May 11, 2012 - Appropriate expenses will be reimbursed, including sales tax if ... contracted with and for each such bus
REQUEST FOR PROPOSALS RFP# DDP-611BB-12-ADAP-Assist Issue Date:
May 11, 2012
Title:
Virginia AIDS Drug Assistance Program (ADAP) Assist
Commodity Code:
95348 Health/Hospitalization Insurance 95300 Insurance & Insurance Services 95861 Insurance & Risk Management 94872 Pharmacy Services
Issuing Agency:
Commonwealth of Virginia Department of Health Office of Epidemiology 109 Governor Street 6th Floor, Room 650 Richmond, VA 23219-0331
Location where work will be performed: Statewide solicitation. Period of Contract: Upon signature of contract – March 31, 2013 with four (4) optional successive one (1) year periods. Sealed proposals will be received until 3:00 p.m. June 19, 2012 by the Virginia Department of Health (VDH); Office of Epidemiology (OEpi) located on the 6th Floor, Room 650, James Madison Building, 109 Governor Street, Richmond, Virginia 23219. To be considered, all proposals must be received at this specific location on or before the date and hour stipulated. Proposals received after the date and hour designated are automatically disqualified and will not be considered. The official time used in the receipt of responses is that time on the clock or automatic time stamp machine in the Office of Epidemiology. The safest way to insure that the proposal is delivered on time, especially if it is submitted within the last seven (7) days prior to the due date, is to deliver it in person. The alternative is to use a commercial delivery service such as FedEx or UPS, or the U.S. Post Office Express Mail Service. The response may be sent via U.S. Mail to Post Office Box 2448, Richmond, VA 23218 provided that it is submitted in adequate time to allow for delivery to the specific office location, Room 650, James Madison Building, 109 Governor Street, Richmond, Virginia 23219. Offerors are responsible for assuring timely receipt of the proposal at the specific office location and should make allowances for the possibility of an untoward event.
IF PROPOSALS ARE MAILED, SEND DIRECTLY TO ISSUING AGENCY SHOWN ABOVE. PROPOSALS ARE HAND DELIVERED, DELIVER TO THE ISSUING AGENCY LISTED ABOVE.
IF
All inquiries for information should be directed to Kim Boehme at (804) 864-7553, or at
[email protected]. In Compliance With This Request For Proposal And To All The Conditions Imposed Therein And Hereby Incorporated By Reference, The Undersigned Offers And Agrees To Furnish The Goods/Services In Accordance With The Attached Signed Proposal Or As Mutually Agreed Upon By Subsequent Negotiation. Name and Address of Firm: _____________________________________________ _____________________________________________ _____________________________________________ __________________________Zip Code: ___________ eVA Vendor ID or DUNS#:______________________ Fax Number: (___) ____________________________ E-mail Address: _______________________________
Date: _____________________________________ By: _____________________________________ (Signature In Ink) Name: ____________________________________ (Please Print) Title: _____________________________________ Telephone Number: (___) _____________________
* PRE-PROPOSAL CONFERENCE: An optional pre-proposal conference will be held on May 24, 2012 at 11 a.m. at the Virginia Department of Health, James Madison Building, 109 Governor Street, Room 333, Richmond, Virginia 23219. (Reference: Paragraph 2 herein, page 13). If special American with Disabilities Act (ADA) accommodations are needed, please contact the person listed above by May 21, 2012. 1 of 44
Note: This public body does not discriminate against faith-based organizations in accordance with the Code of Virginia, § 2.2-4343.1 or against a bidder or offeror because of race, religion, color, sex, national origin, age, disability, or any other basis prohibited by state law relating to discrimination in employment.
TABLE OF CONTENTS I.
PURPOSE: .................................................................................................................................................... 3
II.
BACKGROUND:.......................................................................................................................................... 3
III.
STATEMENT OF NEEDS .......................................................................................................................... 4
IV.
REPORTING AND DELIVERY INSTRUCTIONS: ................................................................................ 9
V.
PROPOSAL PREPARATION AND SUBMISSIION INTRUCTIONS: ............................................... 11 A. B.
VI.
GENERAL INSTRUCTIONS: ..................................................................................................... 11 SPECIFIC PROPOSAL INSTRUCTIONS: ............................................................................... 12
EVALUATION AND AWARD CRITERIA: ........................................................................................... 12 A. B.
EVALUATION CRITERIA: ......................................................................................................... 13 AWARD OF CONTRACT: .......................................................................................................... 14
VII.
OPTIONAL PRE-PROPOSAL CONFERENCE: ................................................................................... 14
VIII.
GENERAL TERMS AND CONDITIONS: .............................................................................................. 14
IX.
SPECIAL TERMS AND CONDITIIONS:............................................................................................... 21
X.
PRICING SCHEDULE: ............................................................................................................................. 27
XIII.
ATTACHMENTS: ...................................................................................................................................... 27 ATTACHMENT A: SUPPLIER DIVERSITY & SMALL BUSINESS SUBCONTRACTING PLAN ATTACHMENT B: SAMPLE PROPOSAL SUBMISSION ENVELOPE LABEL ATTACHMENT C: OFFEROR DATA SHEET ATTACHMENT D: MAP OF HEALTH REGIONS ATTACHMENT E: RYAN WHITE PROGRAM SERVICES DEFINITION ATTACHMENT F: WORK PLAN GUIDELINES ATTACHMENT G: SAMPLE WORK PLANS ATTACHMENT H: PROPOSED BUDGET FORM ATTACHMENT I: VDH INVOICE PROCESSING GUIDELINES ATTACHMENT J: ADAP Data Report (ADR)
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I.
PURPOSE: The purpose of this RFP is to establish a contract through competitive negotiation with one or more Contractors qualified to provide 1) Medical Benefits Management (MBM); and/or 2) Pharmaceutical Benefits Management (PBM) for Virginia’s AIDS Drug Assistance Program’s (VA ADAP) health insurance continuation program, also known as the ADAP-Assist. Through this procurement, VDH will provide health insurance continuation for ADAP clients eligible for Pre-Existing Condition Insurance Plans (PCIP), with the option to expand into other health insurance options or third party payors approved by VDH.
II.
BACKGROUND: The mission of the Virginia Department of Health (VDH) is to promote and protect the health of Virginians. One way that VDH strives to achieve its mission is through expanding access to health care for those with limited resources living with HIV. The Ryan White (RW) HIV/AIDS Treatment Extension Act of 2009 provides program funds to VDH to assist individuals living with HIV/AIDS who have no health insurance, have insufficient health care coverage, or lack the financial resources to get the care they need to manage their HIV disease. RW Part B funds support the provision of essential primary medical care, treatment, and some support services (i.e. case management). This program is administered by the Division of Disease Prevention’s (DDP) HIV Care Services (HCS) unit. Please visit the VDH HCS website for additional information regarding RW Part B services in Virginia: http://www.vdh.virginia.gov/epidemiology/DiseasePrevention/HCS/. As a part of RW funding, VDH receives ADAP funds for the provision of medications to eligible clients for the treatment of HIV disease. ADAP funds may also be used to purchase health insurance for eligible clients, referred to as insurance cost-sharing. Under cost-sharing VDH may cover the costs associated with premiums, deductibles, and co-pays. Currently, VDH provides cost-sharing for eligible clients enrolled in Medicare Part D plans. At the end of November 2011, the VA ADAP had an estimated 2,400 active clients receiving medications directly through the health department and 300 active clients in Medicare Part D cost-sharing. All elements of ADAP eligibility are published on the VDH ADAP website: http://www.vdh.virginia.gov/epidemiology/DiseasePrevention/Programs/ADAP/eligibility.htm Currently, VDH provides access to core HRSA defined medical and support services related to the treatment of HIV for eligible clients through contracts with service providers and lead agents across the state. In addition to the cost-sharing available for clients with Medicare Part D, medications related to the treatment of HIV are made available for ADAP enrollees without insurance coverage at local health departments (LHDs). By insuring clients through ADAP-Assist, clients will be able to access a wider array of medical services (including preventive and primary care services), in addition to their infectious disease treatment and access medications through retail and mail-order pharmacies, rather than the LHD. PCIP is a newly established insurance option available through the Affordable Care Act passed in March 2010 and provides comprehensive medical coverage, including prescription drug coverage. States were given the option to run their own PCIP with federal funding, or to allow the Department of Health and Human Services (HHS) to administer the PCIP in their state. Virginia is one of the 24 states and the District of Columbia where the program is federally administered by HHS. Within HHS, the Office of Personnel Management is responsible for program administration. However, the National Finance Center (NFC) performs eligibility determinations and enrollment and the Government Employee Health Administration (GEHA) administers benefits and pays claims. For more information about PCIP, please see the GEHA PCIP website: http://www.pciplan.com/. Under PCIP, covered benefits are available to enrollees beginning the coverage effective date. There are no waiting periods or higher premiums because of a medical condition. PCIP eligibility is not based on income. It is estimated that approximately 77% of all current ADAP clients are eligible for PCIP. Eligible persons must be: 1) a citizen of the United States or legal resident; 2) without health insurance for at least the last six months; and 3) currently diagnosed with a pre-existing condition or have been denied insurance coverage because of a health condition. 3 of 44
PCIP coverage is offered through three types of plans: Standard, Extended, and a Health Savings Options, each with different levels of premiums, calendar year deductibles, prescription deductibles and prescription co-pays. Beginning calendar year (CY) 2012, PCIP out-of-pocket expenses, including deductibles, cannot exceed $4,000 annually per client/per calendar year in enrolled in the standard plan seeing in-network providers for each calendar year. Payment of monthly premiums is also required, which do not count towards out-of-pocket expenses. Premiums rates vary by age and are to be paid monthly. This procurement will secure one or more Contractors who can manage medical and/or prescription costsharing assistance, as described in later sections of this document. These services are referred to as Medical Benefits Management (MBM) and the Pharmaceutical Benefits Management (PBM). This contract will run on the Ryan White contract year, April 1– March 31. ADAP-Assist will be phased-in by late-2012. The Contractor(s) will be responsible for all aspects of the program, including: the operational components prior to implementation, launching of the program, enrolling clients in PCIP, communicating with clients as needed, issuing electronic payments to ensure continued enrollment, data reporting as specified by VDH, and cost tracking to ensure annual out-of-pocket costs are not exceeded and payment in a timely manner for allowable costs. The Contractor(s) may sub-contract out services under this scope of service. The work plan must demonstrate how the Contractor(s) will ensure that all services will be provided cost effectively and in accordance with the Statement of Needs. III.
STATEMENT OF NEEDS The qualified Contractor(s) shall submit a proposal to VDH to include a time-phased work plan demonstrating how the services described in this section of the RFP will be provided. The work plan will also include a narrative description of the Contractor’s qualifications to provide these services. The Contractor will furnish all materials, labor, and resources in order to provide the services in this section of the RFP. Contractor should provide copies of any satisfaction surveys (client and provider services) conducted by an independent survey company. If applying for MBM, provide responses to A – J. If applying for PBM, respond to A –G and K - Q
PROGRAM MANAGEMENT: A. The Contractor(s) shall possess the staff and technology needed to provide MBM and/or PBM services to clients enrolled in ADAP-Assist. The work plan shall include a comprehensive implementation plan describing how each program will be launched and managed by the Contractor(s). B. The Contractor’s work plan shall demonstrate strategies to interface with other third-party payers to ensure that ADAP is the payer of last resort, notifying VDH when a client should be transferred to another payer source or when retroactive billing is needed for services rendered. The Contractor(s) shall demonstrate the ability to correct overpayments and payment errors within 30 days of discovery. C. The Contractor(s) shall conduct group presentations in each of the Commonwealth’s 5 health regions and at least one statewide presentation via videoconferencing within 6 months of program implementation. The presentation shall provide an overview of the implementation of ADAP-Assist statewide, program processes, and management. The content shall be appropriate for communicating with a diverse audience, including clients, case managers, and medical providers. The statewide presentation will be archived and available for later use. 4 of 44
D. The VDH will be responsible for enrollment into ADAP-Assist and communicating enrollment updates to the Contractor(s) within 48 hours of enrollment. E. The Contractor’s work plan shall include how programmatic changes will be communicated and coordinated with existing contractors as uninsured clients are transitioned to insurance programs without interruption to medical care or treatment. Respective to this, the Contractor(s) shall also develop materials for clients and providers to answer frequently asked questions and provide programmatic overviews. i. The Contractor(s) work plan shall demonstrate its capability to manage 20003000 ADAP-Assist clients, and its capability to manage an increasing client base. 1. The Contractor(s) work plan shall demonstrate its capability to manage up to 600 clients from contract inception to December 31, 2012, and its capability to manage the full eligible client population by March 31, 2013. ii. The Contractor(s) work plan shall describe how they will immediately transition 300 Part D clients from existing vendor into new program without medication service interruption within 60 days. iii. The Contractor(s) work plan shall detail client transition from current ADAP program to PCIP/ADAP Assist without disruption of medication services F. The Contractor(s) shall provide an ADAP-Assist Project Manager, who at a minimum shall provide the following: i. Serve as a primary day-to-day contact with VDH contract monitor and VDH Care Coordinators ii. Coordinate case information with current VDH contractors and staff, including eligibility and pharmacy services to ensure continued access to medical care and treatments for enrollees iii. Notify VDH Care Coordinators of barriers to medication or medical care requiring patient navigation services within one-business day of reported issue iv. Attend VDH meetings either in-person or telephonically v. Request technical assistance as needed vi. Prepare monthly, quarterly, or annual reports as required vii. Attend, lead, and prepare materials for meetings as requested viii. Ensure all necessary operational components are completed prior to implementation. ix. Designate an alternate contact for when the Project Manager is unavailable x. Ensure that the Contractor, as well as any subcontractors, fulfills its duties and responsibilities under the Contract G. The Contractor(s) shall demonstrate the capacity to provide basic program management and reporting to include the following elements: i. Track and provide to VDH the Client Level Data Reporting elements for these services as required of ADAP programs by the Health Resources and Services Administration; (See Attachment) ii. Ensure that clients or their agents may not receive any funds for reimbursement of costs or expenditures provided under this Contract; iii. Comply with all applicable state, and federal statutes and regulations, including but not limited to, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), National Standards to Protect the Privacy of Health Information and Ryan White Treatment Extension Act of 2009;
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iv.
v.
vi.
vii.
viii. ix.
