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					   HARRIS COUNTY
                                                                         JOB NO. 02/0378
REQUEST FOR PROPOSAL                                           Date Due: November 26, 2002
      Cover Sheet                                               DUE NO LATER THAN 1:00 P.M.

                                                               Proposals received later than the date
                                                               and time above will not be considered.


 PROPOSAL TO: Provide Ryan White Title I Services for Harris County

                                         OFFERORS NOTE!!
Carefully read all instructions, requirements and         Please return proposal in the envelope provided or in a
specifications.  Fill out all forms properly and          comparable size envelope. “ENVELOPE MUST
completely. Submit your proposal with all appropriate     SHOW THE JOB NUMBER, DESCRIPTION AND
supplements and/or samples.                               BE MARKED ―SEALED PROPOSAL.‖

                                        RETURN PROPOSAL TO:
                                HARRIS COUNTY PURCHASING AGENT
                                  1001 PRESTON AVENUE, SUITE 670
                                        HOUSTON, TEXAS 77002

   For additional information, contact Mary Lou Sotolongo at (713) 755-6832.

   You must sign below in INK; failure to sign WILL disqualify the offer. All prices must be typewritten or
   written in ink.
                       Service Category Code __________________________

                         Total Amount of Proposal $____________________________

   Company Name:          ________________________________________________________________

   Company Address:       ________________________________________________________________

   City, State, Zip Code: ________________________________________________________________

   Taxpayer Identification Number (T.I.N.): _________________________________________________

   Telephone No. __________________FAX No. _____________________e-mail__________________

   Print Name: ________________________________________________________________________

   Signature: __________________________________________________________________________

                                                                                    Date:______________________


   Revised 05/01




                                                                                                       Page 1
                                                   TABLE OF CONTENTS

Items checked below represent components which comprise this bid/proposal package. If the item IS NOT checked, it is NOT
APPLICABLE to this bid/proposal. Offerors are asked to review the package to be sure that all applicable parts are included. If any
portion of the package is missing, notify the Purchasing Department immediately.

It is the Offeror's responsibility to be thoroughly familiar with all Requirements and Specifications. Be sure you understand the
following before you return your bid packet.

__X__ 1.          Cover Sheet
                  Your company name, address, the total amount of the bid/proposal, and your signature (IN INK) should appear on
                  this page.

__X__ 2.          Table of Contents
                  This page is the Table of Contents.

__X__ 3.          General Requirements
                  You should be familiar with all of the General Requirements.

__X__ 4.          Special Requirements/Instructions
                  This section provides information you must know in order to make an offer properly.

__X__ 5.          Specifications
                  This section contains the detailed description of the product/service sought by the County.

__X__ 6.          Pricing/Delivery Information
                  This form is used to solicit exact pricing of goods/services and delivery costs.

__X__ 7.          Attachments

                  __X__ a.           Residence Certification
                                     Be sure to complete this form and return with packet.

                  _____    b.        Bid Guaranty & Performance Bond Information & Requirements
                                     This form applies only to certain bids/proposals. Please read carefully and fill out completely.

                  _____    c.        Bid Check Return Authorization Form
                                     This form applies only to certain forms. Please read carefully and fill out completely.

                  _____    d.        Vehicle Delivery Instructions
                                     Included only when purchasing vehicles.

                  _____    e.        Minimum Insurance Requirements
                                     Included when applicable (does not supersede "Hold Harmless" section of General
                                     Requirements).

                  _____    f.        Workers' Compensation Insurance Coverage Rule 110.110
                                     This requirement is applicable for a building or construction contract.

                  _____    g.        Financial Statement
                                     When this information is required, you must use this form.

                  _____    h.        Reference Sheet

                  _____    i.        Other
                                     From time to time other attachments may be included.
Revised 09/00




                                                                                                                               Page 2
                                                 GENERAL REQUIREMENTS
                                                     FOR PROPOSALS

READ THIS ENTIRE DOCUMENT CAREFULLY. FOLLOW ALL INSTRUCTIONS. YOU ARE RESPONSIBLE FOR
FULFILLING ALL REQUIREMENTS AND SPECIFICATIONS. BE SURE YOU UNDERSTAND THEM.

General Requirements apply to all advertised requests for proposals; however, these may be superseded, whole or in part, by the
SPECIAL REQUIREMENTS/INSTRUCTIONS OTHER DATA CONTAINED HEREIN. Review the Table of Contents. Be sure
your proposal package is complete.

GOVERNING LAW
This request for proposals is governed by the competitive bidding requirements of the County Purchasing Act, Texas Local Government Code,
§262.021 et seq., as amended. Offerors shall comply with all applicable federal, state and local laws and regulations. Offeror is further advised that
these requirements shall be fully governed by the laws of the State of Texas and that Harris County may request and rely on advice, decisions and
opinions of the Attorney General of Texas and the County Attorney concerning any portion of these requirements.

POTENTIAL CONFLICTS OF INTEREST
An outside consultant or contractor is prohibited from submitting a bid or proposal for services on a Harris County project of which the
consultant or contractor was a designer or other previous contributor, or was an affiliate, subsidiary, joint venturer or was in any other manner
associated by ownership to any party that was a designer or other previous contributor. If such a consultant or contractor submits a prohibited
bid or proposal, that bid or proposal shall be disqualified on the basis of conflict of interest, no matter when the conflict is discovered by Harris
County.

PROPOSAL COMPLETION
Fill out and return to Purchasing, ONE (1) complete proposal form, using the envelope provided or in a comparable size envelope.
ENVELOPE MUST SHOW THE JOB NUMBER, DESCRIPTION AND BE MARKED ―SEALED PROPOSAL.‖                                         authorized
company representative should sign the Cover Sheet. Completion of these forms is intended to verify that the offeror has submitted
the proposal, is familiar with its contents and has submitted the material in accordance with all requirements.

PROPOSAL RETURNS
Offerors must return all completed proposals to the office of the Harris County Purchasing Agent reception desk at 1001 Preston
Avenue, Suite 670, Houston, Texas before 1:00 P.M. on the date specified. Late proposals will not be accepted.

GOVERNING FORMS
In the event of any conflict between the terms and provisions of these requirements and the specifications, the specifications shall
govern. In the event of any conflict of interpretation of any part of this overall document, Harris County's interpretation shall govern.

ADDENDA
When specifications are revised, the Harris County Purchasing Agent will issue an addendum addressing the nature of the change.
Offerors must sign it and include it in the returned proposal package.

HOLD HARMLESS AGREEMENT
Contractor, the successful offeror, shall indemnify and hold Harris County harmless from all claims for personal injury, death and/or
property damage resulting directly or indirectly from contractor's performance. Contractor shall procure and maintain, with respect to
the subject matter of this proposal, appropriate insurance coverage including, as a minimum, public liability and property damage with
adequate limits to cover contractor's liability as may arise directly or indirectly from work performed under terms of this proposal.
Certification of such coverage must be provided to the County upon request.

WAIVER OF SUBROGATION
Offeror and offeror's insurance carrier waive any and all rights whatsoever with regard to subrogation against Harris County as an
indirect party to any suit arising out of personal or property damages resulting from offeror's performance under this agreement.

SEVERABILITY
If any section, subsection, paragraph, sentence, clause, phrase or word of these requirements or the specifications shall be held invalid,
such holding shall not affect the remaining portions of these requirements and the specifications and it is hereby declared that such
remaining portions would have been included in these requirements and the specifications as though the invalid portion had been
omitted.




                                                                                                                                         Page 3
BONDS
If this proposal requires submission of proposal guarantee and performance bond, there will be a separate page explaining those
requirements. Offers submitted without the required proposal bond or Cashier's Check are not acceptable.

TAXES
Harris County is exempt from all federal excise, state and local taxes unless otherwise stated in this document. Harris County claims
exemption from all sales and/or use taxes under Texas Tax Code §151.309, as amended. Texas Limited Sales Tax Exemption
Certificates will be furnished upon written request to the Harris County Purchasing Agent.

FISCAL FUNDING
A multi-year lease or lease/purchase arrangement (if requested by the specifications), or any contract continuing as a result of an
extension option, must include fiscal funding out. If, for any reason, funds are not appropriated to continue the lease or contract, said
lease or contract shall become null and void on the last day of the current appropriation of funds. After expiration of the lease, leased
equipment shall be removed by the contractor from the using department without penalty of any kind or form to Harris County. All
charges and physical activity related to delivery, installation, removal and redelivery shall be the responsibility of the offeror.

PRICING
Prices for all goods and/or services shall be negotiated to a firm amount for the duration of this contract or as agreed to in terms of
time frame. All prices must be written in ink or typewritten. Where unit pricing and extended pricing differ, unit pricing prevails.

SILENCE OF SPECIFICATIONS
The apparent silence of specifications as to any detail, or the apparent omission from it of a detailed description concerning any point,
shall be regarded as meaning that only the best commercial practice is to prevail and that only material and workmanship of the finest
quality are to be used. All interpretations of specifications shall be made on the basis of this statement. The items furnished under this
contract shall be new, unused of the latest product in production to commercial trade and shall be of the highest quality as to materials
used and workmanship. Manufacturer furnishing these items shall be experienced in design and construction of such items and shall
be an established supplier of the item proposed.

SUPPLEMENTAL MATERIALS
Offerors are responsible for including all pertinent product data in the returned proposal package. Literature, brochures, data sheets,
specification information, completed forms requested as part of the proposal package and any other facts which may affect the
evaluation and subsequent contract award should be included. Materials such as legal documents and contractual agreements, which
the offeror wishes to include as a condition of the proposal, must also be in the returned proposal package. Failure to include all
necessary and proper supplemental materials may be cause to reject the entire proposal.

MATERIAL SAFETY DATA SHEETS
Under the "Hazardous Communication Act", commonly known as the "Texas Right To Know Act", an offeror must provide to the
County with each delivery, material safety data sheets which are applicable to hazardous substances defined in the Act. Failure of the
offeror to furnish this documentation will be cause to reject any bid applying thereto.

EVALUATION
Evaluation shall be used as a determinant as to which proposed items or services are the most efficient and/or most economical for the
County. It shall be based on all factors which have a bearing on price and performance of the items in the user environment. All
proposals are subject to negotiations by the Purchasing Agent and other appropriate departments, with recommendation to
Commissioners Court. Compliance with all requirements, delivery and needs of the using department are considerations in evaluating
proposals. Pricing is NOT the only criteria for making a recommendation. A preliminary evaluation by Harris County will be
held and appropriate proposals will be subjected to the negotiating process. Upon completion of the negotiations, Harris County will
make an award. All proposals that have been submitted shall be available and open for public inspection after the contract is awarded
except for trade secrets or confidential information contained in the proposals and identified as such.

INSPECTIONS
Harris County reserves the right to inspect any item(s) or service location for compliance with specifications and requirements and
needs of the using department. If an offeror cannot furnish a sample of a proposed item, where applicable, for review, or fails to
satisfactorily show an ability to perform, the County can reject the offer as inadequate.




                                                                                                                              Page 4
TESTING
Harris County reserves the right to test equipment, supplies, material and goods proposed for quality, compliance with specifications
and ability to meet the needs of the user. Demonstration units must be available for review. Should the goods or services fail to meet
requirements and/or be unavailable for evaluation, the offer is subject to rejection.

DISQUALIFICATION OF OFFEROR
Upon signing this proposal document, an offeror offering to sell supplies, materials, services, or equipment to Harris County certifies
that the offeror has not violated the antitrust laws of this state codified in §15.01, et seq., Business & Commerce Code, or the federal
antitrust laws, and has not communicated directly or indirectly the offer made to any competitor or any other person engaged in such
line of business. Any or all proposals may be rejected if the County believes that collusion exists among the offerors. Proposals in
which the prices are obviously unbalanced may be rejected. If multiple proposals are submitted by an offeror and after the proposals
are opened, one of the proposals is withdrawn, the result will be that all of the proposals submitted by that offeror will be withdrawn;
however, nothing herein prohibits a vendor from submitting multiple offers for different products or services.

AWARD
Harris County reserves the right to award this contract on the basis of LOWEST AND BEST OFFER in accordance with the laws of
the State of Texas, to waive any formality or irregularity, to make awards to more than one offeror, to reject any or all proposals. In
the event the lowest dollar offeror meeting specifications is not awarded a contract, the offeror may appear before the Commissioners
Court and present evidence concerning his responsibility after officially notifying the Office of the Purchasing Agent of his intent to
appear.

ASSIGNMENT
The successful offeror may not assign, sell or otherwise transfer this contract without written permission of Harris County
Commissioners Court.

TERM CONTRACTS
If the contract is intended to cover a specific time period, the term will be given in the specifications under SCOPE.

MAINTENANCE
Maintenance required for equipment proposed should be available in Harris County by a manufacturer-authorized maintenance
facility. Costs for this service shall be shown on the Pricing/Delivery Information. If Harris County opts to include maintenance, it
shall be so stated in the purchase order and said cost will be included. Service will commence only upon expiration of applicable
warranties and should be priced accordingly.

CONTRACT OBLIGATION
Harris County Commissioners Court must award the contract and the County Judge or other person authorized by the Harris County
Commissioners Court must sign the contract before it becomes binding on Harris County or the offeror. Department heads are NOT
authorized to sign agreements for Harris County. Binding agreements shall remain in effect until all products and/or services covered
by this purchase have been satisfactorily delivered and accepted.

TITLE TRANSFER
Title and Risk of Loss of goods shall not pass to Harris County until Harris County actually receives and takes possession of the goods
at the point or points of delivery. Receiving times may vary with the using department. Generally, deliveries may be made between
8:30 a.m. and 4:00 p.m., Monday through Friday. Offerors are advised to consult the using department for instructions. The place of
delivery shall be shown under the "Special Requirements/Instructions" section of this proposal and/or on the Purchase Order as a
"Deliver To:" address.

WARRANTIES
Offerors shall furnish all data pertinent to warranties or guarantees which may apply to items in the proposal. Offerors may not limit
or exclude any implied warranties. Offeror warrants that product sold to the County shall conform to the standards established by the
U.S. Department of Labor under the Occupational Safety and Health Act of 1970. In the event product does not conform to OSHA
Standards, where applicable, Harris County may return the product for correction or replacement at the offeror's expense. If offeror
fails to make the appropriate correction within a reasonable time, Harris County may correct at the offeror's expense.




                                                                                                                            Page 5
PURCHASE ORDER AND DELIVERY
The successful offeror shall not deliver products or provide services without a Harris County Purchase Order, signed by an authorized
agent of the Harris County Purchasing Agent. The fastest, most reasonable delivery time shall be indicated by the offeror in the proper
place on the proposal document. Any special information concerning delivery should also be included, on a separate sheet, if
necessary. All items shall be shipped F.O.B. INSIDE DELIVERY unless otherwise stated in the specifications. This shall be
understood to include bringing merchandise to the appropriate room or place designated by the using department. Every tender or
delivery of goods must fully comply with all provisions of these requirements and the specifications including time, delivery and
quality. Nonconformance shall constitute a breach which must be rectified prior to expiration of the time for performance. Failure to
rectify within the performance period will be considered cause to reject future deliveries and cancellation of the contract by Harris
County without prejudice to other remedies provided by law. Where delivery times are critical, Harris County reserves the right
to award accordingly.

CONTRACT RENEWALS
Renewals may be made ONLY by written agreement between Harris County and the offeror. Any price escalations are limited to
those stated by the offeror in the original proposal.

INVOICES AND PAYMENTS
Offerors shall submit an original invoice on each purchase order or purchase release after each delivery, indicating the purchase order number.
Invoices must be itemized. Any invoice which cannot be verified by the contract price and/or is otherwise incorrect, will be returned to the
offeror for correction. Under term contracts, when multiple deliveries and/or services are required, the offeror may invoice following each
delivery and the County will pay on invoice. Contracts providing for a monthly charge will be billed and paid on a monthly basis only. Prior to
any and all payments made for good and/or services provided under this contract, the offeror should provide his Taxpayer Identification Number
or social security number as applicable. This information must be on file with the Harris County Auditor‟s office. Failure to provide this
information may result in a delay in payment and/or back-up withholding as required by the Internal Revenue Service.

TERMINATION
Harris County reserves the right to terminate the contract for default if Seller breaches any of the terms therein, including warranties of
offeror or if the offeror becomes insolvent or commits acts of bankruptcy. Such right of termination is in addition to and not in lieu of
any other remedies which Harris County may have in law or equity. Default may be construed as, but not limited to, failure to deliver
the proper goods and/or services within the proper amount of time, and/or to properly perform any and all services required to Harris
County's satisfaction and/or to meet all other obligations and requirements. Harris County may terminate the contract without cause
upon thirty (30) days written notice.

RECYCLED MATERIALS
Harris County encourages the use of products made of recycled materials and shall give preference in purchasing to products made of
recycled materials if the products meet applicable specifications as to quantity and quality. Harris County will be the sole judge in
determining product preference application.

SCANNED OR RE-TYPED RESPONSE
If in its response, offeror either electronically scans, re-types, or in some way reproduces the County's published proposal package,
then in the event of any conflict between the terms and provisions of the County's published proposal package, or any portion thereof,
and the terms and provisions of the response made by offeror, the County's proposal package as published shall control. Furthermore,
if an alteration of any kind to the County's published proposal package is only discovered after the contract is executed and is or is not
being performed, the contract is subject to immediate cancellation.

FLOPPY DISK
If offeror obtained the specifications on a floppy disk in order to prepare a response, the proposal must be submitted in hard copy
according to the instructions contained in this Request-for-Proposals package. If, in its response, offeror makes any changes
whatsoever to the County's published specifications, the County's specifications as published shall control. Furthermore, if an
alteration of any kind to the County's published specifications is only discovered after the contract is executed and is or is not being
performed, the contract is subject to immediate cancellation.

E-MAIL ADDRESSES CONSENT
Vendor affirmatively consents to the disclosure of its e-mail addresses that are provided to Harris County, the Harris County Flood
Control District, the Harris County Hospital District including its HMO, the Harris County Appraisal District, or any agency of
Harris County. This consent is intended to comply with the requirements of the Texas Public Information Act, Tex. Gov‟t Code
Ann. §522.137, as amended, and shall survive termination of this agreement. This consent shall apply to e-mail addresses
provided by Vendor, its employees, officers, and agents acting on Vendor‟s behalf and shall apply to any e-mail address provided
in any form for any reason whether related to this bid/proposal or otherwise.
Revised 03/20/02



                                                                                                                                  Page 6
                                  RESIDENCE CERTIFICATION

Pursuant to Texas Government Code §2252.001 et seq., as amended, Harris County requests Residence Certification.
§2252.001 et seq. of the Government Code provides some restrictions on the awarding of governmental contracts;
pertinent provisions of §2252.001 are stated below:

          (3)    "Nonresident bidder" refers to a person who is not a resident.

          (4)    "Resident bidder" refers to a person whose principal place of business is in this state, including
                 a contractor whose ultimate parent company or majority owner has its principal place of
                 business in this state.


         I certify that ______________________________________ is a Resident Bidder of Texas as
                                 [Company Name]
          defined in Government Code §2252.001.



          I certify that ______________________________________ is a Nonresident Bidder as defined in
                           [Company Name]
          Government Code §2252.001 and our principal place of business is _______________________.
                                                                                  [City and State]




Revised 7/97




                                                                                                                      7
                                            ATTENTION VENDORS



This document is an alternative competitive proposal as specified in LGC 262.030.

All documents will be held by the County and are NOT subject to public review until the negotiating process is
completed and an award made. A preliminary evaluation by Harris County will be held. Appropriate proposals will
be subjected to review and may go through negotiating process.

After award by Commissioners Court, proposals will be made public.




                                                                                                             8
                                 SPECIAL REQUIREMENTS/INSTRUCTIONS

Term Contracts To Provide Ryan White Title I Services for Harris County

Where these specific requirements differ from the preceding General Requirements, these specific requirements will
control. If you need additional information, contact Mary Lou Sotolongo at (713) 755-6832. For technical assistance
contact Charles Henley at (713) 439-6034. Specifications are in accordance with the requirements of the Ryan White
C.A.R.E. Act.

The following statement is made in accordance with the FY 1995 Appropriations Act (P.L.103-333). All funds being
offered in this Request for Proposal (RFP) are 100% Ryan White C.A.R.E. Act funds with no contribution of any non-
Federal funds required of the vendor, although subsequent to any award made to the vendor resulting from this RFP
the vendor will be required to document, in a manner acceptable to the County, the total cost of the project, the
amount and percentage financed by federal money and the amount and percentage financed by non-governmental
sources.

PRE-PROPOSAL CONFERENCE
A Pre-Proposal Conference will be held November 6, 2002 from 2:00 to 4:00 pm in the Harris County Public Health
and Environmental Services Building, 4th floor, Room 416, located at 2223 W. Loop South, Houston, TX 77027.
Attendance is not mandatory, however it is highly recommended that vendors attend in order to discuss and clarify the
Request for Proposal (RFP) requirements and answer vendor questions regarding the proposal review and award
process. Persons with disabilities requiring special accommodations please contact Gail LeBlanc at (713) 439-6039
for arrangements.

Special Requirements

I.     SUBMISSION INSTRUCTIONS
Separate proposal responses must be returned for each service category. The service category code number
should be filled in on the request for proposal cover sheet.

Proposals must be formatted as follows:
    Applications must be in English;
    Submit all copies of proposal unbound, (with each individual proposal held together by a metal clip or
       sufficiently strong rubber band);
    Use standard size black type that is not smaller than 10 characters per inch nor larger than 12 characters per
       inch (colored print is not allowable);
    Use 8.5 inch x 11 inch paper that can be photocopied;
    Top, bottom, left and right margins may not be less than 1 inch each;
    Text may be single or 1.5 spaced;
    Do not submit double-sided copies;
    Do not use photo-reduction;
    Do not include photos, pamphlets, brochures, or over-sized documents;

A complete description of all the services the vendor will provide together with all the forms completed and in the
proper order, adequate documentation that the vendor meets the agency qualifications and requirements, cost for unit
of service, etc. will comprise the vendor‟s proposal. All signature pages in the document must also be signed. It is the


                                                                                                                      9
                         SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

vendor‟s responsibility to adequately identify and define their qualifications and capabilities with regard to meeting
the requirements in this RFP including those which are specific to the Service Category under which the response is
submitted. Your proposal must offer substantial assurance that all goals and requirements will be reached and
maintained by your organization. All vendors must respond to items listed below and are encouraged to supply all
other relevant information as Appendices. Narrative answers/statements must be self explanatory and understandable
to members of the independent review panel who may read, evaluate and score your proposal. Assume that these
individuals are unfamiliar with your agency and its programs, and that they have little information about your target
population.

The complement of forms included with this RFP must be completed and submitted in the proper order. All vendors
should address each of the forms by filling out each one with the appropriate, detailed information required by the
form. Omission of any or all forms may be cause to reject your proposal in its entirety. If, for some reason, the
form does not apply to your response, you must note that decision on your copy of the form and include it in your
submitted proposal.

                                                **New for FY 2003**
The vendor is responsible for making additional copies required in order to fulfill the RFP requirements and/or to
respond to additional categories. Original and copies must be secured individually with a single binder clip for each.
SUBMIT TWO (2) SIGNED ORIGINALS AND EIGHT (8) COPIES. All signatures for all forms throughout
this package must be original on the two (2) copies marked, "ORIGINAL". Copies of the original may contain
copies of signatures. If you need to use an envelope other than the one supplied or a small box to submit your sealed
proposal, please include the job number, due date and your company name on the outside of the envelope or box.

Completed proposals must be clocked in at the Harris County Purchasing Department; 1001 Preston Ave., Suite 670;
Houston, Texas 77002 on the date and time specified on the cover sheet. On that date, proposals will be opened.
Under the Request For Proposal process, sealed offers will be received and opened in the Purchasing Department
and considered confidential until an award is made. Neither information nor copies of proposals will be available to
anyone other than Harris County and the External Review Committee until a formal award is made by
Commissioners‟ Court. All proposals shall be available for public inspection under the Open Records Act after all
contracts are awarded. Please call the Purchasing Department to make an Open Records Act request.

II.    EVALUATION CRITERIA AND AWARD PROCESS
       The following guidelines will be used in the Evaluation/Award process.

A.     Submit your best proposal initially. A technical review will be conducted by Harris County to ensure all
       proposals contain the required documentation and are in conformance with the requirements set forth herein.
       In the event 1) the number of proposals submitted is equal to or less than the minimum number of providers to
       be funded as specified in any single service category, and/or 2) the total amount of funding requested by
       vendors is equal to or less than the total amount of funding available in any single service category the County
       reserves the option to waive the External Review step (see B. below), and recommend an award of a contract
       to that vendor provided their proposal is determined by the County to meet all other requirements and
       minimum specifications for that service category.




                                                                                                                    10
                           SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

B.     An independent External Review Committee will score acceptable proposals which conform with all required
       documentation and requirements using a point system based on the following evaluation criteria: 100 Total
       Points (see point distribution below). Submission of a proposal implies vendor‟s acceptance of the evaluation
       criteria and vendor recognition that subjective judgments must be made by reviewers.

C.     Award of contracts shall be made to responsible vendor, whose proposal is determined to be the highest
       scored proposal meeting all other requirements and best meeting the county‟s needs for that service category.
       In the event qualified for-profit and non-profit entities submit proposals in the same service category only the
       non-profit vendor(s) will be eligible for award. All awards will be made in accordance with Department of
       Health & Human Services, Health Resources and Services Administration (HRSA) guidelines and the Ryan
       White Comprehensive AIDS Resources Emergency (CARE) Act of 1990, as amended. Prospective
       vendors are encouraged to read the attached letter from HRSA dated March 6, 1997, regarding Requests for
       Proposals (See Attachment A in this RFP packet). All corporate vendors must provide a copy of their
       Articles of Incorporation. Additionally, all non-profit vendors must provide written proof of their non-
       profit status.

       Any vendors who propose subcontracting any portion of the services to be provided must include a copy of
       their proposed subcontractor‟s Articles of Incorporation, if any, and, where applicable, proof of the
       subcontractor‟s non-profit status. If the documentation is not included in the proposal, County will assume
       the proposed subcontractor is a for-profit entity and award contracts accordingly.

       The vendor‟s legal name must appear on all required licenses or certifications (i.e., the name of proposer as
       stated on the proposal must be the same as the name stated on any required licenses and/or certifications).
       Any vendor who proposes subcontracting any portion of the HIV-related services to be provided must
       include a copy of the executed contract between the vendor and their (proposed) subcontractor in the
       Appendices. In the case where the vendor is subcontracting any portion of services where a license and/or
       certification is required, the legal name of the subcontractor and the name on the subcontractor‟s
       license/certification must be identical. In service categories where Medicaid/Medicare certification is
       required, the County will only contract with entities that meet these criteria. Vendors may not use
       subcontractors to meet these criteria.

D.     No award or acquisition can be made until Commissioners Court approves such action. No County funds will
       be expended for contracts resulting from this RFP. All contracts resulting from this RFP will be funded
       contingent upon funds allocated and received by the County from HRSA under a federal grant awarded to the
       County.

The Evaluation Criteria follows:
All proposals MUST be submitted in the order listed below.

       A.     Request For Proposal Cover Sheet (Enclosed in RFP)

       B.     Residence Certification (Enclosed in RFP)




                                                                                                                    11
         SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)


C.     Signed Assurances Form I (Enclosed in RFP Forms Section)

D.     Signed Certification Concerning Lobbying (Enclosed in RFP Forms Section)

E.     Signed Compliance with Americans With Disabilities Act of 1990 (Enclosed in RFP
       Forms Section)
F.     Assurance - Non-Construction Programs (s-424B) (Enclosed in RFP Forms Section)

G.     Respondent Certification (Enclosed in RFP Forms Section)

H.     Licenses, Permits, & Certifications (Provided by Vendor/Proposer) (see item C.
       under Section II, Evaluation Criteria and Award Process)

I.     Renewal Option (Enclosed in RFP)

J.     Cover Page (Enclosed in RFP Forms Section)

K.     Table of Contents for Proposal (Provided by Vendor) Number all pages and list
       according to this Table of Contents. Page one (1) of the proposal should be the Cover
       Page (item J. Above), with all pages numbered sequentially forward.

NOTE: Sections L through O contain instructions for writing the narrative portion of the proposal and the
accompanying tables and appendices. The completed proposal must follow this outline with the required
information provided in the order shown. Please repeat each question and answer each question
separately and in order.

L.     ABSTRACT – 5 Points
       (Maximum of 2 pages)

       1. Please provide the following information:
          a. Legal Name of Organization
          b. Mailing Address
          c. Street Address (if different from mailing address)
          d. Telephone number and contact person
          e. Service Category
          f. Code Number
          g. Title of Service

       2. What is your agency‟s mission statement? How does providing the proposed Title I service fit
       with your mission statement?

