241.003 Subcontracting HIV Health and Support Services

Policy Number 241.003
Effective Date February 18, 2005
Revision Date August 10, 2007
Subject Matter Expert Program Improvement Group Manager
Approval Authority Acting Branch Manager
Signed by Janna Zumbrun

1.0 Purpose

To ensure the equitable and non-discriminatory selection of subcontractors, the Texas Department of State Health Services (DSHS), HIV/STD Comprehensive Services Branch (the State) requires administrative agencies to implement the processes set forth in this policy. An administrative agency may enter into agreements with providers unless restricted or otherwise prohibited by State contract language.

2.0 Background

The State selects and contracts with administrative agencies (AA) to administer and disburse funds on behalf of the State. Following the guidelines in this policy, AAs select and subcontract with local agencies and individuals to provide client services in accordance with the service priorities and categorical funding allocations established in the area HIV service delivery plan.

3.0 Authority

Ryan White CARE Act, 42 U.S.C. §300ff; Uniform Grant Management Standards, Chapter III, State Uniform Administrative Requirements for Grants and Cooperative Agreements; General Provisions for Texas Department of State Health Services Grant Contracts; Financial Administrative Procedures Manual for DSHS Contractors; V.T.C.A., Health and Safety Code, Chapter 85, Subchapter B; Texas Government Code, Chapter 441, Subchapter L.

4.0 Definitions as Applied to Policy

Administrative Agency – An organization that assists the State in carrying out administrative activities (e.g., planning, disbursing program funds, developing reimbursement and accounting systems, issuing Requests for Proposals [RFPs], monitoring contracts).

Services – Program activities offered by a provider on behalf of the State for HIV or STD prevention, health, medical, and social services.

5.0 Exceptions to Policy for Ryan White Title I Cities

The State recognizes that HIV contractor solicitation and selection methods used by Title I planning bodies and AAs may differ from the methods and principals in this policy. This is of particular concern for AAs responsible for both Title I and II funds. These organizations will be given an exception from the exact methodology contained in this policy, but must use methods consistent with the principles of the policy. When methods used by these AA differ from the approaches in this policy, the AA should document their contractor selection approach, and inform the State of how the processes related in this policy are accomplished in their area.

6.0 Role of the Administrative Agency

It is the role of the AA to distribute funds within their service area according to the declared priorities and allocations in the service delivery plan. Subcontracts must be written and signed, are subject to the requirements of the primary contract with the DSHS, and may be subject to approval by the State. The AA must obtain written approval from the State before entering into any subcontract for an administrative function. The AA is responsible for monitoring the performance of providers and must comply with the General Provisions for DSHS Grant Contracts and Financial Administrative Procedures Manual for DSHS Contractors.

Agencies that function in a dual role as an AA and as a direct service provider must have a formal, internal structure that separates AA responsibilities from those of service provider so that conflict of interest is eliminated. In addition, the AA must ensure that the direct service provider does not have a competitive advantage in the selection or monitoring process. For more information regarding the roles of the AA, refer to HIV/STD Policy No. 241.001.

7.0 Provider Solicitation

7.1 RFP development

The AA develops the RFP according to State requirements. The State may provide assistance or consultation in developing the RFP at the request of the AA.

7.2 Methods of notifying potential providers regarding the RFP

Written notice is required to be published in at least one widely distributed newspaper within the county or counties in which the majority of the clients who are served with the funds reside. The AA determines the content of each notice. The notice will include, but is not limited to, the following items:

  • A description of eligible applicants
  • A listing of categorical and eligible services included in the RFP
  • Required services
  • Deadline dates
  • Notice of applicant meeting dates
  • Contact point for the application/instructions
  • The source of funding

The AA may request a waiver of the newspaper publication requirement from the State and use an alternative means of notification. A request for a waiver must include documentation supporting the reason a waiver from newspaper publication is needed. The following circumstances are examples for justification to use an alternative means of notification:

  • The number of responding bidders has historically been very small
  • The size of the service area and the services available make newspaper publication impractical
  • An alternative method of notification has proven to be at least as effective.