Cooperate with and participate in all programmatic performance monitoring and clinical quality activity required by VDH, including the production of data summary reports requested by VDH; Collaborate with VDH in the development of any instrument for HIPAA compliant client consent needed under the operation of this agreement, and in the development of any information used for routine direct client communication or contact. Maintain a Help Desk that may be used for customer service and claims issues. The Help Desk shall be accessible 24 hours a day by telephone, and is to be responsive during regular business hours of 8:00 AM to 7:00 PM in Virginia, a minimum of 6 days a week. All calls shall be responded to within 24 hours. Translation services shall be available for non-English speaking clients. Agencies that receive more than $100,000 in federal funding must submit a signed "Certification Regarding Lobbying" form and, as appropriate, a "Disclosure of Lobbying Activities" to account for non-appropriated funds used for this purpose to Virginia Department of Health within 90 days of the start of the funding period. Contractors are responsible to ensure they collect and submit this documentation for any subcontractors that receive more than $100,000 in federal funding to Virginia Department of Health within the same time frame. Ensure data exchange systems are in place. VDH may request copies of data at any time and in the requested format. Ensure expenditures are reasonable, allowable, and auditable. All costs must be traceable to source documents and in the accounting system of record.
MBM SERVICES AND MANAGEMENT: H. The Contractor shall provide for electronic or paper claims adjudication and electronic or check payment of client share cost-sharing such as co-pays, deductibles, and coinsurance on allowable medical services. Respective to this, the Contractor shall: i. Make payments for services covered by PCIP plans delivered by providers approved by VDH; ii. Ensure payments are not made for clients who are not active in ADAP-Assist, and that payment shall be made on charges for clients who are active in ADAP-Assist on the date of service, even if they become inactive at a later date when payment is made for that service; iii. The claims adjudication method shall, at a minimum, track and report on the following for medical services: 1. The provider of the medical service, 2. The procedure code, 3. The amount billed to PCIP or the insurance by the provider, 4. The amount covered by the PCIP or insurance plan, 5. The amount paid by the PCIP or insurance plan to the provider, 6. The remaining client share amount, and 7. The amount paid by ADAP-Assist on behalf of the client toward client share amounts; 8. The date the service was provided 9. The client URN (in format specified by VDH). I.
The Contractor shall have or develop a client summary system that can report, at a minimum, the following information: i. The year to date (YTD) total for each client of costs toward any applicable medical deductible, and ii. The YTD total for each client of costs toward co-pays and co-insurance (separate totals for each), 6 of 44
iii. iv.
The YTD for each client of costs toward the out of pocket annual expense limit paid by the ADAP-Assist for medical benefits; The Contractor will provide an end of year reconciliation of all transactions paid under this contract by May 15th, and covering the service period from 4/1 of the prior year through 3/31 of the current year.
J. The Contractor shall demonstrate in the work plan narrative how the Contractor can satisfy the following as it relates to VDH policies and procedures: i. Provide program updates to be shared at HIV Care Services Contractor meetings convened by VDH. ii. Acknowledge that any educational materials (pamphlets, posters, curricula, videos, etc.) proposed to be used, developed or purchased shall be submitted to the VDH AIDS Materials Review Panel for approval. VDH convenes the Review Panel as needed in order to comply with directives from CDC. The content of such materials will be reviewed and approved for scientific accuracy and shall support the contracted scope of services while assuring appropriateness of the message for the targeted population including its culture and language. iii. Develop and implement a quality assurance protocol for all phases of the project. iv. Comply with the Data Security and Confidentiality Guidelines: Division of Disease Prevention, Virginia Department of Health. (Separate Attachment ) v. Contractor must have an emergency plan for continuation of services if an event occurs that may impact service delivery. PBM SERVICES AND MANAGEMENT: K. The Contractor shall provide for electronic claims adjudication and electronic payment of client share cost-sharing such as co-pays and deductibles for prescription drug coverage available through the insurance plan. To this end, the Contractor shall serve as the PBM to the VDH ADAP-Assist program and shall provide services and functions listed below: i. Electronic claims adjudication and direct payment of client share costs such as copays, deductibles, and co-insurance on prescription drugs delivered by insurance formulary under the client’s primary insurance plan, including PCIP; ii. The electronic claims adjudication process shall be effective at point of sale so that payment of the client co-pay on prescription fills can be immediate; iii. Payment shall not be made for clients who are not active in ADAP-Assist on the date of the prescription fill. L. The electronic claims adjudication for PBM services method shall, at a minimum, track and report on the following: i. The provider of the pharmacy service; ii. The dispensing date; iii. The National Drug Code (NDC) established by the Federal Drug Administration (FDA) for the drug dispensed; iv. The quantity and dosage of medication dispensed; v. The amount billed to the client primary insurance plan by the provider; vi. The amount covered under the plan for the medication dispensed; vii. The amount paid by the plan to the provider, viii. The remaining client share amount, and ix. The amount paid by ADAP-Assist on behalf of the client toward the client share amount; x. The prescribing physician (NPI code); xi. Days Supplied; xii. Refill number.
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M. The Contractor shall also provide a monthly client level summary system that reports the accumulated total for each of the following data elements that were paid by the ADAP-Assist program for pharmacy benefits: i. ii. iii.
The YTD costs toward any applicable pharmaceutical deductible; The YTD costs toward any applicable co-payments and co-insurances (separate totals for each), The Contractor will provide an end of year reconciliation of all transactions paid under this contract by May 15th, and covering the service period from 4/1 of the prior year through 3/31 of the current year.
N. For PBM services, the Contractor shall ensure that payment is made only for active clients in
ADAP-Assist on the date of the pharmacy transaction. Allowable costs include client pharmacy co-pays, deductibles and coinsurance costs for medications included in the formulary of the client’s primary insurance plan. O. The Contractor shall ensure that the method by which prescription benefit coordination is conducted will reserve to the Virginia ADAP-Assist the exclusive right to all available 340B partial pay rebates from the transactions in which the ADAP-Assist participates as a payer and shall maintain compliance with the National Council of Prescription Drug Program’s (NCPDP) standards for pharmacy drug claims and coordination of benefits, located at http://www.ncpdp.org/ i. Contractor shall ensure that all data required for rebating procedure is accurately obtained at the client level. ii. Contractor shall ensure that all cost share payments and credits are properly tracked and reported to the VDH. iii. Contractor shall ensure that credits processed in a different quarter than the original payment quarter will be accurately reported to the VDH for rebating purposes. iv. Contractor shall ensure that all rebate data is provided to VDH in an electronic format. P. The Contractor’s work plan shall ensure all pharmacy benefits transactions in which ADAPAssist participates as a payer are subject to ADAP rules and the current ADAP eligibility of the client. Q. The Contractor shall demonstrate in the work plan narrative how the Contractor can satisfy the following as it relates to VDH policies and procedures: i. Provide program updates to be shared at HIV Care Services Contractor meetings convened by VDH. ii. Acknowledge that any educational materials (pamphlets, posters, curricula, videos, etc.) proposed to be used, developed or purchased shall be submitted to the VDH AIDS Materials Review Panel for approval. VDH convenes the Review Panel as needed in order to comply with directives from CDC. The content of such materials will be reviewed and approved for scientific accuracy and shall support the contracted scope of services while assuring appropriateness of the message for the targeted population including its culture and language. iii. Develop and implement a quality assurance protocol for all phases of the project. iv. Comply with the Data Security and Confidentiality Guidelines: Division of Disease Prevention, Virginia Department of Health. (Attachment ) v. Contractor must have an emergency plan for continuity of services if an event occurs that may impact service delivery. Contractor shall have offsite back-up data storage location. vi. Contractor will give reasonable effort to adhere to Virginia Information Technology (VITA) security standards SEC501-07 effective 7/1/11 and policy 8 of 44
SEC519-00 effective www.vita.virginia.gov
7/24/09.
These
documents
are
available
at
COORDINATION OF MBM AND PBM SERVICES WITH VDH AND CARE CONTRACTORS: R. VDH will coordinate and manage client enrollment into PCIP and ADAP-Assist. VDH shall be responsible for ensuring continued enrollment for eligible clients. i. VDH will notify Contractors of client enrollment into ADAP-Assist within 48 hours after the VDH has completed the enrollment process. ii. VDH will provide comprehensive enrollment reports or updates to Contractor(s) at intervals determined by VDH management. S. The Contractor(s) shall be a key stakeholder(s) in the coordination of client care and must demonstrate the ability to provide the following: i. Provide trainings to case managers. Contractor(s) and VDH will determine the frequency and location of trainings. ii. Participate in meetings throughout the state as requested by VDH or others. iii. Maintain an insurance program website with up-to-date information on accessing services. iv. Develop, print and distribute a brochure and/or other document to promote ADAPAssist. Materials will not exceed a 6th grade reading level and will be made available in English and Spanish. Materials must be approved by VDH prior to distribution. T. The Contractor (s) shall demonstrate the ability to provide accurate tracking and monitoring of client cost shares for PBM and MBM services. VDH will house the central database for ADAP-Assist client cost shares and other claim data within the current ADAP/VACRS database. i. Contractor(s) shall be responsible for ensuring data is electronically uploaded into the central database at the designated intervals. All data shall be compatible for uploading to a SQL server. ii. If the Contractor(s) is unable to provide electronic data uploads, the Contractor(s) is responsible for direct manual entry of the required data elements into the central database. iii. Contractor shall provide written documentation of the quality control and quality assurance procedures that are used to ensure accuracy of data, including manual and electronic verification of data. VDH will review procedures and can request changes to these procedures at any time. iv. VDH will perform routine audits of data entry/quality control procedures and data discrepancies found will require a corrective action plan. v. Contractor shall provide de-identified data report of client benefits tracking and rebate/credit coordination. IV.
REPORTING AND DELIVERY INSTRUCTIONS: REPORTS: Monthly progress reports shall be submitted by the 30th of the month following the month being reported to: Diana Jordan, Director Division of Disease Prevention 109 Governor Street, Room 326 Richmond, Virginia 23219 One original of the report shall be submitted in the following format: 9 of 44
By e-mail with approval to the VDH HIV Services Coordinator assigned to subsequent contract/Memorandums of Agreement (MOAs).
INVOICES: Invoices shall be submitted by the 30th of the month following the end of the month for which cost reimbursement is sought. Appropriate expenses will be reimbursed, including sales tax if applicable. In order to ensure accountability and maximize our stewardship over funds, the Division of Disease Prevention is requiring that each contracting agency provide documentation that supports all requests for payment. All supporting documentation that is submitted shall support budget line item expenditure and shall be submitted with the invoice. Examples of supporting documentation may include, but is not limited to invoices, receipts, payroll statements, mileage logs, request for honoraria, monthly rental charges or copy of the annual rental agreement with monthly rate specified, phone bill, etc. The Virginia Department of Health (VDH) will: 1) provide project monitoring and offer technical assistance to contractors. 2) review and provide feedback to monthly progress reports. 3) provide compensation for documented service delivery as agreed upon in negotiated contracts/MOAs. 4) conduct site visits to review expenditures and observe project activities in order to ensure appropriate expenditure of funds. 5) choose a statewide peer review team and oversee the peer review process. Requests for budget or work plan modifications must be made in writing prior to the end of the quarter to which they pertain. No work plan modifications will be accepted after the end of the third quarter. VDH shall be responsible for determining the legitimacy of the extenuating circumstances and the acceptability of revised plans or objectives. Failure to attain objectives may impact payment of monies requested by the contractor. However, in an effort not to penalize innovative efforts, payment shall be prorated according to the degree of attainment and legitimate efforts of the contractor and not solely by success or failure of an intervention. Such decision shall be the sole discretion of VDH. Time and effort (T&E) records for each employee paid in full or in part through this contract shall be kept on file at the Contractor’s site and made available upon request. Report on the participation of Small Business and Businesses Owned by Women and Minorities (SWAM): The Contractor shall submit quarterly, and prior to completion of the contract or at completion of the contract but prior to final payment, a report on the actual dollars spent with small businesses and businesses owned by women and minorities during the performance of this contract. These entities must be certified by the Commonwealth of Virginia, Department of Minority Business Enterprise (DMBE) www.dmbe.virginia.gov. At a minimum, this report shall include for each firm contracted with and for each such business class (i.e., small, minority-owned, women-owned) a comparison of the total dollars spent on this contract with the planned involvement of the firm and business class as specified in the sole source contract, and the actual percent of the total estimated contract value. A suggested format is as follows: Business Class: (Identify Small, Women-owned, Minority-owned) Name of Firm, DMBE Certification #, Address, Phone # and E-mail Contact Person Type of 10 of 44
Goods/Services Dollar Amount %Total Company Expenditures
V.
PROPOSAL PREPARATION AND SUBMISSIION INTRUCTIONS:
A.
GENERAL INSTRUCTIONS:
1.
RFP Response: In order to be considered for selection, offerors must submit a complete response as part of your proposal to each service offering for which they wish to be considered; MBM and/or PBM. One (1) original (so marked) and (5) copies of each proposal must be submitted to the issuing agency. No other distribution of the proposal shall be made by the offeror.
2.
Proposal Preparation: a.
Proposals shall be signed by an authorized representative of the offeror. All information requested should be submitted. Failure to submit all information requested may result in the purchasing agency requiring prompt submission of missing information and/or giving a lowered evaluation of the proposal. Proposals which are substantially incomplete or lack key information may be rejected by the purchasing agency. Mandatory requirements are those required by law or regulation or are such that they cannot be waived and are not subject to negotiation.
b.
Proposals should be prepared simply and economically, providing a straightforward, concise description of capabilities to satisfy the requirements of the RFP. Emphasis should be placed on completeness and clarity of content.
c.
Proposals should be organized in the order in which the requirements are presented in the RFP. All pages of the proposal should be numbered. Each paragraph in the proposal should reference the paragraph number of the corresponding section of the RFP. It is also helpful to cite the paragraph number, sub-letter, and repeat the text of the requirement as it appears in the RFP. If a response covers more than one page, the paragraph number and sub-letter should be repeated at the top of the next page. The proposal should contain a table of contents which cross-references the RFP requirements. Information which the offeror desires to present that does not fall within any of the requirements of the RFP should be inserted at an appropriate place or be attached at the end of the proposal and designated as additional material. Proposals that are not organized in this manner risk elimination from consideration if the evaluators are unable to find where the RFP requirements are specifically addressed.
d.