       3. Briefly summarize your proposed project's scope of work, listing project goals, objectives,
       activities, target audience and geographic area to be served.


                                                                                                      12
                     SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)


M.      FINANCIAL CAPACITY AND BUDGET – 25 Points
        (Maximum of 3 pages, not including tables)

        1. What experience does your agency have in grants and contracts management?

        2. What is your agency‟s experience in submitting financial and contract expenditure reports to
        funding sources? Describe the financial management staff, including any financial management
        conducted by volunteers and outside accountants.

        3. If your organization is a nonprofit agency, describe the role your Board of Directors takes in the
        following activities:
         Approving annual agency budgets
         Approving grant application budgets
         Examining agency financial statements
         Monitoring agency expenditures compared to the budget
         Approving budget amendments and variances
         Determining appropriate salary levels for the Executive Director
         Raising funds for the agency

        4. Complete the following tables as applicable. If the proposal is for a service category that
        requires a fee-for-service budget complete and include three (3) budget forms for that category. If
        no subcontractors will be used to provide HIV-related services under this proposal, mark form 1.D
        “N/A” (not applicable) and include it in the order shown below. For a fee-for-service budget
        complete tables I.A., I.B., and I.D. For a hybrid fee-for-service budget complete tables I.A., I.C.,
        and I.D.

        a.   I.A.   Budget Narrative
        b.   I.B.   Fee-for-Service Budget Form or
        c.   I.C.   Hybrid Fee-for-Service Budget Form
        d.   I.D.   Subcontractor Budget Form

The following documentation must be included in the appendices:

    Job description for each type of personnel position listed in the budget narrative, with a limit of one (1)
     page per job description
    Proof of Non-Profit Status and Articles of Incorporation. Include only with the two (2) originals. Do
     not include in the eight (8) copies.
    Copy of applicant's most recent fiscal year audit and/or certified financial statement. Include only with
     the two (2) originals. Do not include in the eight (8) copies.
    Copy of all signed and dated contracts with subcontractors to be used by applicant agency in the
     provision of Ryan White Title I funded HIV-related services (if applicable). Include only with the two
     (2) originals. Do not include in the eight (8) copies.



                                                                                                             13
                  SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

    Proof of Non-Profit Status and Articles of Incorporation of any subcontractors to be used in the
     provision of direct services (if applicable). Include only with the two (2) originals. Do not include
     in the eight (8) copies.

N.      ORGANIZATION – 30 Points
        (Maximum of 15 pages, not including tables)

        1. Describe the history of your agency. Specifically, describe the history of your agency in
        providing services to People Living with HIV (PLWH) in the Houston EMA. If your organization
        has not provided services to PLWH in the past, please describe why you are proposing to serve this
        population.

        2. Briefly describe your agency‟s structure. Describe its organizational structure, such as board of
        directors, key staff positions, officers, advisory councils or committees. Include a current
        organizational chart in the appendices.

        3. Describe your agency‟s current programs and activities, especially those targeted to PLWH in the
        Houston EMA.
         Discuss the impact of new therapies (i.e., multiple drug regimens, etc.) on PLWH served by your
           agency and how your agency has adapted to the changes in the treatment modalities.
         Discuss how the changing demographics of PLWH in the Houston EMA have impacted your
           agency‟s programs and activities.

        4. Discuss the role of PLWH in your agency‟s program development activities, quality management
        activities and other aspects of organizational development.

        5.    Outline your agency‟s capacity to serve PLWH who are members of historically
        underserved/unserved populations and/or who are characterized by co-morbidities as defined by
        HRSA. For each bulleted co-morbidity and population below, provide information about the
        methods/capacity/processes used to target these clients and to ensure their access to services,
        including but not limited to geographic location of services, hours of operation, availability of
        bilingual staff and TTY capacity. Note whether each process is currently in place or would be
        implemented if your agency receives funding as a result of this RFP.

               Tuberculosis
               Homelessness
               Sexually transmitted diseases
               Substance abuse
               Severe mental illness
               White/Anglo men who have sex with men
               Men of color who have sex with men
               Women of child bearing age (13 years and older)
               Adolescents and youth (13 – 19 and 20 - 24 years)
               Blind/sight impaired or deaf/hard of hearing individuals
               Recently released from incarceration

                                                                                                         14
                  SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

        6. Describe your data management capacity, including qualifications and job duties of staff
        assigned to data management.

        7. Describe your agency‟s experience in handling and protecting confidential client information.

        8. Outline your agency‟s client complaint procedure.

        9. Complete the following tables as applicable:

            a. II.A: Organization Information Table
            b. II.B: Current HIV/AIDS Related Funding
            c. II.C: Documented Services to PLWH by Gender, Age, Co-Morbidity and Severe Need
               Category

The following documentation, if applicable, must be included in the appendices:

    Name, address, phone and fax number of each board member. Include only with the two (2) originals.
     Do not include in the eight (8) copies.
    Current agency organizational chart
    Letters from all administrative agencies listed in Table II.B for the applicant agency's current City,
     County, State or Federal HIV/AIDS-related prevention and/or treatment grants or contracts concerning
     applicant agency's compliance and performance with each current contract (excluding Ryan White Title
     I contracts with Harris County Public Health and Environmental Services). These letters must be dated
     no earlier than the release date of the RFP under which this proposal is submitted. Include only with
     the two (2) originals. Do not include in the eight (8) copies.

O.      PROGRAM – 40 Points
        (Maximum of 15 pages, not including tables)

        1. Describe your agency‟s plan for delivering the proposed service. Outline the goal(s), objectives
        and activities of the service you propose to provide. Discuss how your agency will operationalize
        each goal, objective and activity so that PLWH will receive quality services in a timely manner.

        2. Describe in detail how the proposed service fits in the overall continuum of care for PLWH.
        According to the Comprehensive HIV Services Plan for the Houston Area Through December 31,
        2005, the continuum of care includes the following:
               A: Public Advocacy to the General Population
               B: Outreach to At Risk Populations
               C: Prevention of HIV Infection
               D: Early Treatment of HIV Infection
               E: AIDS Treatment to PLWA



                                                                                                           15
          SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

3. Describe the proposed population to be served in terms of demographics – including gender, age,
race/ethnicity and Hispanic status – and the geographic area you propose to serve. Describe your
plan to deliver the proposed service to this population in this geographic area.

4. a. Clearly delineate where your agency expects clients to come from (i.e. incoming referrals).
Include information on current referral sources and provide the number of clients expected from
each source.
4. b. Summarize the services that clients served by the proposed program will be referred to (i.e.
outgoing referrals), your process of making such referrals and what methods will be used to assure
that clients receive the services to which they are referred.
4. c. Case Management and Adult Outpatient/Ambulatory Primary Medical Care categories
only: Discuss your relationship with entities considered to be Points of Entry into the continuum of
care, such as hospital emergency rooms, correctional facilities and HIV counseling and testing sites.
As instructed in Table III.D, provide the number of clients expected from each point of entry entity
and list each specific “point of entry” entity that your agency has a formal written agreement with
for the purpose of transitioning clients into the continuum of care.

5. Detail the specific processes to be used by your agency to assure that the services provided will
meet contractual requirements in terms of numbers of clients served, units of services provided and
allocated funds expended on allowable costs in accordance with all contract provisions.

6. Describe the activities you will undertake to assure that services provided to PLWH will be of
the highest possible quality, consistent with all RWPC-established standards for care (see
attachment C for applicable standards for care), Public Health Service guidelines and/or rules and
regulations from all applicable licensing entities. Include the job titles of the staff responsible for
ensuring quality of care.

7. Discuss how your agency will ensure full participation in Title I outcomes evaluation activities
(see attachment C for applicable outcome measures). This may include administering HIV
Services-developed surveys to clients and submitting this data to HIV Services on a quarterly basis.
Describe how your agency has used and/or will use outcomes evaluation results to improve program
design and performance.

8. Describe how your agency will ensure full participation in Title I client satisfaction measurement
activities. This may include administering HIV Services-developed surveys to clients and
submitting this data to HIV Services on a quarterly basis. Describe how your agency has used
and/or will use results from client satisfaction activities to improve agency processes and program
design and performance. In addition, outline any client satisfaction measurement methodologies
that your agency is currently utilizing or has utilized in the past.




                                                                                                    16
                   SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

        9. Include the following tables:

            a.   III.A: Goals and Objectives
            b.   III.B: Proposed Clients to be Served by Program During Contract Term
            c.   III.C: Collaborative Agreements with Other Service Providers
            d.   III.D: Formal Referral Agreements with Entities Considered to be Points of Entry (POE) into
                 the Continuum of HIV/AIDS Treatment and Care (adult primary medical care and case
                 management applicants only)


The following documentation must be included in the appendices:

    Copies of signed and dated collaborative and POE agreements with other service providers


P.      APPLICATION CHECKLIST
        Applications must be submitted in the order of the Application Checklist, including appendices. Do
        not submit any material that is not stipulated on the Application Checklist.

Q.      OTHER REQUIREMENTS:

        No proposal will be considered if, at the time the proposal is submitted or thereafter, the
        offeror employs or receives consulting services or other services relating to the proposal, from
        a current or former HIV Services staff member, unless the former staff member’s
        employment with HIV Services terminated more than six months prior to the date the
        proposal is submitted.

        Harris County may terminate a Contract after it is awarded if Contractor employs, in any
        capacity, any person who is then currently employed by HIV Services, or who has been
        employed by HIV Services within the six months immediately preceding the commencement of
        employment by Contractor. For the purposes of this paragraph, the term ―employs in any
        capacity‖ shall mean the receipt of services of any kind in exchange for consideration,
        regardless of whether the person performs the services as an employee, consultant, agent,
        independent contractor, subcontractor or in some other capacity. The Executive Director of
        Harris County Public Health and Environmental Services may waive this requirement upon
        written request from Contractor. The granting of a waiver is at the discretion of the
        Executive Director and any such decision by the Executive Director is final.

        Services MUST be available to ALL eligible clients in the Houston EMA. All clients will be
        served without regard to age, sex, race, color, religion, national origin or sexual orientation and
        in accordance with the American Disabilities Act (ADA). No eligible client will be refused
        services.




                                                                                                         17
                    SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

          For the 2003 grant year, the Re-authorized CARE Act mandates a 10% aggregate cap on
          administrative costs. The result of this mandate is that the total administrative costs from all service
          contracts, planning council and program support activities cannot exceed 10% of the total funds
          available for those purposes. The County will review each contract budget to determine allowable
          administrative costs. While the aggregate cap does not limit any single contract to 10% administrative
          costs, the County will, to the extent possible, require each contract to meet this requirement. Such
          negotiations as are necessary to ensure compliance with this CARE Act requirement will be conducted
          prior to the County issuing a contract for services with any provider. The County will monitor
          administrative costs of each individual contract on a monthly basis.

          Harris County is required under CARE Act legislation to provide and support programs and services
          targeting women, infants, children and youth. The EMA must assure that funds are allocated to
          women, infants and children and youth (“WICY”) with AIDS, based on the percentage that they
          represent in the total population of people living with AIDS. For FY 2003 grant year contracts in the
          Houston EMA those percentages will be at least: Women (25 years and older) 16.50%, Infants (less
          than 2 years) 0.30%, Children (ages 2 to 12) 0.60% and youth (ages 13 to 24) 7.10%. All direct client
          services subcontractors for FY 2003 will be expected to provide no less than the above percentages of
          their available RW Title I funded service units to women, infants, children and youth as applicable. In
          service categories where this is not possible the County must assure an overall grant expenditure of no
          less than the above percentages on women, children, infants and youth. Any contract which fails to
          provide at least these minimum percentages of expenditures (as determined by number of units
          provided to women, infants, children and youth multiplied by the unit cost of the service) is subject to
          review by the County and the implementation of corrective actions including, but not limited to,
          termination for failure to maintain this legislatively mandated rate of expenditure.

          No single funding source is likely to adequately support activities for an entire client population and in
          such cases multiple funding of the same activity is acceptable; however, Title I grant funds must not
          be used for duplicate funding of the same activity.

          No indirect costs can be charged to Title I funding requests in the Houston EMA.

     R.   APPENDIX - All required information that has been specified. Only include in your proposal
          submission information specifically requested in the RFP (including any addendums which may
          be issued). Do not include extraneous or unrelated documents in the appendices. Do not use
          appendices to provide information that is required in the narrative or tables.

III. ADDITIONAL INFORMATION

     A.   SUGGESTIONS FOR COMPLETING PROPOSALS
          In addition to the proposal writer, one or more individuals should review your proposal for content and
          form. Have them read through this RFP, and then let them pretend that they are on the independent
          review panel: have them read through your application, paying special attention to the narrative
          information that you have provided, and using the evaluation criteria as a basis for their review and
          comment. Check that the information provided on all of the forms and documents is consistent and
          complete and all budget forms are consistent with other information (for example, the math is correct).

                                                                                                                 18
                           SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

               Also, one or more individuals should review your application for completeness and format correctness,
               taking the time to verify that your narrative responses conform to the physical space limitations given
               for each section; that all required information has been assembled; that all pages, including
               attachment(s), have been numbered sequentially; that binder clips have been used; that the correct
               number (two originals and eight copies) of the finished proposal has been prepared for delivery.

       B. GRIEVANCES

       Grievance Procedures are as required by the Ryan White CARE Act for contracts funded with Ryan White
       Title I grant money.

       Eligibility:   Only individuals within the following groups are authorized to bring grievances.
               1.     HIV service providers eligible to receive Ryan White Title I funding;
               2.     persons with HIV disease;
               3.     consumer groups or coalitions or caucuses of persons with HIV disease; or
               4.     members of the Houston Area HIV Health Services Planning Council (“Planning Council”).

       Grievable Actions: Only the following actions are the proper subject of a grievance under these procedures:
              1. deviations from the procedures established by the Harris County Purchasing Agent in the
                  competitive proposal package;
              2. contracts and awards which are inconsistent with the priorities and resource allocations made by
                  the Planning Council; and
              3. deviations from any established, written process for any subsequent changes to priorities or
                  allocations.

       *note: only a member of the Planning Council is authorized to bring a grievance under
       grievable actions item 2.

The procedure with timelines and appropriate forms for grievances defined in Grievable Actions above may be
obtained from the Harris County Purchasing Department by calling 713-755-5036.

The awarding of contracts is the responsibility of Harris County Commissioners Court and their award decision is
final. Award will be based on the evaluation criteria and process described in the RFP document.

Contact Mary Lou Sotolongo at (713) 755-6832 in order to seek an informal resolution to your concerns. Prior to
scheduling appearances before Commissioners Court, grievance procedures must have been followed with
notification given to the Purchasing Department.

The priority setting of service categories is the responsibility of the Ryan White Planning Council. All grievances
pertaining to the priority setting process should be directed in writing to the Ryan White Planning Council. For
information call the Ryan White Planning Council Coordinator at (713) 572-3724.




                                                                                                                   19
                        SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

IV.   DEFINITION OF SPECIAL LANGUAGE AND GUIDELINES

A.    Culturally Sensitive and Language Competent is the ability to communicate effectively and interact with
      individuals whose cultural, ethnic and socio-economic status is different from your own as demonstrated by
      shared values, beliefs, understanding of community norms, traditions, language and customs. Culturally
      competent services include, but are not limited to services that are provided in a language and format the client
      understands; interpreter services; communications devices for the deaf/hard of hearing; and staff with
      documented prior experience, training and/or education regarding populations to be served.

B.    CDC/OSHA refers to Centers for Disease Control and the Occupational Safety and Health Administration.
      The contracting organization must adhere to all CDC and/or OSHA recommended guidelines for blood borne
      pathogens and infectious diseases and must document that in the application.

C.    Quality Management is intended to ensure that providers have a means to control for appropriateness and
      quality of services. HIV Services facilitates the HRSA-mandated Quality Management program. Contracting
      agencies must comply with all applicable Quality Management activities. Components of the Quality
      Management program include, but are not limited to:
        Standards for Care have been approved by the RWPC to establish the minimal acceptable levels of
          quality in service delivery and to provide a measurement of the effectiveness of services. Each fiscal
          year the RWPC reviews and revises standards for care for each service category. HIV Services
          monitors for compliance at site monitoring visits. A list of applicable Standards for Care can be found
          in the appendix of this document.
        Outcomes Evaluations assess health, quality of life, knowledge, attitudes and practices (KAP) and cost-
          effectiveness measures for each Title I service category. Each fiscal year the RWPC reviews and revises
          outcome measures for each service category. Contracting agencies are required to participate fully in all
          evaluation activities, including but not limited to the ongoing administration of HIV Services-developed
          client surveys and the submission of data to HIV Services on a regular basis. A list of applicable outcome
          measures can be found in the appendix of this document.
        Clinical Review will be conducted on an ongoing basis to determine whether primary care, health-related
          support services and case management programs meet Public Health Service guidelines (or other relevant
          and established guidelines). Clinical review activities include but are not limited to client chart/record
          review by appropriate and qualified professional(s) designated by HIV Services.
        Client Satisfaction assesses client opinion regarding the quality of services provided. Through methods
          such as post-service surveys, clients should be given the opportunity to express whether expectations were
          met, exceeded or not met. Areas to be assessed include but are not limited to interactions with agency
          staff, accessibility of the facility, amount of time spent on a waiting list and quality of service(s) rendered.
          Contracting agencies are required to participate fully in all client satisfaction measurement activities,
          including but not limited to the administration of HIV Services-developed client surveys and the
          submission of data to HIV Services on a regular basis.

D.    Houston EMA is a six county area including Chambers, Fort Bend, Harris, Liberty, Montgomery and Waller
      in which services under this agreement must be provided.




                                                                                                                       20
                       SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

E.   Health Resources and Services Administration (HRSA) is the Federal administrator for Ryan White Title I
     funds.

F.   Centralized Patient Care Data Management System (CPCDMS) is the County mandated automated client-
     level reporting system. The County requires that agencies utilize the CPCDMS to determine eligibility status
     for clients and enter service utilization data (including client demographic, client stage of illness and co-
     morbidity data). If a funded agency chooses to send the required service utilization data in batch mode, this
     must be done in accordance with Harris County CPCDMS business rules. All funded agencies will be
     required to have an ISDN line for all participating service sites if the site is located in the Southwestern Bell
     service area. This ISDN line must be utilized for the CPCDMS. Funded agencies must use the County
     implemented CPCDMS as a condition of award.

G.   CARE Act Data Report (CADR) is the HRSA mandated reporting requirement that includes unduplicated
     numbers of clients served per provider, basic demographics (gender, ethnicity, age) regarding clients served,
     relevant medical markers and co-morbidities, estimated percent of clients by transmission category, minority
     composition of entity's board and/or staff, amounts and types of services provided, percent of clients who are
     HIV positive and number with AIDS, amount of HIV/AIDS funding by source and information on numbers,
     types and salaries of HIV/AIDS staff. This information must be summarized annually in the annual CARE
     Act Data Report. The CPCDMS is the County‟s primary means for collecting client-level data for the CADR.
     All entities receiving FY 2003 funds must submit this report to Harris County by 1-20-04 summarizing
     activities from 01/01/03 through 12-31-03. The County will provide the required format for submission of
     these required annual reports.

H.   Monthly Activity Report (MAR) is a monthly summary of clients served per service contract, including
     demographics and service related information. The minimum data set for the Monthly Activity Report
     includes Age, Gender, Ethnicity, Stage of Illness, Severe Need Category, Co-morbidity, number of service
     units or interventions received, number of clients who are deaf/hard of hearing and sight impaired. The MAR
     must describe the number of unduplicated clients served per month and for the total term of the contract
     according to the minimum data set described above. The County will provide the required format for the
     submission of the MAR. The MAR report will be generated from data collected through the CPCDMS.

J.   Collaboration occurs when two or more agencies or organizations have a formal written commitment to work
     together in a cooperative effort toward agreed upon objectives. Referrals to other agencies do not
     constitute collaboration.


V.   OVERVIEW

A.   The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 provides federal support
     for comprehensive health and social services for people living with HIV/AIDS in the Houston Eligible
     Metropolitan Area (Houston EMA). Houston EMA includes Chambers, Fort Bend, Harris, Liberty,
     Montgomery, and Waller counties. Title I provides emergency relief grants to meet needs of individuals
     infected and affected. CARE Act funding is intended to supplement, not supplant, existing and planned
     funding for HIV/AIDS services at local and state levels.



                                                                                                                   21
                       SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

     Eligible recipients of these funds are providers of relevant services such as public or nonprofit private entities,
     or private for-profit entities if such entities are the only available provider of quality HIV care in the area,
     including hospitals (which may include Department of Veterans Affairs facilities), community-based
     organizations, hospices, ambulatory care facilities, community health centers, migrant health centers, homeless
     health centers, substance abuse treatment programs, and mental health programs.

     The Ryan White Planning Council is responsible for establishing priorities, conducting needs assessments, and
     long range planning for Title I funds. Its members are appointed by the Harris County Judge and represent
     various segments of the community including service providers, caregivers, medical authorities, and persons
     infected and affected by HIV/AIDS.

     The Harris County Commissioners Court has appointed the Executive Director of Harris County Public Health
     and Environmental Services (PHES) as the Administrative Agent to the program. The HIV Services section
     of Harris County Public Health and Environmental Services assists the Planning Council in its duties and
     provides grant administration and monitoring for the Houston EMA. The Harris County Commissioners
     Court, as the governing body of the grant recipient, has ultimate authority over awards of Ryan White Title I
     Grant funds.

B.   AVAILABLE MONIES
     Estimated dollar amounts are listed for each Service Category. Awardees will be notified at time of award of
     the specific contract period and amount. All contracts will be for a maximum 12 month term. All awards are
     contingent on the amount of Harris County’s Federal Fiscal Year 2003 Ryan White CARE Act Title I
     award from HRSA. The Planning Council has approved the FY 2003 Ryan White Title I service priorities
     and funding allocations. These funding allocations include contingencies in the event that the total FY 2003
     Title I award received by the County is more or less than the amount of funding anticipated. The County will
     adjust all awards made based on the contingency plan approved by the Planning Council.

C.   FUNDING REQUESTS
     Agencies must submit complete proposals for each Service Category in which they seek funding. DO NOT
     COMBINE FUNDING REQUESTS FOR MORE THAN ONE SERVICE CATEGORY INTO THE SAME
     PROPOSAL. Organizations must write separate proposals for each Service Category.

D.   COMMENCEMENT OF SERVICES/FORFEITURE OF FUNDS
     Each agency must demonstrate its ability to implement proposed services quickly, including hiring/training
     appropriate personnel. If an agency fails to begin providing services and expending funds within 30 days from
     receipt of funds, the agency may have to forfeit said funds.

E.   CHARGES FOR SERVICES
     If an agency charges for its services, it must do so on a sliding fee schedule which is available to the public.
     Individual, annual aggregate charges to clients receiving services must conform to the following limits:

     INDIVIDUAL/FAMILY                              TOTAL ALLOWABLE
     ANNUAL GROSS INCOME                            ANNUAL CHARGES
     Equal to or below official                     No charges permitted
     poverty line (OPL)
     101 to 200% of OPL                             5% or less of Gross Income Level (GIL)
     201 to 300% of OPL                             7% or less of GIL
     300+% of OPL                                   10% or less of GIL


                                                                                                                     22
                       SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

     "Aggregate Charges" applies to annual charges imposed for all services regardless of terminology (i.e.
     enrollment fees, premiums, deductibles, cost-sharing, co-payments, coinsurance, etc.) and applies to all service
     providers from whom individuals receive services. The Planning Council may waive this requirement for a
     provider when said provider does not impose a charge or accept reimbursement from a third party payor,
     including reimbursement under any insurance policy or any Federal or State health benefits program.

     A simple application showing annual gross salary of an individual or family shall be used to establish the
     appropriate level of fees.

F.   APPLICABLE LAWS
     Proposers MUST comply with all applicable federal, state, and local laws, regulations, HIV Services Site Visit
     Guidelines and Quality Management initiatives and Houston Ryan White Title I Standards of Care. HIV
     Services and/or their designees will conduct site visits to insure compliance of all the above. Proposers may
     contact the Project Monitoring section of HIV Services, at 713-439-6069, for a copy of the Site Visit
     Guidelines and any additional information.

G.   OTHER CONDITIONS/RESTRAINTS
     The following conditions/restraints are imposed on all recipients of Ryan White Title I funds. Vendors are not
     required to submit information concerning these issues within their proposals; however, agencies must comply
     with them if they receive Ryan White Title I funds.
     1.      AUDIT
             Not for profit and governmental agencies receiving Federal funding assistance in the aggregate amount
             of $300,000.00 or more within their fiscal year must have an audit conducted in accordance with
             Office of Management and Budget (OMB) Circular A-133. The audit must be submitted to the Harris
             County Auditor‟s Office no later than 13 months of an agency‟s fiscal year end (within 9 months for
             fiscal years beginning after June 30, 1998). Proprietary agencies receiving awards of $25,000.00 or
             more must submit an audit of their general financial statements within 12 months of their fiscal year
             end. Not for profit and governmental agencies meeting the $300,000.00 aggregate threshold may
             charge OMB A-133 single audit costs proportionally to their Ryan White grants. However, agencies
             who do not meet the $300,000.00 aggregate threshold may not use Federal funds to pay for OMB A-
             133 single audit costs. Those agencies not meeting the $300,000.00 aggregate threshold may use
             Federal funds to pay for limited scope audits, site visits, document reviews and other monitoring
             activities.

     2.     BONDING
            All employees of agencies receiving Title I funds must be covered by the terms of a fidelity bond, if
            they handle those funds, providing for indemnification of losses by:

            a.      any fraudulent or dishonest act or acts committed by any of the above mentioned employees
                    either individually or in concert with others, and/or

            b.      the failure of the agency or any of its employees to perform faithfully his/her duties or to
                    account properly for all monies and properties received by virtue of his/her position of
                    employment.


                                                                                                                  23
               SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

            Fidelity bond will be in an amount not less than ten thousand dollars ($10,000).
            Documentation of bonding must be provided within sixty (60) days of receipt of grant award.

3.   REPORTING AND MONITORING
     All agencies receiving Title I funds must comply with all aspects of "Aggregate Level Reporting" as
     implemented by HRSA (See "Definitions of Special Language and Guidelines").

     All agencies receiving Title I funds must submit monthly activity reports. Agencies must provide a
     year-end final financial report (FFR) certifying the total amount of grant funds received and amount
     expended for each funded contract. Agencies receiving funding must provide monthly expenditure
     reports for the purposes of reimbursement. Agencies must report the amount of funds expended for
     administrative purposes monthly. The County will provide contractors with the required format for
     these reports.

4.   DOCUMENTATION OF SERVICES AND COSTS
     All agencies receiving Title I funding are expected to comply with the development of a standard data
     set to provide information on costs of services and client demographics. As a condition of receiving
     grant funds, each organization must provide all information required under the CARE Act Data Report
     (CADR) as instituted by HRSA and the Centralized Patient Care Data Management System
     (CPCDMS) as implemented by Harris County.

5.   MEDICAID
     If a particular service is available under State Medicaid Plan, the political subdivision involved either
     must provide service directly or enter into an agreement with a public or private entity to provide the
     service. The entity providing service must enter into a participation agreement under the State
     Medicaid Plan and must be qualified to receive payment under the State Medicaid Plan. Funds must
     not be used to provide items or services for which payment has already been made or reasonably can
     be expected to be made, by third party payors, including Medicaid, Medicare and/or other state or local
     entitlement programs, prepaid health plans or private insurance. Proposers are reminded that this is
     subject to audit and must be carefully documented in the year-end program report. Applicants should
     refer to the August 10, 2000 letter from HRSA included in Attachment A for a summary of the HRSA
     Medicaid/Medicare requirement.

6.   PURCHASE OF LAND - NEW CONSTRUCTION
     No use of Title I funds may be made for improving or purchasing land or constructing or permanently
     repairing any building. Minor remodeling is acceptable.

7.   All agencies receiving Title I funding must have available during regular business hours at least one
     staff member who is fluent in both English and Spanish. Agencies targeting Hispanic/Latino clients
     must have sufficient bilingual (English/Spanish) staff to serve their client population.

8.   The Ryan White Planning Council has determined that all Ryan White Title I funded agencies must
     utilize the Centralized Patient Care Data Management System (CPCDMS). This will require that




                                                                                                           24
                SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

      agencies utilize the CPCDMS to determine eligibility status for clients and enter service utilization
      data (including client demographic, client stage of illness and co-morbidity data). If a funded agency
      chooses to send the required service utilization data in batch mode, this must be done in accordance
      with Harris County HIV Services business rules. All funded agencies will be required to have an
      ISDN line for all participating service sites if the site is located in the Southwestern Bell service area.
      This ISDN line must be utilized for the CPCDMS. Funded agencies must use the County
      implemented CPCDMS as a condition of award.

