between the City and any personnel provided by you. (c) You will not condition, base, or knowingly prejudice or affect any term or aspect of the employment of any personnel provided under the grant agreement, or offer employment to any individual to provide services under the grant agreement, based upon or because of any political reason or factor, including, without limitation, any individual's political affiliation, membership in a political organization or party, political support or activity, political financial contributions, promises of such political support, activity or financial contributions, or such individual's political sponsorship or recommendation. For purposes of the grant agreement, a political organization or party is an identifiable group or entity that has as its primary purpose the support of or opposition to candidates for elected public office. Individual political activities are the activities of individual persons in support of or in opposition to political organizations or parties or candidates for elected public office. (d) In the event of any communication to you by a City employee or City official in violation of paragraph (b) above, or advocating a violation of paragraph (c) above, you will, as soon as is reasonably practicable, report such communication to the Hiring Oversight Section of the City's Office of the Inspector General ( IGO Hiring Oversight ), and also to the head of the Department. You will also cooperate with any inquiries by IGO Hiring Oversight or the Shakman Monitor s Office related to the grant agreement. 9. False Statements (a) False Statements Any person who knowingly makes a false statement of material fact to the city in violation of any statute, ordinance or regulation, or who knowingly falsifies any statement of material fact made in connection with an proposal, report, affidavit, oath, or attestation, including a statement of material fact made in connection with a bid, proposal, contract or economic disclosure statement or affidavit, is liable to the city for a civil penalty of not less than $ and not more than $1,000.00, plus up to three times the amount of damages which the city sustains because of the person's violation of this section. A person who violates this section shall also be liable for the city's litigation and collection costs and attorney's fees. 19

20 The penalties imposed by this section shall be in addition to any other penalty provided for in the municipal code. (Added Coun. J , p , 1) (b) Aiding and Abetting. Any person who aids, abets, incites, compels or coerces the doing of any act prohibited by this chapter shall be liable to the city for the same penalties for the violation. (Added Coun. J , p , 1) (c) Enforcement. In addition to any other means authorized by law, the corporation counsel may enforce this chapter by instituting an action with the department of administrative hearings. (Added Coun. J , p , 1) 20