As used in this RFP, the terms "must", "shall", "should" and “may” identify the criticality of requirements. "Must" and "shall" identify requirements whose absence will have a major negative impact on the suitability of the proposed solution. Items labeled as "should" or “may” are highly desirable, although their absence will not have a large impact and would be useful, but are not necessary. Depending on the overall response to the RFP, some individual "must" and "shall" items may not be fully satisfied, but it is the intent to satisfy most, if not all, "must" and "shall" requirements. The inability of an Offeror to satisfy a "must" or "shall" requirement does not automatically remove that Offeror from consideration; however, it may seriously affect the overall rating of the Offeror’s proposal. 11 of 44
3.
e.
Each copy of the proposal should be bound or contained in a single volume where practical. All documentation submitted with the proposal should be contained in that single volume.
f.
Ownership of all data, materials, and documentation originated and prepared for the State pursuant to the RFP shall belong exclusively to the State and be subject to public inspection in accordance with the Virginia Freedom of Information Act. Trade secrets or proprietary information submitted by an offeror shall not be subject to public disclosure under the Virginia Freedom of Information Act; however, the offeror must invoke the protections of § 2.2-4342F of the Code of Virginia, in writing, either before or at the time the data or other material is submitted. The written notice must specifically identify the data or materials to be protected and state the reasons why protection is necessary. The proprietary or trade secret material submitted must be identified by some distinct method such as highlighting or underlining and must indicate only the specific words, figures, or paragraphs that constitute trade secret or proprietary information. The classification of an entire proposal document, line item prices, and/or total proposal prices as proprietary or trade secrets is not acceptable and will result in rejection of the proposal.
Oral Presentation: Offerors who submit a proposal in response to this RFP may be required to give an oral presentation of their proposal to the agency. This provides an opportunity for the offeror to clarify or elaborate on the proposal. This is a fact finding and explanation session only and does not include negotiation. The issuing agency will schedule the time and location of these presentations. Oral presentations are an option of the purchasing agency and may or may not be conducted.
B. SPECIFIC PROPOSAL INSTRUCTIONS: Proposals should be as thorough and detailed as possible so that the Virginia Department of Health may properly evaluate your capabilities to provide the required goods/services. Offerors are required to submit the following items as a complete proposal:
1.
Return the RFP cover sheet and all addenda acknowledgments, if any, signed and filled out as required.
2.
Offeror Data Sheet, included as an attachment to the RFP, and other specific items or data requested in the RFP.
3.
A written narrative statement to include: a. An overview of the Offeror’s history and experience relevant to items detailed in Section III of this RFP. b. If responding to the PBM request, contractor shall provide documentation of PBM service provision for other ADAP programs. c. A complete program overview of the proposed project, including implementation strategies, to conducting ADAP-Assist. The overview shall include enrollment management, coordination of PBM and MBM services, data management and reporting. The narrative should also describe the Offeror’s ability to provide services that are linguistically appropriate in a culturally competent manner. Include names, qualifications and experience of personnel to be assigned to the project, along with resumes of staff to be assigned to the project. d. The narrative shall demonstrate the Offeror’s communication plan to coordinate in a timely manner with existing VDH service providers and enrollees/potential enrollees 12 of 44
e.
VI.
1.
2.
3.
4.
5.
to ensure that cost-sharing services for medical services and prescription drug coverage are available at point of service/sale. A comprehensive work plan identifying how services outlined in Section III will be provided, including a transition plan from the current system of medical care and treatment provision to one facilitated through insurance, specifically PCIP. The work plans should be described through specific, time-phased and measurable objectives. The work plan shall demonstrate how the timeline in Section III, Ei shall be achieved respective to the transition to this program.
4.
The work plan shall include a detailed description of how the technology and processes to be used will work to issue, track, and report all cost-sharing assistance. The narrative will describe how these processes will meet all MBM and PBM requirements outlined in Section III.
5.
A proposed budget for the time frame of July 1, 2012 – March 31, 2013. The budget for July 2012 – March 2013 shall not exceed $9,750,000. Contractor shall provide separate budget by PBM costs and by MBM costs. If proposal covers both services, provide the % of cost saving in doing both. The budget must be submitted on the form provided (Attachment H). The budget shall be submitted with a comprehensive budget narrative. Administrative costs may not exceed 10% of the total award. Indirect costs are allowable only when the contractor/subcontractor has a certified indirect cost rate approved by their Federal cognizant agency. A copy of the indirect cost letter must be provided at the time of the proposal submission. Funds shall not be carried forward from one performance period to another.
6.
Small Business Subcontracting Plan: Summarize the planned utilization of DMBE-certified small businesses which include businesses owned by women and minorities, when they have received DMBE small business certification, under the contract to be awarded as a result of this solicitation. This is a requirement for all prime contracts in excess of $100,000 unless the solicitation has been set-aside for small businesses or no subcontracting opportunities exist. Complete Attachment A.
EVALUATION AND AWARD CRITERIA: A. EVALUATION CRITERIA: Proposals shall be evaluated by the Department of Health using the following criteria: POINTS FOR SERVICES VALUE Experience and qualifications of Offeror and staff to provide the proposed MBM and/or PBM services for a high volume of clients, including at least 3 letters of support or references. Experience and qualifications of Offeror and staff to provide the proposed reports needed to VDH, including adequacy of data and financial systems to provide needed information including rebates and credits Specific plans or methodology to be used to perform PBM and/or MBM as detailed in Section III. There is a detailed description of how services will be administered and how payments will be issued, tracked, and reported in compliance with this RFP. Cost Effectiveness and Cost/Benefit analysis including description and rationale of how Offeror will ensure lowest prices for RW services including most cost effective means of providing services. Work plan demonstrates that Offeror has: at least three years experience with an ADAP program other than the VA ADAP providing pharmacy benefits management at least three years experience providing medical benefits management
6. Small Business Subcontracting Plan Participation of Small, Women-Owned, and Minority Business or Plan TOTAL: 13 of 44
15
15
25
10
10 5 20 100
B. AWARD OF CONTRACT: Selection shall be made to one or more Offerors deemed to be fully qualified and best suited among those submitting proposals on the basis of the evaluation factors included in the Request for Proposals. Negotiations shall be conducted with the Offerors so selected for each service. Price shall be considered, but need not be the sole determining factor. After negotiations have been conducted with the Offerors so selected, the Department of Health shall select the Offeror(s), which, in its opinion, has made the best proposal, and shall award the contract to that Offeror(s). The Commonwealth may cancel this Request for Proposals or reject proposals at any time prior to an award, and is not required to furnish a statement of the reasons why a particular proposal was not deemed to be the most advantageous (Code of Virginia, §2.24359D). Should the Commonwealth determine in writing and in its sole discretion that only one Offeror is fully qualified, or that one Offeror is clearly more highly qualified than the others under consideration, a contract may be negotiated and awarded to that Offeror. The award document will be a contract incorporating by reference all the requirements, terms and conditions of the solicitation and the Offeror’s proposal as negotiated. VDH reserves the right to award this RFP in part or in whole to one or more Vendors.
VII.
OPTIONAL PRE-PROPOSAL CONFERENCE: An optional pre-proposal conference will be held on May 24, 2012 at 11 a.m. at the Virginia Department of Health, James Madison Building, 109 Governor Street, Room 333, Richmond, Virginia 23219. The purpose of this conference is to allow potential Offerors an opportunity to present questions and obtain clarification relative to any facet of this solicitation. While attendance at this conference will not be a prerequisite to submitting a proposal, Offerors who intend to submit a proposal are encouraged to attend. Any changes resulting from this conference will be issued in a written addendum to the solicitation. Bring a copy of the solicitation with you to the conference. Call-in information will be provided upon request. Please contact Jeannie Rector at 804-864-7965 for call-in information.
VIII.
GENERAL TERMS AND CONDITIONS:
A.
VENDORS MANUAL: This solicitation is subject to the provisions of the Commonwealth of Virginia Vendors Manual and any revisions thereto, which are hereby incorporated into this contract in their entirety. The procedure for filing contractual claims is in section 7.19 of the Vendors Manual. A copy of the manual is normally available for review at the purchasing office and is accessible on the Internet at www.dgs.virginia.gov/dps/ under “Manuals”.
B.
APPLICABLE LAWS AND COURTS: This solicitation and any resulting contract shall be governed in all respects by the laws of the Commonwealth of Virginia and any litigation with respect thereto shall be brought in the courts of the Commonwealth. The agency and the Contractor are encouraged to resolve any issues in controversy arising from the award of the contract or any contractual dispute using Alternative Dispute Resolution (ADR) procedures (Code of Virginia, §2.2-4366). ADR procedures are described in Chapter 9 of the Vendors Manual. The Contractor shall comply with all applicable federal, state and local laws, rules and regulations.
C.
ANTI-DISCRIMINATION: By submitting his/her proposals, Offerors certify to the Commonwealth that they will conform to the provisions of the Federal Civil Rights Act of 1964, as amended, as well as the Virginia Fair Employment Contracting Act of 1975, as amended, where applicable, the Virginians With Disabilities Act, the Americans With Disabilities Act and §2.2-4311 of the Virginia Public Procurement Act. If the award is made to a faith-based organization, the organization shall not 14 of 44
discriminate against any recipient of goods, services, or disbursements made pursuant to the contract on the basis of the recipient’s religion, religious belief, refusal to participate in a religious practice, or on the basis of race, age, color, gender or national origin and shall be subject to the same rules as other organizations that contract with public bodies to account for the use of the funds provided; however, if the faith-based organization segregates public funds into separate accounts, only the accounts and programs funded with public funds shall be subject to audit by the public body. (Code of Virginia, §2.2-4343.1E) In every contract over $10,000 the provisions in 1. and 2. below apply: 1.
2.
During the performance of this contract, the Contractor agrees as follows: a.
The Contractor will not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, disability, or any other basis prohibited by state law relating to discrimination in employment, except where there is a bona fide occupational qualification reasonably necessary to the normal operation of the Contractor. The Contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices setting forth the provisions of this nondiscrimination clause.
b.
The Contractor, in all solicitations or advertisements for employees placed by or on behalf of the Contractor, will state that such Contractor is an equal opportunity employer.
c.
Notices, advertisements and solicitations placed in accordance with federal law, rule or regulation shall be deemed sufficient for the purpose of meeting these requirements.
The Contractor will include the provisions of 1. above in every subcontract or purchase order over $10,000, so that the provisions will be binding upon each subcontractor or vendor.
D.
ETHICS IN PUBLIC CONTRACTING: By submitting his/her proposals, Offerors certify that his/her proposals are made without collusion or fraud and that they have not offered or received any kickbacks or inducements from any other Offeror, supplier, manufacturer or subcontractor in connection with his/her proposal, and that they have not conferred on any public employee having official responsibility for this procurement transaction any payment, loan, subscription, advance, deposit of money, services or anything of more than nominal value, present or promised, unless consideration of substantially equal or greater value was exchanged.
E.
IMMIGRATION REFORM AND CONTROL ACT OF 1986: By entering into a written contract with the Commonwealth of Virginia, the Contractor certifies that the Contractor does not, and shall not during the performance of the contract for goods and services in the Commonwealth, knowingly employ an unauthorized alien as defined in the federal Immigration Reform and Control Act of 1986.
F.
DEBARMENT STATUS: By submitting his/her proposals, Offerors certify that they are not currently debarred by the Commonwealth of Virginia from submitting proposals on contracts for the type of goods and/or services covered by this solicitation, nor are they an agent of any person or entity that is currently so debarred.
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G.
ANTITRUST: By entering into a contract, the Contractor conveys, sells, assigns, and transfers to the Commonwealth of Virginia all rights, title and interest in and to all causes of action it may now have or hereafter acquire under the antitrust laws of the United States and the Commonwealth of Virginia, relating to the particular goods or services purchased or acquired by the Commonwealth of Virginia under said contract.
H.
MANDATORY USE OF STATE FORM AND TERMS AND CONDITIONS: Failure to submit a proposal on the official state form provided for that purpose may be cause for rejection of the proposal. Modification of or additions to the General Terms and Conditions of the solicitation may be cause for rejection of the proposal; however, the Commonwealth reserves the right to decide, on a case by case basis, in its sole discretion, whether to reject such a proposal.
I.
CLARIFICATION OF TERMS: If any prospective Offeror has questions about the specifications or other solicitation documents, the prospective Offeror should contact the buyer whose name appears on the face of the solicitation no later than five working days before the due date. Any revisions to the solicitation will be made only by addendum issued by the buyer.
J.
PAYMENT: 1. To Prime Contractor a. Invoices for items ordered, delivered and accepted shall be submitted by the Contractor directly to the payment address shown on the purchase order/contract. All invoices shall show the state contract number and/or purchase order number, social security number (for individual Contractors) or the federal employer identification number (for proprietorships, partnerships, and corporations).
b.
Any payment terms requiring payment in less than 30 days will be regarded as requiring payment 30 days after invoice or delivery, whichever occurs last. This shall not affect offers of discounts for payment in less than 30 days, however.
c.
All goods or services provided under this contract or purchase order, that are to be paid for with public funds, shall be billed by the Contractor at the contract price, regardless of which public agency is being billed.
d.
The following shall be deemed to be the date of payment: the date of postmark in all cases where payment is made by mail, or the date of offset when offset proceedings have been instituted as authorized under the Virginia Debt Collection Act.
e.
Unreasonable Charges. Under certain emergency procurements and for most time and material purchases, final job costs cannot be accurately determined at the time orders are placed. In such cases, Contractors should be put on notice that final payment in full is contingent on a determination of reasonableness with respect to all invoiced charges. Charges, which appear to be unreasonable, will be researched and challenged, and that portion of the invoice held in abeyance until a settlement can be reached. Upon determining that invoiced charges are not reasonable, the Commonwealth shall promptly notify the Contractor, in writing, as to those charges, which it considers unreasonable, and the basis for the determination. A Contractor may not institute legal action unless a settlement cannot be reached within thirty (30) days of notification. The provisions of this section do not relieve an agency of its prompt payment obligations with respect to those charges, which are not in dispute (Code of Virginia, §2.2-4363).
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2.
To Subcontractors:
a.
b.
A Contractor awarded a contract under this solicitation is hereby obligated:
(1).