9.    All agencies receiving Title I funding must participate fully in any HIV/AIDS community needs
      assessment and/or service effectiveness activities undertaken by the Houston Ryan White Planning
      Council. Failure to participate in such assessments and evaluations may be cause for the County to
      terminate contracts awarded under this RFP.

10.   RECEIPT FOR SERVICE.
      a. Each Ryan White Title I funded agency is encouraged to provide each client a receipt for services
         provided and request the client‟s signature. This receipt should include the definition of the unit of
         service or procedure provided, the unit/procedure cost (including the amount charged to the
         County and, if applicable, the amount charged to the client) and the total charges for the service,
         the number of units provided, the date and time the services were provided. This recommendation
         applies to all FY 2003 Ryan White Title I funded services.

11.   COUNCIL AND HIV SERVICES NOTICES.
      The service provider is required to post, in a timely manner, notices provided by the County regarding
      Houston EMA Ryan White Planning Council and HIV Services activities.

12.   RURAL DEFINITION
      “Rural” is defined as any area outside of Beltway 8. If a zip code area straddles Beltway 8, it is
      considered to be rural.

13.   RENEWAL OPTION:
      The County has the option of renewing contracts in specific service categories on an annual basis. The
      renewal criteria is as follows:

      1. Only those contracts with fee-for-service (unit cost) budgets (including “hybrid”) are eligible. The
         vendor must agree to the same terms, specifications, unit cost(s) and conditions of the previous
         contract term (i.e., the unit cost and service definition must remain the same, the total value of the
         contract may increase or decrease as necessary depending on service category allocations);

      2. All renewals are contingent upon Planning Council service category allocations, receipt of such
         funding from HRSA and Commissioners Court approval;

      3. All providers in the service category must agree to the renewal option.




                                                                                                              25
          SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

RENEWAL OPTION
Harris County wishes to consider two (2) annual renewal options, renewable one year at a time, based
on the same terms, conditions and pricing as the original year. If the vendor does not wish to renew,
mark ―N.A.‖ in the space for the year indicated. If the vendor is willing to accept one or two
annual renewals do not mark the form, but include the form in your proposal.

Harris County retains the option to rebid at any time if in its best interest and is not
automatically bound to renewal or rebid.

Vendor agrees to continue this contract for the time frames stated below under the same terms and
conditions and pricing as the original contract. If vendor does not wish to renew, write “N.A.” in the
space provided.

Renewal Year 1 (FY 2004):             ____________ 3-1-04 through 2-28-05

Renewal Year 2 (FY 2005):             ____________ 3-1-05 through 2-28-06

DO NOT MARK THE FORM IF VENDOR WILL ACCEPT ONE (1) OR TWO (2) ONE
YEAR RENEWALS. REGARDLESS OF CHOICE, THIS FORM MUST BE INCLUDED IN
PROPOSAL SUBMISSION.




                                                                                                   26
                        SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

VI.    SPECIFICATIONS

SERVICE CATEGORIES:
The detailed description and specifications for each Service Category directly follow this listing.
*MAI denotes Minority AIDS Initiative funds. Applicant entities must meet the definition of an MAI provider.

                                              Healthcare Services

       1.     Outpatient Ambulatory Primary Medical Care Targeted to African American - Code HS-01 (MAI)*
       2.     Outpatient Ambulatory Primary Medical Care Targeted to Pediatric - Code HS-02
       3.     Home Health Care - Code HS-03
       4.     Local AIDS Drug Assistance Program - Code HS-04
       5.     Health Insurance Deductibles and Co-pays - Code HS-05

                                               Support Services

       1.     Case Management Team (Untargeted) - Code SS-01
       2.     Case Management Team Targeted to Hispanic/Latino - Code SS-02
       3.     Case Management Team Targeted to African American - Code SS-03 (MAI)*
       4.     Case Management Team Targeted to Rural - Code SS-04
       5.     Medical Case Management Team Targeted to African American Women/Children - Code SS-05
       6.     Outreach Targeted to African American Code SS-06 (MAI)*
       7.     Early Intervention Services Targeted to Youth – Code SS-07 (new category for FY 2003)
       8.     Health Education/Risk Reduction Targeted to African American – Code SS-08 (MAI)*
       9.     Health Education/Risk Reduction Targeted to Hispanic/Latino – Code SS-09
       10.    Health Education/Risk Reduction Targeted (Untargeted) – Code SS-10
       11.    Buddy/Companion Services: Volunteers/Direct Client Care – Code SS-11
       12.    Buddy/Companion Services: Volunteers/Respite Care – Code SS-12
       13.    Direct Emergency Assistance: Housing and Utility Assistance/In-home Support – Code SS-13
       14.    Direct Emergency Assistance: Household Items – Code SS-14
       15.    Housing Coordination and Emergency Shelter Vouchers – Code SS-15 (MAI)*
       16.    Nutritional Supplements – Code SS-16




                                                                                                               27
APPLICATION CHECKLIST

__________      REQUEST FOR PROPOSAL COVER SHEET
__________      SIGNED ADDENDUM (if applicable)
__________      RESIDENCE CERTIFICATION
__________      SIGNED ASSURANCES FORM I
__________      SIGNED CERTIFICATION CONCERNING LOBBYING
__________      SIGNED COMPLIANCE WITH AMERICANS WITH DISABILITIES ACT OF 1990
__________      ASSURANCE – NON-CONSTRUCTION PROGRAMS
__________      RESPONDENT CERTIFICATION
__________      LICENSES, PERMITS & CERTIFICATION
__________      RENEWAL OPTION
__________      COVER PAGE
__________      TABLE OF CONTENTS FOR PROPOSAL
__________      ABSTRACT
__________      FINANCIAL CAPACITY and BUDGET
 _________Narrative
 _________Table I.A. Budget Narrative
 _________Table I.B. Fee-for-Service Budget Form or
 _________Table I.C. Hybrid “Fee-for-Service” Budget Form
 _________Table I.D. Subcontractor Budget Form
__________      ORGANIZATION
 _________History of applicant agency
 _________Table II.A. Organization Information Table
 _________Table II.B. Current HIV/AIDS Related Funding
 _________Capacity to serve underserved/unserved populations
 _________Capacity to serve populations with special (severe) needs
 _________Table II.C. Documented Services to PLWH
__________      PROGRAM
 _________Goals & Objectives
 _________Table III.A. Goals & Objectives
 _________Proposed Clients to be served
 _________Table III.B. Proposed Clients to be Served
 _________Table III.C. Collaborative Agreements
 _________Table III.D. Points of Entry Agreements (Case Management and Adult Primary Care only)
 _________Evaluation Process
__________      APPENDIX
               _________Job description of each type of personnel position
               _________Proof of Non-profit status and Articles of Incorporation. Include only with the two (2) originals. Do not
           include with the eight (8) copies.
               _________Copy of all signed and dated contracts with subcontractors. Include only with the two (2) originals. Do not
           include with the eight (8) copies.
               _________Proof of Non-profit status and Articles of Incorporation of any subcontractors. Include only with the two (2)
           originals. Do not include with the eight (8) copies.
               _________Copies of signed and dated collaborative agreement(s)
               _________Copies of signed and dated POE agreements (case management and adult primary care only)
               _________Copies of all client surveys/evaluations (English & Spanish)
               _________List of Board Members Include only with the two (2) originals. Do not include with the eight (8) copies.
               _________Copy of applicant‟s most recent fiscal year audit and/or certified financial statement. Include only with the two
           (2) originals. Do not include with the eight (8) copies.
               _________Letters from all administrative agencies listed in Table II.B. Include only with the two (2) originals. Do not
           include with the eight (8) copies.




                                                                                                                                       28
FOLLOWING ARE DESCRIPTIONS OF

     SERVICE CATEGORIES




                                29
HRSA Service Category    Ambulatory/Outpatient Medical Care
Title:
Local Service Category
Title:                   Community-Based Outpatient/Ambulatory Primary Care
                         Targeted to African Americans

Revision Date:            05-15-02
Service Category Code:   HS-01
Amount Available:        $716,419.00 ($265,892.00 MAI Funds)
Budget Type:             Hybrid
Budget Requirements or   100% of MAI funds must be spent on target population.
Restrictions:            Maximum allowable unit cost for Primary Care Visit = $275.00/unit
                         Maximum allowable unit cost for Psychiatry Visit = $120.00/unit
                         Maximum allowable unit cost for Med. Coordination = $18.00/unit
                         Reimbursement* for CPCDMS new client registration = $140.00
                         Reimbursement* for CPCDMS registration update = $70.00
                         *New client registrations and registration updates may only be
                         provided for clients accessing primary care services from agency.
HRSA Service Category    Ambulatory/Outpatient Medical Care: Provision of professional,
Definition:              diagnostic and therapeutic services rendered by a physician,
                         physician‟s assistant, clinical nurse specialist, or nurse practitioner in
                         an outpatient, community-based, and/or office-based setting. This
                         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,
                         care of minor injuries, education and counseling on health and
                         nutritional issues, minor surgery and assisting at surgery, well-baby
                         care, continuing care and management of chronic conditions, and
                         referral to and provision of specialty care. Primary Medical Care
                         for the Treatment of HIV Infection includes the provision of care that
                         is consistent with Public Health Service guidelines. Such care must
                         include access to antiretrovirals and other drug therapies, including
                         prophylaxis and treatment of opportunistic infections and
                         combination antiretroviral therapies.
Local Service Category   Primary Care Office/Clinic Visit is defined as client examination
Definition:              by a qualified Medical Doctor, Nurse Practitioner, and/or
                         Physician‟s Assistant and includes all ancillary services below:
                              Eligibility Screening (as necessary)
                              Patient Medication/Treatment Education
                              Social Services/Case Coordination
                              Medication Access/Linkage
                              Ob/Gyn specialty procedures (as clinically indicated)
                              Nutritional Counseling (as clinically indicated)
                              Laboratory (as clinically indicated)
                              Radiology (as clinically indicated)

                         Medical Care Coordination: Conduct a psychosocial assessment,
                                                                                                      30
                            education and consultation by an LMSW within a system of
                            information, referral, case management, and/or general psychosocial
                            client services.
                            Psychiatry: Provision of outpatient psychiatric care by a Board
                            certified Psychiatrist.
                            CPCDMS Registration and Registration Update: A complete
                            patient registration and/or registration update in the CPCDMS in
                            accordance with CPCDMS business rules and procedures.
                            Registrations and updates may only be provided for clients
                            accessing primary care services under this RFP.
Target Population (age,     African-Americans; targeted contracts must serve at least 75% of the
gender, geographic, race,   targeted population.
ethnicity, etc.):
Services to be Provided:    Services include on site physician, physician extender, nursing,
                            phlebotomy, radiographic, laboratory, pharmacy, intravenous
                            therapy, home health care referral, licensed dietician, patient
                            medication education, and patient care coordination. The
                            agency/clinic must provide continuity of care with inpatient services
                            and subspecialty services (either on-site or through specific referral
                            to appropriate agencies).

                            Community-Based Primary Care must provide:
                               Continuity of care for all stages of adult HIV infection;
                               Laboratory and pharmacy services including intravenous
                                medications (either on-site or through established referral
                                systems);
                               Outpatient psychiatric care, including lab work necessary for
                                the prescribing of psychiatric medications when appropriate
                                (either on-site or through established referral systems);
                               Access to the Texas ADAP program (either on-site or
                                through established referral systems);
                               Access to compassionate use HIV medication programs
                                (either directly or through established referral systems);
                               Access to HIV related research protocols (either directly or
                                through established referral systems);
                               Must at a minimum, comply with the attached Adult
                                Standards for HIV Primary Medical Care Components of
                                Medical Practice. The Contractor must demonstrate on an
                                ongoing basis the ability to provide state-of-the-art HIV-
                                related primary care medicine in accordance with the most
                                recent National Institute of Health (NIH) HIV treatment
                                guidelines. The recent rapid advances in HIV treatment
                                protocols require that the Contractor provide services which
                                to the greatest extent possible maximize a patient‟s
                                opportunity for long-term survival and maintenance of the
                                highest quality of life possible.
                               On-site pelvic exams as needed with appropriate treatment
                                and referral.
                               Nutritional Counseling by a Licensed Dietitian.
                                                                                                     31
Nutritional Counseling: Services include provision of information
about therapeutic nutritional/supplemental foods that are beneficial
to the wellness and increased health conditions of clients by a
Licensed Dietitian. Services may be provided either through
educational or counseling sessions. Also included in this service are
follow up sessions with clients and/or clients‟ Primary Care
Physicians regarding the effectiveness of the services. The number
of sessions for each client shall be determined by a written
assessment conducted by the Licensed Dietitian but may not exceed
twelve (12) sessions per client per contract year. Clients who
receive these services may utilize Ryan White Title I funded Food
Pantries to obtain recommended nutritional supplements.

Patient Medication Education Services must adhere to the
following requirements:
     Educators must be a State Licensed Registered Nurse, a
       licensed Masters Level Mental Health Professional, a
       licensed pharmacist, or have a Bachelor’s degree with at
       least five years of documented paid experience as an
       HIV/AIDS medication educator under a doctor’s
       supervision.
     Clients must be allowed to form an ongoing relationship
       with the assigned staff member responsible for the
       patient medication education.
     Clients who will be prescribed ongoing medical regimens
       (i.e. protease inhibitors) must be assessed for adherence.
       Clients with adherence issues related to lack of
       understanding must receive more education regarding
       their medical regimen. Clients with adherence issues that
       are behavioral or involve mental health issues must be
       provided counseling by the Medication Educator and
       assessment and treatment by a psychiatrist as clinically
       indicated.

Community-Based Primary Care must also provide Outpatient
Psychiatric Services:
The program must be able to provide:
    Diagnostic Assessments: comprehensive evaluation for
       identification of psychiatric disorders, mental status
       evaluation, differential diagnosis which may involve use of
       other clinical and laboratory tests, case formulation, and
       treatment plans or disposition.
    Emergency Psychiatric Services: rapid evaluation,
       differential diagnosis, acute treatment, crisis intervention,
       and referral. To be available on a 24 hour basis, emergency
       room referral o.k.
    Brief Psychotherapy: individual, supportive, group, couple,
       family, hypnosis, biofeedback, and other

                                                                        32
                                    psychophysiological treatments and behavior modification.
                                   Psychopharmacotherapy: evaluation and medication
                                    treatment of psychiatric disorders, including, but not limited
                                    to, anxiety disorders, major depression, pain syndromes,
                                    habit control problems, psychosis and organic mental
                                    disorders.
                                   Rehabilitation Services: some, but not necessarily all, of the
                                    following: physical, psychosocial, behavioral, and cognitive
                                    training.


Service Unit Definition(s): Primary Care: 1 unit of service = 1 primary care office/clinic visit
                            which includes the following:
                             Primary care physician/nurse practitioner/physician‟s assistant
                               examination of the patient
                             Medication/treatment education
                             Social services/care coordination
                             Medication access/linkage
                             Ob/Gyn specialty procedures (as clinically indicated)
                             Nutritional counseling (as clinically indicated)
                             Laboratory (as clinically indicated)
                             Radiology (as clinically indicated, not including CAT scan or
                               MRI)
                             Eligibility verification/screening (as necessary)
                             Follow-up visits wherein the patient is not seen by the
                               MD/NP/PA are considered to be a component of the original
                               primary health care visit that is billed to the County.

                            Outpatient Psychiatric Services: 1 unit of service = A single (1)
                            office/clinic visit wherein the patient is seen by a State licensed and
                            board-eligible Psychiatrist. This visit may or may not occur on the
                            same date as a primary care office visit.

                            Medical Care Coordination: 1 unit of service = 15 minutes of
                            direct client service providing medical care coordination by an
                            LMSW for eligible clients with HIV disease.
Financial Eligibility:      Refer to the RWPC‟s approved Financial Eligibility for Houston
                            EMA Services.
Client Eligibility:         HIV positive, meeting financial requirements listed in Attachment B.
Agency Requirements:        Providers and system must be Medicaid/Medicare certified.
Staff Requirements:         Primary care providers are responsible for ensuring that services
                            are provided by State licensed internal medicine and OBGYN
                            physicians, specialty care physicians, psychiatrists, registered nurses,
                            nurse practitioners, vocational nurses, pharmacists, physician
                            assistants, physician extenders with a colposcopy provider
                            qualification, x-ray technologists, State licensed dieticians, social
                            workers and ancillary health care providers in accordance with
                            appropriate State licensing and/or certification requirements and
                            with knowledge and experience of HIV disease.
                                                                                                       33
                        Medical Educators must have at least a Bachelor‟s degree with at
                        least 5 years of documented paid experience as an HIV/AIDS
                        medication educator under a doctor‟s supervision, or be an RN or a
                        Masters level licensed Mental Health Professional (e.g. LMSW,
                        LPC) or licensed pharmacist.

                        Outpatient Psychiatric Services: Director of the Program must be
                        a Board Certified Psychiatrist. Licensed and/or Certified allied
                        health professionals (Licensed Psychologists, Physicians, Licensed
                        Master Social Workers, Licensed Professional Counselors, Licensed
                        Marriage and Family Therapists, Certified Alcohol and Drug Abuse
                        Counselors, etc.) must be used in all treatment modalities.
                        Documentation of the Director‟s credentials, licensures and
                        certifications must be included in the proposal. Documentation of
                        the Allied Health professional licensures and certifications must be
                        included in the proposal.

                        Medical Care Coordinator must be an LMSW.
Special Requirements:   Primary Medical Care Services: Services funded under this grant
                        cannot be used to supplant insurance or Medicare/Medicaid
                        reimbursements for such services. Clients eligible for such
                        reimbursement may not be billed to this contract. Medicare and
                        private insurance co-payments are eligible for reimbursement under
                        the contract (in this situation the County will reimburse the client‟s
                        co-payment only, not the cost of the session which must be billed to
                        Medicare and/or the Third party payer). Under no circumstances
                        may the Contractor bill the County for the difference between the
                        reimbursement from Medicaid, Medicare or Third party insurance
                        and the fee schedule under the contract.

                        Furthermore, potential clients who are Medicaid/Medicare eligible
                        or have other 3rd party insurance coverage may not be denied
                        services by the Contractor based on their reimbursement status
                        (Medicaid/Medicare eligible clients may not be referred elsewhere in
                        order that non-Medicaid/Medicare eligible clients may be added to
                        this contract). Failure to serve Medicaid/Medicare eligible clients
                        based on their reimbursement status will be grounds for the
                        immediate termination of contract.


                        The following diagnostic procedures are approved by HIV Services:

                        HEP C RNA
                        Bronchoscopy
                        EGD (esophageal gastroduodenoscopy)
                        Flexible Sigmoidoscopy
                        Barium Studies
                        Colposcopies

                                                                                                 34
ECHO
Stress EKG/EKG- 12 lead
CT Scans as dictated by exam and clinical course
MRI Scans as dictated by exam and clinical course
CAT Scans
Upper and Lower GI
Radiological Procedures: non-routine chest, cervical spine, lumbar
spine, upper extremities, lower extremities, KUB-abdomen, I.V.P. -
Intravenous Pyleograms, Barium Swallows
Echocardiograms
Lumbar Punctures
Liver Biopsies
Incision/removal of cysts
Gastroscopies
Mammograms
Sonograms
Lumpectomies
Colposcopies
KS Lesion - punch biopsies
These procedures and those not listed above require prior approval
by HIV Services:
Genotypic testing
Phenotypic testing

Outpatient Psychiatric Services: Client must not be eligible for
services from other programs/providers (i.e. MHMRA of Harris
County) or any other reimbursement source (i.e. Medicaid,
Medicare, Private Insurance) unless the client is in crisis and cannot
be provided immediate services from the other programs/providers.
In this case, clients may be provided services, as long as the client
applies for the other programs/providers, until the other
programs/providers can take over services. Program must be
supervised by a Psychiatrist and include diagnostic assessments,
emergency evaluations and psychopharmacotherapy.

All primary care services must meet or exceed current Public
Health Service guidelines for the treatment and management of
HIV disease.




                                                                         35
HRSA Service Category    Ambulatory/Outpatient Medical Care
Title:
Local Service Category
Title:                   Community-Based Primary Care Targeted to Pediatric

Revision Date:           05-15-02
Service Category Code:   HS-02
Amount Available:        $93,590.00
Budget Type:             Hybrid
Budget Requirements or   Maximum allowable unit cost for Primary Care Visit = $300.00/unit
Restrictions:            Maximum allowable unit cost for Psychiatry Visit = $120.00/unit
                         Maximum allowable unit cost for Med. Coordination = $18.00/unit
                         Reimbursement* for CPCDMS new client registration = $140.00
                         Reimbursement* for CPCDMS registration update = $70.00
                         *New client registrations and registration updates may only be
                         provided for clients accessing primary care services from agency.
HRSA Service Category    Ambulatory/Outpatient Medical Care: Provision of professional,
Definition:              diagnostic and therapeutic services rendered by a physician,
                         physician‟s assistant, clinical nurse specialist, or nurse practitioner in
                         an outpatient, community-based, and/or office-based setting. This
                         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,
                         care of minor injuries, education and counseling on health and
                         nutritional issues, minor surgery and assisting at surgery, well-baby
                         care, continuing care and management of chronic conditions, and
                         referral to and provision of specialty care. Primary Medical Care
                         for the Treatment of HIV Infection includes the provision of care that
                         is consistent with Public Health Service guidelines. Such care must
                         include access to antiretrovirals and other drug therapies, including
                         prophylaxis and treatment of opportunistic infections and
                         combination antiretroviral therapies.
Local Service Category   Primary Care Office/Clinic Visit is defined as client examination
Definition:              by a qualified Medical Doctor, Nurse Practitioner, and/or
                         Physician‟s Assistant and includes all ancillary services below:
                              Eligibility Screening (as necessary)
                              Patient Medication/Treatment Education
                              Social Services/Case Coordination
                              Medication Access/Linkage
                              Ob/Gyn specialty procedures (as clinically indicated)
                              Nutritional Counseling (as clinically indicated)
                              Laboratory (as clinically indicated)
                              Radiology (as clinically indicated)

                         Medical Care Coordination: Conduct a psychosocial assessment,
                         education and consultation by an LMSW within a system of
                         information, referral, case management, and/or general psychosocial
                                                                                                      36
                            client services.
                            Psychiatry: Provision of outpatient psychiatric care by a Board
                            certified Psychiatrist.
Target Population (age,     African-Americans; targeted contracts must serve at least 75% of the
gender, geographic, race,   targeted population.
ethnicity, etc.):
Services to be Provided:    Services include on site physician, physician extender, nursing,
                            phlebotomy, radiographic, laboratory, pharmacy, intravenous
                            therapy, home health care referral, licensed dietician, patient
                            medication education, and patient care coordination. The
                            agency/clinic must provide continuity of care with inpatient services
                            and subspecialty services (either on-site or through specific referral
                            to appropriate agencies).

                            Community-Based Primary Care must provide:
                               Continuity of care for all stages of adult HIV infection;
                               Laboratory and pharmacy services including intravenous
                                medications (either on-site or through established referral
                                systems);
                               Outpatient psychiatric care, including lab work necessary for
                                the prescribing of psychiatric medications when appropriate
                                (either on-site or through established referral systems);
                               Access to the Texas ADAP program (either on-site or
                                through established referral systems);
                               Access to compassionate use HIV medication programs
                                (either directly or through established referral systems);
                               Access to HIV related research protocols (either directly or
                                through established referral systems);
                               Must at a minimum, comply with the attached Adult
                                Standards for HIV Primary Medical Care Components of
                                Medical Practice. The Contractor must demonstrate on an
                                ongoing basis the ability to provide state-of-the-art HIV-
                                related primary care medicine in accordance with the most
                                recent National Institute of Health (NIH) HIV treatment
                                guidelines. The recent rapid advances in HIV treatment
                                protocols require that the Contractor provide services which
                                to the greatest extent possible maximize a patient‟s
                                opportunity for long-term survival and maintenance of the
                                highest quality of life possible.
                               On-site pelvic exams as needed with appropriate treatment
                                and referral.
                               Nutritional Counseling by a Licensed Dietitian.

                            Nutritional Counseling: Services include provision of information
                            about therapeutic nutritional/supplemental foods that are beneficial
                            to the wellness and increased health conditions of clients by a
                            Licensed Dietitian. Services may be provided either through
                            educational or counseling sessions. Also included in this service are
                            follow up sessions with clients and/or clients‟ Primary Care
                                                                                                     37
Physicians regarding the effectiveness of the services. The number
of sessions for each client shall be determined by a written
assessment conducted by the Licensed Dietitian but may not exceed
twelve (12) sessions per client per contract year. Clients who
receive these services may utilize Ryan White Title I funded Food
Pantries to obtain recommended nutritional supplements.

Patient Medication Education Services must adhere to the
following requirements:
     Educators must be a State Licensed Registered Nurse, a
       Masters Level Mental Health Professional, a licensed
       pharmacist, or have a Bachelor’s degree with at least five
       years of documented paid experience as an HIV/AIDS
       medication educator under a doctor’s supervision.
     Clients must be allowed to form an ongoing relationship
       with the assigned staff member responsible for the
       patient medication education.
     Clients who will be prescribed ongoing medical regimens
       (i.e. protease inhibitors) must be assessed for adherence.
       Clients with adherence issues related to lack of
       understanding must receive more education regarding
       their medical regimen. Clients with adherence issues that
       are behavioral or involve mental health issues must be
       provided counseling by the Medication Educator and
       assessment and treatment by a psychiatrist as clinically
       indicated.

Community-Based Primary Care must also provide Outpatient
Psychiatric Services:
The program must be able to provide:
    Diagnostic Assessments: comprehensive evaluation for
       identification of psychiatric disorders, mental status
       evaluation, differential diagnosis which may involve use of
       other clinical and laboratory tests, case formulation, and
       treatment plans or disposition.
    Emergency Psychiatric Services: rapid evaluation,
       differential diagnosis, acute treatment, crisis intervention,
       and referral. To be available on a 24 hour basis, emergency
       room referral o.k.
    Brief Psychotherapy: individual, supportive, group, couple,
       family, hypnosis, biofeedback, and other
       psychophysiological treatments and behavior modification.
    Psychopharmacotherapy: evaluation and medication
       treatment of psychiatric disorders, including, but not limited
       to, anxiety disorders, major depression, pain syndromes,
       habit control problems, psychosis and organic mental
       disorders.
    Rehabilitation Services: some, but not necessarily all, of the
       following: physical, psychosocial, behavioral, and cognitive
                                                                        38
                                   training.

Service Unit Definition(s): Primary Care: 1 unit of service = 1 primary care office/clinic visit
                            which includes the following:
                             Primary care physician/nurse practitioner/physician‟s assistant
                               examination of the patient
                             Medication/treatment education
                             Social services/care coordination
                             Medication access/linkage
                             Ob/Gyn specialty procedures (as clinically indicated)
                             Nutritional counseling (as clinically indicated)
                             Laboratory (as clinically indicated)
                             Radiology (as clinically indicated, not including CAT scan or
                               MRI)
                             Eligibility verification/screening (as necessary)
                             Follow-up visits wherein the patient is not seen by the
                               MD/NP/PA are considered to be a component of the original
                               primary health care visit that is billed to the County.

                            Outpatient Psychiatric Services: 1 unit of service = A single (1)
                            office/clinic visit wherein the patient is seen by a State licensed and
                            board-eligible Psychiatrist. This visit may or may not occur on the
                            same date as a primary care office visit.

                            Medical Care Coordination: 1 unit of service = 15 minutes of
                            direct client service providing medical care coordination by an
                            LMSW for eligible clients with HIV disease.
Financial Eligibility:      Refer to the RWPC‟s approved Financial Eligibility for Houston
                            EMA Services.
Client Eligibility:          HIV positive, meeting financial requirements listed in Attachment
                            B.
Agency Requirements:        Providers and system must be Medicaid/Medicare certified.
Staff Requirements:         Primary care providers are responsible for ensuring that services
                            are provided by State licensed pediatric, internal medicine and
                            OB/GYN physicians, specialty care physicians, psychiatrists,
                            registered nurses, nurse practitioners, vocational nurses, pharmacists,
                            physician assistants, physician extenders with a colposcopy provider
                            qualification, x-ray technologists, State licensed dieticians, social
                            workers and ancillary health care providers in accordance with
                            appropriate State licensing and/or certification requirements and
                            with knowledge and experience of HIV disease.

                            Medical Director and/or primary physician must be Board
                            certified in Pediatric medicine. Documentation of this
                            requirement must be included in the RFP.