When a waiver is granted, the AA must retain documentation of the alternative methods of notification. Two or more of the following methods of notification must be used when a waiver has been granted:

  • Public service announcements on radio and television
  • Mail-outs to service providers, organizations appearing on bidders list, local chamber of commerce list, and past applicants
  • Phone calls
  • Facsimile transmission of the announcement
  • Posters and/or fliers.

7.3 Contract solicitation methods

A competitive RFP is an open competition in which anyone that meets the qualifications for the RFP may submit a proposal. In most cases, multiple proposals requesting funding considerations for particular service categories will be submitted. The proposals are then evaluated by an external review committee selected by the AA. The external review committee will review and evaluate all proposals and submit them to the AA for review and final funding decision. The AA must make a public announcement of the final funding decisions by service category for each HSDA. The method of announcement is determined by the AA.

A sole source RFP is an unusual situation in which a noncompetitive proposal is solicited due to one of the following circumstances:

  • the requested services are only available from one source, or
  • an emergency need for the services will not permit the delay associated with competitive solicitation, or
  • having sought a number of sources, competition is determined to be inadequate.

A single source RFP is a noncompetitive RFP that is adequately justified with restricted qualifications. The item(s) or service(s) are so specifically and narrowly defined that item(s) or service(s) could only be procured from a single source.

Justification must be documented and approved in advance by the State for sole source and single source contracts.

7.4 Request for proposal content

The RFP contents must include the selection criteria tool that will be used to evaluate and score proposals. It must also contain the following information, depending on the type of the potential provider:

  • For eight-category budget providers, the following information must be included in the proposal to provide services:
    • background of the agency,
    • program objectives,
    • experience delivering the services to the targeted populations,
    • time-line and activity plan,
    • budget,
    • other funding awarded or pending for similar HIV projects,
    • letters indicating interagency collaboration,
    • community outreach to target audience,
    • project evaluation,
    • quality management system description
    • assurances of licensure or certification (if applicable),
    • assurances of audit and other internal controls for funds, and
    • all other assurances required of the primary contract with the State.
  • For fee-for-service providers (e.g. an individual doctor, dentist, therapist, nutritionist, or home health agency), service units are reimbursable at a predetermined rate per unit that includes all associated costs relevant to the delivery of that service. To encourage participation of fee-for-service providers, the AA must ask for a detailed resume to include valid state licensure (if applicable) and background experience. The RFP may allow fee-for-service providers to submit a proposal that does not contain information that may be expected of an eight-category budget provider (i.e., community outreach, project evaluation, agency background, etc.).

The RFP may also stipulate that potential bidders should provide information about any special considerations that apply to the category for which the proposal is submitted.

The AA must conduct meetings/workshops to provide assistance to potential applicants in the application process. Meetings/workshops should be announced and scheduled in advance of the proposal submission deadline. Announcements regarding the meeting/workshop and other pertinent information should be sufficiently broadcasted to ensure all potential applicants receive the notice in a timely manner. Samples and examples of all information requested in the RFP should be provided.

7.5 Other suggested RFP contents

The AA in some areas may find it difficult to attract service providers or may receive only one bid for a particular service each year. These agencies may find it more beneficial to fund services for a project period extending beyond a single year. In this situation, the administrative agency may consider wording the RFP to extend the project period for no more than an additional two years or a period equivalent to the project period defined in the corresponding State contract. For each year of the project period, subcontractors are required to submit an annual negotiable budget and project plan. With such a proposal, the administrative agency will need to make the contract continuation dependent on such things as renewed funding, satisfactory contractor performance during the previous period, and submission of a second year renegotiable budget.

The State reserves the right to apply limits to local multi-year project periods. In general, limitations will be addressed in the RFP or renewal application published by the State.

8.0 External Review Committee

8.1 Purpose

The AA is responsible for ensuring the external review process meets the standards set forth in this section. All actions related to external review committee processes must be documented.

The purpose of the external review committee is to fairly and equitably evaluate proposals submitted as a result of the RFP using a selection criteria tool developed by the AA. This selection criteria tool must be included in the RFP. When two or more agencies are to be funded to deliver the same service, the AA decides funding amounts based on an objective and equitable process.

When the AA is also competing for funding, the external review process (which includes reviewer criteria, reviewer profiles, reviewer guidance, confidentiality statements, and conflict of interest statements) must be approved by the State.