To pay the subcontractor(s) within seven (7) days of the Contractor’s receipt of payment from the Commonwealth for the proportionate share of the payment received for work performed by the subcontractor(s) under the contract; or
(2).
To notify the agency and the subcontractor(s), in writing, of the Contractor’s intention to withhold payment and the reason.
The Contractor is obligated to pay the subcontractor(s) interest at the rate of one percent per month (unless otherwise provided under the terms of the contract) on all amounts owed by the Contractor that remain unpaid seven (7) days following receipt of payment from the Commonwealth, except for amounts withheld as stated in (2) above. The date of mailing of any payment by U. S. Mail is deemed to be payment to the addressee. These provisions apply to each sub-tier Contractor performing under the primary contract. A Contractor’s obligation to pay an interest charge to a subcontractor may not be construed to be an obligation of the Commonwealth.
3.
Each prime Contractor who wins an award in which provision of a SWaM procurement plan is a condition to the award, shall deliver to the contracting agency or institution, on or before request for final payment, evidence and certification of compliance (subject only to insubstantial shortfalls and to shortfalls arising from subcontractor default) with the SWaM procurement plan. Final payment under the contract in question may be withheld until such certification is delivered and, if necessary, confirmed by the agency or institution, or other appropriate penalties may be assessed in lieu of withholding such payment.
4.
The Commonwealth of Virginia encourages contractors and subcontractors to accept electronic and credit card payments.
K.
PRECEDENCE OF TERMS: The following General Terms and Conditions: VENDORS MANUAL, APPLICABLE LAWS AND COURTS, ANTI-DISCRIMINATION, ETHICS IN PUBLIC CONTRACTING, IMMIGRATION REFORM AND CONTROL ACT OF 1986. DEBARMENT STATUS, ANTITRUST, MANDATORY USE OF STATE FORM AND TERMS AND CONDITIONS, CLARIFICATION OF TERMS, PAYMENT shall apply in all instances. In the event there is a conflict between any of the other General Terms and Conditions and any Special Terms and Conditions in this solicitation, the Special Terms and Conditions shall apply.
L.
QUALIFICATIONS OF OFFERORS: The Commonwealth may make such reasonable investigations as deemed proper and necessary to determine the ability of the Offeror to perform the services/furnish the goods and the Offeror shall furnish to the Commonwealth all such information and data for this purpose as may be requested. The Commonwealth reserves the right to inspect Offeror’s physical facilities prior to award to satisfy questions regarding the Offeror’s capabilities. The Commonwealth further reserves the right to reject any proposal if the evidence submitted by, or investigations of, such Offeror fails to satisfy the Commonwealth that such Offeror is properly qualified to carry out the obligations of the contract and to provide the services and/or furnish the goods contemplated therein.
M.
TESTING AND INSPECTION: The Commonwealth reserves the right to conduct any test/inspection it may deem advisable to assure goods and services conform to the specifications. 17 of 44
N.
ASSIGNMENT OF CONTRACT: A contract shall not be assignable by the Contractor in whole or in part without the written consent of the Commonwealth.
O.
CHANGES TO THE CONTRACT: Changes can be made to the contract in any of the following ways:
P.
1.
The parties may agree in writing to modify the scope of the contract. An increase or decrease in the price of the contract resulting from such modification shall be agreed to by the parties as a part of their written agreement to modify the scope of the contract.
2.
The Department of Health may order changes within the general scope of the contract at any time by written notice to the Contractor. Changes within the scope of the contract include, but are not limited to, things such as services to be performed, the method of packing or shipment, and the place of delivery or installation. The Contractor shall comply with the notice upon receipt. The Contractor shall be compensated for any additional costs incurred as the result of such order and shall give the Department of Health a credit for any savings. Said compensation shall be determined by one of the following methods:
a.
By mutual agreement between the parties in writing; or
b.
By agreeing upon a unit price or using a unit price set forth in the contract, if the work to be done can be expressed in units, and the Contractor accounts for the number of units of work performed, subject to the Department of Correction’s right to audit the Contractor’s records and/or to determine the correct number of units independently; or
c.
By ordering the Contractor to proceed with the work and keep a record of all costs incurred and savings realized. A markup for overhead and profit may be allowed if provided by the contract. The same markup shall be used for determining a decrease in price as the result of savings realized. The Contractor shall present the Department of Health with all vouchers and records of expenses incurred and savings realized. The Department of Health shall have the right to audit the records of the Contractor, as it deems necessary to determine costs or savings. Any claim for an adjustment in price under this provision must be asserted by written notice to the Department of Health within thirty (30) days from the date of receipt of the written order from the Department of Health. If the parties fail to agree on an amount of adjustment, the question of an increase or decrease in the contract price or time for performance shall be resolved in accordance with the procedures for resolving disputes provided by the Disputes Clause of this contract or, if there is none, in accordance with the disputes provisions of the Commonwealth of Virginia Vendors Manual. Neither the existence of a claim nor a dispute resolution process, litigation or any other provision of this contract shall excuse the Contractor from promptly complying with the changes ordered by the Department of Health or with the performance of the contract generally.
DEFAULT: In case of failure to deliver goods or services in accordance with the contract terms and conditions, the Commonwealth, after due oral or written notice, may procure them from other sources and hold the Contractor responsible for any resulting additional purchase and administrative costs. This remedy shall be in addition to any other remedies, which the Commonwealth may have.
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Q.
INSURANCE: By signing and submitting a proposal under this solicitation, the Offeror certifies that if awarded the contract, it will have the following insurance coverage at the time the contract is awarded. For construction contracts, if any subcontractors are involved, the subcontractor will have workers’ compensation insurance in accordance with §§ 2.2-4332 and 65.2-800 et seq. of the Code of Virginia. The Offeror further certifies that the Contractor and any subcontractors will maintain this insurance coverage during the entire term of the contract and that all insurance coverage will be provided by insurance companies authorized to sell insurance in Virginia by the Virginia State Corporation Commission. INSURANCE COVERAGES AND LIMITS REQUIRED:
1.
Worker's Compensation – Statutory requirements and benefits. Coverage is compulsory for employers of three or more employees, to include the employer. Contractors who fail to notify the Commonwealth of increases in the number of employees that change their workers’ compensation under the Code of Virginia during the course of the contract shall be in noncompliance with the contract.
2.
Employers Liability - $100,000.
3.
Commercial General Liability - $1,000,000 per occurrence. Commercial General Liability is to include bodily injury and property damage, personal injury and advertising injury, products and completed operations coverage. The Commonwealth of Virginia must be named as an additional insured and so endorsed on the policy.
R.
ANNOUNCEMENT OF AWARD: Upon the award or the announcement of the decision to award a contract as a result of this solicitation, the purchasing agency will publicly post such notice on the DGS/DPS eVA VBO (www.eva.virginia.gov) for a minimum of 10 days.
S.
DRUG FREE WORKPLACE: During the performance of this contract, the Contractor agrees to (i) provide a drug-free workplace for the Contractor’s employees, (ii) post in conspicuous places, available to employees and applicants for employment, a statement notifying employees that the unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance, marijuana or alcohol is prohibited in the Contractor’s workplace and specifying the actions that will be taken against employees for violations of such prohibition; (iii) state in all solicitations or advertisements for employees placed by or on behalf of the Contractor that the Contractor maintains a drug-free workplace; and (iv) include the provisions of the foregoing clauses in every subcontract or purchase order of over $10,000, so that the provisions will be binding upon each subcontractor or vendor. For the purposes of this section, “drug-free workplace” means a site for the performance of work done in connection with a specific contract awarded to a Contractor in accordance with this chapter, the employees of whom are prohibited from engaging in the unlawful manufacture, sale, distribution, dispensation, possession or use of any controlled substance, marijuana or alcohol during the performance of the contract.
T.
NONDISCRIMINATION OF CONTRACTORS: A Bidder, Offeror, or Contractor shall not be discriminated against in the solicitation or award of this contract because of race, religion, color, sex, national origin, age, disability, faith-based organizational status, any other basis prohibited by state law relating to discrimination in employment or because the bidder or offeror employs ex-offenders unless the state agency, department or institution has made a written determination that employing ex-offenders on the specific contract is not in its best interest. If the award of this contract is made to a faith-based organization and an individual, who applies for or receives goods, services, or disbursements 19 of 44
provided pursuant to this contract objects to the religious character of the faith-based organization from which the individual receives or would receive the goods, services, or disbursements, the public body shall offer the individual, within a reasonable period of time after the date of their objection, access to equivalent goods, services, or disbursements from an alternative provider.
U.
eVA BUSINESS-TO-GOVERNMENT VENDOR REGISTRATION: The eVA Internet electronic procurement solution, website portal www.eVA.virginia.gov, streamlines and automates government purchasing activities in the Commonwealth. The eVA portal is the gateway for vendors to conduct business with state agencies and public bodies. All vendors desiring to provide goods and/or services to the Commonwealth shall participate in the eVA Internet eprocurement solution either through the eVA Basic Vendor Registration Service or eVA Premium Vendor Registration Service. All bidders or offerors must register in eVA and pay the Vendor Transaction Fees specified below; failure to register will result in the bid/proposal being rejected. Effective July 1, 2011, vendor registration and registration-renewal fees have been discontinued. Registration options are as follows: a. eVA Basic Vendor Registration Service: eVA Basic Vendor Registration Service includes electronic order receipt, vendor catalog posting, on-line registration, electronic bidding, and the ability to research historical procurement data available in the eVA purchase transaction data warehouse. b. eVA Premium Vendor Registration Service: eVA Premium Vendor Registration Service includes all benefits of the eVA Basic Vendor Registration Service plus automatic email or fax notification of solicitations and amendments. Vendor transaction fees are determined by the date the original purchase order is issued and are as follows: a. For orders issued prior to August 16, 2006, the Vendor Transaction Fee is 1%, capped at a maximum of $500 per order. b.
For orders issued August 16, 2006 thru June 30, 2011, the Vendor Transaction Fee is: (i) DMBE-certified Small Businesses: 1%, capped at $500 per order. (ii) Businesses that are not DMBE-certified Small Businesses: 1%, capped at $1,500 per
order. c.
For orders issued July 1, 2011 thru June 30, 2013, the Vendor Transaction Fee is: (i) DMBE-certified Small Businesses: 0.75%, capped at $500 per order. (ii) Businesses that are not DMBE-certified Small Businesses: 0.75%, capped at $1,500 per
order. d.
For orders issued July 1, 2013 and after, the Vendor Transaction Fee is: (i) DMBE-certified Small Businesses: 1%, capped at $500 per order. (ii) Businesses that are not DMBE-certified Small Businesses: 1%, capped at $1,500 per
order. The specified vendor transaction fee will be invoiced, by the Commonwealth of Virginia Department of General Services, approximately 30 days after the corresponding purchase order is issued and payable 30 days after the invoice date. Any adjustments (increases/decreases) will be handled through purchase order changes.
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IX.
V.
AVAILABILITY OF FUNDS: It is understood and agreed between the parties herein that the agency shall be bound hereunder only to the extent of the funds available or which may hereafter become available for the purpose of this agreement.
W.
BID PRICE CURRENCY: Unless stated otherwise in the solicitation, Offerors shall state offer prices in US dollars.
X.
AUTHORIZATION TO CONDUCT BUSINESS IN THE COMMONWEALTH: A contractor organized as a stock or nonstock corporation, limited liability company, business trust, or limited partnership or registered as a registered limited liability partnership shall be authorized to transact business in the Commonwealth as a domestic or foreign business entity if so required by Title 13.1 or Title 50 of the Code of Virginia or as otherwise required by law. Any business entity described above that enters into a contract with a public body pursuant to the Virginia Public Procurement Act shall not allow its existence to lapse or its certificate of authority or registration to transact business in the Commonwealth, if so required under Title 13.1 or Title 50, to be revoked or cancelled at any time during the term of the contract. A public body may void any contract with a business entity if the business entity fails to remain in compliance with the provisions of this section.
SPECIAL TERMS AND CONDITIONS:
A.
ADVERTISING: In the event a contract is awarded for supplies, equipment, or services resulting from this bid/proposal, no indication of such sales or services to the Virginia Department of Health will be used in product literature or advertising. The contractor shall not state in any of its advertising or product literature that Virginia Department of Health has purchased or uses any of its products or services, and the contractor shall not include Virginia Department of Health in any client list in advertising and promotional materials.
B.
ADDITIONAL USERS: This procurement is being conducted on behalf of state agencies, institutions and other public bodies who may be added or deleted at anytime during the period of the contract. The addition or deletion of authorized users not specifically named in the solicitation shall be made only by written contract modification issued by this agency or institution and upon mutual agreement of the contractor. Such modification shall name the specific agency added or deleted and the effective date. The contractor shall not honor an order citing the resulting contract unless the ordering entity has been added by written contract modification.
C.
AUDIT: The Contractor shall retain all books, records, and other documents relative to this contract for five (5) years after final payment, or until audited by the Commonwealth of Virginia, whichever is sooner. The agency, its authorized agents, and/or state auditors shall have full access to and the right to examine any of said materials during said period.
D.
BACKGROUND CHECKS:
1.
The VDH will require a background check for Contractor staff assigned to any resulting contract. The Contractor shall be required to pay for all background checks processed for staff assigned to any contract resulting from this solicitation at a rate of $50.00. Fees are on a per background check basis and will be invoiced by VDH Accounting. The Contractor employees will be required to complete a form granting authority to release 21 of 44
information. The Contractor shall allow the VDH access to review Contractor staff personnel and employment records.
2.
Background investigation results will be reviewed by the VDH, and are not releasable to the Contractor, however, can be provided to the individual of the investigation upon a written request.
3.
In the event contract award is made prior to completion of background checks, any unfavorable results shall be subject to the terms and conditions of this solicitation and the contract resulting from this solicitation.
4.
In the event of any staff turnover or staff reassignments, the Contractor shall notify the VDH and shall submit the appropriate background history questionnaire, authority for release of information and have fingerprints obtained for any proposed new staff member. This shall be in addition to the requirement to provide the required credentials information. The VDH may remove any Contractor employee that the Contract Administrator feels threatens the health or safety of staff, security of the facility, or quality of the service provided by the Contractor.
E.
CANCELLATION OF CONTRACT: The Purchasing Agency reserves the right to cancel and terminate any resulting contract, in part or in whole, without penalty, upon 60 days written notice to the Contractor. In the event the initial contract period is for more than 12 months, the resulting contract may be terminated by either party, without penalty, after the initial 12 months of the contract period upon 60 days written notice to the other party. Any contract cancellation notice shall not relieve the Contractor of the obligation to deliver and/or perform on all outstanding orders issued prior to the effective date of cancellation.