                            Medical Educators must have a BA degree with at least 5 years of
                            paid experience as an HIV/AIDS medication educator under a
                            doctor‟s supervision, or be an RN or a Masters level Mental Health
                                                                                                      39
                        Professional or licensed pharmacist.

                        Outpatient Psychiatric Services: Director of the Program must be
                        a Board Certified Psychiatrist. Licensed and/or Certified allied
                        health professionals (Licensed Psychologists, Physicians, Licensed
                        Master Social Workers, Licensed Professional Counselors, Licensed
                        Marriage and Family Therapists, Certified Alcohol and Drug Abuse
                        Counselors, etc.) must be used in all treatment modalities.
                        Documentation of the Director‟s credentials, licensures and
                        certifications must be included in the proposal. Documentation of
                        the Allied Health professional licensures and certifications must be
                        included in the proposal.

                        Medical Care Coordinator must be an LMSW.
Special Requirements:   Primary Medical Care Services: Services funded under this grant
                        cannot be used to supplant insurance or Medicare/Medicaid
                        reimbursements for such services. Clients eligible for such
                        reimbursement may not be billed to this contract. Medicare and
                        private insurance co-payments are eligible for reimbursement under
                        the contract (in this situation the County will reimburse the client‟s
                        co-payment only, not the cost of the session which must be billed to
                        Medicare and/or the Third party payer). Under no circumstances
                        may the Contractor bill the County for the difference between the
                        reimbursement from Medicaid, Medicare or Third party insurance
                        and the fee schedule under the contract.

                        Furthermore, potential clients who are Medicaid/Medicare eligible
                        or have other 3rd party payers may not be denied services by the
                        Contractor based on their reimbursement status (Medicaid/Medicare
                        eligible clients may not be referred elsewhere in order that non-
                        Medicaid/Medicare eligible clients may be added to this contract).
                        Failure to serve Medicaid/Medicare eligible clients based on their
                        reimbursement status will be grounds for the immediate termination
                        of contract.

                        The following diagnostic procedures are approved by HIV Services:

                        HEP C RNA
                        Bronchoscopy
                        EGD (esophageal gastroduodenoscopy)
                        Flexible Sigmoidoscopy
                        Barium Studies
                        Colposcopies
                        ECHO
                        Stress EKG/EKG- 12 lead
                        CT Scans as dictated by exam and clinical course
                        MRI Scans as dictated by exam and clinical course
                        CAT Scans
                        Upper and Lower GI

                                                                                                 40
Radiological Procedures non-routine chest, cervical spine, lumbar
spine, upper extremities, lower extremities, KUB-abdomen, I.V.P. -
Intravenous Pyleograms, Barium Swallows
Echocardiograms
Lumbar Punctures
Liver Biopsies
Incision/removal of cysts
Gastroscopies
Mammograms
Sonograms
Lumpectomies
Colposcopies
KS Lesion - punch biopsies
These procedures and those not listed above require prior approval
by HIV Services:
Genotypic testing
Phenotypic testing

Outpatient Psychiatric Services: Client must not be eligible for
services from other programs/providers (i.e. MHMRA of Harris
County) or any other reimbursement source (i.e. Medicaid,
Medicare, Private Insurance) unless the client is in crisis and cannot
be provided immediate services from the other programs/providers.
In this case, clients may be provided services, as long as the client
applies for the other programs/providers, until the other
programs/providers can take over services. Program must be
supervised by a Psychiatrist and include diagnostic assessments,
emergency evaluations and psychopharmacotherapy.

All primary care services must meet or exceed current Public Health
Service guidelines for the treatment and management of pediatric
HIV disease.




                                                                         41
HRSA Service Category       Home Health Care
Title:
Local Service Category      Home Health Care
Title:
Revision Date:               4/26/02
Service Category Code:      HS-03
Amount Available:           $245,435.00
Budget Type:                Unit Cost
Budget Requirements or      Maximum allowable unit cost for IV Therapy = $90.00/unit
Restrictions:               Maximum allowable unit cost for Skilled Nursing = $80.00/unit
                            Maximum allowable unit cost for Home Health Aide =
                            $13.00/unit
                            Maximum allowable unit cost for in-home rehabilitation =
                            $80.00/unit
HRSA Service Category       Therapeutic, nursing, supportive and/or compensatory health
Definition:                 services provided by a licensed/certified home-health agency in a
                            home/residential setting in accordance with a written, individualized
                            plan of care established by a case management team that includes
                            appropriate health care professionals. Component services include:
                                 Durable Medical Equipment
                                 Homemaker or home-health aide services and personal care
                                     services
                                 Day treatment or other partial hospitalization services
                                 Intravenous and aerosolized drug therapy, including related
                                     prescription drugs
                                 Routine diagnostic testing administered in the home of the
                                     individual
                                 Appropriate mental health, developmental, and rehabilitation
                                     services
Local Service Category      a. Home Health Care is defined as Physician-ordered skilled
Definition:                 nursing care provided by a Licensed Vocational or Registered Nurse
                            for HIV patients in their place of residency. Physician-ordered
                            intravenous medication therapies must be administered by a
                            qualified home infusion nurse in the patient's home or residential
                            facility. Home Health Aide care is defined as a home visit by a
                            Home Health Aide for the purpose of performing specific tasks to
                            allow the patient to remain in his/her place of residency.
                            b. Rehabilitation Care is defined as physical and/or skilled
                            rehabilitation or palliative care provided to HIV patients in the
                            patient‟s home.
Target Population (age,     HIV-positive individuals residing in the Houston Eligible
gender, geographic, race,   Metropolitan Area (EMA).
ethnicity, etc.):
Services to be Provided:    Skilled Nursing Visits: Services include Medication administration,
                            medication supervision, central line dressing changes, starting
                            intravenous lines, intravenous line and wound dressing changes,
                            phlebotomy services, palliative care services, nutritional support and
                            training (including tube feedings), Foley catheter insertion,
                                                                                                     42
restorative nursing, training of family/significant others in patient
care techniques, ongoing monitoring of patient's physical condition
and communication with attending physician(s). Services must be
initiated within 24 hours of receipt of physician's order. Services
must be available on a 24-hour basis. Provider must coordinate
patient referrals with Harris County Hospital District Thomas Street
Outpatient Home Care Coordinator and other outpatient/ambulatory
health care providers, including inpatient discharge planners.

Intravenous Therapy Visits: Services include intravenous line
initiation (including med-line catheter insertion), management of
central lines, administration and supervision of intravenous
therapies, monitoring of patient's physical condition, and
collaboration with referring physician(s). Services must be available
on a 24-hour basis. Services must be delivered within 48 hours of
receipt of a physician's order. Provider must have a licensed
pharmacist on staff or provide pharmacy services via contract.
Provider must coordinate patient referrals and supplies with Harris
County Hospital District Thomas Street Outpatient Home Care
Coordinator and other outpatient/ambulatory health care providers,
including inpatient discharge planners.

Skilled Rehabilitation: Services may include and are not limited to
diagnostic evaluations, pain management and training/rehabilitation
in the following areas: activities of daily living, neuromuscular
rehabilitation, gait, mobility, speech, language and cognitive
abilities.

Home Health Aide Care: Phone contact must be made with the
patient by the agency within 24 hours of the date of the referral, as a
part of the service delivery process. A home visit with the patient by
the Registered Nurse will be within 72 hours of the referral. The
care plan and consent for service are to be signed during the initial
home visit. Services must be re-evaluated every 60 days by the
Registered Nurse, or more often if necessary, to determine the
adequacy of the care plan. Home health aide services must be
authorized by a licensed physician.

Home Health Aide services include: 1) Personal care assistance,
including bathing, grooming, oral hygiene, shampooing hair and
reminders to take medication; 2) Personal environmental care
includes changing bed linens and light laundry (2 loads); 3) Meal
preparation/feeding/serving/clean-up; 4) Basic communication skills
include talking, listening, recording and observation; 5) RN
assessment/monitoring, supervision of the Home Health Aide.

Guidelines for termination of services: 1) The goal of the service has
been attained; the patient has been rehabilitated to a point where the
patient is able to manage without agency assistance. 2) Three (3)
visits by the Home Health Aide to the patient's home and the patient
                                                                          43
                            is not available for service (does not include hospitalization, medical
                            appointments) and the patient fails to notify the agency to cancel or
                            reschedule the home visit. 3) Patient's behavior becomes abusive,
                            unpredictable or a threat to the employee's health and safety.
                            4) Maintenance of the patient's care can be assumed by capable adult
                            family members or other service providers (TDH, etc.). 5) Patient or
                            patient's family, guardian (power of attorney) requests termination of
                            services. Referring agency will be notified when and the reason why
                            the patient is terminated from service.
Service Unit Definition(s): In-Home Skilled Nursing Care - One unit of service is defined as
                            one (1) skilled nursing visit.
                            In-Home Intravenous Therapy - A unit of service is defined as one
                            (1) in-home intravenous therapy visit.
                            Home Health Aide Care - A unit of service is defined as one (1)
                            hour of home health aide care.
                            Skilled Rehabilitation Care - A unit of service is defined as one (1)
                            hour of Physician-ordered physical therapy and/or skilled
                            rehabilitation service encounter, including palliative care, provided
                            to an HIV-positive patient in the patient's home or place of
                            residence.
Financial Eligibility:      Refer to the RWPC‟s approved Financial Eligibility for Houston
                            EMA Services.
Client Eligibility:         Refer to Attachment B for eligibility requirements. Must be ordered
                            by a qualified medical professional (e.g., physician). Home care
                            eligibility must be based on medical need with an initial assessment
                            conducted by a registered nurse.
Agency Requirements:
                                 The providing agency must be licensed/certified by the
                                     Texas Department of Health and Human Services as a
                                     Home and Community Support Services Agency. The
                                     acceptable documentation for licensure is a copy of the
                                     agency’s current Home and Community Support
                                     Services Agency license from the Texas Department of
                                     Health.
                                 The provider agency must be licensed and certified to seek
                                     reimbursement from Medicare and Medicaid.




                                                                                                      44
Staff Requirements:     Skilled Nursing Services must be provided by a Licensed
                        Vocational or Registered Nurse.
                        Intravenous Therapy must be provided by a qualified home
                        infusion nurse. Agency must have a licensed pharmacist on staff or
                        provide pharmacy services via contract.
                        Home Health Care Services must be provided by individuals
                        appropriately trained and certified in the provision of home health
                        aide services including infection control to HIV patients.
                        Skilled Rehabilitation shall be provided by Licensed Physical
                        Therapists (PT), Licensed PT Assistants, Physical Therapy aides,
                        Registered Occupational Therapists, Certified Occupational Therapy
                        Assistants or Licensed Speech Pathologists. Providers must have
                        documented expertise in providing HIV-specific therapies.
Special Requirements:   None.




                                                                                              45
HRSA Service Category
Title:                      Local Drug Reimbursement Program
Local Service Category      Drug Reimbursement Program
Title:
Revision Date:              05-15-02
Service Category Code:      HS-04
Amount Available:           $2,300,119.00
Budget Type:                Hybrid
Budget Requirements or      The maximum transaction (unit) cost is $58.00 per unit.
Restrictions:               At least 75% of the total amount of the budget must be solely
                            allocated to the actual cost of medications and may not include any
                            storage, administrative, processing or other costs associated with
                            managing the medication inventory or distribution.
HRSA Service Category       A program established, operated, and funded locally by a Title I
Definition:                 EMA or a consortium to expand the number of covered medications
                            available to low-income patients and/or to broaden eligibility beyond
                            that established by a State-operated Title II or other State-funded
                            Drug Reimbursement Program. Medications include prescription
                            drugs provided through ADAP to prolong life or prevent
                            deterioration of health. The definition does not include medications
                            that are dispensed or administered during the course of a regular
                            medical visit or that are considered part of the services provided
                            during that visit. If medications are paid for and dispensed as part of
                            an Emergency Financial Assistance Program, they should be
                            reported as such.
Local Service Category      a. Local Drug Reimbursement Program is defined as a local
Definition:                 (Houston EMA only) drug reimbursement program to provide
                            pharmaceuticals to patients otherwise ineligible for medications
                            through private insurance, Medicaid/Medicare, State ADAP or other
                            sources. Medications available are those in the State ADAP (Levels
                            I and II) and local Medication Plus formularies. Clients are limited
                            to a maximum of $1,500 per month, up to 5 medications per month
                            through this program.

                            b. Non-HIV Medication Needs Program services are defined as
                            reimbursement for provision of non-HIV related medication not
                            already covered under the local drug formulary, not including drugs
                            available free of charge (such as birth control and TB medications).
Target Population (age,     All Ryan White eligible clients in the Houston EMA may participate
gender, geographic, race,   in this program. Priority should be given to serving clients receiving
ethnicity, etc.):           outpatient/ambulatory primary health care funded by Ryan White
                            Title I.

                            Clients‟ prescription must not be covered under the Texas Medicaid
                            program, State ADAP program, or any other third party payer.




                                                                                                      46
Services to be Provided:    Contractor may provide up to 5 HIV medications from an approved
                            formulary for a total of $1,500 per month and provide up to $1,500
                            in non-HIV medications in the course of the contract year per client.
Service Unit Definition(s): A unit of service will consist of a transaction involving the filling of
                            a prescription or any other medication need advised by a physician.
                            The transaction will involve at least one item being provided for the
                            client, but can be any multiple of items.
Financial Eligibility:      HIV positive and 200% of Federal Poverty Guideline for non-HIV
                            medications.
                            HIV positive and 500% of Federal Poverty Guideline for HIV
                            medications.
Client Eligibility:         Client may not be eligible for HIV or Non-HIV medication(s) under
                            the Texas Medicaid Program, State ADAP program, or any other
                            third-party payer.
Agency Requirements:        Agency must either directly, or via subcontract with an
                            eligible 340B Pharmacy program entity, provide the
                            following:
                             A comprehensive financial intake application to
                                determine client eligibility for this program to insure
                                that these funds are used as a last resort for purchase of
                                medications.
                             Regularly scheduled onsite staff at community-based
                                Ryan White Title I primary medical care providers to
                                facilitate the rapid approval of clients‟ applications for
                                medication assistance through the Texas State
                                Medication Program (ADAP) in Austin.
                             Ensure that medication assistance provided to clients
                                does not duplicate services already being provided
                                through Ryan White Title II. The process for
                                accomplishing this must be fully documented in the
                                proposal.
                             Documented capability of interfacing with the Texas
                                State AIDS Drug Assistance Program operated by the
                                Texas Department of Health. This capability must be
                                fully documented in the proposal.
                             Have, either directly or via a 340B Pharmacy Program
                                subcontractor, at least 2 years of continuous
                                documented experience in providing HIV/AIDS
                                medication programs utilizing Ryan White CARE Act
                                or similar public sector funding. This experience must
                                be documented in the proposal. Medications must be
                                purchased through a qualified participant in the 340B
                                Drug Pricing Program and Prime Vendor Program
                                administered by the Health Resources and Services
                                Administration‟s Office of Pharmacy Affairs. This
                                documentation must be included in your proposal
                                appendices. Failure to have 340B or Prime Vendor
                                drug pricing may result in a negative audit finding,
                                                                                                       47
                           cost disallowance or termination of contract awarded.
                           Agency must maintain 340B Program participation
                           throughout the contract term. Failure to maintain
                           340B Program participation may result in a negative
                           audit finding, cost disallowance or termination of any
                           contract issued under this RFP. All eligible
                           medications must be purchased in accord with
                           Program 340B guidelines.
                         Conduct marketing activities with Houston area
                           HIV/AIDS service providers to inform them of this
                           program and how the client referral and enrollment
                           processes function.
                         Provide outreach to HIV-infected PLWH/A of color (e.g.,
                           African American, Hispanic/Latino, Asian, Native American,
                           Pacific Islander) not currently obtaining prescribed HIV and
                           non-HIV medications
Staff Requirements:     None.
Special Requirements:   None.




                                                                                          48
HRSA Service Category       Health Insurance
Title:
Local Service Category      Health Insurance Co-Pays
Title:
Revision Date:              04-25-02
Service Category Code:      HS-05
Amount Available:           $84,464.00
Budget Type):               Hybrid
Budget Requirements or      Maximum allowable unit cost = $8.00/unit.
Restrictions:
                            Contractor must spend no more than 20% of funds on disbursement
                            transactions. The remaining 80% of funds must be expended on the
                            actual cost of the payment(s) disbursed.
HRSA Service Category       A program of financial assistance for eligible individuals with HIV
Definition:                 disease to maintain a continuity of health insurance or to receive
                            medical benefits under a health insurance program, including risk
                            pools.
Local Service Category      A program of financial assistance for the payment of health
Definition:                 insurance deductibles and co-payments to enable eligible individuals
                            with HIV disease to utilize their existing third party or public
                            assistance (e.g. Medicare) medical insurance. Contractor may
                            provide help with client co-payments and deductibles in amounts up
                            to $350 per month.
Target Population (age,     All Ryan White eligible clients with insurance coverage (COBRA,
gender, geographic, race,   private policies, Medicare) within the Houston EMA are to be
ethnicity, etc.):           targeted.
Services to be Provided:    Contractor may provide help with client co-payments and
                            deductibles in amounts up to $350 per month.
Service Unit Definition(s): A unit of service will consist of payment of a co-payment or
                            deductible for an HIV positive person with insurance coverage.
Financial Eligibility:      Refer to the RWPC‟s approved Financial Eligibility for Houston
                            EMA Services.
Client Eligibility:         HIV positive, meeting financial requirements listed in Attachment B.




                                                                                                   49
Agency Requirements:    Agency must:
                         Provide a comprehensive financial intake/application to
                           determine client eligibility for this program to insure that these
                           funds are used as a last resort in order for the client to utilize
                           his/her existing insurance.
                         Ensure that assistance provided to clients does not duplicate
                           services already being provided through Ryan White Title II.
                           The process for accomplishing this must be fully documented in
                           the proposal.
                         Have at least 2 years of continuous documented experience in
                           providing HIV/AIDS insurance assistance programs utilizing
                           Ryan White CARE Act or similar public sector funding.
                         Conduct marketing in-services with Houston area HIV/AIDS
                           service providers to inform them of this program and how the
                           client referral and enrollment processes function.
Staff Requirements:     None
Special Requirements:   None




                                                                                                50
HRSA Service Category       Case Management
Title:
Local Service Category      Case Management Team/Untargeted
Title:
Revision Date:              05-15-02
Service Category Code:      SS-01
Amount Available:           $211,994.00 per team*
                            *Three (3) Untargeted Case Management teams to be awarded
Budget Type:                Unit Cost
Budget Requirements or      A single agency may have no more than 1 targeted and 1 untargeted
Restrictions:               Case Management Team.
                            Maximum allowable unit cost = $14.00/unit.
                            Reimbursement for CPCDMS new client registration = $140.00
                            Reimbursement for CPCDMS registration update = $70.00
HRSA Service Category       A range of client-centered services that links clients with primary
Definition):                medical care, psychosocial and other services to insure timely,
                            coordinated access to medically-appropriate levels of health and
                            support services, continuity of care, ongoing assessment of the
                            client‟s and other family members‟ needs and personal support
                            systems, and inpatient case-management services that prevent
                            unnecessary hospitalization or that expedite discharge, as medically
                            appropriate, from inpatient facilities. Key activities include initial
                            comprehensive assessment of the client‟s needs and personal support
                            systems; development of a comprehensive, individualized service
                            plan; coordination of the services required to implement the plan;
                            client monitoring to assess the efficacy of the plan; and periodic
                            reevaluation and revision of the plan as necessary over the life of the
                            client. May include client-specific advocacy and/or review of
                            utilization of services.
Local Service Category      Identifying and screening clients; assessing each client‟s medical and
Definition:                 psychosocial history and current service needs; developing and
                            regularly updating a service plan based upon the client‟s needs and
                            choices; implementing the plan in a timely manner; providing
                            information, referrals and assistance with linkage to medical and
                            psychosocial services as needed; monitoring the efficacy and quality
                            of services through periodic reevaluation; advocating on behalf of
                            clients to decrease service gaps and remove barriers to services;
                            helping clients develop and utilize independent living skills and
                            strategies.
Target Population (age,     Services will be available to eligible HIV-infected clients residing in
gender, geographic, race,   the Houston EMA with priority given to clients most in need. No
ethnicity, etc.):           eligible client will be refused services. All clients will be served
                            without regard to age, gender, race, color, religion, national origin,
                            sexual orientation, or handicap. Services will target low income
                            individuals with HIV/AIDS who demonstrate multiple medical and
                            psychosocial needs including, but not limited to: primary care,
                            specialized care, alternative treatment, medications, placement in a
                            medical facility, emotional support, mental health counseling,
                                                                                                      51
                            substance abuse treatment, basic needs for food, clothing, and
                            shelter, transportation, legal services and vocational services.
                            Services will also target clients who cannot function in the
                            community due to barriers which include, but are not limited to:
                            extreme lack of knowledge regarding available services, inability to
                            maintain financial independence, inability to complete necessary
                            forms, inability to arrange and complete entitlement and medical
                            appointments, homelessness, deteriorating medical condition,
                            psychiatric illness, illiteracy, language/cultural barriers and/or the
                            absence of speech, sight, hearing, or mobility.
                            Case Managers are to serve eligible clients, especially those
                            underserved or unserved population groups which include: African
                            American, Hispanic/Latino, Women and Children, Veteran,
                            Deaf/Hard of Hearing, Substance Abusers,
                            Gay/Lesbian/Transsexual, and Homeless.
                            For the targeted case management systems, 75% of clients will be in
                            the targeted population. Clients living outside Beltway 8 are defined
                            as rural.
Services to be Provided:    Case Management Team (3 Teams of staff, untargeted): Provision
                            of case management, service linkage, and outreach activities
                            performed by the Case Manager or Service Linkage Worker. Case
                            management is a working agreement between a client and a case
                            manager for a defined period of time based on the client‟s assessed
                            needs. The purpose of case management is to assist clients with the
                            procurement of needed services so that the problems associated with
                            living with HIV are mitigated. Case management is primarily home
                            and community-based. Service linkage is a working agreement
                            between a client and a service linkage worker for a variable period
                            of time, based on client need, during which information, referrals
                            and service linkage are provided on an as-needed basis. The purpose
                            of service linkage is to assist clients who do not require the intensity
                            of a case management relationship, as determined by service need
                            level. Service linkage is primarily office-based.
Service Unit Definition(s): One unit of service is defined as 15 minutes of direct client services
                            and allowable charges.
Financial Eligibility:      Refer to the RWPC‟s approved Financial Eligibility for Houston
                            EMA Services.
Client Eligibility:         HIV positive, meeting financial requirements listed in Attachment B.
Agency Requirements:        Case Management/Service Linkage services will comply with the
                            RWPC Case Management Standards of Care, including linkage to
                            the CPCDMS database.




                                                                                                       52
Staff Requirements:   Case Management Team of 4 F.T.E.:
                      One of the Team Members must function as the designated F.T.E.
                      Supervisor. The designated Supervisor is required to have at least
                      10% direct service time with the clients of the Team. Case
                      Managers/Service Linkage Workers must spend at least 50% (1,040
                      hours per FTE) of their time providing direct case management
                      services. Direct case management services include any activities
                      with a client (face-to-face or by telephone), communication with
                      other service providers or significant others to access client services,
                      monitoring client care, and accompanying clients to services. Case
                      Managers are required to have at least one (1) face-to-face encounter
                      every thirty (30) days with all clients on active status. At least one
                      (1) visit in the clients' natural environment will occur every ninety
                      (90) days. A minimum of one (1) contact by phone every thirty (30)
                      days for all clients who had been case managed prior to being placed
                      on monitor status. Indirect activities include travel to and from a
                      client's residence or agency, staff meetings, supervision, community
                      education, documentation, and computer input. Direct case
                      management activities must be documented in the CPCDMS
                      according to the Case Management/Service Linkage Standards of
                      Care.



                      Must comply with the RWPC Case Management Standards of Care
                      and Position Descriptions. At least one (1) of the Case Manager FTE
                      positions on the Case Management/Service Linkage Team must be
                      fluent in both English and Spanish (both oral and written). Failure to
                      maintain this requirement may be cause for contract termination.



                      Agency must employ full time case managers under this RFP. Prior
                      approval must be obtained from HIV Services to split FTE case
                      management positions among other contracts.



                      Agency must provide to HIV Services the names of each case
                      manager, service linkage worker and supervisor assigned to the case
                      management team. Agency must inform HIV Services in writing of
                      any changes in personnel assigned to contract within seven (7)
                      business days of change.




                                                                                                 53
Special Requirements:          Agency must comply with CPCDMS system business rules and
                               procedures.

                               Agency must perform CPCDMS new client registrations and
                               registration updates for clients needing ongoing case management
                               services as well as those clients on independent status who may only
                               need to establish system of care eligibility.

                               Upon new CPCDMS registration or annual CPCDMS registration
                               update Agency must distribute METRO bus passes to eligible
                               client‟s residing in the METRO service area in accordance with HIV
                               Services policies and procedures, RWPC-approved standards of care
                               and approved financial eligibility guidelines.

Other Allowable Activities - FY 2003

                         Service                             Minutes   Units         Comments
CPCDMS Registration & Intake                                  150       10     New clients only
CPCDMS Update – record owners only                             75       5      Once annually
Psychosocial Assessment – as clinically indicated             120       8      Four times per year cap
Service Plan – as clinically indicated                         60       4      Four times per year cap
Client-specific Supervision - all clients on CM‟s caseload    240       16     Per CM per month
CM trainings provided by designated provider                  Exact            As required by SOC
CM meetings provided by designated provider                   Exact            As required by SOC
CPCDMS trainings                                              Exact            As required




                                                                                                         54
HRSA Service Category       Case Management
Title:
Local Service Category      Team Case Management Targeted to Hispanics
Title:
Revision Date:              05-15-02
Service Category Code:      SS-02
Amount Available:           $211,994.00
Budget Type):               Unit Cost
Budget Requirements or      A single agency may have no more than 1 targeted and 1 untargeted
Restrictions:               Case Management Team.
                            Maximum allowable unit cost = $14.00/unit.
                            Reimbursement for CPCDMS new client registration = $140.00
                            Reimbursement for CPCDMS registration update = $70.00
HRSA Service Category       A range of client-centered services that links clients with primary
Definition):                medical care, psychosocial and other services to insure timely,
                            coordinated access to medically-appropriate levels of health and
                            support services, continuity of care, ongoing assessment of the
                            client‟s and other family members‟ needs and personal support
                            systems, and inpatient case-management services that prevent
                            unnecessary hospitalization or that expedite discharge, as medically
                            appropriate, from inpatient facilities. Key activities include initial
                            comprehensive assessment of the client‟s needs and personal support
                            systems; development of a comprehensive, individualized service
                            plan; coordination of the services required to implement the plan;
                            client monitoring to assess the efficacy of the plan; and periodic
                            reevaluation and revision of the plan as necessary over the life of the
                            client. May include client-specific advocacy and/or review of
                            utilization of services.
Local Service Category      Identifying and screening clients; assessing each client‟s medical and
Definition:                 psychosocial history and current service needs; developing and
                            regularly updating a service plan based upon the client‟s needs and
                            choices; implementing the plan in a timely manner; providing
                            information, referrals and assistance with linkage to medical and
                            psychosocial services as needed; monitoring the efficacy and quality
                            of services through periodic reevaluation; advocating on behalf of
                            clients to decrease service gaps and remove barriers to services;
                            helping clients develop and utilize independent living skills and
                            strategies.
Target Population (age,     Services will be available to eligible HIV-infected clients residing in
gender, geographic, race,   the Houston EMA with priority given to clients most in need. No
ethnicity, etc.):           eligible client will be refused services. All clients will be served
                            without regard to age, gender, race, color, religion, national origin,
                            sexual orientation, or handicap. Services will target low income
                            individuals with HIV/AIDS who demonstrate multiple medical and
                            psychosocial needs including, but not limited to: primary care,
                            specialized care, alternative treatment, medications, placement in a
                            medical facility, emotional support, mental health counseling,
                            substance abuse treatment, basic needs for food, clothing, and
                                                                                                      55
                            shelter, transportation, legal services and vocational services.
                            Services will also target clients who cannot function in the
                            community due to barriers which include, but are not limited to:
                            extreme lack of knowledge regarding available services, inability to
                            maintain financial independence, inability to complete necessary
                            forms, inability to arrange and complete entitlement and medical
                            appointments, homelessness, deteriorating medical condition,
                            psychiatric illness, illiteracy, language/cultural barriers and/or the
                            absence of speech, sight, hearing, or mobility.
                            Case Managers are to serve eligible clients, especially those
                            underserved or unserved population groups which include: African
                            American, Hispanic/Latino, Women and Children, Veteran, Deaf/
                            Hard of Hearing, Substance Abusers, Gay/Lesbian/Transsexual, and
                            Homeless.
                            For the targeted case management systems, 75% of clients will be in
                            the targeted population. Clients living outside Beltway 8 are defined
                            as rural.
Services to be Provided:    Case Management Team targeted to the Hispanic population:
                            Provision of case management, service linkage, and outreach
                            activities performed by the Case Manager or Service Linkage
                            Worker. Case management is a working agreement between a client
                            and a case manager for a defined period of time based on the client‟s
                            assessed needs. The purpose of case management is to assist clients
                            with the procurement of needed services so that the problems
                            associated with living with HIV are mitigated. Case management is
                            primarily home and community-based. Service linkage is a working
                            agreement between a client and a service linkage worker for a
                            variable period of time, based on client need, during which
                            information, referrals and service linkage are provided on an as-
                            needed basis. The purpose of service linkage is to assist clients who
                            do not require the intensity of a case management relationship, as
                            determined by service need level. Service linkage is primarily office-
                            based.
Service Unit Definition(s): One unit of service is defined as 15 minutes of direct client services
                            and allowable charges.
Financial Eligibility:      Refer to the RWPC‟s approved Financial Eligibility for Houston
                            EMA Services.
Client Eligibility:         HIV positive, meeting financial requirements listed in Attachment B.
Agency Requirements:        Case Management/Service Linkage services will comply with
                            RWPC Case Management Standards of Care, including linkage to
                            the CPCDMS database.