8.2 Membership

The AA selects the members of the external review committee. The AA must set up the external review committee to provide a balance of service expertise and consumer concerns. A balanced membership can be achieved by using the following guidelines:

  • The maximum membership should be set prior to soliciting members, but must have no fewer than three members.
  • The committee must include at least one person living with HIV/AIDS.
  • The committee must include an experienced health care professional when reviewing ambulatory care or case management services.
  • The committee must include persons who have expertise in the services to be delivered under the RFP

In addition to these requirements, the AA should consider including business professionals, representatives of faith based organizations, and members who are affected by HIV; however, seating affected members do not relieve the AA of the obligation to seat at least one HIV-infected person on the committee. The AA should strive for a diverse membership in terms of race/ethnicity, sex and age. When more than one person living with HIV/AIDS is included, the AA should strive for a diverse representation of consumer perspective.

If the AA is unable to create a committee that meets the requirements, it must document how it attempted to meet these requirements and submit this documentation to the State for review prior to convening the external review committee.

8.3 Process

The AA develops the selection criteria tool used to evaluate proposals submitted in response to the RFP. The tool is included in the RFP and must not discriminate against any class of provider. Criteria should address, but are not limited to the following topics:

  • Fiscal management (e.g., qualified financial management staff, accounting system which allows for funds tracking by source, board adopted financial management procedures, incorporation as legal business entity).
  • Administrative management (e.g., well defined, measurable goals and objectives, client grievance policies, clear and easily understood evaluation methods, quality management systems, relevance to service priorities).
  • Service capabilities (e.g.; access to target population; service delivery experience in HIV/AIDS or in providing services to similar populations; qualified staff; adequate facilities to deliver the services covered under the funding; history of cooperation and collaboration with other service providers; ability to meet national, state, and/or community level standards of care, service, and quality).
  • Other areas deemed appropriate to ensure that selected providers will deliver quality services to those in need.

8.4 Conflict of Interest

Members of the external review committee who serve as a director, trustee, salaried employee, volunteer, or who otherwise materially benefit from association with any agency currently receiving funds, or may seek funds being considered by the administrative agency, are considered to have a conflict of interest. This conflict of interest must be declared and such individuals may not serve on the external review committee.

A committee member who is aware of an undeclared conflict of interest on the part of another member must report the conflict to the committee as a whole. The committee must disqualify the member with the conflict and dismiss the member for failure to declare the conflict of interest.

Note: Conflict of interest does not refer to a PLWH whose sole relationship to a Title II funded provider is as a client receiving services. To lessen concerns about bias in the process, the AA may partner with another AA to locate a client out of area for the review committee, or engage a client within their area who is not receiving the services presently being reviewed.

9.0 Subcontractor Information

The AA must submit the following to the State as required by the State’s RFP or renewal application:

  • the Administrative Agency Contractor Data Sheet,
  • the Subcontractor Data Sheet,
  • detailed budget information, and
  • other documentation as requested by the State for all providers.

10.0 Documentation

The AA must maintain all documentation supporting the selection process described in this policy as specified in the General Provisions for DSHS Contracts. The documentation must be kept on file and available for inspection by state or federal officials upon request.

The required supporting documentation includes the following information.

  • Copies of the service priorities allocations set in the plan
  • Announcements published in area newspapers or other media
  • Copies of RFPs and requests for renewal applications, formats for competitive proposals and documentation for sole source and single source proposals and awards
  • Documentation of the criteria selection tool used to review and score proposals
  • Copies of scoring sheets, minutes of meetings in which determination of funding recommendations were discussed, and resulting scores
  • Lists of the external review committee membership, including a brief description of each member and their expertise/experience that justified their participation
  • All waivers that have been requested

11.0 Grievances

Grievances concerning service category funding allocation decisions must be submitted to the AA in a manner consistent with the AA’s grievance process. Grievances concerning funding award decisions must be submitted in writing to the AA in a manner consistent with the administrative agency’s grievance process.

12.0 Revision History

Date Action Section
10/1/2014 Converted format (Word to HTML) -
8/10/2007 Added note under conflict of interest 8.4