F.
CONFIDENTIALITY OF PERSONALLY IDENTIFIABLE INFORMATION: The contractor assures that information and data obtained as to personal facts and circumstances related to patients or clients will be collected and held confidential, during and following the term of this agreement, and will not be divulged without the individual’s and the agency’s written consent and only in accordance with federal law or the Code of Virginia. Contractors who utilize, access, or store personally identifiable information as part of the performance of a contract are required to safeguard this information and immediately notify the agency of any breach or suspected breach in the security of such information. Contractors shall allow the agency to both participate in the investigation of incidents and exercise control over decisions regarding external reporting. Contractors and their employees working on this project may be required to sign a confidentiality statement.
G.
CONFIDENTIALITY (Commonwealth): The Commonwealth agrees that neither it nor its employees, representatives, or agents shall knowingly divulge any proprietary information with respect to the operation of the software, the technology embodied therein, or any other trade secret or proprietary information related thereto, except as specifically authorized by the contractor in writing or as required by the Freedom of Information Act or similar law. It shall be the contractor’s responsibility to fully comply with § 2.2-4342F of the Code of Virginia. All trade secrets or proprietary information must be identified in writing or other tangible form and conspicuously labeled as “proprietary” either prior to or at the time of submission to the Commonwealth.
H.
CONFIDENTIALITY (Contractor): The contractor assures that information and data obtained as to personal facts and circumstances related to patients or clients will be collected and held confidential, during and following the term of this agreement, and will not be divulged without the individual’s and the agency’s written consent. Any information to be disclosed, except to the agency, must be in summary, statistical, or other form which does not identify particular 22 of 44
individuals. Contractors and their employees working on this project will be required to sign the Confidentiality statement in this solicitation.
I.
EXCESSIVE DOWNTIME: Equipment or software furnished under the contract shall be capable of continuous operation. Should the equipment or software become inoperable for a period of more than 24 hours, the contractor agrees to pro-rate maintenance charges to account for each full day of inoperability. The period of in operability shall commence upon initial notification. In the event the equipment or software remains inoperable for more than 14 consecutive calendar days, the contractor shall promptly replace the equipment or software at no charge upon request of the procuring agency. Such replacement shall be with new, unused product(s) of comparable quality, and must be installed and operational within 7 days following the request for replacement.
J.
IDENTIFICATION OF PROPOSAL ENVELOPE: Envelopes containing proposals shall be sealed and marked in the lower left-hand corner with the solicitation number, commodity, hour and due date of the proposal. A sample of a return mailing label for identifying the package as a sealed proposal has been provided as Attachment B. This format should be used on your response envelope. It is further suggested that if you submit your proposal by a courier such as FedEx or UPS, and place your sealed envelope inside the courier’s envelope, that you clearly mark the courier’s envelope with the same information. The courier’s envelope should be addressed as directed on the cover page of the solicitation. Proposals may be hand delivered to the Issuing Agency's Purchasing Office, however, ample time must be allowed for security check-in at the front desk and getting to the Purchasing Office prior to the closing time for the solicitation. No other correspondence or other proposals should be placed in the envelope.
K.
LIQUIDATED DAMAGES, GOODS AND NONPROFESSIONAL SERVICES: Delivery is required not later than 30 days from specified target dates for activities within the work plan. It is understood and agreed by the offeror that time is of the essence in the delivery of supplies, services, materials, or equipment of the character and quality specified in the proposal document. In the event these specified supplies, services, materials, or equipment are not delivered by the date specified there will be deducted, not as a penalty but as liquidated damages, the sum of $250 per day for each and every calendar day of delay beyond the time specified; except that if the delivery be delayed by any act, negligence, or default on the part of the Commonwealth, public enemy, war, embargo, fire, or explosion not caused by the negligence or intentional act of the contractor or his supplier(s), or by riot, sabotage, or labor trouble that results from a cause or causes entirely beyond the control or fault of the contractor or his supplier(s), a reasonable extension of time as the procuring public body deems appropriate may be granted. Upon receipt of a written request and justification for any extension from the contractor, the purchasing office may extend the time for performance of the contract or delivery of goods herein specified, at the purchasing office’s sole discretion, for good cause shown.
L.
OWNERSHIP OF INTELLECTUAL PROPERTY: All copyright and patent rights to all papers, reports, forms, materials, creations, or inventions created or developed in the performance of this contract shall become the sole property of the Commonwealth. On request, the contractor shall promptly provide an acknowledgment or assignment in a tangible form satisfactory to the Commonwealth to evidence the Commonwealth’s sole ownership of specifically identified intellectual property created or developed in the performance of the contract.
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M.
PRIME CONTRACTOR RESPONSIBILITIES: The Contractor shall be responsible for completely supervising and directing the work under this contract and all subcontractors that he may utilize, using their best skill and attention. Subcontractors who perform work under this contract shall be responsible to the prime Contractor. The Contractor agrees that he is as fully responsible for the acts and omissions of their subcontractors and of persons employed by them as he is for the acts and omissions of their own employees.
N.
PROPOSAL ACCEPTANCE PERIOD: Any proposal in response to this solicitation shall be valid for 120 days. At the end of the 120 days the proposal may be withdrawn at the written request of the Offeror. If the proposal is not withdrawn at that time it remains in effect until an award is made or the solicitation is canceled.
O.
RENEWAL OF CONTRACT: This contract may be renewed by the Commonwealth upon written agreement of both parties for 4 successive one year periods, under the terms of the current contract, and at a reasonable time (approximately 90 days) prior to the expiration.
P.
SMALL BUSINESS SUBCONTRACTING AND EVIDENCE OF COMPLIANCE: 1.
It is the goal of the Commonwealth that 40% of its purchases be made from small businesses. This includes discretionary spending in prime contracts and subcontracts. All potential Offerors are required to submit a Small Business Subcontracting Plan. Unless the Offeror is registered as a DMBE-certified small business and where it is practicable for any portion of the awarded contract to be subcontracted to other suppliers, the contractor is encouraged to offer such subcontracting opportunities to DMBE-certified small businesses. This shall not exclude DMBE-certified women-owned and minority-owned businesses when they have received DMBE small business certification. No Offeror or subcontractor shall be considered a Small Business, a Women-Owned Business or a Minority-Owned Business unless certified as such by the Department of Minority Business Enterprise (DMBE) by the due date for receipt of bids or proposals. If small business subcontractors are used, the prime contractor agrees to report the use of small business subcontractors by providing the purchasing office at a minimum the following information: name of small business with the DMBE certification number, phone number, total dollar amount subcontracted, category type (small, women-owned, or minority-owned), and type of product/service provided.
2.
Each prime contractor who wins an award in which provision of a small business subcontracting plan is a condition of the award, shall deliver to the contracting agency or institution on a quarterly basis, evidence of compliance (subject only to insubstantial shortfalls and to shortfalls arising from subcontractor default) with the small business subcontracting plan. When such business has been subcontracted to these firms and upon completion of the contract, the contractor agrees to furnish the purchasing office at a minimum the following information: name of firm with the DMBE certification number, phone number, total dollar amount subcontracted, category type (small, women-owned, or minority-owned), and type of product or service provided. Payment(s) may be withheld until compliance with the plan is received and confirmed by the agency or institution. The agency or institution reserves the right to pursue other appropriate remedies to include, but not be limited to, termination for default.
3.
Each prime contractor who wins an award valued over $200,000 shall deliver to the contracting agency or institution on a quarterly basis, information on use of subcontractors that are not DMBE-certified small businesses. When such business has been subcontracted 24 of 44
to these firms and upon completion of the contract, the contractor agrees to furnish the purchasing office at a minimum the following information: name of firm, phone number, total dollar amount subcontracted, and type of product or service provided.
Q.
SUBCONTRACTS: No portion of the work shall be subcontracted without prior written consent of the Purchasing Agency. In the event that the Contractor desires to subcontract some part of the work specified herein, the Contractor shall furnish the Purchasing Agency the names, qualifications and experience of their proposed subcontractors. The Contractor shall, however, remain fully liable and responsible for the work to be done by its subcontractor(s) and shall assure compliance with all requirements of the contract. Accordingly, this agreement basis is considered a sub-recipient relationship in accordance with the Federal Office of Management and Budget Circular No A-133. The Virginia Department of Health (VDH/OEpi), as a pass-through entity for numerous federal grants, is responsible for ensuring certain activities occur with respect to monitoring of subrecipients. When a sub-recipient expends $500,000 or more in federal grant funds in a year from any and all sources, the sub-recipient is required to have an A-133 “Single Audit” performed. Within thirty (30) days of the effective date of this agreement, the contractor will provide the assigned OEpi contract monitor with a copy of its most recent (last) single audit. If any findings were noted in the audit report, corrective actions taken to fully resolve the finding must be provided. If an A-133 audit occurs during the term of this agreement, a copy of that audit and response to any findings must be provided as well. If the contractor does not expend $500,000 or more in federal grant funds in a year from any and all sources, a written statement must be filed with the VDH contract monitor within 30 days of the effective date of this agreement.
R.
eVA BUSINESS-TO-GOVERNMENT CONTRACTS AND ORDERS: The solicitation/contract will result in 1 or more purchase order(s) with the eVA transaction fee specified below assessed for each order. a. For orders issued prior to August 16, 2006, the Vendor Transaction Fee is 1%, capped at a maximum of $500 per order. b.
For orders issued August 16, 2006 thru June 30, 2011, the Vendor Transaction Fee is: (i) DMBE-certified Small Businesses: 1%, Capped at $500 per order. (ii) Businesses that are not DMBE-certified Small Businesses: 1%, Capped at $1,500 per order. c.
For orders issued July 1, 2011 thru June 30, 2013, the Vendor Transaction Fee is: (i) DMBE-certified Small Businesses: 0.75%, Capped at $500 per order. (ii) Businesses that are not DMBE-certified Small Businesses: 0.75%, Capped at $1,500 per order. d.
For orders issued July 1, 2013, and after, the Vendor Transaction Fee is: (i) DMBE-certified Small Businesses: 1%, Capped at $500 per order. (ii) Businesses that are not DMBE-certified Small Businesses: 1%, Capped at $1,500 per order. The specified vendor transaction fee will be invoiced, by the Commonwealth of Virginia Department of General Services, approximately 30 days after the corresponding purchase order is issued and payable 30 days after the invoice date. Any adjustments (increases/decreases) will be handled through purchase order changes. 25 of 44
The eVA Internet electronic procurement solution, website portal www.eva.virginia.gov , streamlines and automates government purchasing activities in the Commonwealth. The portal is the gateway for vendors to conduct business with state agencies and public bodies. Vendors desiring to provide goods and/or services to the Commonwealth shall participate in the eVA Internet e-procurement solution and agree to comply with the following: If this solicitation is for a term contract, failure to provide an electronic catalog (price list) or index page catalog for items awarded will be just cause for the Commonwealth to reject your bid/offer or terminate this contract for default. The format of this electronic catalog shall conform to the eVA Catalog Interchange Format (CIF) Specification that can be accessed and downloaded from www.eVA.virginia.gov. Contractors should email Catalog or Index Page information to
[email protected].
S.
CONTINUITY OF SERVICES: A.
The Contractor recognizes that the services under this contract are vital to the Agency and must be continued without interruption and that, upon contract expiration, a successor, either the Agency or another contractor, may continue them. The Contractor agrees1. 2.
3.
T.
To exercise its best efforts and cooperation to effect an orderly and efficient transition to a successor; To make all Agency owned facilities, equipment, and data available to any successor at an appropriate time prior to the expiration of the contract to facilitate transition to successor; and That the Agency Contract Officer shall have final authority to resolve disputes related to the transition of the contract from the Contractor to its successor.
B.
The Contractor shall, upon written notice from the Contract Officer, furnish phasein/phase-out services for up to one hundred twenty (120) days after this contract expires and shall negotiate in good faith a plan with the successor to execute the phase-in/phaseout services. This plan shall be subject to the Contract Officer's approval.
C.
The Contractor shall be reimbursed for all reasonable, pre-approved phase-in/phase-out costs (i.e., costs incurred within the agreed period after contract expiration that result from phase-in, phase-out operations) and a fee (profit) not to exceed a pro rata portion of the fee (profit) under this contract. All phase-in/phase-out work fees must be approved by the Contract Officer in writing prior to commencement of said work.
STATE CORPORATION COMMISSION IDENTIFICATION NUMBER: Pursuant to Code of Virginia, §2.2-4311.2 subsection B, a bidder or offeror organized or authorized to transact business in the Commonwealth pursuant to Title 13.1 or Title 50 is required to include in its bid or proposal the identification number issued to it by the State Corporation Commission (SCC). Any bidder or offeror that is not required to be authorized to transact business in the Commonwealth as a foreign business entity under Title 13.1 or Title 50 or as otherwise required by law is required to include in its bid or proposal a statement describing why the bidder or offeror is not required to be so authorized. Indicate the above information on the SCC Form provided. Contractor agrees that the process by which compliance with Titles 13.1 and 50 is checked during the solicitation stage (including without limitation the SCC Form provided) is streamlined and not definitive, and the Commonwealth’s use and acceptance of such form, or its acceptance of Contractor’s statement describing why the bidder or offeror was not legally required to be authorized to transact business in the Commonwealth, shall not be conclusive of the issue and shall not be relied upon by the Contractor as demonstrating compliance. 26 of 44
X.
PRICING SCHEDULE: VDH shall fund the Contractor(s) for actual expenditures as a result of services performed under the terms of this Agreement, consistent with the approved budget. The Contractor(s) shall record expenditures in an established cost code. The Contractor(s) agrees to ensure that all expenditures made under this agreement are recorded correctly, are allowable, and are in support of the objectives of this agreement. The Contractor(s) shall maintain supporting documentation for all expenditures made under this Agreement and maintain such documentation until audited by the Virginia auditors of Public Accounts. All obligations made by the Contractor(s) under this Agreement shall be liquidated no later than 30 days after termination of contract. This agreement is a cost reimbursement contract this is negotiated prior to annual renewal each year depending on the approved budget. Price adjustment may be allowed at any time during the term of this agreement
XI.