                                                                                                     56
Staff Requirements:   Hispanic/Monolingual Case Management Team of 4 F.T.E.:

                      Services to be provided by staff that are bilingual and bicultural.

                      One of the Team Members must function as the designated F.T.E.
                      Supervisor. The designated Supervisor is required to have at least
                      10% direct service time with the clients of the Team. Case
                      Managers/Service Linkage Workers must spend at least 50% (1,040
                      hours per FTE) of their time providing direct case management
                      services. Direct case management services include any activities
                      with a client (face-to-face or by telephone), communication with
                      other service providers or significant others to access client services,
                      monitoring client care, and accompanying clients to services. Case
                      Managers are required to have at least one (1) face-to-face encounter
                      every thirty (30) days with all clients on active status. At least one
                      (1) visit in the clients' natural environment will occur every ninety
                      (90) days. A minimum of one (1) contact by phone every thirty (30)
                      days for all clients who had been case managed prior to being placed
                      on monitor status. Indirect activities include travel to and from a
                      client's residence or agency, staff meetings, supervision, community
                      education, documentation, and computer input. Direct case
                      management activities must be documented in the CPCDMS
                      according to the Case Management Standards of Care.



                      Must comply with the RWPC Case Management Standards of Care
                      and Position Descriptions. All of the Case Manager FTE positions
                      on the Case Management/Service Linkage Team must be fluent in
                      both English and Spanish (both oral and written). Failure to maintain
                      this requirement may be cause for contract termination.


                      Agency must employ full time case managers under this RFP. Prior
                      approval must be obtained from HIV Services to split FTE case
                      management positions among other contracts.


                      Agency must provide to HIV Services the names of each case
                      manager, service linkage worker and supervisor assigned to the case
                      management team. Agency must inform HIV Services in writing of
                      any changes in personnel assigned to contract within seven (7)
                      business days of change.




                                                                                                 57
Special Requirements:          Agency must comply with CPCDMS system business rules and
                               procedures.

                               Agency must perform CPCDMS new client registrations and
                               registration updates for clients needing ongoing case management
                               services as well as those clients on independent status who may only
                               need to establish system of care eligibility.

                               Upon new CPCDMS registration or annual CPCDMS registration
                               update Agency must distribute METRO bus passes to eligible
                               client‟s residing in the METRO service area in accordance with HIV
                               Services policies and procedures, RWPC-approved standards of care
                               and approved financial eligibility guidelines.

Other Allowable Activities - FY 2003

                         Service                             Minutes   Units         Comments
CPCDMS Registration & Intake                                  150       10     New clients only
CPCDMS Update – record owners only                             75       5      Once annually
Psychosocial Assessment – as clinically indicated             120       8      Four times per year cap
Service Plan – as clinically indicated                         60       4      Four times per year cap
Client-specific Supervision - all clients on CM‟s caseload    240       16     Per CM per month
CM trainings provided by designated provider                  Exact            As required by SOC
CM meetings provided by designated provider                   Exact            As required by SOC
CPCDMS trainings                                              Exact            As required




                                                                                                         58
HRSA Service Category       Case Management
Title:
Local Service Category
Title:                      Case Management Team Targeted to African Americans
Revision Date:               05-15-02
Service Category Code:      SS-03
Amount Available:           $265,552.00 ($133,826.00 MAI funds)
Budget Type):               Unit Cost
Budget Requirements or      100% of MAI funds must be spent on African American clients.
Restrictions:               A single agency may have no more than 1 targeted and 1 untargeted
                            Case Management Team.
                            Maximum allowable unit cost = $14.00/unit.
                            Reimbursement for CPCDMS new client registration = $140.00
                            Reimbursement for CPCDMS registration update = $70.00
HRSA Service Category       A range of client-centered services that links clients with primary
Definition:                 medical care, psychosocial and other services to insure timely,
                            coordinated access to medically-appropriate levels of health and
                            support services, continuity of care, ongoing assessment of the
                            client‟s and other family members‟ needs and personal support
                            systems, and inpatient case-management services that prevent
                            unnecessary hospitalization or that expedite discharge, as medically
                            appropriate, from inpatient facilities. Key activities include initial
                            comprehensive assessment of the client‟s needs and personal support
                            systems; development of a comprehensive, individualized service
                            plan; coordination of the services required to implement the plan;
                            client monitoring to assess the efficacy of the plan; and periodic
                            reevaluation and revision of the plan as necessary over the life of the
                            client. May include client-specific advocacy and/or review of
                            utilization of services.
Local Service Category      Identifying and screening clients; assessing each client‟s medical and
Definition:                 psychosocial history and current service needs; developing and
                            regularly updating a service plan based upon the client‟s needs and
                            choices; implementing the plan in a timely manner; providing
                            information, referrals and assistance with linkage to medical and
                            psychosocial services as needed; monitoring the efficacy and quality
                            of services through periodic reevaluation; advocating on behalf of
                            clients to decrease service gaps and remove barriers to services;
                            helping clients develop and utilize independent living skills and
                            strategies.
Target Population (age,     Services will be available to eligible HIV-infected clients residing in
gender, geographic, race,   the Houston EMA with priority given to clients most in need. No
ethnicity, etc.):           eligible client will be refused services. All clients will be served
                            without regard to age, gender, race, color, religion, national origin,
                            sexual orientation, or handicap. Services will target low income
                            individuals with HIV/AIDS who demonstrate multiple medical and
                            psychosocial needs including, but not limited to: primary care,
                            specialized care, alternative treatment, medications, placement in a
                            medical facility, emotional support, mental health counseling,
                                                                                                      59
                            substance abuse treatment, basic needs for food, clothing, and
                            shelter, transportation, legal services and vocational services.
                            Services will also target clients who cannot function in the
                            community due to barriers which include, but are not limited to:
                            extreme lack of knowledge regarding available services, inability to
                            maintain financial independence, inability to complete necessary
                            forms, inability to arrange and complete entitlement and medical
                            appointments, homelessness, deteriorating medical condition,
                            psychiatric illness, illiteracy, language/cultural barriers and/or the
                            absence of speech, sight, hearing, or mobility.
                            Case Managers are to serve eligible clients, especially those
                            underserved or unserved population groups which include: African
                            American, Hispanic/Latino, Women and Children, Veteran, Deaf/
                            Hard of Hearing, Substance Abusers, Gay/Lesbian/Transsexual, and
                            Homeless.
                            For the targeted case management systems, 75% of clients will be in
                            the targeted population. Clients living outside Beltway 8 are defined
                            as rural.
Services to be Provided:    Case Management Team targeted to the African American
                            population: Provision of case management, service linkage, and
                            outreach activities performed by the Case Manager or Service
                            Linkage Worker. Case management is a working agreement between
                            a client and a case manager for a defined period of time based on the
                            client‟s assessed needs. The purpose of case management is to assist
                            clients with the procurement of needed services so that the problems
                            associated with living with HIV are mitigated. Case management is
                            primarily home and community-based. Service linkage is a working
                            agreement between a client and a service linkage worker for a
                            variable period of time, based on client need, during which
                            information, referrals and service linkage are provided on an as-
                            needed basis. The purpose of service linkage is to assist clients who
                            do not require the intensity of a case management relationship, as
                            determined by service need level. Service linkage is primarily office-
                            based.
Service Unit Definition(s): One unit of service is defined as 15 minutes of direct client services
                            and allowable charges.
Financial Eligibility:      Refer to the RWPC‟s approved Financial Eligibility for Houston
                            EMA Services.
Client Eligibility:         HIV positive, meeting financial requirements listed in Attachment B.
Agency Requirements:        Case Management/Service Linkage services will comply with
                            RWPC Case Management Standards of Care , including linkage to
                            the CPCDMS database.




                                                                                                     60
Staff Requirements:   Case Management Team of 5 FTEs Targeting African
                      Americans

                      Services to be provided by a staff who is culturally sensitive to this
                      population. One of the 5 FTEs must target African American men
                      who have sex with men.

                      One of the Team Members must function as the designated F.T.E.
                      Supervisor. The designated Supervisor is required to have at least
                      10% direct service time with the clients of the Team. Case
                      Managers/Service Linkage Workers must spend at least 50% (1,040
                      hours per FTE) of their time providing direct case management
                      services. Direct case management services include any activities
                      with a client (face-to-face or by telephone), communication with
                      other service providers or significant others to access client services,
                      monitoring client care, and accompanying clients to services. Case
                      Managers are required to have at least one (1) face-to-face encounter
                      every thirty (30) days with all clients on active status. At least one
                      (1) visit in the clients' natural environment will occur every ninety
                      (90) days. A minimum of one (1) contact by phone every thirty (30)
                      days for all clients who had been case managed prior to being placed
                      on monitor status. Indirect activities include travel to and from a
                      client's residence or agency, staff meetings, supervision, community
                      education, documentation, and computer input. Direct case
                      management activities must be documented in the Uniform
                      Reporting System (CPCDMS) according to the Case
                      Management/Service Linkage Standards of Care.

                      Must comply with the RWPC Case Management Standards of Care
                      and Position Descriptions. At least one (1) of the Case Manager FTE
                      positions on the Case Management/Service Linkage Team must be
                      fluent in both English and Spanish (both oral and written). Failure to
                      maintain this requirement may be cause for contract termination.

                      Agency must employ full time case managers under this RFP. Prior
                      approval must be obtained from HIV Services to split FTE case
                      management positions among other contracts.


                      Agency must provide to HIV Services the names of each case
                      manager, service linkage worker and supervisor assigned to the case
                      management team. Agency must inform HIV Services in writing of
                      any changes in personnel assigned to contract within seven (7)
                      business days of change.




                                                                                                 61
Special Requirements:          Agency must comply with CPCDMS system business rules and
                               procedures.

                               Agency must perform CPCDMS new client registrations and
                               registration updates for clients needing ongoing case management
                               services as well as those clients on independent status who may only
                               need to establish system of care eligibility.

                               Upon new CPCDMS registration or annual CPCDMS registration
                               update Agency must distribute METRO bus passes to eligible
                               client‟s residing in the METRO service area in accordance with HIV
                               Services policies and procedures, RWPC-approved standards of care
                               and approved financial eligibility guidelines.

Other Allowable Activities - FY 2003

                         Service                             Minutes   Units         Comments
CPCDMS Registration & Intake                                  150       10     New clients only
CPCDMS Update – record owners only                             75       5      Once annually
Psychosocial Assessment – as clinically indicated             120       8      Four times per year cap
Service Plan – as clinically indicated                         60       4      Four times per year cap
Client-specific Supervision - all clients on CM‟s caseload    240       16     Per CM per month
CM trainings provided by designated provider                  Exact            As required by SOC
CM meetings provided by designated provider                   Exact            As required by SOC
CPCDMS trainings                                              Exact            As required




                                                                                                         62
HRSA Service Category       Case Management
Title:
Local Service Category      Case Management Team Targeted to Rural
Title:
Revision Date:              05-15-02
Service Category Code:      SS-04
Amount Available:           $218,696.00
Budget Type:                Unit Cost
Budget Requirements or      A single agency may have no more than 1 targeted and 1 untargeted
Restrictions:               Case Management Team.
                            Maximum allowable unit cost = $14.50/unit.
                            Reimbursement for CPCDMS new client registration = $140.00
                            Reimbursement for CPCDMS registration update = $70.00
HRSA Service Category       A range of client-centered services that links clients with primary
Definition:                 medical care, psychosocial and other services to insure timely,
                            coordinated access to medically-appropriate levels of health and
                            support services, continuity of care, ongoing assessment of the
                            client‟s and other family members‟ needs and personal support
                            systems, and inpatient case-management services that prevent
                            unnecessary hospitalization or that expedite discharge, as medically
                            appropriate, from inpatient facilities. Key activities include initial
                            comprehensive assessment of the client‟s needs and personal support
                            systems; development of a comprehensive, individualized service
                            plan; coordination of the services required to implement the plan;
                            client monitoring to assess the efficacy of the plan; and periodic
                            reevaluation and revision of the plan as necessary over the life of the
                            client. May include client-specific advocacy and/or review of
                            utilization of services.
Local Service Category      Identifying and screening clients; assessing each client‟s medical and
Definition:                 psychosocial history and current service needs; developing and
                            regularly updating a service plan based upon the client‟s needs and
                            choices; implementing the plan in a timely manner; providing
                            information, referrals and assistance with linkage to medical and
                            psychosocial services as needed; monitoring the efficacy and quality
                            of services through periodic reevaluation; advocating on behalf of
                            clients to decrease service gaps and remove barriers to services;
                            helping clients develop and utilize independent living skills and
                            strategies.
Target Population (age,     Services will be available to eligible HIV-infected clients residing in
gender, geographic, race,   the Houston EMA with priority given to clients most in need. No
ethnicity, etc.):           eligible client will be refused services. All clients will be served
                            without regard to age, gender, race, color, religion, national origin,
                            sexual orientation, or handicap. Services will target low income
                            individuals with HIV/AIDS who demonstrate multiple medical and
                            psychosocial needs including, but not limited to: primary care,
                            specialized care, alternative treatment, medications, placement in a
                            medical facility, emotional support, mental health counseling,
                            substance abuse treatment, basic needs for food, clothing, and
                                                                                                      63
                            shelter, transportation, legal services and vocational services.
                            Services will also target clients who cannot function in the
                            community due to barriers which include, but are not limited to:
                            extreme lack of knowledge regarding available services, inability to
                            maintain financial independence, inability to complete necessary
                            forms, inability to arrange and complete entitlement and medical
                            appointments, homelessness, deteriorating medical condition,
                            psychiatric illness, illiteracy, language/cultural barriers and/or the
                            absence of speech, sight, hearing, or mobility.
                            Case Managers are to serve eligible clients, especially those
                            underserved or unserved population groups which include: African
                            American, Hispanic/Latino, Women and Children, Veteran,
                            Deaf/Hard of Hearing, Substance Abusers,
                            Gay/Lesbian/Transsexual, and Homeless.
                            For the targeted case management systems, 75% of clients will be in
                            the targeted population. Clients living outside Beltway 8 are defined
                            as rural.
Services to be Provided:    Case Management Team targeted to the rural population: (Provision
                            of) case management, service linkage, and outreach activities
                            performed by the Case Manager or Service Linkage Worker. Case
                            management is a working agreement between a client and a case
                            manager for a defined period of time based on the client‟s assessed
                            needs. The purpose of case management is to assist clients with the
                            procurement of needed services so that the problems associated with
                            living with HIV are mitigated. Case management is primarily home
                            and community-based. Service linkage is a working agreement
                            between a client and a service linkage worker for a variable period
                            of time, based on client need, during which information, referrals
                            and service linkage are provided on an as-needed basis. The purpose
                            of service linkage is to assist clients who do not require the intensity
                            of a case management relationship, as determined by service need
                            level. Service linkage is primarily office-based.
Service Unit Definition(s): One unit of service is defined as 15 minutes of direct client services
                            and allowable charges.
Financial Eligibility:      Refer to the RWPC‟s approved Financial Eligibility for Houston
                            EMA Services.
Client Eligibility:         HIV positive, meeting financial requirements listed in Attachment B.
Agency Requirements:        Case Management/Service Linkage services will comply with
                            RWPC Case Management Standards for Care , including linkage to
                            the CPCDMS database.
Staff Requirements:         Case Management Team of 4 F.T.E. targeted to clients living
                            outside Beltway 8:

                             One of the Team Members must function as the designated F.T.E.
                             Supervisor. The designated Supervisor is required to have at least
                             10% direct service time with the clients of the Team. Case
                             Managers/Service Linkage Workers must spend at least 50% (1,040
                             hours per FTE) of their time providing direct case management
                             services. Direct case management services include any activities
                                                                                                       64
with a client (face-to-face or by telephone), communication with
other service providers or significant others to access client services,
monitoring client care, and accompanying clients to services. Case
Managers are required to have at least one (1) face-to-face encounter
every thirty (30) days with all clients on active status. At least one
(1) visit in the clients' natural environment will occur every ninety
(90) days. A minimum of one (1) contact by phone every thirty (30)
days for all clients who had been case managed prior to being placed
on monitor status. Indirect activities include travel to and from a
client's residence or agency, staff meetings, supervision, community
education, documentation, and computer input. Direct case
management activities must be documented in the CPCDMS
according to the Case Management Standards of Care.



Must comply with RWPC Case Management Standards of Care and
Position Descriptions. At least one (1) of the Case Manager FTE
positions on the Case Management/Service Linkage Team must be
fluent in both English and Spanish (both oral and written). Failure to
maintain this requirement may be cause for contract termination.
Case Management/Service Linkage staff must have at least one year
of paid HIV/AIDS experience.



Agency must employ full time case managers under this RFP. Prior
approval must be obtained from HIV Services to split FTE case
management positions among other contracts.



Agency must provide to HIV Services the names of each case
manager, service linkage worker and supervisor assigned to the case
management team. Agency must inform HIV Services in writing of
any changes in personnel assigned to contract within seven (7)
business days of change.




                                                                           65
Special Requirements:          Agency must comply with CPCDMS system business rules and
                               procedures.

                               Agency must perform CPCDMS new client registrations and
                               registration updates for clients needing ongoing case management
                               services as well as those clients on independent status who may only
                               need to establish system of care eligibility.

                               Upon new CPCDMS registration or annual CPCDMS registration
                               update Agency must distribute METRO bus passes to eligible clients
                               residing in the METRO service area in accordance with HIV
                               Services policies and procedures, RWPC-approved standards of care
                               and approved financial eligibility guidelines.

                               Agency must distribute gasoline vouchers to eligible clients residing
                               in the rural service area in accordance with HIV Services policies
                               and procedures, RWPC-approved standards of care and approved
                               financial eligibility guidelines.

Other Allowable Activities - FY 2003

                         Service                             Minutes   Units         Comments
CPCDMS Registration & Intake                                  150       10     New clients only
CPCDMS Update – record owners only                             75       5      Once annually
Psychosocial Assessment – as clinically indicated             120       8      Four times per year cap
Service Plan – as clinically indicated                         60       4      Four times per year cap
Client-specific Supervision - all clients on CM‟s caseload    240       16     Per CM per month
CM trainings provided by designated provider                  Exact            As required by SOC
CM meetings provided by designated provider                   Exact            As required by SOC
CPCDMS trainings                                              Exact            As required




                                                                                                         66
HRSA Service Category       Case Management
Title:
Local Service Category      Medical Case Management Team Targeted to African American
Title:                      Women and Children
Revision Date:              05-15-02
Service Category Code:      SS-05
Amount Available):          $294,196.00
Budget Type:                Unit Cost
Budget Requirements or      A single agency may have no more than 1 targeted and 1 untargeted
Restrictions:               Case Management Team.
                            Maximum allowable unit cost = $14.00/unit.
                            Reimbursement for CPCDMS new client registration = $140.00
                            Reimbursement for CPCDMS registration update = $70.00
HRSA Service Category       A range of client-centered services that links clients with primary
Definition:                 medical care, psychosocial and other services to insure timely,
                            coordinated access to medically-appropriate levels of health and
                            support services, continuity of care, ongoing assessment of the
                            client‟s and other family members‟ needs and personal support
                            systems, and inpatient case-management services that prevent
                            unnecessary hospitalization or that expedite discharge, as medically
                            appropriate, from inpatient facilities. Key activities include initial
                            comprehensive assessment of the client‟s needs and personal support
                            systems; development of a comprehensive, individualized service
                            plan; coordination of the services required to implement the plan;
                            client monitoring to assess the efficacy of the plan; and periodic
                            reevaluation and revision of the plan as necessary over the life of the
                            client. May include client-specific advocacy and/or review of
                            utilization of services.
Local Service Category      Identifying and screening clients; assessing each client‟s medical and
Definition:                 psychosocial history and current service needs; developing and
                            regularly updating a service plan based upon the client‟s needs and
                            choices; implementing the plan in a timely manner; providing
                            information, referrals and assistance with linkage to medical and
                            psychosocial services as needed; monitoring the efficacy and quality
                            of services through periodic reevaluation; advocating on behalf of
                            clients to decrease service gaps and remove barriers to services;
                            helping clients develop and utilize independent living skills and
                            strategies.
Target Population (age,     Services will be available to eligible HIV-infected clients residing in
gender, geographic, race,   the Houston EMA with priority given to clients most in need. No
ethnicity, etc.):           eligible client will be refused services. All clients will be served
                            without regard to age, gender, race, color, religion, national origin,
                            sexual orientation, or handicap. Services will target low income
                            individuals with HIV/AIDS who demonstrate multiple medical and
                            psychosocial needs including, but not limited to: primary care,
                            specialized care, alternative treatment, medications, placement in a
                            medical facility, emotional support, mental health counseling,
                            substance abuse treatment, basic needs for food, clothing, and
                                                                                                      67
                            shelter, transportation, legal services and vocational services.
                            Services will also target clients who cannot function in the
                            community due to barriers which include, but are not limited to:
                            extreme lack of knowledge regarding available services, inability to
                            maintain financial independence, inability to complete necessary
                            forms, inability to arrange and complete entitlement and medical
                            appointments, homelessness, deteriorating medical condition,
                            psychiatric illness, illiteracy, language/cultural barriers and/or the
                            absence of speech, sight, hearing, or mobility.
                            Case Managers are to serve eligible clients, especially those
                            underserved or unserved population groups which include: African
                            American, Hispanic/Latino, Women and Children, Veteran,
                            Deaf/Hard of Hearing, Substance Abusers,
                            Gay/Lesbian/Transsexual, and Homeless.
                            For the targeted case management systems, 75% of clients will be in
                            the targeted population. Clients living outside Beltway 8are defined
                            as rural.
Services to be Provided:    Case Management Team targeted to African American Women and
                            Children: (Provision of) case management, service linkage, and
                            outreach activities performed by the Case Manager or Service
                            Linkage Worker. Case management is a working agreement
                            between a client and a case manager for a defined period of time
                            based on the client‟s assessed needs. The purpose of case
                            management is to assist clients with the procurement of needed
                            services so that the problems associated with living with HIV are
                            mitigated. Case management is primarily home and community-
                            based. Service linkage is a working agreement between a client and
                            a service linkage worker for a variable period of time, based on
                            client need, during which information, referrals and service linkage
                            are provided on an as-needed basis. The purpose of service linkage
                            is to assist clients who do not require the intensity of a case
                            management relationship, as determined by service need level.
                            Service linkage is primarily office-based.
Service Unit Definition(s): One unit of service is defined as 15 minutes of direct client services
                            and allowable charges.
Financial Eligibility:      Refer to the RWPC‟s approved Financial Eligibility for Houston
                            EMA Services.
Client Eligibility:         HIV positive, meeting financial requirements listed in Attachment B.
Agency Requirements:        Case Management services will comply with RWPC Case
                            Management Standards of Care, including linkage to the CPCDMS
                            database.




                                                                                                     68
Staff Requirements:   Medical Case Management Team of 5 F.T.E.:
                      One of the Team Members must function as the designated F.T.E.
                      Supervisor. The designated Supervisor is required to have at least
                      10% direct service time with the clients of the Team. Case
                      Managers/Service Linkage Workers must spend at least 50% (1,040
                      hours per FTE) of their time providing direct case management
                      services. Direct case management services include any activities
                      with a client (face-to-face or by telephone), communication with
                      other service providers or significant others to access client services,
                      monitoring client care, and accompanying clients to services. Case
                      Managers are required to have at least one (1) face-to-face encounter
                      every thirty (30) days with all clients on active status. At least one
                      (1) visit in the clients' natural environment will occur every ninety
                      (90) days. A minimum of one (1) contact by phone every thirty (30)
                      days for all clients who had been case managed prior to being placed
                      on monitor status. Indirect activities include travel to and from a
                      client's residence or agency, staff meetings, supervision, community
                      education, documentation, and computer input. Direct case
                      management activities must be documented in the CPCDMS
                      according to the Case Management Standards of Care.



                      Must comply with the RWPC Case Management Standards of Care
                      and Position Descriptions. At least one (1) of the Case Manager FTE
                      positions on the Case Management/Service Linkage Team must be
                      fluent in both English and Spanish (both oral and written). Failure to
                      maintain this requirement may be cause for contract termination.
                      Case Management/Service Linkage staff must have at least one year
                      of paid HIV/AIDS experience.

                      Medical Case Management Team targeting AA women/children.
                      The focus of the Medical Case Management Team concept will be to
                      provide short-term intensive intervention by a team of case managers
                      which will address service linkage, medical needs and psychosocial
                      needs depending on client need followed by long-term availability of
                      information, referrals and intermittent interventions, if required.
                      Clients at all levels of need will be served. This project will provide
                      case management services through a team approach that integrates
                      service linkage, case management, medical assessment and
                      consultation and supervision.
                      Psychosocial Assessment and Consultation: To be performed
                      through the participation (either directly or via consultation) of the
                      Registered Nurse CPCDMS member of the Team:
                      Client assessments: Develop a service plan for each client and
                      ensure its implementation; Home visits; Interaction and advocacy
                      with medical providers on behalf of clients; Monitor medical
                      services accessed by clients and follow-up as needed; Transition
                      clients out of medical case management upon completion of medical
                                                                                                 69
                        service plan and medical stabilization; Medical Assessment and
                        Consultation

                        Minimum Personnel Requirements for Medical staff member of the
                        Team:
                        LMSW or BSN/RN with two (2) years paid health care
                        experience, with at least one of those years of experience in the
                        field of HIV/AIDS.
                        Any deviations from the Case Management Standards of Care
                        needed to accommodate the Medical Case Management Team
                        concept will require prior written approval from the Manager of HIV
                        Services or designee.


                        Agency must employ full time case managers under this RFP. Prior
                        approval must be obtained from HIV Services to split FTE case
                        management positions among other contracts.


                        Agency must provide to HIV Services the names of each case
                        manager, medical case manager, service linkage worker and
                        supervisor assigned to the case management team. Agency must
                        inform HIV Services in writing of any changes in personnel assigned
                        to contract within seven (7) business days of change.
Special Requirements:   Agency must comply with CPCDMS system business rules and
                        procedures.

                        Agency must perform CPCDMS new client registrations and
                        registration updates for clients needing ongoing case management
                        services as well as those clients on independent status who may only
                        need to establish system of care eligibility.

                        Upon new CPCDMS registration or annual CPCDMS registration
                        update Agency must distribute METRO bus passes to eligible
                        client‟s residing in the METRO service area in accordance with HIV
                        Services policies and procedures, RWPC-approved standards of care
                        and approved financial eligibility guidelines.