ATTACHMENTS: ATTACHMENT A: SUPPLIER DIVERSITY & SMALL BUSINESS SUBCONTRACTING PLAN ATTACHMENT B: SAMPLE PROPOSAL SUBMISSION ENVELOPE LABEL ATTACHMENT C: OFFEROR DATA SHEET ATTACHMENT D: MAP OF HEALTH REGIONS ATTACHMENT E: RYAN WHITE PROGRAM SERVICES DEFINITION ATTACHMENT F: WORK PLAN GUIDELINES ATTACHMENT G: SAMPLE WORK PLANS ATTACHMENT H: PROPOSED BUDGET FORM ATTACHMENT I: VDH INVOICE PROCESSING GUIDELINES ATTACHMENT J: ADAP Data Report (ADR)
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ATTACHMENT A: SUPPLIER DIVERSITY & SMALL BUSINESS SUBCONTRACTING PLAN Small Business Subcontracting Plan Definitions Small Business: "Small business " means an independently owned and operated business which, together with affiliates, has 250 or fewer employees, or average annual gross receipts of $10 million or less averaged over the previous three years. Note: This shall not exclude DMBE-certified women- and minority-owned businesses when they have received DMBE small business certification. Women-Owned Business: Women-owned business means a business concern that is at least 51% owned by one or more women who are citizens of the United States or non-citizens who are in full compliance with United States immigration law, or in the case of a corporation, partnership or limited liability company or other entity, at least 51% of the equity ownership interest is owned by one or more women who are citizens of the United States or non-citizens who are in full compliance with United States immigration law, and both the management and daily business operations are controlled by one or more women who are citizens of the United States or non-citizens who are in full compliance with the United States immigration law. Minority-Owned Business: Minority-owned business means a business concern that is at least 51% owned by one or more minority individuals or in the case of a corporation, partnership or limited liability company or other entity, at least 51% of the equity ownership interest in the corporation, partnership, or limited liability company or other entity is owned by one or more minority individuals and both the management and daily business operations are controlled by one or more minority individuals. All small businesses must be certified by the Commonwealth of Virginia, Department of Minority Business Enterprise (DMBE) by the due date of the solicitation to participate in the SWAM program. Certification applications are available through DMBE online at www.dmbe.virginia.gov (Customer Service). Offeror Name: _____________________________________________ Preparer Name: ________________________________________
Date: ____________________
Instructions A. If you are certified by the Department of Minority Business Enterprise (DMBE) as a small business, complete only Section A of this form. This shall not exclude DMBE-certified women-owned and minority-owned businesses when they have received DMBE small business certification. B. If you are not a DMBE-certified small business, complete Section B of this form. For the offeror to receive credit for the small business subcontracting plan evaluation criteria, the offeror shall identify the portions of the contract that will be subcontracted to DMBE-certified small business in this section. Points will be assigned based on each offeror’s proposed subcontracting expenditures with DMBE certified small businesses for the initial contract period as indicated in Section B in relation to the offeror’s total price. Section A If your firm is certified by the Department of Minority Business Enterprise (DMBE), are you certified as a (check only one below): ______ Small Business ______ Small and Women-owned Business ______ Small and Minority-owned Business Certification number: __________________________Certification Date: ___________________________ Section B Populate the table below to show your firm's plans for utilization of DMBE-certified small businesses in the performance of this contract. This shall not exclude DMBE-certified women-owned and minority-owned businesses when they have received the DMBE small business certification. Include plans to utilize small businesses as part of joint ventures, partnerships, subcontractors, suppliers, etc. 28 of 44
B. Plans for Utilization of DMBE-Certified Small Businesses for this Procurement Small Business Name & Address DMBE Certificate #
Status if Small Business is also: Women (W), Minority (M)
Contact Person, Telephone & Email
Type of Goods and/or Services
Totals $
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Planned Involvement During Initial Period of the Contract
Planned Contract Dollars During Initial Period of the Contract
ATTACHMENT B: SAMPLE PROPOSAL SUBMISSION ENVELOPE LABEL Offeror’s Name: Offeror’s Address:
Commonwealth of Virginia Department of Health Office of Epidemiology (OEpi) 109 Governor St. 6th Floor, Rm 650 Richmond, Virginia 23219
Buyer: Kim Boehme RFP #: DDP-611BB-12-ADAP-Assist RFP Due Date: June 19, 2012 by 3:00 p.m.
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ATTACHMENT C OFFEROR DATA SHEET Note: The following information is required as part of your response to this solicitation. Failure to complete and provide this sheet may result in a lower score. 1. Qualification: The vendor must have the capability and capacity in all respects to satisfy fully all of the contractual requirements. 2. Vendor’s Primary Contact: Name: __________________________________ Phone: _________________________ 3. Years in Business: Indicate the length of time you have been in business providing this type of good or service: __________ Years ________ Months 4. Vendor Information: eVA Vendor ID or DUNS Number: ________________________________ 5. Indicate below a listing of at least four (4) current or recent accounts, either commercial or governmental, that your company is servicing, has serviced, or has provided similar goods. Include the length of service and the name, address, and telephone number of the point of contact. A. Company: _________________________________Contact: ____________________________________ Phone :(_____) ______________________________ Fax: (_____) ________________________________ Project: _____________________________________________________________________________ Dates of Service: _________________________________$ Value: _______________________ B. Company________________________________ Contact: ____________________________________ Phone :(_____) ___________________________ Fax: (_____) _________________________________ Project: ______________________________________________________________________________ Dates of Service: _________________________________$ Value: ________________________ C. Company: ________________________________ Contact: ____________________________________ Phone :(_____) ______________________________Fax :(_____) _________________________________ Project: ______________________________________________________________________________ Dates of Service: _________________________________$ Value: ________________________ D. Company: _________________________________Contact: ____________________________________ Phone :(_____) ______________________________Fax :(_____) _________________________________ Project: ______________________________________________________________________________ Dates of Service: _________________________________$ Value: _______________________ I certify the accuracy of this information. Signed: ____________________________________Title: ________________________________ Date: _______________
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ATTACHMENT D MAP OF HEALTH REGIONS
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ATTACHMENT E Ryan White Program Services Definitions
CORE SERVICES Service categories: a. Outpatient/Ambulatory medical care (health services) is the provision of professional diagnostic and therapeutic services rendered by a physician, physician's assistant, clinical nurse specialist, or nurse practitioner in an outpatient setting. Settings include clinics, medical offices, and mobile vans where clients generally do not stay overnight. Emergency room services are not outpatient settings. Services includes diagnostic testing, early intervention and risk assessment, preventive care and screening, practitioner examination, medical history taking, diagnosis and treatment of common physical and mental conditions, prescribing and managing medication therapy, education and counseling on health issues, wellbaby care, continuing care and management of chronic conditions, and referral to and provision of specialty care (includes all medical subspecialties). Primary medical care for the treatment of HIV infection includes the provision of care that is consistent with the Public Health Service’s guidelines. Such care must include access to antiretroviral and other drug therapies, including prophylaxis and treatment of opportunistic infections and combination antiretroviral therapies. NOTE: Early Intervention Services provided by Ryan White Part C and Part D Programs should be included here under Outpatient/ Ambulatory medical care. b. AIDS Drug Assistance Program (ADAP treatments) is a State-administered program authorized under Part B of the Ryan White Program that provides FDA-approved medications to low-income individuals with HIV disease who have limited or no coverage from private insurance, Medicaid, or Medicare. c. AIDS Pharmaceutical Assistance (local) includes local pharmacy assistance programs implemented by Part A or Part B Grantees to provide HIV/AIDS medications to clients. This assistance can be funded with Part A grant funds and/or Part B base award funds. Local pharmacy assistance programs are not funded with ADAP earmark funding. d. Oral health care includes diagnostic, preventive, and therapeutic services provided by general dental practitioners, dental specialists, dental hygienists and auxiliaries, and other trained primary care providers. e. Early intervention services (EIS) include counseling individuals with respect to HIV/AIDS; testing (including tests to confirm the presence of the disease, tests to diagnose to extent of immune deficiency, tests to provide information on appropriate therapeutic measures); referrals; other clinical and diagnostic services regarding HIV/AIDS; periodic medical evaluations for individuals with HIV/AIDS; and providing therapeutic measures. NOTE: EIS provided by Ryan White Part C and Part D Programs should NOT be reported here. Part C and Part D EIS should be included under Outpatient/ Ambulatory medical care. f.
Health Insurance Premium & Cost Sharing Assistance is the provision of financial assistance for eligible individuals living with HIV to maintain a continuity of health insurance or to receive medical benefits under a health insurance program. This includes premium payments, risk pools, co-payments, and deductibles.
g. Home Health Care includes the provision of services in the home by licensed health care workers such as nurses and the administration of intravenous and aerosolized treatment, parenteral feeding, diagnostic testing, and other medical therapies. h. Home and Community-based Health Services include skilled health services furnished to the individual in the individual’s home based on a written plan of care established by a case management team that includes appropriate health care professionals. Services include durable medical equipment; home health aide services and personal care services in the home; day treatment or other partial hospitalization services; home intravenous and aerosolized drug therapy (including prescription drugs administered as 33 of 44
part of such therapy); routine diagnostics testing administered in the home; and appropriate mental health, developmental, and rehabilitation services. Inpatient hospitals services, nursing home and other long term care facilities are NOT included. i.
Hospice services include room, board, nursing care, counseling, physician services, and palliative therapeutics provided to clients in the terminal stages of illness in a residential setting, including a nonacute-care section of a hospital that has been designated and staffed to provide hospice services for terminal clients.
j.
Mental health services are psychological and psychiatric treatment and counseling services offered to individuals with a diagnosed mental illness, conducted in a group or individual setting, and provided by a mental health professional licensed or authorized within the State to render such services. This typically includes psychiatrists, psychologists, and licensed clinical social workers.
k. Medical nutrition therapy is provided by a licensed registered dietitian outside of a primary care visit and includes the provision of nutritional supplements. Medical nutrition therapy provided by someone other than a licensed/registered dietitian should be recorded under psychosocial support services. l.
Medical Case management services (including treatment adherence) are a range of client-centered services that link clients with health care, psychosocial, and other services. The coordination and followup of medical treatments is a component of medical case management. These services ensure timely and coordinated access to medically appropriate levels of health and support services and continuity of care, through ongoing assessment of the client’s and other key family members’ needs and personal support systems. Medical case management includes the provision of treatment adherence counseling to ensure readiness for, and adherence to, complex HIV/AIDS treatments. Key activities include (1) initial assessment of service needs; (2) development of a comprehensive, individualized service plan; (3) coordination of services required to implement the plan; (4) client monitoring to assess the efficacy of the plan; and (5) periodic re-evaluation and adaptation of the plan as necessary over the life of the client. It includes client-specific advocacy and/or review of utilization of services. This includes all types of case management including face-to-face, phone contact, and any other forms of communication.
m. Substance abuse services outpatient is the provision of medical or other treatment and/or counseling to address substance abuse problems (i.e., alcohol and/or legal and illegal drugs) in an outpatient setting, rendered by a physician or under the supervision of a physician, or by other qualified personnel. SUPPORT SERVICES n. Case Management (non-Medical) includes the provision of advice and assistance in obtaining medical, social, community, legal, financial, and other needed services. Non-medical case management does not involve coordination and follow-up of medical treatments, as medical case management does. o. Child care services are the provision of care for the children of clients who are HIV-positive while the clients attend medical or other appointments or Ryan White Program-related meetings, groups, or training. NOTE: This does not include child care while a client is at work. p. Pediatric developmental assessment and early intervention services are the provision of professional early interventions by physicians, developmental psychologists, educators, and others in the psychosocial and intellectual development of infants and children. These services involve the assessment of an infant’s or child’s developmental status and needs in relation to the involvement with the education system, including early assessment of educational intervention services. It includes comprehensive assessment of infants and children, taking into account the effects of chronic conditions associated with HIV, drug exposure, and other factors. Provision of information about access to Head Start services, appropriate educational settings for HIV-affected clients, and education/assistance to schools should also be reported in this category. q. Emergency financial assistance is the provision of short-term payments to agencies or establishment of voucher programs to assist with emergency expenses related to essential utilities, housing, food 34 of 44
(including groceries, food vouchers, and food stamps), and medication when other resources are not available. NOTE: Part A and Part B programs must be allocated, tracked and report these funds under specific service categories as described under 2.6 in DSS Program Policy Guidance No. 2 (formally Policy No. 9702). r. Food bank/home-delivered meals include the provision of actual food or meals. It does not include finances to purchase food or meals. The provision of essential household supplies such as hygiene items and household cleaning supplies should be included in this item. Includes vouchers to purchase food. s. Health education/risk reduction is the provision of services that educate clients with HIV about HIV transmission and how to reduce the risk of HIV transmission. It includes the provision of information; including information dissemination about medical and psychosocial support services and counseling to help clients with HIV improve their health status. t.
Housing services are the provision of short-term assistance to support emergency, temporary or transitional housing to enable an individual or family to gain or maintain medical care. Housing-related referral services include assessment, search, placement, advocacy, and the fees associated with them. Eligible housing can include both housing that does not provide direct medical or supportive services and housing that provides some type of medical or supportive services such as residential mental health services, foster care, or assisted living residential services.
u. Legal services are the provision of services to individuals with respect to powers of attorney, do-notresuscitate orders and interventions necessary to ensure access to eligible benefits, including discrimination or breach of confidentiality litigation as it relates to services eligible for funding under the Ryan White Program. It does not include any legal services that arrange for guardianship or adoption of children after the death of their normal caregiver. v. Linguistics services include the provision of interpretation and translation services. w. Medical transportation services include conveyance services provided, directly or through voucher, to a client so that he or she may access health care services. x. Outreach services are programs that have as their principal purpose identification of people with unknown HIV disease or those who know their status so that they may become aware of, and may be enrolled in care and treatment services (i.e., case finding), not HIV counseling and testing nor HIV prevention education. These services may target high-risk communities or individuals. Outreach programs must be planned and delivered in coordination with local HIV prevention outreach programs to avoid duplication of effort; be targeted to populations known through local epidemiologic data to be at disproportionate risk for HIV infection; be conducted at times and in places where there is a high probability that individuals with HIV infection will be reached; and be designed with quantified program reporting that will accommodate local effectiveness evaluation. y. Permanency planning is the provision of services to help clients or families make decisions about placement and care of minor children after the parents/caregivers are deceased or are no longer able to care for them. z. Psychosocial support services are the provision of support and counseling activities, child abuse and neglect counseling, HIV support groups, pastoral care, caregiver support, and bereavement counseling. Includes nutrition counseling provided by a non-registered dietitian but excludes the provision of nutritional supplements. aa. Referral for health care/supportive services is the act of directing a client to a service in person or through telephone, written, or other type of communication. Referrals may be made within the nonmedical case management system by professional case managers, informally through support staff, or as part of an outreach program. ab.
Rehabilitation services are services provided by a licensed or authorized professional in accordance with an individualized plan of care intended to improve or maintain a client’s quality of life and optimal 35 of 44
capacity for self-care. Services include physical and occupational therapy, speech pathology, and lowvision training. ac.
Respite care is the provision of community or home-based, non-medical assistance designed to relieve the primary caregiver responsible for providing day-to-day care of a client with HIV/AIDS.
ad.
Substance abuse services–residential is the provision of treatment to address substance abuse problems (including alcohol and/or legal and illegal drugs) in a residential health service setting (short-term).
ae.
Treatment adherence counseling is the provision of counseling or special programs to ensure readiness for, and adherence to, complex HIV/AIDS treatments by non-medical personnel outside of the medical case management and clinical setting.
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ATTACHMENT F WORK PLAN GUIDELINES Each Work Plan should clearly identify: 1. target population to be reached 2. the intervention to be utilized 3. process objectives 4. plan of operation or action steps taken 5. outcome objectives 6. the total number of clients to be reached annually 7. evaluation component Notes Well-written objectives provide all the information a reviewer needs to understand your organization’s work plan. Strong objectives demonstrate your organization’s expertise with program implementation and anticipatory goal attainment. Objectives should be contained in one sentence and should be specific (who, what, where), time-phased (when) and measurable (how many, how much). Additional information should be included in the Plan of Operation as either a narrative or bulleted points. Outcome objectives are not needed for each process objective. Several process objectives may contribute to one outcome measurement. DEFINITIONS: Process Objectives - describe specific intervention activities for a targeted population within a given timeframe. It describes the work to be done (your intervention) or services to be carried out. It allows you to monitor the progress of your project. A process objective never describes the benefits gained, knowledge acquired or behavior changed. Example of a Process Objective: ASO will perform a minimum of 1400 encounters by the end of the grant year with individuals who are HIV-positive in the cities of the Hampton Roads region of South Eastern Virginia Outcome Objectives - define a measurable result: a change in knowledge, attitudes, beliefs or behaviors that occur as a result of the intervention. Outcome objectives allow an organization to monitor changes over time and indicate whether the activities or strategies employed have had an effect on the target population. Outcome evaluation helps an organization demonstrate its program effectiveness. Outcome objectives should always describe how the change or benefit will be measured. Examples of Outcome Objectives: By the end of the grant year, at least 75% of those referred into primary care will still be actively participating in this service. Action Steps - what you intend to do in order to obtain the process and outcome objectives. Example of Action Step: ASO will document complete demographic information and case identification for all persons registering into HIV primary care services through June 30, 2008. 36
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ATTACHMENT G SAMPLEWORK PLANS (for illustration only) Target Population: HIV-positive racial/ethnic minorities, primarily African Americans Goal: To increase access to primary medical care, ADAP, and HIV related support services for HIV-positive racial/ethnic minorities living in Hampton Roads (Norfolk, Virginia Beach, Portsmouth, Chesapeake, Newport News, and Hampton) by March 31, 2013. Intervention: Outreach Case Finding Process Objective 1: ASO will provide a minimum of 6,000 conASOs by the end of the grant year in the cities of the Hampton Roads region to include the Peninsula to individuals who engage in high risk behavior yet whose HIV status is unknown in order to refer to HIV testing. Action Steps: 1) ASO will employ 2 outreach case finders to provide services under this grant through March 31, 2013 to provide services to the Southside of Hampton Roads. This includes the cities of Norfolk, Virginia Beach, Chesapeake and Portsmouth. 2) ASO will employ one outreach specialist to provide services under the Minority AIDS Initiative grant program through March 31, 2013 to provide services to the cities of the Hampton and Newport News. 3) ASO will employ one .25 FTE to target the Minority Faith Base Organization throughout the Hampton Roads Region. 4) ASO will retain the services of a full time ADAP Outreach worker whose sole purpose will be to work closely with health providers in helping persons in need of primary HIV medical care obtain primary HIV medical care. 5) ASO will develop a weekly schedule of sites in Norfolk, Virginia Beach, Portsmouth, Newport News, Hampton and Chesapeake to be visited including area feeding centers, churches, homeless shelters, etc. 6) ASO will develop a weekly schedule of primary HIV medical care providers in Norfolk, Virginia Beach, Portsmouth, Newport News, Hampton and Chesapeake to be visited. 7) The full time outreach case finders will perform outreach activities to agencies and units that are not at high risk for safety when alone. Process Objective 2: ASO will perform a minimum of 1400 encounters by the end of the grant year with individuals who are HIV positive in cities of the Hampton Roads region of South Eastern Virginia. Action Steps: 1) ASO will target the following cities: Norfolk, Virginia Beach, Portsmouth, Newport News, Hampton and Chesapeake through March 31, 2013 2) ASO staff will provide information on and referral to primary care, ADAP, and other HIV-related support services to all individuals who identify as HIV-positive and are either new to care or have been lost to care (i.e. out of service for a minimum of 1 year) through March 31, 2013 3) ASO will accept referrals from prevention education staff for those newly tested HIV-positive through the ASO HIV testing program as well as those receiving other prevention services through March 31, 2013. 4) ASO will accept referrals from case management staff for those who have been lost to care for a minimum of one year through March 31, 2013. 5) Through March 31, 2013, ASO staff will provide ongoing encounters until such as time as the individual successfully enrolls into primary care. 6) Through March 31, 2013, ASO staff will document the number of encounters provided to each individual in order for that individual to successfully enroll into care. Process Objective 3: ASO will provide written materials regarding the program to community resources throughout the region that may be accessed by HIV-positive individuals with a goal of providing materials to a minimum of 50 organizations, businesses, service agencies, hospitals, etc. by the end of the grant year. In conjunction with this effort, ASO will also establish linkages with those local HIV primary medical providers so as to provide resource information and outreach for ADAP services for persons who are HIV positive. Action Steps: 1) ASO will secure written materials from the Virginia Department of Health as well as make additional 38 of 44
copies of those previously approved promotional materials (flyer and business card) by April 30, 2012. 2) ASO will identify various entities, agencies, and community organizations to receive written material on the Southside by April 30, 2012. 3) ASO will make conASO with these entities, agencies, and community organizations and distribute material to each by April 30, 2012. 4) ASO will identify various entities, agencies, and community organizations to receive written material on the Peninsula by April 30, 2012. 5) ASO will make conASO with these entities, agencies, and community organizations on the Peninsula and distribute material to each by September 15, 2012. 6) From April 1, 2012 to March 31, 2013, ASO will replenish materials to each site on a quarterly basis. Outcome Objective 1: ASO will refer a minimum of 60 HIV-positive people into primary care services (as well as ADAP and HIV-related support services as needed) by the end of the grant year. Action Steps: 1) ASO will document complete demographic information and case identification for all persons registering into HIV primary care services through July 31, 2012.
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ATTACHMENT H PROPOSED BUDGET FORM The following categories and format are being provided to ensure appropriate ordering of budget categories and placement of line items. The descriptions under each are examples of allowable costs but may not be approved/included in every contract. Specific line items and costs are negotiated in your initial contract with any modifications requiring approval. If you have any questions, please contact your HIV Services Coordinator. Caps on expenses: Part B contractors can allocate up to 10% of their grant award for administration. Indirect costs are allowable only when the contractor/subcontractor has a certified indirect cost rate approved by their Federal cognizant agency. Include the following in the Budget Justification narrative: Personnel Costs: Personnel costs should be explained by listing each staff member who will be supported from funds, name (if possible), position title, percent full time equivalency, and annual salary. Indirect Costs: Indirect costs are those costs incurred for common or joint objectives which cannot be readily identified but are necessary to the operations of the organization, e.g., the cost of operating and maintaining facilities, depreciation, and administrative salaries. For institutions subject to OMB Circular A-21, the term “facilities and administration” is used to denote indirect costs. If an organization applying for an assistance award does not have an indirect cost rate, the applicant may wish to obtain one through HHS’s Division of Cost Allocation (DCA). Visit DCA’s website at: http://rates.psc.gov/ to learn more about rate agreements, the process for applying for them, and the regional offices which negotiate them. Fringe Benefits: List the components that comprise the fringe benefit rate, for example health insurance, taxes, unemployment insurance, life insurance, retirement plan, tuition reimbursement. The fringe benefits should be directly proportional to that portion of personnel costs that are allocated for the project. Travel: List travel costs according to local and long distance travel. For local travel, the mileage rate, number of miles, reason for travel and staff member/consumers completing the travel should be outlined. The budget should also reflect the travel expenses associated with participating in meetings and other proposed trainings or workshops. Equipment: List equipment costs and provide justification for the need of the equipment to carry out the program’s goals. Extensive justification and a detailed status of current equipment must be provided when requesting funds for the purchase of computers and furniture items that meet the definition of equipment (a unit cost of $5000 and a useful life of one or more years). Supplies: List the items that the project will use. In this category, separate office supplies from medical and educational purchases. Office supplies could include paper, pencils, and the like; medical supplies are syringes, blood tubes, plastic gloves, etc., and educational supplies may be pamphlets and educational videotapes. Remember, they must be listed separately. Subcontracts: To the extent possible, all subcontract budgets and justifications should be standardized, and contract budgets should be presented by using the same object class categories contained in the Standard Form 424A. Provide a clear explanation as to the purpose of each contract, how the costs were estimated, and the specific contract deliverables. Other: Put all costs that do not fit into any other category into this category and provide and explanation of each cost in this category. In some cases, grantee rent, utilities and insurance fall under this category if they are not included in an approved indirect cost rate.) Start-up: Start-up funds are available for new contracts only. This does not include renewals. Start up funds should be requested at the time of contract negotiations. Once contracts have been signed by the DDP and VDH administration, the DDP will process start-up fund requests. Start-up funds may not exceed 1/12 of the total budget. Letters requesting start-up funds should be submitted along with the budget and work plan to the Division Director. Premiums: The periodic payment (generally monthly or quarterly) made to an insurance policy on behalf of eligible clients.
Co-Pays and Deductibles: Co-pays are the fixed amount of money paid when covered services or medications are provided. Deductibles are the fixed amount of covered expenses that must be incurred on behalf of the client for certain services, supplies, and medications before the insurance plan pays for covered benefits. 40 of 44
PROGRAM: _____________________________________________ AGENCY: _______________________________________________ CONTRACT/MOA #:________________________________________________ GRANT YEAR (specify start and end dates) _____________________________
Direct Service
Administrative
TOTAL
Personnel Fringe Travel Equipment Supplies Contractual Other Indirect Start-Up Co-Pays and Deductibles Premiums TOTALS
Signature:
Date:
Definitions Direct Service – Activities related to direct client service (i.e. personnel that work with clients and/or determine eligibility and those that directly supervise service provision) Administrative– Activities related to operation of the agency, but not directly involved in client services (i.e. accountant, rent, agency operations, and administrative staff).
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ATTACHMENT I VDH Invoice Processing Guidelines (Please Note: Invoice Processing Guidelines are periodically reviewed to ensure compliance with the most recent federal and state requirements. Contractors will be provided with updated guidelines when appropriate.) Salary and fringe categories: A spreadsheet or word document that includes an employee name (as it appears on the payroll-no nicknames), amount of salary and fringe charged to the contract requesting reimbursement for the current billing cycle. If the salary/fringe is allocated to numerous grants add two columns (one for salary and one for fringe) and key the amount charged for each grant impacted. Be sure to label columns appropriately. Timesheets or other documents which include personal employee information are not required but should be maintained for site review. The employee name, salary charged and fringe charged should be submitted as in the following example. June, 2009
Employee Last Name
Supporting
First Name
Grant #1 (enter grant title)
Grant #2 (enter grant title)
Salary
Salary
Fringe
Fringe
Trump
Peter
$270.00
$32.40
$270.00
$32.40
Bush
Taylor
$175.50
$21.06
$175.50
$21.06
Hall
Alan
$367.50
$44.10
$367.50
$44.10
Hale
Danny
$185.95
$22.31
$185.95
$22.31
Timely
Elvis
$195.00
$23.40
$195.00
$23.40
Esther
Polly
$396.50
$47.58
$396.50
$47.58
Freely
Inga P.
$39.00
$4.68
$39.00
$4.68
Romig
Karen
$177.83
$21.34
$177.83
$21.34
Parker
David
$948.75
$113.85
$948.75
$113.85
Hayes
Rachel
$236.74
$28.41
$236.74
$28.41
Woods
Sharon
$546.00
$65.52
$546.00
$65.52
Buquet
Mercy
$84.50
$10.14
$84.50
$10.14
$3,623.27
$434.79
$3,623.27
$434.79
Total
Documentation: Contractors are required to provide supporting documentation with each request for payment to reflect each line item expenditure. To receive payment, these entities must submit vendor invoices to the agency that received the goods or services. The term, invoice, refers to the original vendor prepared bill that must be attached to the payment as supporting documentation.” Proof of payment must be included. Write at the top of each receipt the category that it matches as supporting documentation. This should indicate the line item to be charged on the payment request. Making this quick note will help the finance staff to process your request quicker. Although no receipts are required for indirect costs, the negotiated percent needs to be noted as well as the items used to calculate the indirect cost. Examples of supporting documentation may include, but are not limited to: Copy of a travel reimbursement request Copy of original receipt for equipment, supplies or other expenses Copy of the contractual agreement or contractor’s invoice for services rendered Copy of bill/invoice with the check number and date noted or copy of rental/lease agreement indicating agreement period and rental amount or copy of check with rental month noted on the memo line. Supplies: o Food expenditures - specify on the receipt the event where the food was served or distributed (i.e.: intervention, workshop, committee meeting) 42 of 44
o o
General Office supplies – include copy of original receipt noted as supplies Gift cards/incentives – specify on the receipt the intervention supported.