                                                                                               70
Other Allowable Activities - FY 2003

                               Service                             Minutes   Units         Comments
      CPCDMS Registration & Intake                                  150       10     New clients only
      CPCDMS Update – record owners only                             75       5      Once annually
      Psychosocial Assessment – as clinically indicated             120       8      Four times per year cap
      Service Plan – as clinically indicated                         60       4      Four times per year cap
      Client-specific Supervision - all clients on CM‟s caseload    240       16     Per CM per month
      CM trainings provided by designated provider                  Exact            As required by SOC
      CM meetings provided by designated provider                   Exact            As required by SOC
      CPCDMS trainings                                              Exact            As required




                                                                                                               71
HRSA Service Category         Outreach Services
Title:
Local Service Category        Outreach Targeting African American
Title:
Revision Date:                04/19/02
Service Category Code:        SS-06
Amount Available:             $50,829.00
Budget Type:                  Unit Cost
Budget Requirements or        MAI funds
Restrictions:                 Maximum unit cost = $14.00 per unit.
                              100% of funds must be expended on African American clients.
HRSA Service Category         Programs which have as their principal purpose identifying people
Definition):                  with HIV disease so that they may become aware of and may be
                              enrolled in care and treatment services. Outreach services do not
                              include HIV counseling and testing nor HIV-prevention education.
                              Outreach services 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 HIV-infected individuals will be reached, and be designed with
                              quantified program reporting that will accommodate local
                              effectiveness evaluation. Broad marketing of the availability of
                              health-care services for PLWH should be prioritized and funded as
                              Planning Council or Consortium supported activities.
Local Service Category        A program that identifies HIV-infected individuals who are newly
Definition:                   diagnosed and/or not in care in order that these individuals may
                              become enrolled in healthcare and support services (not HIV
                              counseling and testing nor prevention education). Agency shall assist
                              clients in securing and completing required documentation to become
                              eligible for medical, prescription/drug and other support services.
Target Population (age,       African American HIV-positive individuals living within the
gender, geographic, race,     Houston Eligible Metropolitan Area (EMA), especially the recently
ethnicity, etc.):             released, youth and MSM.
Services to be Provided:      Services to be provided include: 1.) Making appropriate referrals
                              within the HIV Care System, 2.) Working with clients to fill out
                              appropriate forms and obtain documentation in order for the client to
                              be eligible for medical, prescription/drug, and other support services.
Service Unit Definition(s):   One unit of service = 15 minutes of direct client services.

Financial Eligibility:        Refer to the RWPC‟s approved Financial Eligibility for Houston
                              EMA Services.




                                                                                                        72
Client Eligibility:          HIV-positive individuals residing in the Houston EMA and who
                             have not previously been registered in the CPCDMS data system or
                             whose registration has been expired for more than 180 days. HIV-
                             infected homeless and soon-to-be-released individuals with no
                             permanent address are eligible for outreach services.
Agency Requirements:         Agency must document:
                              1. Established linkages with agencies that serve HIV-infected men,
                                  women, adolescents and children.
                              2. Cultural sensitivity training for program staff.
                              3. Training dealing with the needs of adolescents, women and
                                  children (i.e. transportation, daycare, power issues within
                                  relationships).
Staff Requirements:          All Outreach Workers are required to attend the Planning Council‟s
                             designated Case Management training.
Special Requirements:        Agency may work with incarcerated individuals within 60 days of
                             release.
                             Eligible clients identified in Outreach efforts must be transferred to a
                             Ryan White or TDH funded case manager within 60 days of
                             registration in the CPCDMS.

Other Allowable Activities - FY 2003

                        Service                          Minutes     Units         Comments
CPCDMS Registration & Intake                               150        10     New clients only
Basic Assessment – one per client                           60         4     Once per client
CM trainings provided by designated provider              Exact              As required by SOC
CM meetings provided by designated provider               Exact              As required by SOC
CPCDMS trainings                                          Exact              As required




                                                                                                        73
HRSA Service Category       Early Intervention Services (EIS)
Title:
Local Service Category      Early Intervention Services (EIS) Targeting Youth
Title:
Revision Date:               05-15-02
Service Category Code:      SS-07
Amount Available:           $83,886.00
Budget Type:
                             Unit Cost
Budget Requirements or      A single agency must deploy 2 FTEs – one FTE must be bilingual
Restrictions:               (English/Spanish). The EIS workers must serve at least 80
                            unduplicated clients. Maximum unit cost is $18.00/unit. The cost
                            of providing documentation for identification (e.g., Texas ID card)
                            must be incorporated into the unit cost.
HRSA Service Category       Counseling, testing, and referral services to PLWH who know their
Definition:                 status but are not in primary medical care or who are recently
                            diagnosed and are not in primary medical care for the purpose of
                            facilitating access to HIV-related health services.
Local Service Category      Counseling, testing, and referral activities designed to bring HIV
Definition:                 positive youth into the local HIV continuum of care. The goal is to
                            decrease the number of underserved youth with HIV/AIDS while
                            increasing their access to the local continuum of care by providing:
                            Blood test results that identify HIV status earlier in the progression
                            of the disease; age appropriate information and education on living
                            with HIV disease and managing therapeutic regimens; counseling on
                            modifying behaviors that compromise own or other‟s health status;
                            referrals to appropriate prevention and risk reduction programs and
                            to primary care or case management for those testing positive;
                            referrals to prevention programs for high risk individuals who test
                            negative; help for clients in obtaining documentation required for
                            eligibility; strategies regarding disclosure of HIV status to family.
                            Program must be inclusive of rural areas of the Houston EMA. EIS
                            worker must be able to travel to all points of entry in the EMA
                            where HIV positive youth not in care have been identified.

Target Population (age,     At-risk youth: ages 13-18 & 19-24
gender, geographic, race,
ethnicity, etc.):




                                                                                                     74
Services to be Provided:    1. HIV testing;
                            2. Information on living with HIV disease and managing
                                therapeutic regimens;
                            3. Counseling on modifying behaviors that compromise own or
                                other‟s health status;
                            4. Procurement of identification documentation necessary for
                                eligibility;
                            5. Referrals to appropriate prevention and risk reduction programs
                                and to primary care or case management for those testing
                                positive;
                            6. Referrals to prevention programs for high-risk individuals who
                                test negative;
                            7. An individual client may receive EIS services for a maximum of
                                6 months.
Service Unit Definition(s): One unit of service = 15 minutes of direct client services.

Financial Eligibility:      Refer to the RWPC‟s approved Financial Eligibility for Houston
                            EMA Services.
Client Eligibility:         HIV positive youth ages 13 – 24.
Agency Requirements:        1. Must have documented formal collaborations with early
                                intervention sites, HIV counseling and testing sites, and other
                                sites where newly diagnosed PLWH are routinely identified;
                            2. Must secure training from the Ryan White Case Management
                                training provider for both EIS workers;
                            3. A Registered Nurse (RN) or more qualified medical professional
                                with at least 2 years HIV-related experience must review
                                curriculum.
                            4. Services must be consistent with CDC guidelines for counseling,
                                testing and referral;
                            5. Post-test counseling must place an emphasis on the individual‟s
                                responsibility to inform their sex partner and/or injection drug
                                equipment sharing partners about their status in order to reduce
                                transmission;
                            6. Establish referral relationships to be maintained by EIS provider
                                that include a mechanism for receiving feedback from health and
                                social support service providers to which clients are referred.
Staff Requirements:         2 FTE‟s – one must be bilingual (English/Spanish). Must have
                            reliable transportation, valid driver‟s license and good driving
                            record. Minimum of 2 years direct client experience working with
                            at-risk youth (at least age 13-19) and health service experience or
                            appropriate HIV training. Must attend the Planning Council‟s
                            designated case management training.




                                                                                                   75
Special Requirements:        Agency must have the capability to obtain appropriate lab work for
                             clients as necessary to implement program.

Other Allowable Activities - FY 2003

                        Service                        Minutes    Units         Comments
CPCDMS Registration & Intake                              150       10    New clients only
Basic Assessment – one per client                         60        4     Once per client
CM trainings provided by designated provider             Exact            As required by SOC
CM meetings provided by designated provider              Exact            As required by SOC
CPCDMS trainings                                         Exact            As required




                                                                                                  76
HRSA Service Category         Health Education/Risk Reduction
Title:
Local Service Category
Title:                        Health Education and Risk Reduction – Targeted to African
                              Americans
Revision Date:                04/19/02
Service Category Code:        SS-08
Amount Available:             $145,070.00
Budget Type:                  Unit Cost
Budget Requirements or        MAI funds - 100% of these funds must be spent on African
Restrictions:                 American clients.

                              Maximum allowable unit cost is $30.00 unit.

                              An HE/RR course must have at least three (3) eligible HIV-positive
                              individuals in attendance in order to be reimbursed by the County.
HRSA Service Category         Provision of information, including the dissemination about medical
Definition:                   and psychosocial support services and counseling or
                              preparation/distribution of materials in the context of medical and
                              psychosocial support services to educate clients with HIV about
                              methods to reduce the spread of HIV.
Local Service Category        This service is defined as the provision of information about medical
Definition:                   and psychosocial support services and counseling. Materials and
                              curriculum must be age and situation specific (example: Youth
                              comprise individuals who are 1) Born HIV positive; 2) 13-18 years
                              of age; 3) 19-24 years of age).
Target Population (age,       Services are for all eligible HIV/AIDS infected individuals. 100%
gender, geographic, race,     of the participants must represent the population being targeted.
ethnicity, etc.):
Services to be Provided:      The service includes the preparation and distribution of materials in
                              the context of medical and psychosocial support services to educate
                              clients with HIV about methods to reduce the spread of HIV.
                              Materials must be age appropriate for youth. Services include, but
                              are not limited to, health education on understanding and
                              communicating about HIV infection; its effects on the body,
                              emotions and interpersonal relations; risk reduction on the
                              transmission of HIV; treatment adherence issues; and how to
                              effectively access services. Also included is information on
                              complimentary/alternative therapies.
Service Unit Definition(s):   A unit of service is defined as one (1) HE/RR course lasting a
                              minimum of two hours provided to one eligible HIV-positive
                              individual. This service is designed for groups with a minimum of 3
                              and a maximum of 8 participants per session.
Financial Eligibility:        Refer to the RWPC‟s approved Financial Eligibility for Houston
                              EMA Services.
Client Eligibility:           HIV positive, meeting financial requirements listed in Attachment B.

                                                                                                      77
Agency Requirements:    Agency must do pre and post testing to measure the effectiveness of
                        the education provided.
Staff Requirements:     The Program must utilize a Registered Nurse licensed by the State of
                        Texas, who has a minimum of a Bachelors of Nursing educational
                        level, and who has at least two years paid experience in all areas of
                        HIV/AIDS care, to provide the educational services. This nurse
                        must be present during all HE/RR courses billed to the County.
Special Requirements:   None.




                                                                                                78
HRSA Service Category        Health Education/Risk Reduction
Title:
Local Service Category
Title:                       Health Education and Risk Reduction – Targeted to Hispanics
Revision Date:               04/19/02
Service Category Code:       SS-09
Amount Available:            $81,579.00
Budget Type:                 Unit Cost
Budget Requirements or       Maximum allowable unit cost is $30.00 unit.
Restrictions:
                             An HE/RR course must have at least three (3) eligible HIV-positive
                             individuals in attendance in order to be reimbursed by the County.
HRSA Service Category        Provision of information, including the dissemination about medical
Definition:                  and psychosocial support services and counseling or
                             preparation/distribution of materials in the context of medical and
                             psychosocial support services to educate clients with HIV about
                             methods to reduce the spread of HIV.
Local Service Category       This service is defined as the provision of information about medical
Definition:                  and psychosocial support services and counseling. Materials and
                             curriculum must be age and situation specific (example: Youth
                             comprise individuals who are 1) Born HIV positive; 2) 13-18 years
                             of age; 3) 19-24 years of age).
Target Population (age,      Services are for all eligible HIV/AIDS infected individuals. 75% of
gender, geographic, race,    the participants must represent the population being targeted.
ethnicity, etc.):
Services to be Provided:    The service includes the preparation and distribution of materials in
                            the context of medical and psychosocial support services to educate
                            clients with HIV about methods to reduce the spread of HIV.
                            Materials must be age appropriate for youth. Services include, but
                            are not limited to, health education on understanding and
                            communicating about HIV infection; its effects on the body,
                            emotions and interpersonal relations; risk reduction on the
                            transmission of HIV; treatment adherence issues; and how to
                            effectively access services. Also included is information on
                            complimentary/alternative therapies.
Service Unit Definition(s): A unit of service is defined as one (1) HE/RR course lasting a
                            minimum of two hours provided to one eligible HIV-positive
                            individual. This service is designed for groups with a minimum of 3
                            and a maximum of 8 participants per session
Financial Eligibility:      Refer to the RWPC‟s approved Financial Eligibility for Houston
                            EMA Services.
Client Eligibility:          HIV positive, meeting financial requirements listed in Attachment
                            B.
Agency Requirements:        Agency must do pre and post testing to measure the effectiveness of
                            the education provided.
Staff Requirements:         The Program must utilize a Registered Nurse licensed by the State of
                            Texas, who has a minimum of a Bachelors of Nursing educational
                            level, and who has at least two years, paid experience in all areas of
                                                                                                     79
                        HIV/AIDS care, to provide the educational services. This nurse
                        must be present during all HE/RR courses billed to the County.
                        For Hispanic/Latino targeted population, facilitator staff must be
                        bilingual in Spanish.
Special Requirements:   None.




                                                                                             80
HRSA Service Category        Health Education/Risk Reduction
Title:
Local Service Category
Title:                       Health Education and Risk Reduction – Untargeted
Revision Date:               04/19/02
Service Category Code:       SS-10
Amount Available:            $55,603.00
Budget Type:                 Unit Cost
Budget Requirements or       Maximum allowable unit cost is $30.00 unit.
Restrictions:
                             An HE/RR course must have at least three (3) eligible HIV-positive
                             individuals in attendance in order to be reimbursed by the County.
HRSA Service Category        Provision of information, including the dissemination about medical
Definition:                  and psychosocial support services and counseling or
                             preparation/distribution of materials in the context of medical and
                             psychosocial support services to educate clients with HIV about
                             methods to reduce the spread of HIV.
Local Service Category       This service is defined as the provision of information about medical
Definition:                  and psychosocial support services and counseling. Materials and
                             curriculum must be age and situation specific (example: Youth
                             comprise individuals who are 1) Born HIV positive; 2) 13-18 years
                             of age; 3) 19-24 years of age).
Target Population (age,      Services are for all eligible HIV/AIDS infected individuals.
gender, geographic, race,
ethnicity, etc.):
Services to be Provided:    The service includes the preparation and distribution of materials in
                            the context of medical and psychosocial support services to educate
                            clients with HIV about methods to reduce the spread of HIV.
                            Materials must be age appropriate for youth. Services include, but
                            are not limited to, health education on understanding and
                            communicating about HIV infection; its effects on the body,
                            emotions and interpersonal relations; risk reduction on the
                            transmission of HIV; treatment adherence issues; and how to
                            effectively access services. Also included is information on
                            complimentary/alternative therapies.
Service Unit Definition(s): A unit of service is defined as one (1) HE/RR course lasting a
                            minimum of two hours provided to one eligible HIV-positive
                            individual. This service is designed for groups with a minimum of 3
                            and a maximum of 8 participants per session.
Financial Eligibility:      Refer to the RWPC‟s approved Financial Eligibility for Houston
                            EMA Services.
Client Eligibility:          HIV positive, meeting financial requirements listed in Attachment
                            B. Refer to Attachment B for eligibility requirements.
Agency Requirements:        Agency must do pre and post testing to measure the effectiveness of
                            the education provided.



                                                                                                     81
Staff Requirements:     The Program must utilize a Registered Nurse licensed by the State of
                        Texas, who has a minimum of a Bachelors of Nursing educational
                        level, and who has at least two years, paid experience in all areas of
                        HIV/AIDS care, to provide the educational services. This nurse
                        must be present during all HE/RR courses billed to the County.
Special Requirements:   None.




                                                                                                 82
HRSA Service Category       Buddy/Companion Services
Title:
Local Service Category
Title:                      Buddy/Companion Services – Direct Client Care
Revision Date:              05/15/02
Service Category Code:      SS-11
Amount Available:           $72,560.00
Budget Type:                Unit Cost
Budget Requirements or      Maximum allowable unit cost = $6.00/unit.
Restrictions:
HRSA Service Category       Activities provided by peers or volunteers to assist a client in
Definition:                 performing household or personal tasks. Buddies also provide
                            mental and social support to combat loneliness and isolation.
Local Service Category      Volunteers/Direct Client Care
Definition:                 Volunteer programs to provide support services for HIV/AIDS
                            infected individuals which may include, but are not limited to, buddy
                            programs, spiritual and emotional support and companionship. The
                            intent of volunteer programs is to provide direct “hands on”
                            volunteer services and not volunteers for agency administrative
                            assistance.
Target Population (age,     HIV/AIDS infected and affected individuals living within the
gender, geographic, race,   Houston Eligible Metropolitan Area (EMA). Special consideration
ethnicity, etc.):           to be given to populations with special needs including mental or
                            physical constraints limiting access to services.
Services to be Provided:    The provider must demonstrate a capacity to recruit, train,
                            coordinate and support a pool of volunteers to service a broad
                            geographical area. An agency may not provide outreach or case
                            management services under this category.
Service Unit Definition(s): One unit of service is defined as one hour of direct client service
                            provided by an individual volunteer, regardless of the number of
                            clients served.
Financial Eligibility:      Refer to the RWPC‟s approved Financial Eligibility for Houston
                            EMA Services.
Client Eligibility:         HIV positive, meeting financial requirements listed in Attachment B.
Agency Requirements:        The agency must document that they have a formal, written referral
                            process with primary care, case management, home healthcare and
                            TDH and DHS Community Service program providers to ensure
                            continuity of care and appropriate referrals.




                                                                                                    83
Staff Requirements:     The supervisor must be an LMSW or an RN with 2 years of
                        healthcare experience, including one year working with People
                        Living with HIV/AIDS. In-home volunteers or paid staff must have
                        a criminal background check with no felony convictions and must
                        have received the following training prior to providing services to
                        clients:
                         8 hours of basic HIV/AIDS training
                         universal precautions
                         food service and nutrition
                         other training as described in the HIV/AIDS site visit guidelines
Special Requirements:   None.




                                                                                              84
HRSA Service Category        Buddy/Companion Services
Title:
Local Service Category
Title:                       Buddy/Companion Services – Respite Care
Revision Date:               05/15/02
Service Category Code:       SS-12
Amount Available:            $34,145.00
Budget Type:                 Unit Cost
Budget Requirements or       Maximum unit cost = $6.00 per unit.
Restrictions:
HRSA Service Category       Activities provided by peers or volunteers to assist a client in
Definition:                 performing household or personal tasks. Buddies also provide
                            mental and social support to combat loneliness and isolation.
Local Service Category      Volunteers/respite care teams
Definition:                 Respite Care Teams - The use of volunteers to provide social,
                            emotional and physical care to HIV/AIDS infected individuals that
                            includes training these volunteers to provide in-home bedside
                            care/support services and providing supervision and support for
                            respite care teams dealing with the stress of caring for these clients.
                            The intent of the volunteer program is to provide direct “hands on”
                            volunteer services and not volunteers for agency administrative
                            assistance.
Target Population (age,     HIV/AIDS infected and affected individuals living within the
gender, geographic, race,   Houston Eligible Metropolitan Area (EMA). Special consideration
ethnicity, etc.):           to be given to populations with special needs including mental or
                            physical constraints limiting access to services.
Services to be Provided:    The provider must demonstrate a capacity to recruit, train,
                            coordinate and support a pool of volunteers to service a broad
                            geographical area. An agency may not provide outreach or case
                            management services under this category (See Case Management
                            Section).
Service Unit Definition(s): One unit of service is defined as one hour of direct client service by
                            an individual volunteer, regardless of the number of clients served.
Financial Eligibility:      Refer to the RWPC‟s approved Financial Eligibility for Houston
                            EMA Services.
Client Eligibility:         HIV positive, meeting financial requirements listed in Attachment B.
Agency Requirements:        The agency must document that they have a formal, written referral
                            process with primary care, case management, home healthcare and
                            TDH and DHS Community Service program providers to ensure
                            continuity of care and appropriate referrals.




                                                                                                      85
Staff Requirements:     The supervisor must be an LMSW or an RN with 2 years of
                        healthcare experience, including one year working with People
                        Living with HIV/AIDS. In-home volunteers or paid staff must have
                        a criminal background check with no felony convictions and must
                        have received the following training prior to providing services to
                        clients:
                         8 hours of basic HIV/AIDS training
                         Universal precautions
                         Food service and nutrition
                         Other training as described in the HIV/AIDS site visit guidelines
Special Requirements:   None




                                                                                              86
HRSA Service Category       Direct Emergency Assistance
Title:                      Housing Assistance
Local Service Category      Direct Emergency Assistance (Emergency Utility, In-Home
Title:                      Support and Rental Assistance).
Revision Date:              04/19/02
Service Category Code:      SS-13
Amount Available:           $644,737.00 (DEA and in-home support =$154,714.00;
                            Rent=$490,023.00)
Budget Type:                Hybrid
Budget Requirements or      The maximum transaction (unit) cost is $30.00 per unit.
Restrictions:               At least 85% of the total amount of the budget must be solely
                            allocated to the actual cost of disbursements and may not include
                            any administrative, processing or other costs associated with
                            managing the Direct Emergency Financial Assistance Program.

                            Only one (1) award for the full service category amount will be
                            made in this service category.
HRSA Service Category       a. Emergency Financial Assistance
Definition:                 Provision of short-term payments for transportation, food, essential
                            utilities, or medication assistance, which planning councils, Title II
                            grantees, and consortia may allocate. These short-term payments
                            must be carefully monitored to assure limited amounts, limited use,
                            and for limited periods of time. Expenditures must be reported
                            under the relevant service category.

                            b. Housing Assistance
                            This assistance is limited to short-term or emergency financial
                            assistance to support temporary and/or transitional housing to enable
                            the individual or family to gain and/or maintain medical care. Use
                            of Ryan White Title I funds for short-term or emergency housing
                            must be linked to medical and/or health-care services or be certified
                            as essential to a client‟s ability to gain or maintain access to HIV-
                            related medical care or treatment.
Local Service Category      Direct Emergency Assistance: The term “emergency” is defined as
Definition:                 a need for funds within five (5) working days. Agency is required to
                            acknowledge receipt of the assistance request within 24 hours.
                            Agency will have three (3) working days for turn around time to
                            issue the funds. Emergency essential living needs include housing,
                            utilities, rent, electricity, telephone, TTY, water and gas for
                            HIV/AIDS infected individuals. There will be a limit of $1,200 per
                            client/family in a contract year with no limit to frequency.

                            In-Home Support Voucher Program: The use of vouchers to
                            provide in-home support services for HIV/AIDS infected
                            individuals, which must include, but are not limited to, the
                            performance of household and personal tasks.
Target Population (age,     HIV/AIDS-infected individuals living within the Houston Eligible
gender, geographic, race,   Metropolitan Area (EMA).
                                                                                                     87
ethnicity, etc.):           *A written referral from a primary medical care provider, including
                            a nurse practitioner or M.D., is required for In-Home Support.
Services to be Provided:    Emergency Housing/Utilities Assistance consists of the following
                            needs:
                                1. Rent (late rental payments excluded)
                                2. Utilities (gas, water and electricity-late payments excluded)
                                3. Telephone bills/TTY basic services and/or long distance
                                    charges up to $35

                            The agency must adhere to the following guidelines in providing
                            these services:
                                 Assistance must be in the form of vouchers made payable to
                                    vendors, merchants, landlords, etc. No payments may be
                                    made directly to individual clients or family members.
                                 Agency must operate during regular business hours, Monday
                                    through Friday from 8:00 a.m. to 5:00 p.m.
                                 Agency must provide services to homebound clients.
                                 Agency may not require a client to have a case manager as a
                                    prerequisite for assistance.


                            In-Home Support services include:

                                1) Environmental care such as light housekeeping, light
                                   furniture dusting, sweeping/mopping/vacuuming floors,
                                   changing bed linens and light laundry (2 loads);

                                2) Shopping assistance;

                                3) Meal preparation/serving/clean-up;

                                4) Verbal interaction with the client such as talking and
                                   listening;

                                5)  Limited supervision of child/children while client is in the
                                    home. The agency is required to get prior approval to exceed
                                    10 hours/week/client. The client is to be reassessed a
                                    minimum of every 90 calendar days.
Service Unit Definition(s): A unit of service is defined as provision of in-home support
                            vouchers or emergency housing and/or utility assistance and
                            financial counseling to an eligible client.
Financial Eligibility:      Refer to the RWPC‟s approved Financial Eligibility for Houston
                            EMA Services.
Client Eligibility:         HIV positive, meeting financial requirements listed in Attachment B.




                                                                                                   88
Agency Requirements:    Agency must document how it will accommodate monolingual/non-
                        English speaking clients.

                        Agency must work closely with other service providers to minimize
                        duplication of services and ensure that assistance is given only when
                        no reasonable alternatives are available. Additionally, agency must
                        document ability to refer clients for food, transportation, clothing
                        and other needs from other service providers when client need is
                        justified.
Staff Requirements:     None.
Special Requirements:   Only one transaction may be billed per instance of emergency
                        assistance voucher disbursement, regardless if Agency splits
                        payment into multiple installments or issues single payment.

                        Only one transaction may be billed every 30 days for in-home
                        support services to a single client.




                                                                                                89
HRSA Service Category        Direct Emergency Assistance
Title:
Local Service Category       Household Items
Title:
Revision Date:               04/19/02
Service Category Code:       SS-14
Amount Available:            $31,162.00
Budget Type:                 Hybrid
Budget Requirements or       Maximum transaction (unit) cost = $30.00 unit
Restrictions:
                             No more than 35% of Household Items funds can be used for the
                             purchase of household items.
HRSA Service Category        a. Emergency Financial Assistance
Definition:                  Provision of short-term payments for transportation, food, essential
                             utilities, or medication assistance, which planning councils, Title II
                             grantees, and consortia may allocate. These short-term payments
                             must be carefully monitored to assure limited amounts, limited use,
                             and for limited periods of time. Expenditures must be reported
                             under the relevant service category.

Local Service Category       Household Items
Definition:                  To provide HIV/AIDS infected persons with household items to
                             support their independent living. No more than 35% of these funds
                             can be used for the purchase of household items.
Target Population (age,      HIV/AIDS-infected individuals living within the Houston Eligible
gender, geographic, race,    Metropolitan Area (EMA).
ethnicity, etc.):
Services to be Provided:
                            Household Items services include pickup, delivery, and storage of
                            donated household items including but not limited to furniture, small
                            appliances, kitchen utensils, bathroom accessories, and linens;
                            purchase of basic household items that are not donated including but
                            not limited to mattresses, new and safety approved items including
                            baby cribs. Contractor will make appropriate provisions (on site or
                            voucher) for clothing to eligible indigent clients.
Service Unit Definition(s): 1 unit of service = single visit or multiple visits based upon a single
                            initial request wherein a client is provided with one or more donated
                            household items. (No additional transaction fees will be charged for
                            clients returning to pick up additional items listed on the original
                            request.)

Financial Eligibility:       Refer to the RWPC‟s approved Financial Eligibility for Houston
                             EMA Services.

Client Eligibility:          HIV positive, meeting financial requirements listed in Attachment B.
                             Agency must document how it will accommodate monolingual/non-
Agency Requirements:         English speaking clients.

                                                                                                      90
                        Agency must work closely with other service providers to minimize
                        duplication of services and ensure that assistance is given only when
                        no reasonable alternatives are available. Additionally, agency must
                        document ability to refer clients for food, transportation, clothing
                        and other needs from other service providers when client need is
                        justified.
Staff Requirements:     None.
Special Requirements:   None.




                                                                                                91
HRSA Service Category    Housing Assistance*
Title:                   Housing Related Services*
Local Service Category
Title:                   Housing Coordination and Emergency Shelter Vouchers

                         a) Housing Assistance
                         b) Housing Related Services

                         *NOTE: These two HRSA categories are combined together in
                         this local service category
Revision Date:           04-19-02
Service Category Code:   SS-15
Amount Available:        $316,464.00
                         ($188,022.00 = Vouchers; $128,442.00=Coordination)
Budget Type:             Hybrid
Budget Requirements or   MAI funds.
Restrictions:
                         Maximum allowable unit cost for coordination = $14.00/unit

                         Housing Assistance - Vouchers
                         $ 33,843 must be allocated for Hispanics
                         $127,854 must be allocated for AA
                         $ 7,521 must be allocated for PI/Asians/Native Americans
                         $ 18,804 must be allocated for Anglos

                         Vouchers are reimbursed at actual cost to Agency.
HRSA Service Category    a.      Housing Assistance:
Definition:              This assistance is limited to short-term or emergency financial
                         assistance to support temporary and/or transitional housing to enable
                         the individual or family to gain and/or maintain medical care. Use
                         of Titles I, II and IV funds for short-term or emergency housing must
                         be linked to medical and/or health-care services or be certified as
                         essential to a client‟s ability to gain or maintain access to HIV-
                         related medical care or treatment.
                             b. Housing Related Services:
                         Includes assessment, search, placement, and advocacy services
                         provided by professionals who possess an extensive knowledge of
                         local, State and Federal housing programs and how they can be
                         accessed.
Local Service Category   This service is designed to assist clients in accessing temporary
Definition:              short-term emergency housing, disburse emergency shelter vouchers,
                         link clients with appropriate housing resources throughout the EMA,
                         network with other urban and rural housing resources, and assist
                         clients in securing permanent housing.




                                                                                                 92
Target Population (age,     HIV/AIDS infected individuals living within the Houston Eligible
gender, geographic, race,   Metropolitan Area (EMA) who need short-term or emergency
ethnicity, etc.):           housing in order to gain or maintain access to HIV-related medical
                            care or treatment. This includes individuals who are homeless;
                            women with children; clients with no income; and clients who are
                            medically unable to work.
Services to be Provided:        Services to be provided include:
                                1) Advocacy for and assistance to clients in accessing
                                    temporary short-term emergency housing;
                                2) Linking clients with appropriate housing resources
                                    throughout the EMA;
                                3) Providing referrals to Emergency Assistance programs;
                                4) Networking with other urban and rural housing resources;
                                5) Assisting clients in securing permanent housing;
                                6) Providing short-term placement via emergency shelter
                                    vouchers.
Service Unit Definition(s): b. Housing Related Services - Coordination
                            One unit of service is defined as 15 minutes of direct client services.
Financial Eligibility:      Refer to the RWPC‟s approved Financial Eligibility for Houston
                            EMA Services.
Client Eligibility:         HIV positive, meeting financial requirements listed in Attachment B.
Agency Requirements:        Agency must document that housing assistance is essential to a
                            client‟s ability to gain/maintain access to HIV-related medical care
                            or treatment.
Staff Requirements:         Housing Coordinators:
                            A minimum of two (2) FTE‟s who meet the following requirements:
                            2 years of college
                            2 years of recent housing referral experience at local, state, or federal
                            levels
                            2 years of recent HIV/AIDS work experience
                            1 bilingual FTE required
Special Requirements:       Housing Coordinators must attend RWPC-approved Case
                            Management Training within 90 days of hire.




                                                                                                        93
HRSA Service Category       Food Bank/Home Delivered Meals/Nutritional Supplements
Title:
Local Service Category      Nutritional Supplements
Title:
Revision Date:              04/19/02
Service Category Code:      SS-16
Amount Available:           $154,036.00
Budget Type:                Hybrid
Budget Requirements or      Maximum allowable unit cost $30.00/unit
Restrictions:               Nutritional Supplements – No more than 25% of funds can be used
                            for disbursement transactions. The remaining 75% of funds must be
                            expended only on the actual cost of the item(s) disbursed.
HRSA Service Category       Provision of food, meals, or nutritional supplements.
Definition:
Local Service Category      Nutritional Supplements
Definition:                 Up to a 90-day supply at any given time, per client, of nutritional
                            supplements. There are no restrictions on the type of nutritional
                            supplements provided, so long as the supplement is prescribed by a
                            licensed physician, licensed dietician, Nurse Practitioner or
                            Physician Assistant. Nutritional counseling must be offered with
                            each disbursement of nutritional supplements.
Target Population (age,       Not Applicable.
gender, geographic, race,
ethnicity, etc.):
Services to be Provided:    Nutritional Supplements
                            The provision of nutritional supplements to clients with a written
                            referral from a physician or licensed dietician that specifies
                            frequency, duration and amount. The per client cap may not exceed
                            $1,000.00 annually. A request to exceed the cap may be made to the
                            administrative agent based on demonstrated need by client.
                            Information on this service must be communicated to health care
                            providers funded by Titles I and II.

                            Counseling is a component of Nutritional Supplements. Counseling
                            is defined as the provision of information about therapeutic
                            nutritional/supplemental foods that are beneficial to the wellness and
                            increased health condition of clients by a Licensed Dietitian.
                            Services may be provided either through educational or counseling
                            sessions. Also included in this service are follow up sessions with
                            clients and/or clients‟ Primary Care Physicians regarding the
                            effectiveness of the supplements. The number of sessions for each
                            client shall be determined by a written assessment conducted by the
                            Licensed Dietitian but may not exceed twelve (12) sessions per
                            client per contract year. Clients who receive these services may
                            utilize Ryan White Title I funded Food Pantries to obtain
                            recommended nutritional supplements.


                                                                                                     94
Service Unit Definition(s): Nutritional Supplements: 1 unit of service = single visit wherein
                            an eligible client receives allowable nutritional supplements (up to a
                            90 day supply) and nutritional counseling by a licensed dietician.
Financial Eligibility:      Refer to the RWPC‟s approved Financial Eligibility for Houston
                            EMA Services.
Client Eligibility:         HIV positive, meeting financial requirements listed in Attachment B.

Agency Requirements:         Not Applicable
Staff Requirements:          Nutritional Supplements: Counseling must be provided by a
                             licensed dietician.
Special Requirements:        None.




                                                                                                     95
                                        FORMS & TABLES SECTION


The forms contained in this section must be inserted in the appropriate section of your proposal response.

There are three options from which you may choose to present your Table information. They are:

      You may type on these forms.

      You may create your own forms in the same format as those contained in this packet.

      You may pick up a diskette in Word for Windows 6.0 at the office of HIV Services, 2223 W. Loop S., Suite
       417.




                                                                                                                  96
                                                            Assurances Form I



By signing and submitting this proposal, the applicant organization certifies compliance with the following assurances in the event that
Ryan White funds are awarded:

·        Assurance that applicant agency will provide services without regard to ability to pay or the current or past health condition of an
         individual and in settings accessible to low-income persons; and funds awarded not be used to make payments for any item or
         service to the extent that payment has been made, or can reasonably be expected to be made, by another third party benefits
         program or by an entity that provides services on a prepaid basis.

·        Assurance that applicant agency will provide outreach to low-income persons to inform them of the availability of services.

·        Assurance that applicant agency will not discriminate against persons eligible for services on the grounds of race, creed, color,
         handicap, national origin, sex, political affiliation or beliefs, or sexual orientation.

·        Assurance that applicant agency will provide information to clients, either verbally or in print, on use of condoms and risk
         avoidance/reduction behaviors for sharing of intravenous needles, or make referrals to other agencies that will do so.

·        Assurance that drug-free workplace guidelines are or will be in place in agency at time of funding award in accordance with
         Federal Regulation 45 CFR part 76.

·        Assurance that applicant agency will maintain the confidentiality of client records.

·        Assurance that applicant agency will comply with Federal Regulation 45 CFR part 76 regarding debarment and suspension.

·        Assurance that agency understands specified restrictions on the use of grant award funds.




                                                                         ______________________________________
         Date                                                                               Applicant Organization



                            ___________________________________________________
                                     Signature and Title of Authorized Official
                                          Certification Concerning Lobbying

                               DEPARTMENT OF HEALTH AND HUMAN SERVICES
                                      U.S. PUBLIC HEALTH SERVICE


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

         (1)       No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person or
                   influencing organization attempting to influence an officer or employee of any agency, a member of Congress, or an
                   employee of a member of Congress in connection with the awarding of any Federal contract, the making of any Federal
                   grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation,
                   renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

         (2)       If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or
                   attempting to influence an officer or employee of any agency, a member of Congress, or an employee of a member of
                   Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete
                   and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.

         (3)       The undersigned shall require that the language of this certification be included in the award documents for all
                   subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements)
                   and that all subrecipients shall certify and disclose accordingly.

This certification is a material representation of the fact upon which reliance was placed with this transaction was made or enter into.
Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, Title 31, U.S. Code.
Any persons who fail to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than
$100,000 for each such failure.



                                                                           _____________________________________
Date                                                                                                       Entity



                                                                ______________________________________________
Address of Organization                                              Name and Title of Official Signing for Organization



                                                                      _________________________________________
Telephone of Organization                                                                      Signature of Official
                             Compliance with American With Disabilities Act of 1990




_______________________________________
Name of Applicant Agency


guarantees and assures, with respect to the operation of the program and activities outlined in this proposal and all agreements or
arrangements to carry out such program or activities for which financial assistance may be awarded in any subsequent subcontract, that will
comply fully with the Americans with Disabilities Act of 1990 (ADA) and any and all Regulations promulgated thereunder. The applicant
agency understands that failure to comply with this requirement shall be sufficient cause to terminate any contract existing between the
applicant agency and the Harris County HIV Services Division.




_______________________________________________________
Signature of Person Authorized to Represent Applicant Agency




___________________________________________________
Printed Name and Title




____________________________________________________
Date Signed
                             ASSURANCE — NON-CONSTRUCTION PROGRAMS


Note:            Certain of these assurance may not be applicable to your project or program. If you have questions,
                 please contact the awarding agency. Further, certain Federal awarding agencies may require
                 applicants to certify to additional assurances. If such is the case, you will be notified.


        As the duly authorized representative of the applicant I certify that the applicant:

1.      Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability (including funds
        sufficient to pay the non-Federal share of project costs) to ensure proper planning, management and completion of the project
        described in this application.

2.      Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any authorized
        representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish
        a proper accounting system in accordance with generally accepted accounting standards or agency directives.

3.      Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the
        appearance of personal or organizational conflict of interest, or personal gain.

4.      Will initiate and complete the work within the application time frame after receipt of approval of the awarding agency.

5.      Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728-4763) relating to prescribed standard for merit
        systems for programs funding under one of the nineteen statutes of regulations specified in Appendix A of OPM's Standards of a
        Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).

6       Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil
        Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color, or national origin; (b) Title IX of the
        Educational Amendments of 1972, as amended (20 U.S.C. 1681-1683, and 1685-1686), which prohibits discrimination on the
        basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), which prohibits discrimination on
        the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. 6101-6107), which prohibits
        discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255, as amended, relating to
        nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and
        Rehabilitation Act of 1970 (P.L. 91-616, as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism;
        (g) 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. 290 dd-3 and 290 ee-3), as amended, relating to
        confidentiality of alcohol and drug abuse patient records; (h) Title VII of the Civil Rights Act of 1968 (42 U.S.C. 3501 et seq.) as
        amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in
        the specific statute(s) under which application for Federal assistance is being made; and (j) the requirements of any other
        nondiscrimination statute(s) which may apply to the application.

7.      Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation Assistance and Real
        Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or
        whose property is acquired as a result of Federal or federally assisted programs. These requirements apply to all interests in real
        property acquired for project purposes regardless of Federal participation in purchases.

8.      Will comply with the provisions of the Hatch Act (5 U.S.C. 1501-1508 and 7324-7328) which limit the political activities of
        employees whose principal employment activities are funded in whole or in part with Federal funds.

9.      Will comply, as application, with the provisions of the Davis-Bacon Act (40 U.S.C. 276a to 276a-7), the Copeland Act (40
        U.S.C. 276c and 18 U.S.C 874, and the Contract Work House and Safety Standards Act (40 U.S.C. 327-333), regarding labor
        standards for federally assisted construction subagreements.

10.     Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of
        1973 (P.L. 93-2343) which requires recipients in a special flood hazard area to participate in the program and to purchase flood
        insurance if the total cost of insurable construction and acquisition is $10,000 or more.
11.     Will comply with environmental standards which may be prescribed pursuant to the following (a) institution of environmental
        quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO 11514;
        (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of
        flood hazards in flood plains in accordance with EO 11988; (e) assurance of project consistency with the approved State
        management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. 1451 et seq.); (f) conformity of
        Federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42
        U.S.C. 7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as
        amended, (P.L. 93-523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L.
        93-205).

12.     Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 1271 et seq.) related to protecting components or potential
        components of the national wild and scenic rivers system.


13.     Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as
        amended (16 U.S.C. 470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historical
        Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.).

14.     Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related
        activities supported by this award assistance.

15.     Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. 2131 et seq.) pertaining to the
        care, handling, and treatment of warm-blooded animals held for research, teaching, or other activities supported by this award of
        assistance.

16.     Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.) which prohibits the use of lead-based
        pain in the construction or rehabilitation of residence structures.

17.     Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act of 1984.

18.     Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies governing this
        program.



 Signature of Authorized Certifying Official                Title


 Applicant Organization                                     Date Submitted
RESPONDENT CERTIFICATION



________________________________________
Name of Applicant Agency




I,                                       , certify that I am the



__________________________________________
Title Printed


of the corporation, committee, commission, association, partnership, or public agency named as the Applicant
Agency herein, that this proposal was duly submitted and signed for on behalf of said corporation, committee,
commission, association, or public agency by authority of its governing body and is within the scope of its legal
powers.

__________________________________________
Signature of Person Making Certification


_________________________________
Date Signed
                                              COVER PAGE
                                      FY 2003 Ryan White Title I Funds


Applicant organization: _________________________________________________________________

Service Category of proposal as designated in RFP: __________________________________________

Code Number: ________________________________________________________________________

Total amount requested: ________________________________________________________________

Contact Person for proposal clarifications/negotiations: ________________________________________

Title: _______________________________________________________________________________

Contact person telephone number: ________________________________________________________

Fax number: _________________________________________________________________________

Identify your agency as one of the following: For - Profit ______________, Non-Profit ______________ or Public
(governmental) _______________.

Has your agency complied with all HRSA requirements and regulations for all previously funded programs.
yes_________ no___________ If no, explain.

All applicants for categories HS-01, SS-03, SS-06, SS-08 and SS-15 must complete the section below:

The applicant must comply with the following criteria as mandated by HRSA in the FY 2002 Ryan White
CARE Act Title I Conditions of Award for Minority AIDS Initiative (MAI) Funds:

       A: Is your agency located in or near the targeted community you are intending to serve:

       Yes              No             Proposer‟s compliance with this criteria must be clearly documented in
       the “Organization” section of the submitted proposal (refer to criteria N.1. – N.5. in the RFP).



       B: Does your agency have a documented history of providing service to the targeted community?

       Yes              No             Proposer‟s compliance with this criteria must be clearly documented in
       the “Organization” section of the submitted proposal (refer to criteria N.1. – N.5. in the RFP).
                                           (continued on next page)
C: Does your agency have documented linkages to the targeted populations, so that your agency can
help close the gap in access to service for highly impacted communities of color?

Yes               No             Proposer‟s compliance with this criteria must be clearly documented in
the “Organization” and “Program” sections of the submitted proposal (refer to criteria N.1. – N.5, O.1.
– O.4. and tables III.C. and III.D. in the RFP).


D: Does your agency have the capability to provide services to the targeted populations that is
culturally and linguistically appropriate?

Yes               No             Proposer‟s compliance with this criteria must be clearly documented in
the “Organization” and “Program” sections of the submitted proposal (refer to criteria N.1. – N.5, O.1.
– O.6. in the RFP).


An answer of ―no‖ to any of the 4 criteria above disqualifies any applicant for consideration of an
award funded in whole or in part with MAI funds. Note that answers of ―yes‖ must be adequately
documented in the relevant sections of the submitted proposal.
                                      BUDGET NARRATIVE
                                          (Table I.A.)


                    You must complete this form whether you are submitting
                         a line item budget or a fee for service budget


Name of Agency:            ____________________________________

       Name of Sub-Contracting Agency: ________________________
       (If applicable)

Service Category:

Title of Service:

1.     PERSONNEL                                                        $

                                             $
       (             /mo. x 12 months x %)
       Duties:



                                             $
       (             /mo. x 12 months x %)
       Duties:



                                             $
       (             /mo. x 12 months x %)
       Duties:



                                             $
       (             /mo. x 12 months x %)
       Duties:
1.     PERSONNEL (continued)
                                              $
       (              /mo. x 12 months x %)
       Duties:



                                              $
       (              /mo. x 12 months x %)
       Duties:



                                              $
       (              /mo. x 12 months x %)
       Duties:



                                              $
       (              /mo. x 12 months x %)
       Duties:



                                              $
       (              /mo. x 12 months x %)
       Duties:



                                              $
       (              /mo. x 12 months x %)
       Duties:



                                              $
       (              /mo. x 12 months x %)
       Duties:



Note: Use additional pages as needed.
2.   FRINGE                                                                     $
     (Total Personnel costs x TOTAL %)
             FICA                                 %
             State Unemployment                   %
             Workers Comp.                        %
             Health Insurance                     %
             Life Insurance                       %
                                                  %
                                                  %
                                                  %
            TOTAL                                 %

            Note: All fringe benefits must be included.

3.   TRAVEL                                                                     $
     Local Travel                                 $
                    miles x $      /mile

     Describe the purpose of this travel. Be specific about who will travel, where, when and why the travel is
     necessary:
     _____________________________________________________________________________________
     _____________________________________________________________________________________
     _____________________________________________________________________________________
     _____________________________________________________________________________________

     Out of Town Travel                           $
     (within the Houston EMA only)
                                           :
     Transportation        $
     Lodging               $
     Per Diem/Meals        $
     TOTAL                 $

                                           :
     Transportation        $
     Lodging               $
     Per Diem/Meals        $
     TOTAL                 $

     Describe the purpose of this travel. Be specific about who will travel, where, when and why the travel is
     necessary:
     _____________________________________________________________________________________
     _____________________________________________________________________________________
     _____________________________________________________________________________________
     _____________________________________________________________________________________
4.   EQUIPMENT                                                                   $
     Description:                                 $
                                                  $
                                                  $

     Describe the purpose of this equipment. Be specific about who will use the equipment and why it is
     necessary to purchase the equipment:
     _____________________________________________________________________________________
     _____________________________________________________________________________________
     _____________________________________________________________________________________
     _____________________________________________________________________________________


5.   SUPPLIES                                                                    $
     General Consumable Office Supplies           $
     Other:                                       $
                                                  $
                                                  $
                                                  $

     Describe the purpose of these supplies. Be specific about who will use the supplies and why it is necessary
     to purchase these supplies:
     _____________________________________________________________________________________
     _____________________________________________________________________________________
     _____________________________________________________________________________________
     _____________________________________________________________________________________


6.   CONTRACTUAL                                                                 $

                                                  $
     ($     /hr. x          hours)

                                                  $
     ($     /hr. x          hours)

     Describe the purpose of the services/staff/items listed as “Contractual.” Be specific about why it is
     necessary to obtain these services/staff/items:
     _____________________________________________________________________________________
     _____________________________________________________________________________________
     _____________________________________________________________________________________
     _____________________________________________________________________________________
7.   OTHER                                                                      $
                                                  $
                                                  $
                                                  $
                                                  $
                                                  $
                                                  $
                                                  $
                                                  $
                                                  $
                                                  $
                                                  $
                                                  $
                                                  $
                                                  $
                                                  $
                                                  $
     TOTAL                                        $

     Note: Include all other expenses.

     Describe the purpose of any items listed in the “Other” category. Be specific about who will use the items
     and why it is necessary to purchase these items:
     _____________________________________________________________________________________
     _____________________________________________________________________________________
     _____________________________________________________________________________________
     _____________________________________________________________________________________


TOTAL DIRECT COSTS                                                              $

TOTAL INDIRECT COSTS (NOT ALLOWED)                                              $       ---

TOTAL COSTS                                                                     $
                                   FEE FOR SERVICE BUDGET FORM
                                             (Table I.B.)




                           You must complete this form if you are submitting
                                       a fee for service budget



Service Category:

Title of Service:


1.     Fee Charged per Unit of Service:                                   $


2.     Number of Units of Service to be Provided:


3.     Total Cost of these Services (#1 x #2):                            $____________

4.     Breakdown of Fee per Unit of Service:


                                                    $
                                                    $
                                                    $
                                                    $
                                                    $
                                                    $
                                                    $
                                                    $
                                                    $
        TOTAL                                       $


5.      Definition of Unit of Service:

        1 unit of service = _______________________________________
                               HYBRID FEE FOR SERVICE BUDGET FORM
                                            (Table I.C.)


 You must complete this form if you are submitting a ―hybrid‖ (transaction) fee for service budget


Service Category:

Title of Service:


1.     Fee Charged per Service Transaction:                             $


2.     Number of Service Transactions to be Provided:


3.     Total Cost of these Services (#1 x #2):                          $

4.     Breakdown of Fee per Service Transaction:


                                                 $
                                                 $
                                                 $
                                                 $
                                                 $
                                                 $
                                                 $
                                                 $
                                                 $
        SUBTOTAL                                 $


5.      Definition of Service Transaction:

        1 unit of service = _______________________________________

6.     Total Amount of Funds to Invoiced (e.g., dollar amount of        $
       assistance vouchers, medication prescriptions, bus passes,
       gasoline vouchers, bus tokens, etc.)

7.     Total Budget Request (#3 + #6):                                  $
                                               SUBCONTRACTOR LIST BUDGET FORM
                                                          (Table I.D.)



     You must complete this form if you are using any subcontractors to provide direct services under this proposal


Service Category:

Title of Service:


Name of Subcontractor(s): 1. _____________________________________

                            2. _____________________________________

                            3. _____________________________________

Amount of Funds from this contract assigned to each subcontractor:

1. $_________________ 2. $_________________ 3. $__________________

Ownership status of each subcontractor:

1. non-profit (or public) ___ yes    ___ no

2. non-profit (or public) ___ yes    ___ no

3. non-profit (or public) ___ yes    ___ no

Any Vendors who propose subcontracting any portion of the direct services to be provided must include a copy of their proposed subcontractor’s
Articles of Incorporation, if any, and, where applicable, proof of the subcontractor’s non-profit status. For each subcontractor, a Budget Narrative
(Budget Form I.A) must be included. If the documentation is not included in the proposal, County will assume the proposed subcontractor is a for-
profit entity.
The vendor‟s legal name must appear on all required licenses or certifications (i.e., the name of vendor as stated on the proposal must be the same as the name
stated on any required licenses and/or certifications). Any vendor who proposes subcontracting any portion of the services to be provided must include a copy
of the executed contract between the vendor and their (proposed) subcontractor in the Appendices. In the case where the vendor is subcontracting any portion of
services where a license and/or certification is required, the legal name of the subcontractor and the name on the subcontractor‟s license/certification must be
identical.

                                                            use additional sheets if necessary
TABLE II.A. - ORGANIZATION INFORMATION TABLE

Complete Table II.A. for each of applicant agency's locations (include all sites which will be used in the provision of services described in this
proposal). Include non-agency sites if those sites will be used to provide services described in this proposal. Answer each required data element
in the column to the right of the shaded area. Every data element must be answered. If the applicant agency does not have a TTY phone line, or
Bilingual staff, etc., the appropriate answer is "none available". Do not leave any cells blank. Use additional copies as necessary.

 Legal Name of Entity                                                      Days/hours of operation.

 Street Address of Entity's                                                Is location within walking distance of
 Administrative Office.                                                    Metro bus stop? (yes or no) If yes,
                                                                           what is walking distance (in miles).
                                                                           (not applicable for locations outside of
                                                                           Harris County)
 Mailing Address (if different).                                           Is facility wheelchair accessible? (yes
                                                                           or no).


 Phone number of this location                                             Bilingual (English/Spanish) speaking
 Fax number of this location                                               staff on duty during all business
 TTY number of this location.                                              hours? (yes or no) (if yes, how many
                                                                           staff).

 PRIMARY CLIENT SERVICES                                                   Days/hours of operation.
 LOCATION
 Street address of Entity's primary                                        Is location within walking distance of
 client services location (primary                                         Metro bus stop? (yes or no) If yes,
 location is defined as that location                                      what is walking distance (in miles).
 which serves the greatest number of                                       (not applicable for locations outside of
 PLWH).                                                                    Harris County)
 Number of years at this location.                                         Is facility wheelchair accessible? (yes
                                                                           or no).
 Phone number of this location                                             Bilingual (English/Spanish) speaking
 Fax number of this location                                               staff on duty during all business
 TTY number of this location.                                              hours? (yes or no) (if yes, how many
                                                                           staff).
PRIMARY CLIENT SERVICES                Days/hours of operation.
LOCATION
Street address of Entity's primary     Is location within walking distance of
client services location (primary      Metro bus stop? (yes or no) If yes,
location is defined as that location   what is walking distance (in miles).
which serves the greatest number of    (not applicable for locations outside of
PLWH).                                 Harris County)
Number of years at this location.      Is facility wheelchair accessible? (yes
                                       or no).
Phone number of this location          Bilingual (English/Spanish) speaking
Fax number of this location            staff on duty during all business
TTY number of this location.           hours? (yes or no) (if yes, how many
                                       staff).




PRIMARY CLIENT SERVICES                Days/hours of operation.
LOCATION
Street address of Entity's primary     Is location within walking distance of
client services location (primary      Metro bus stop? (yes or no) If yes,
location is defined as that location   what is walking distance (in miles).
which serves the greatest number of    (not applicable for locations outside of
PLWH).                                 Harris County)
Number of years at this location.      Is facility wheelchair accessible? (yes
                                       or no).
Phone number of this location          Bilingual (English/Spanish) speaking
Fax number of this location            staff on duty during all business
TTY number of this location.           hours? (yes or no) (if yes, how many
                                       staff).
TABLE II.B. - CURRENT HIV/AIDS CONTRACTS

Complete the Current HIV/AIDS Contracts Table below. Use additional copies as necessary. Include all HIV/AIDS related
prevention and services contracts (including RW Title I contracts with Harris County) for which the applicant has signed and fully
executed contracts or formal written notifications of award. A letter noting the applicant's performance and compliance with contract
conditions from each administrative agency listed on Table II.B. must be included only in the appendices of the two original
proposals. Any situation wherein applicant is reported by these administrative agencies to have problematic performance issues must
be resolved to the County's satisfaction prior to an award being made subsequent to this RFP.

      Funding Source         Administrative Agency         Contract Term       Amount of Funding         Services to be Provided
(e.g., RW Title I, RW II,          for these funds
RW III, RW IV, TDH          (e.g., HIV Services, The
State Services, HOPWA,      Resource Group, City of
etc.)                       Houston, etc.)
          Table II.C. Documented Services To PLWH/A in Calendar Year 2001
             By Age, Gender, Race/Ethnicity, Co-morbidity, and Severe Need

          Category               Number of Unduplicated      Actual ()    Estimate ()
                                    Clients Served
Ages 0 – 12
Ages 13 – 19
Ages 20 – 44
Ages 45+
Male
Female
African American
White
Asian
Pacific Islander
Native American
Number above who report
being of Hispanic origin
   Co-morbidity/Severe Need     Number of Clients (may be    Actual ()    Estimate ()
                                      duplicated)
Number with Tuberculosis
Number who were Homeless
Number with an STD
Number with Mental Illness
Number of Substance Abusers
Number of Men who have Sex
with Men (MSM)
Number of Men of Color who
have Sex with Men (MSM)
Number Deaf/Hard of Hearing
Number Blind/Sight Impaired
Number Recently Released
from Incarceration


Provide the number of clients who received any Ryan White eligible service in calendar year
2001 (1/1/01 – 12/31/01) by each indicated data category. Indicate whether each data element is
actual (preferred) or an estimate. If agency did not provide Ryan White eligible services in
calendar year 2001 mark each data element as NA (not available) and include form in proposal
TABLE III.A. - GOALS and OBJECTIVES

Complete Table III.A. Clearly state measurable goals, objectives, activities, title of staff person(s) responsible for implementation and
specific measurement criteria for the services applicant agency is proposing to provide with the funds requested. (Use additional copies of
this table if additional space is needed to list objectives, activities, etc.).
 Service Category:                                                              New Service or Continuation Funding? (check one)

 Category           Amount ($$) Requested:                                   New Service ________                 Continuation* ________
 Code:
                                                                             *Continuation = currently funded for this service by RW Title I

 GOAL ___:                           OBJECTIVES:                             ACTIVITIES:                                      RESPONSIBLE
                                                                                                                              PERSON(S):




                                                                                                                              MEASUREMENT
                                                                                                                              CRITERIA:




 GOAL ___:                           OBJECTIVES:                             ACTIVITIES:                                      RESPONSIBLE
                                                                                                                              PERSON(S):




                                                                                                                              MEASUREMENT
                                                                                                                              CRITERIA:
TABLE III.B. - PROPOSED CLIENTS TO BE SERVED DURING CONTRACT TERM

Complete Table III.B. Delineate the specific number of clients you propose to serve under this service category with the amount of
funding you are requesting. Indicate the number (not percentages) of clients you propose to serve under each demographic category.
Note that agencies awarded funds will be held accountable for the numbers they project on this table.


                                     MALES                                                        FEMALES
             White/    African    Asian   Pacific-   Native     No. of     White/   African    Asian   Pacific-   Native     No. of
             Anglo     American           Islander   American   Hispanic   Anglo    American           Islander   American   Hispanic
                                                                Origin                                                       Origin     Totals
                                                                Males*                                                       Females*
 Age
 0-12

 Age
 13-19

 Age
 20-44

 Age 45+


 Totals



NOTE: Number of Hispanic males and females is a subset of the total number of males and females of each of the 5 racial categories.