Contractors that divide costs for specific line items across multiple grants programs/funding sources should indicate on the documentation what portion or amount is being charged to the request submitted. If the supporting documentation does not match the total requested for reimbursement, it will not be processed until the discrepancy is resolved. Please put the grant program name, full contract number and Federal Tax ID number (FIN) on each request for payment. Also, include on the payment request the name, phone number and email address of the individual to contact with any questions. This will help to expedite the payment request. Contractors must request reimbursement for the exact amount of money spent in each budget line item. VDH does not allow contractors to round costs to the nearest dollar.
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ATTACHMENT J
ADAP Data Report: Client Report Summary of Changes to the Client‐Level Variables Key Changes: 1) Headers were added to discern between System Variables and Client Variables. 2) The sections have been re‐ordered to reflect that Clinical Information is only required for ADAP clients who received medication services. Sections are now in this order: Client Demographics, Enrollment and Certification, ADAP Insurance and Services, Drugs and Drug Expenditures, and Clinical Information. 3) Two items, pregnancy outcome and client’s first service date, have been deleted. a. The pregnancy outcome variable has been deleted. HAB no longer requires that ADAPs report a client’s pregnancy outcome. b. Client’s first service date has been deleted. HAB no longer requires that ADAPs report a client’s first service date 4) The definition for Item 12 (previously Item 13) has been clarified. Any Pre‐Existing Condition Insurance Plans (PCIPs) participation should be reported in the question for high risk insurance pool participation. 5) Item 24 (previously Item 34) now requires the actual number of days for which medications were dispensed for any medications dispensed for a period of less than 30 days. For example, if the client received a 14 day supply of medication, you would report 14, not 30. 6) Language in the Clinical Information section was clarified. Specifically, while the most recent CD4 count and VL test are required to be reported, values will be accepted as long as they occur within 12 months preceding the end of the reporting period. For example, the first period for which data will be reported is October 1, 2012 – March 31, 2013. Therefore, any CD4 or VL tests reported must have occurred no earlier than March 31, 2012.
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ATTACHMENT J
ADAP Data Report: Client Report Final Client‐Level Variables
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ATTACHMENT J
ADAP Client Report – Final Client‐Level Data Variables
System Variables Field #
Variable Description
1.
Reporting period
2.
Encrypted UCI
3.
ADAP number
Variable definition The report period identifier.
Allowed Values
The encrypted, unique client identifier generated by the HAB UCI generation utilities. The unique provider organization identifier assigned through the ADR Web Application.
Rationale
1 = 10/01/2012 – 03/31/2013 2 = 04/01/2013 – 09/30/2013 3 = 10/01/2013 – 03/31/2014 4 = 04/01/2014 – 09/30/2014 41‐character string
State ADAP number
Client Variables Client Demographics: To describe the socio‐demographic characteristics of all clients enrolled in the ADAP, whether or not they received services. 4.
Ethnicity
Client’s ethnicity. OMB‐approved categories are used.
5.
Race
Client’s race. Select all that apply. OMB‐approved categories are used.
6.
Gender
Client’s current gender
7.
Transgender
Client’s current transgender status. To be completed only if the response is “Transgender” in Item #6.
Hispanic/Latino(a) Non‐Hispanic Unknown White Black or African American Asian Native Hawaiian/Pacific Islander American Indian or Alaska Native Unknown Male Female Transgender Unknown Male‐to‐Female Female‐to‐Male Unknown
Description of clients served
Description of clients served
Description of clients served Description of clients served
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ATTACHMENT J
ADAP Client Report – Final Client‐Level Data Variables
Field # Variable Description Variable definition Allowed Values Rationale Client Demographics: To describe the socio‐demographic characteristics of all clients enrolled in the ADAP, whether or not they received services. 8.
Pregnancy status
9.
Client’s year of birth
10.
11.
12.
13.
HIV/AIDS status
Value indicating whether the client was pregnant at any time during the reporting period. This should be completed for HIV+ women only. The year in which the client was born
Client’s HIV/AIDS status as of the end of the reporting period
Poverty level
Client’s annual household income as a percent of the Federal Poverty Level (FPL) at the end of the reporting period.
High Risk Insurance
Was this client in a High Risk Insurance Pool (including Pre‐Existing Condition Insurance Plans (PCIPs)) at any time during the reporting period?
Client’s health insurance coverage during the reporting period
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No Yes Not applicable Unknown
Indicate all sources of client’s health insurance during the reporting period. Report all that apply.
Description of clients served Description of clients served
YYYY
HIV positive, not‐AIDS HIV positive, AIDS status unknown CDC‐defined AIDS Unknown Equal to or below the FPL 101‐200% of the FPL 201‐300% of the FPL 301% ‐ 400% of the FPL 401% ‐ 500% of the FPL Over 500% of the FPL Unknown/ unreported No Yes Unknown
Medicare Part A/B Medicare Part D Medicaid Private Other public No insurance Other
Description of clients served
Description of clients served
Description of clients served
Description of clients served
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ATTACHMENT J
ADAP Client Report – Final Client‐Level Data Variables
Field # Variable Description Variable definition Allowed Values Enrollment and Certification: To describe client enrollment patterns and certification processes
Rationale
Newly enrolled clients in ADAP this reporting period refers to individuals who meet all of the following criteria: applied to ADAP for the first time ever; met the financial and medical eligibility criteria of the ADAP during the period for which you are reporting data Examples of clients who should NOT be included in this number are the following: Was the individual a 14. new or existing client?
Clients who have been recertified as eligible or clients who have been re‐enrolled after a period of having been decertified/disenrolled. Clients who have moved out of the State and then returned, and Clients who move on and off ADAP because of fluctuations in eligibility for a Medicaid/ Medically Needy program, based on whether they met spend‐ down requirements.
Newly enrolled client Existing Client (skip to Item #17)
HAB ADAP Performance Measures
An existing ADAP client is a client who met the following criteria: enrolled in ADAP in a previous reporting period and; continues to be enrolled in the current reporting period, regardless of whether they used ADAP services in either reporting period. Note: An individual enrolled in ADAP (new or existing client) may or may not use services. Use of services is not required to be an enrolled client.
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ATTACHMENT J
ADAP Client Report – Final Client‐Level Data Variables
Field # Variable Description Variable definition Allowed Values Enrollment and Certification: To describe client enrollment patterns and certification processes What was the date of receipt of the 15. completed client ADAP application? What was the date of approval of this 16. client’s ADAP application?
Rationale
The date that the completed application was received by the ADAP program.
MM/DD/YYYY
HAB ADAP Performance Measures
The date that the client was approved to begin to receive ADAP services. This is when the client was first enrolled in the ADAP program.
MM/DD/YYYY
HAB ADAP Performance Measures
The date on which a client was determined to be eligible to continue to receive ADAP services. Note: All individuals enrolled in ADAP, regardless of What was this client’s whether or not they receive services, must be recertified recertification date 17. every six months. This includes clients on a waiting list. during this reporting The minimum activities for recertification include: period? 1) Financial Eligibility determination. 2) Ensuring that ADAP is the Payer of Last Resort 3) Appropriate documentation (ie: financial/ insurance –or lack thereof/ denial of coverage) The status of an individual in the ADAP program as of the end of the reporting period. There are four possible options which are: The individual is enrolled in ADAP but did not What was the client’s need/request any services enrollment status as 18. The individual is enrolled in ADAP but is on a waiting of the end of the list reporting period? The individual is enrolled in ADAP and received either ADAP‐funded medications or insurance services during the reporting period The individual was disenrolled from ADAP
HAB ADAP Performance Measures
MM/DD/YYYY
Enrolled, receiving services (skip to Item #20) Enrolled, on waiting list (skip to Item #20) Enrolled, services not requested (skip to Item #20) Disenrolled
Description of clients served
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ATTACHMENT J
ADAP Client Report – Final Client‐Level Data Variables
Field # Variable Description Variable definition Allowed Values Enrollment and Certification: To describe client enrollment patterns and certification processes 19.
What was/were the reason(s) for disenrollment?
Please note the reasons for disenrollment/discharge. Select all that apply. If the reason is unknown, please report under “other”.
Rationale
Ineligible, change in ADAP program FPL requirements Ineligible for ADAP, now eligible for Medicaid Ineligible, other reason Did not recertify Did not fill prescription Deceased Dropped out, no reason given Other/Unknown
To determine service utilization
ADAP Insurance Services Received: To describe ADAP‐funded insurance assistance services and expenditures. ADAP‐funded insurance assistance includes premiums, co‐pays and deductibles. Co‐pays and deductibles for medications should be reported in this section. Did this client receive any ADAP‐funded insurance assistance This includes premiums, deductibles and co‐payments 20. during this reporting for which ADAP funds were used. period, including Medicare Part D premiums? Total amount of insurance Premium The total amount of insurance premium paid on behalf paid on behalf of this of the client. This pertains to any premium paid during 21. client during the the reporting period, regardless of the time frame that it reporting period [not covers (i.e. if it extends outside the reporting period) including Medicare Part D]. For how many months The total number of months of coverage for which of coverage was this insurance premium in Item #20 was paid. Please 22. insurance Premium report all months even if they fall outside of the during the reporting reporting period. period?
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To describe service utilization
No (skip to Item #25) Yes
$$$
To describe service utilization and to determine annualized costs by type of insurance assistance
##
To describe service utilization and to determine annualized costs by medication type
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ATTACHMENT J
ADAP Client Report – Final Client‐Level Data Variables
Field # Variable Description Variable definition Allowed Values Rationale ADAP Insurance Services Received: To describe ADAP‐funded insurance assistance services and expenditures. ADAP‐funded insurance assistance includes premiums, co‐pays and deductibles. Co‐pays and deductibles for medications should be reported in this section. To describe service Total amount of The total amount of insurance deductibles and co‐pays utilization and to deductible and co‐ paid on behalf of the client, not including Medicare determine annualized $$$ 23. pays paid on behalf of Part D. The amount reported should be based on the costs by medication this client during the date that the deductible or co‐pay was paid. type reporting period. Total amount of Medicare Part D Co‐ The total amount of Medicare Part D Co‐Insurance, To describe service Insurance, Co‐ Co‐Payment or donut hole coverage (true out of utilization and to Payment or donut pocket expenses) paid on behalf of the client during determine annualized $$$ 24. hole coverage (true this reporting period. The amount reported should be costs by medication out of pocket based on the date that the co‐insurance, co‐payment type expenses) paid on or donut hole coverage amount was paid. behalf of this client during the reporting period. Drugs and Drug Expenditures: To describe the ADAP‐funded medications dispensed to clients and total expenditures for those services. This section is only for clients who were dispensed ADAP‐funded medications paid in full by ADAP (i.e. not clients for whom only the co‐pay or deductible was paid). This includes ARVs, Hepatitis B and Hepatitis C medications. Were any ADAP‐ Whether or not ADAP‐funded medications were funded medications dispensed to this client during this reporting period? No (skip to end) To describe service 25. dispensed to this ADAP‐funded medications include any medication on utilization Yes client during this your ADAP formulary which was paid for in full by reporting period? ADAP funds. The specific list of ADAP funded medications that were To describe service Please list the ADAP‐ dispensed to the client during the reporting period. utilization and to funded medication Please use the five‐digit drug code (d#####) of the d##### 26. determine annualized dispensed to the client medication. costs by medication during this reporting Items #26‐29 will be reported for each ADAP‐funded type period. medication.
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ATTACHMENT J
ADAP Client Report – Final Client‐Level Data Variables
Field # Variable Description
Variable definition
Allowed Values
Rationale
Drugs and Drug Expenditures: To describe the ADAP‐funded medications dispensed to clients and total expenditures for those services. This section is only for clients who were dispensed ADAP‐funded medications paid in full by ADAP (i.e. not clients for whom only the co‐pay or deductible was paid). This includes ARVs, Hepatitis B and Hepatitis C medications. What is the start date To describe service of the ADAP‐funded utilization and to List the start date for each ADAP funded medication 27. medication dispensed MM/DD/YYYY determine annualized listed in Item #26. to the client during costs by medication this reporting period? type The number of days for which the medication was To describe service For how many days dispensed for each ADAP funded medication listed in utilization and to Item #26. Number of days should be reported in 30‐ was the ADAP‐funded ## determine annualized 28. day increments (i.e. 30, 60, 90).Anything less than 30 medication costs by medication dispensed? days should be reported as the actual number of days type supplied (i.e., 14) What was the Total To describe service The total cost of each ADAP‐funded medication cost of the ADAP‐ utilization and to dispensed during the reporting period. Include total funded medication 29. $$ determine annualized costs of each ADAP‐funded medication paid during the dispensed to the costs by medication reporting period, even if the medication prescription client during the type period extended beyond the reporting period. reporting period? To describe service Do you pay dispensing fees for medications separate utilization and to Dispensing fees No (skip to end) 30. from other fees such other administrative? determine annualized collected separately Yes costs by medication type. What is the total cost The total cost of all dispensing fees for medications To describe service of all Dispensing Fees paid on behalf of the client during the reporting utilization and to for medications paid period. Include all costs paid during the reporting $$ 31. determine annualized on behalf of this client period, even if the medication period extended costs by medication during the reporting beyond the reporting period. type. period?
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ATTACHMENT J
ADAP Client Report – Final Client‐Level Data Variables
Field # Variable Description Variable definition Allowed Values Rationale Clinical Information: To describe the clinical characteristics of ADAP clients who received ADAP‐funded medications. All clients receiving ADAP‐funded medications should have at least one CD4 and one VL in the last 12 months. 32.
33.
34.
35.
Report the date of the most recent CD4 count for this client in the last 12 months Report the value of the most recent CD4 count for this client in the last 12 months Report the date for the most recent Viral load count for this client in the last 12 months Report the value of the most recent Viral load count for this client in the last 12 months
Value indicating the date of the most recent CD4 count for this client within the last 12 months preceding the end of the reporting period. Value indicating the value of the most recent CD4 count for this client within the last 12 months preceding the end of the reporting period.
Value indicating the date of the most recent Viral load count for this client within the last 12 months preceding the end of the reporting period.
Value indicating the value of the most recent Viral load count for this client within the last 12 months preceding the end of the reporting period.
To determine the impact of ADAP‐funded medications
MM/DD/YYYY
To determine the impact of ADAP‐funded medications
Value: ###
To determine the impact of ADAP‐funded medications
MM/DD/YYYY
To determine the impact of ADAP‐funded medications
Value: ###
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