Total number of unduplicated clients proposed to be served if agency is awarded all funds requested in this proposal: ___________
TABLE III.C. - COLLABORATIVE AGREEMENTS WITH OTHER SERVICE PROVIDERS

Complete Table III.C. Specifically identify all collaborative agreements with other agencies which are a component of the service
delivery proposed by applicant agency. Proposer must include signed and dated copies of all referenced collaborative agreements in
the appendices. These collaborative agreements must be in place at the time of proposal submission as documented by appropriate
signature. In order to be valid in respect to this RFP the collaborative agreement must be current, as documented by a signed
agreement dated no earlier than September 1, 2002. Any collaborative agreement not dated September 1, 2002, or later, will be
considered unacceptable for purposes of this RFP process. Use additional copies of this table as necessary.

Collaboration is defined as: Two or more separate entities who have a formal written agreement to work together in a
cooperative effort toward specified and agreed upon objectives.

Name and Street Address of     What specific services will this   What specific services will be    What will be the net benefit to
Collaborative Agency:          collaborative agency provide in    provided by applicant agency in   PLWH from this collaborative
                               support of applicant agency's      this collaborative effort?        effort? Be specific - how does
                               proposed services?                                                   this collaboration make a
                                                                                                    positive difference - what is the
                                       (answer below)                     (answer below)            gain? (answer below)



Phone and Fax Number of
Collaborative Agency:


Contact Person at
Collaborative Agency:

Date Collaboration
Formalized in Writing:
Table III.D. Formal Referral Agreements with Entities Considered to be Points of Entry (POE) into the
Continuum of HIV/AIDS Treatment and Care. This requirement is applicable to the Case Management and Adult
Primary Medical Care service categories only. For all other services categories this requirement is not applicable. If
you are not completing this application for Case Management or Adult Primary Medical Care do not submit Table
III.D.

Instructions: For each required group (A and B) document the minimum number of entities with which the applicant
has formally executed Point of Entry (POE) agreements. Refer to Attachment D of the RFP for a list of Group A and
Group B entities. Copies of applicant‟s formal POE agreements must be included in the Appendix of the proposal.
Formal POE agreements must be current (i.e., must be dated no earlier than 07/01/2002 and extend at least through
02/29/2004).

Applicant agency and POE entity agreement must contain at a minimum the following language:
   “Agency” and “POE” will ensure newly diagnosed HIV-positive and/or those PLWH/A defined as “out-of-care”
      are linked with and provided appropriate care. For purposes of these agreements “out-of-care” shall be defined
      as those HIV-positive individuals who have not had a primary medical care encounter within the previous six
      months.
   During the period of 03/01/2003 through 02/28/2004 “POE” will refer an estimated ___ newly-identified or out-
      of-care HIV-positive individuals for the following services (check  those that apply)
      ____ Primary Medical Care
      ____ Case Management
      ____ Other (list)_____________________________

     “Agency” will maintain documentation of referrals made by “POE” subject to review by HIV Services.
     “Agency” and “POE” will monitor the delivery of services in order to provide coordination of services, avoid
      duplication of services and address service concerns and resolutions to identified concerns.
     The agreement must be signed by the Executive Director (or individual authorized to execute such agreements)
      of both Agency and POE.
     Applicant may create a Group C (optional) to list other appropriate POE entities not included in Group A or B.
     This requirement is applicable to the Case Management and Adult Primary Medical Care service
      categories only. For all other services categories this requirement is not applicable.
TABLE III.D. Formal Referral Agreements with Entities Considered to be Points of Entry (POE) into the
             Continuum of HIV/AIDS Treatment and Care.

Group A
Governmental Entities:
Must list and attach a copy of a minimum of two (2) formal POE agreements from Group A in Attachment D of the
RFP (minimum of one if applicant agency is included in this group).
Name of Entity            POE Activity           Contact Person       Number of New to       Term of POE
                                                                      Care and/or Out of     Agreement
                                                                      Care Clients to be     (dd/mm/yyyy – dd/mm/yyyy)
                                                                      Referred by Entity
                                                                      (3/1/03 – 2/29/04)



Group B
Community-Based Entities:
Must list and attach a copy of a minimum of three (3) formal POE agreements from Group B in Attachment D of the
RFP (minimum of two if applicant agency is included in this group).
Name of Entity            POE Activity           Contact Person        Number of New to       Term of POE
                                                                       Care and/or Out of     Agreement
                                                                       Care Clients to be     (dd/mm/yyyy – dd/mm/yyyy)
                                                                       Referred by Entity
                                                                       (3/1/03 – 2/29/04)
SAMPLE BUDGET TABLES
 (For all Budget Categories)
                                              TABLE I.A. (SAMPLE)




                You must complete this form when you are submitting a fee for service budget


Name of Agency:                ________________My Child Care_______________

        Name of Sub-Contracting Agency:        ________________________
        (If applicable)

Service Category:                       Day Care

Title of Service:                      Child Day Care

1.      PERSONNEL                                                             $182,660.00

        Day Care Coordinator                $27,500.00
        (2,600.00/mo. x 5 months x 50 %)
        (4,000.00/mo. X 7 months x 75%)
        Duties: Supervises schedule and coordinates
        day care activities

        Day Care Transportation Coordinator               $16,340.00
        (1,361.67/mo. X 12 months x 100 %)
        Duties: Responsible for coordinating the
        transportation of children to the day care facility.

        Day Care Worker                            $16,340.00
        (1,361.67/mo. X 12 months x 100 %)
        Duties: Responsible for planning and over-
        Seeing daily activities including but not
        Limited to daily classroom activities

        Day Care Worker                            $16,340.00
        (1,361.67/mo. X 12 months x 100 %)
        Duties: Responsible for planning and over-
        Seeing daily activities including but not
        Limited to daily classroom activities
1.     PERSONNEL (continued)
       Day Care Worker                            $16,340.00
       (1,361.67/mo. X 12 months x 100 %)
       Duties: Responsible for planning and over-
       Seeing daily activities including but not
       Limited to daily classroom activities

       Day Care Worker                            $16,340.00
       (1,361.67/mo. X 12 months x 100 %)
       Duties: Responsible for planning and over-
       Seeing daily activities including but not
       Limited to daily classroom activities

       Day Care Worker                            $16,340.00
       (1,361.67/mo. X 12 months x 100 %)
       Duties: Responsible for planning and over-
       Seeing daily activities including but not
       Limited to daily classroom activities

       Day Care Worker                            $16,340.00
       (1,361.67/mo. X 12 months x 100 %)
       Duties: Responsible for planning and over-
       Seeing daily activities including but not
       Limited to daily classroom activities

       Day Care Worker                            $16,340.00
       (1,361.67/mo. X 12 months x 100 %)
       Duties: Responsible for planning and over-
       Seeing daily activities including but not
       Limited to daily classroom activities

       Clerical Staff                             $14,675.00
       (1300.00/mo. x 5 months x75 %)
       (1400.00/mo. X 7 months x100%)
       Duties: Provides clerical support to the
       coordinator. Maintain accurate records.

       Accountant                               $9,765.00
       (3,255.00/mo. x 12 months x 25 %)
       Duties: Provides AR/AP bookkeeping records.
       Prepares fiscal reports and audits.

Note: Use additional pages as needed.
2.   FRINGE                                                                      $21,919.00
     (Total Personnel costs x TOTAL %)
             FICA                      7.65%
             State Unemployment        2.70%
             Workers Comp.             1.65%
             Health Insurance                %
             Life Insurance                  %
                                             %
                                             %
                                             %
             TOTAL                     12.00%

            Note: All fringe benefits must be included.

3.   TRAVEL                                                                      $4,667.00
     Local Travel                                 $4,667.00
     17,285 miles x $.27/mile

     Describe the purpose of this travel. Be specific about who will travel, where, when and why the travel is
     necessary:
     The purpose of this travel is to transport children to and from the day care facility when their parents or
     guardians cannot drop them off or pick them up. A van will be leased for this purpose (see “Other”
     category below). The Day Care Transportation Coordinator will drive this van.

     Out of Town Travel                           $
     (within the Houston EMA only)
                                           :
     Transportation        $
     Lodging               $
     Per Diem/Meals        $
     TOTAL                 $

                                           :
     Transportation        $
     Lodging               $
     Per Diem/Meals        $
     TOTAL                 $

     Describe the purpose of this travel. Be specific about who will travel, where, when and why the travel is
     necessary:
     _____________________________________________________________________________________
     _____________________________________________________________________________________
     _____________________________________________________________________________________
     _____________________________________________________________________________________
4.   EQUIPMENT                                                                          $1,080.00
     Description: 1 Laptop Computer                    $1,080.00
                                                       $
                                                       $

     Describe the purpose of this equipment. Be specific about who will use the equipment and why it is
     necessary to purchase the equipment:
     This laptop computer will be used „on the road‟ by the Transportation Coordinator to record transportation
     information such as number of miles driven, trips taken and clients transported.

5.   SUPPLIES                                                                           $3,000.00
     General Consumable Office Supplies                $3,000.00
     Other:                                            $
                                                       $
                                                       $
                                                       $

     Describe the purpose of these supplies, especially any listed as ―Other.‖ Be specific about who will use the supplies
     and why it is necessary to purchase these supplies:
     These generable consumable office supplies will be used by the Day Care Coordinator, the Clerical Staff
     Member, and the Accountant to carry out day-to-day job duties.

6.   CONTRACTUAL                                                                        $

                                                       $
     ($      /hr. x           hours)

                                                       $
     ($      /hr. x           hours)

     Describe the purpose of the services/staff/items listed as “Contractual.” Be specific about why it is
     necessary to obtain these services/staff/items:
     _____________________________________________________________________________________
     _____________________________________________________________________________________
     _____________________________________________________________________________________
     _____________________________________________________________________________________
7.   OTHER                                                                       $ 35,586.00

     Telecommunications                           $ 9,727.00
     Printing                                     $ 7 90.00
     Insurance                                    $ 3,100.00
     Office Space                                 $12,846.00
     Infection Control Supplies                   $ 790.00
     Van Lease                                    $ 8,333.00
                                                  $
                                                  $
                                                  $
                                                  $
                                                  $
                                                  $
                                                  $
                                                  $
                                                  $
                                                  $
     TOTAL                                        $35,586.00

     Note: Include all other expenses.

     Describe the purpose of any items listed in the “Other” category. Be specific about who will use the items
     and why it is necessary to purchase these items:
     Telecommunication expenses include monthly local telephone, facsimile and ISDN line charges. Printing
     expenses include informational flyers for parents and guardians. Insurance expenses will cover ____.
     Office space is leased at $1070.50 per month (1000 sq. feet). Infection control supplies include ___, which
     will be administered by the Day Care Coordinator in case of emergency. The van, which seats eight
     passengers, is leased at $694.44 per month. This van will be used by the Transportation Coordinator to
     transport children to and from the day care facility.


TOTAL DIRECT COSTS                                                               $ 248,912.00

TOTAL INDIRECT COSTS (NOT ALLOWED)                                               $       ---

TOTAL COSTS                                                                      $248,912.00
                                      FEE FOR SERVICE BUDGET FORM

                                              TABLE I.B. (SAMPLE)


            You must complete this form when you are submitting a fee for service budget



Service Category:              Day Care

Title of Service:              Child Day Care


1.     Fee Charged per Unit of Service:                                    $94.00


2.     Number of Units of Service to be Provided:                   2648


3.     Total Cost of these Services (#1 x #2):                             $ 248,912.00

4.     Breakdown of Fee per Unit of Service:


        Personnel                                        $68.98
        Fringe                                           $ 8.28
        Travel                                           $ 1.75
        Equipment                                        $ .41
        Supplies                                         $ 1.13
        Other                                            $13.45
        Total                                            $94.00




5.      Definition of Unit of Service:

        1 unit of service =4 hours of day care service
                             SUBCONTRACTOR LIST BUDGET FORM
                                    FORM I.D. SAMPLE




  You must complete this form if you are using any subcontractors to provide direct
                            services under this proposal


Service Category:                     Day Care

Title of Service:                  Child Day Care


Name of Subcontractor(s):        1.              N/A

                              2. _____________________________________

                              3. _____________________________________

Amount of Funds from this contract assigned to each subcontractor:

1. $_________________ 2. $_________________ 3. $__________________

Ownership status of each subcontractor:

1. non-profit (or public) ___ yes        ___ no

2. non-profit (or public) ___ yes        ___ no

3. non-profit (or public) ___ yes        ___ no

Any Vendors who propose subcontracting any portion of the direct services to be provided must include a
copy of their proposed subcontractor’s Articles of Incorporation, if any, and, where applicable, proof of the
subcontractor’s non-profit status. For each subcontractor, a Budget Narrative (Budget Form I.A) must be
included. If the documentation is not included in the proposal, County will assume the proposed
subcontractor is a for-profit entity.
                                    BUDGET NARRATIVE

                                     FORM I.A. SAMPLE
                           (hybrid/transaction fee for service budget)




       You must complete this form when you are submitting a Hybrid fee for service
                                        budget


Name of Agency:               ____Sloppy Joe‟s, Inc.________________________________

        Name of Sub-Contracting Agency:      ___N/A_____________________
        (If applicable)

Service Category:                    SS-13

Title of Service:                    Nutritional Supplements

1.      PERSONNEL                                                        $   8,600.00

               Pharmacist                         $         2,600.00
        (4,333.00/mo. x 12 months x .05%)
        Duties: Dispenses Nutritional Supplements



               Pharmacy Clerk                       $6,000.00
        (2,000.00/mo. x 12 months x 25%)
        Duties: Orders supplies and processes
        requests for Services

                                                    $
        (             /mo. x 12 months x %)
        Duties:



                                                    $
        (             /mo. x 12 months x %)
        Duties:
2.   FRINGE                                                              $ 1,290.00
     (Total Personnel costs x TOTAL %)
             FICA                     7.65%
             State Unemployment       1.01%
             Workers Comp.            2.44%
             Health Insurance         3.90%
             Life Insurance           0.00%
             TOTAL                   15.00%

            Note: All fringe benefits must be included.

3.   TRAVEL                                                                     $
     Local Travel                                 $
                    miles x $      /mile

     Describe the purpose of this travel. Be specific about who will travel, where, when and why
     the travel is necessary:
     _________________________________________________________________________
     _________________________________________________________________________
     _________________________________________________________________________
     _________________________________________________________________________

     Out of Town Travel                           $
     (within the Houston EMA only)
                                           :
     Transportation        $
     Lodging               $
     Per Diem/Meals        $
     TOTAL                 $

     Describe the purpose of this travel. Be specific about who will travel, where, when and why
     the travel is necessary:
     _________________________________________________________________________
     _________________________________________________________________________
     _________________________________________________________________________
     _________________________________________________________________________
4.   EQUIPMENT                                                                    $ 2,500.00
     Description: Computer                         $1,500.00
                  Printer                          $ 500.00
                  Fax Machine                      $ 500.00

     Describe the purpose of this equipment. Be specific about who will use the equipment and
     why it is necessary to purchase the equipment:
     The personal computer will be used by the pharmacy clerk to log prescriptions and track
     availability of supplements, along with routine administrative functions. The printer and the
     fax machine will be used by the pharmacist and the pharmacy clerk to carry out routine
     administrative functions.


5.   SUPPLIES                                                                     $ 870.00
     General Consumable Office Supplies            $870.00
     Other:                                        $
                                                   $
                                                   $
                                                   $

     Describe the purpose of these supplies, especially any listed as “other.” Be specific about
     who will use the supplies and why it is necessary to purchase these supplies:
     The pharmacist and the pharmacy clerk will use the general consumable office supplies to
     conduct routine administrative functions.


6.   CONTRACTUAL                                                                  $

                                                   $
     ($     /hr. x          hours)

                                                   $
     ($     /hr. x          hours)

     Describe the purpose of the services/staff/items listed as “Contractual.” Be specific about
     why it is necessary to obtain these services/staff/items:
     _________________________________________________________________________
     _________________________________________________________________________
     _________________________________________________________________________
     _________________________________________________________________________
     7.     OTHER                                                               $ 38,759.00
     Rent______                                   $1,200.00
     Telephone                                    $ 600.00
                                                  $
                                                  $
                                                  $
     Nutritional Supplements                      $36,959.00
                                                  $
                                                  $
                                                  $
     TOTAL                                        $38,759.00

     Note: Include all other expenses.

     Describe the purpose of any items listed in the “Other” category. Be specific about who
     will use the items and why it is necessary to purchase these items:
     The pharmacy‟s leased office space is 1200 sq. feet. One third of the rent is being charged
     to this grant. The telephone expenses will be used by the pharmacy clerk to facilitate
     processing of prescriptions and to order supplements.


TOTAL DIRECT COSTS                                                              $ 52,019.00

TOTAL INDIRECT COSTS (NOT ALLOWED)                                              $       ---

TOTAL COSTS                                                                     $ 52,019.00
                             HYBRID FEE FOR SERVICE BUDGET FORM
                                      Table I.C. (SAMPLE)




                           You must complete this form if you are submitting
                            a ―hybrid‖ (transaction) fee for service budget




Service Category:         SS-13

Title of Service:                         Nutritional Supplements


1.      Fee Charged per Service Transaction:                                         $        30.00


2.      Number of Service Transactions to be Provided:                               502


3.      Total Cost of these Services (#1 x #2):                                      $ 15,060

4.      Breakdown of Fee per Service Transaction:


             Personnel                                     $17.13
             Fringe                                        $ 2.57
             Equipment                                     $ 4.98
             Supplies                                      $ 1.73
             Other                                         $ 3.59
        SUBTOTAL                                           $30.00

7.      Definition of Service Transaction:

        1 unit of service = 1 visit where a eligible client receives allowable nutritional supplements (up to a
        90 day supply) and nutritional counseling by a licensed dietician.

8.      Total Amount of Funds to Invoiced (e.g., dollar amount of                     $       36,959
        assistance vouchers, medication prescriptions, bus passes,
        gasoline vouchers, bus tokens, etc.)

7.      Total Budget Request (#3 + #6):                                              $        52,019
                             SUBCONTRACTOR LIST BUDGET FORM
                                    FORM I.D. SAMPLE




  You must complete this form if you are using any subcontractors to provide direct
                            services under this proposal


Service Category:                  Food Banks/Home Delivered Meals/Nutritional Supplements

Title of Service:                  Nutritional Supplements


Name of Subcontractor(s):        1. N/A

                              2. _____________________________________

                              3. _____________________________________

Amount of Funds from this contract assigned to each subcontractor:

1. $_________________ 2. $_________________ 3. $__________________

Ownership status of each subcontractor:

1. non-profit (or public) ___ yes      ___ no

2. non-profit (or public) ___ yes      ___ no

3. non-profit (or public) ___ yes      ___ no

Any Vendors who propose subcontracting any portion of the direct services to be provided must include a
copy of their proposed subcontractor’s Articles of Incorporation, if any, and, where applicable, proof of the
subcontractor’s non-profit status. For each subcontractor, a Budget Narrative (Budget Form I.A) must be
included. If the documentation is not included in the proposal, County will assume the proposed
subcontractor is a for-profit entity.
                               Attachment A

                Health Resources and Services Administration

                  March 6, 1997 letter (Non-profit Status)

                     August 10, 2000 letter (Medicaid)




FOR COPY OF THE ATTACHMENT ―A‖, PLEASE CALL MARIA ALMAZAN AT
(713) 755-4657. PROVIDE THE FOLLOWING INFORMATION: COMPANY NAME,
FAX NUMBER, AND TO WHOM ATTENTION IT SHOULD BE FAXED.
                    Attachment B

FY 2002 Financial Eligibility for Houston EMA Services
                                               ATTACHMENT B

          FY 2003 FINANCIAL ELIGIBILITY for HOUSTON EMA SERVICES
    (PERCENTAGE OF INCOME COMPARED TO 2002 HHS POVERTY GUIDELINES)
                                                                                                             300%
OUTPATIENT/AMBULATORY PRIMARY CARE
COMMUNITY-BASED CASE MANAGEMENT                                                                     No income restriction
ORAL HEALTH                                                                                                  300%
DRUG REIMBURSEMENT PROGRAM      HIV MEDS                                                                     500%
                           NON-HIV MEDS                                                                      200%
HEALTH INSURANCE CO-PAYMENTS and DEDUCTIBLES                                                                 300%
HOME HEALTH CARE                                                                                             300%
HOSPICE CARE                                                                                                 300%
MENTAL HEALTH THERAPY/COUNSELING                                                                             300%
SUBSTANCE ABUSE TREATMENT/COUNSELING                                                                         300%
VOLUNTEER SERVICES                                                                                           300%
LEGAL SERVICES                                                                                               300%
COUNSELING/OTHER (including Peer Counseling)                                                                 300%
OUTREACH                                                                                            No income restriction
EARLY INTERVENTION SERVICES (EIS)                                                                   No income restriction
ADULT DAY CARE                                                                                               300%
CHILD DAY CARE                                                                                               300%
DIRECT EMERGENCY ASSISTANCE                                                                                  200%
FOOD BANK/HOME DELIVERED MEALS                                                                               300%
NUTRITIONAL SUPPLEMENTS                                                                                      300%
HEALTH EDUCATION/RISK REDUCTION                                                                     No income restriction
HOUSING                 COORDINATION                                                                         300%
                        EMERGENCY RENTAL and SHELTER VOUCHERS                                                300%
REHABILITATION                                                                                               300%
TRANSPORTATION                                                                                               300%

       2002 HHS Poverty Guidelines (source, Federal Register, Vol. 67, No. 31, February 14, 2002, pp. 6931 – 6933)

                                      Percent of Poverty          48 Contiguous States and
      Size of Family Unit
                                                                    District of Columbia
               1                             100%                                  $ 8,860
               2                             100%                                    11,940
               3                             100%                                    15,020
               4                             100%                                    18,100
               5                             100%                                    21,180
               6                             100%                                    24,260
               7                             100%                                    27,340
               8                             100%                                    30,420
      For each additional
                                                                                       3,080
         person, add:
                      Attachment C

Ryan White Title I Standards of Care and Outcome Measures
                                                                  2002-2003


                                                           RYAN WHITE TITLE I

                                                       STANDARDS FOR CARE

                                                         CASE MANAGEMENT

I.     PURPOSE

                                       The purpose of the Ryan White Title I Standards for Care is to determine the minimal
                                       acceptable levels of quality in service delivery and to provide a measurement of the
                                       effectiveness of or need for services.

II.    CASE MANAGEMENT DEFINITION

       Case management is a working agreement between a client and a case manager for a defined period of time based on the client‟s
       assessed needs. The purpose of case management is to assist clients with the procurement of needed services so that the problems
       associated with living with the disease are mitigated. Case Managers may also provide Client Registration for clients who do not
       want/need case management services, but are requesting Client Registration only.

       Activities of case management include, but are not limited to:

          screening client‟s eligibility and need for RW I services and entering them into the CPCDMS
          assessing each client‟s medical and psychosocial history and current service needs
          developing and regularly updating a service plan based upon the client‟s needs and choices with the client
          implementing the plan in a timely manner
          providing information, referrals and assistance with linkage to medical and psychosocial services as needed
          monitoring the efficacy and quality of services through periodic reevaluation
          advocating on behalf of clients to decrease service gaps and remove barriers to services
          helping clients develop and utilize independent living skills and strategies
          placing clients who no longer require case management services on monitor or independent status




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III.   CODE OF ETHICS

       The following is adapted from the National Social Work Code of Ethics.

       A case manager must observe and comply with the code of ethics and standards of practice set forth below. Any violation of the
       code of ethics or standards of practice will constitute unethical conduct.
       1. A case manager shall not refuse to perform any act or service solely on the basis of a client‟s age, sex, race, color, religion,
          national origin, disability, sexual orientation or political affiliation.
       2. A case manager shall truthfully report or present her or his services, professional credentials and qualifications to clients or
          potential clients.
       3. A case manager shall only offer those services that are within his or her professional competency.
       4. A case manager shall strive to maintain and improve her or his professional knowledge, skills and abilities.
       5. A case manager shall base all services on an assessment, evaluation or diagnosis of the client.
       6. A case manager shall provide the client with a clear description of services, timelines and possible outcomes at the initiation of
          services.
       7. A case manager shall safeguard the client‟s rights to confidentiality within the limits of the law.
       8. A case manager shall avoid relationships with other persons that are detrimental to a client or former client.
       9. A case manager shall not engage in any exploitative or sexual act with a client or former client.
       10. A case manager shall refrain from providing service while impaired due to physical or mental health or the use of drugs or
           alcohol.
       11. A case manager shall evaluate a client‟s progress on a continuing basis to guide service delivery and will make use of
           supervision and consultation as indicated by the client‟s needs.
       12. A case manager shall refer a client for those services that the case manager is unable to provide and terminate service to a
           client when continued service is no longer in the client‟s best interest.
       13. A case manager shall not exploit his or her position of trust with a client or former client.

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       IV.      POPULATION TO BE SERVED

       In order to be eligible for case management or CPCDMS registration services, a person must meet all of the following criteria:

            HIV+
            reside in the contractually-defined catchment area
            meet RWI eligibility guidelines

       Non-HIV infected family members of persons meeting the above eligibility criteria will be served to the extent that their needs are
       related to or result from the HIV+ status of the infected individual.

       Services will target individuals who are members of traditionally unserved and/or underserved populations. No eligible person will
       be refused services. All clients will be served without regard to age, gender, race, color, religion, national origin, sexual
       orientation, political affiliation or disability.


V.     CASE MANAGEMENT GOAL

       The goal of case management services is to promote client empowerment and self-sufficiency.


VI.    OBJECTIVES

       To accomplish this goal each agency will:

       1.       hire case managers who meet the qualifications described in the case manager job description;

       2.       ensure that case managers attend the bi-monthly networking meetings for case managers and service linkage workers
                facilitated by the designated RWI provider;

       3.       ensure that case managers attend required training and ongoing education offered by the designated RWI provider;

       4.       maintain agency policies and procedures regarding confidentiality, consents, grievance procedures and client rights;

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       5.      assure that services are delivered in a culturally competent manner with special attention given to ensure accommodation
               of individuals with special needs;

       6.      ensure that services are rendered in a timely and appropriate manner;

       7.      ensure that service linkage policies and procedures are followed; and

       8.      provide ongoing clinical supervision and support to each case manager.




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VII.   PROCESS STANDARDS

                                   STANDARD                                                           MEASURE
1.0     Staff/Training
1.1     MINIMUM QUALIFICATIONS                                                A file will be maintained on each case manager. Supportive
        Case managers meet minimum qualifications for positions as            documentation of case manager credentials is maintained by
        described in the position description attached to the RFPs, and       the agency and in each case manager file. Documentation
        attached to this document.                                            may include, but is not limited to, transcripts, diplomas,
                                                                              certifications, and/or licensure.
1.2     Background Check                                                            Review of Policies and Procedures Manual indicates
        Procedures exist for obtaining background checks and other                   compliance.
        required documentation of all staff.                                        Review of personnel files indicates compliance
1.3     Agency Orientation                                                    Documentation of completion of agency orientation is
        Agency will provide new hires with training regarding                 maintained by the agency.
        confidentiality, client rights and the agency‟s client grievance
        procedure.
1.4     Required Meetings                                                     Agency will maintain verification of attendance.
        Case managers will attend a minimum of four (4) of the six (6) bi-
        monthly networking meetings facilitated by the designated RWI
        provider annually.
1.5     Required Certifications                                               Documentation of certification by a certified trainer is
        WITHIN  THREE (3) MONTHS OF EMPLOYMENT, CASE MANAGERS                 maintained by the agency and will appear in each case
        OBTAIN CERTIFICATION IN FIRST AID/CPR AND NON-VIOLENT                 manager‟s file.
        CRISIS INTERVENTION. CASE MANAGERS WILL MAINTAIN FIRST
        AID/CPR     AND     NON-VIOLENT   CRISIS  INTERVENTION
        CERTIFICATIONS AS REQUIRED.




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                                   STANDARD                                                          MEASURE
1.6     Required Training for New Employees                                   Certificates of completion are maintained by the agency
                                                                              and will appear in case manager’s file.
        Within the first six (6) months of employment, case managers will
        complete at least ten (10) hours medical, at least ten (10) hours
        psychosocial and at least eight (8) hours cultural competency
        training offered by the designated RWI Provider.


 1.7                                                                          Certificates of completion are maintained by the agency.
        Ongoing Education/Training for Case Managers
        After the first year of employment, each case manager will obtain
        a minimum of fifteen (15) hours per year additional education
        and/or training offered by the designated RWI Provider.
2.0     Rights and Responsibilities
2.1     Confidentiality                                                       Agency Policy and Procedure.
        Agency has Policy and Procedure regarding client confidentiality
        in accordance with HIV Services site visit guidelines, local, State
        and Federal laws.
2.2     Consents                                                              Agency Policy and Procedure and signed and dated consent
        All consent forms comply with State and Federal law, are signed       forms in client record.
        by an individual legally able to give consent and must include the
        Consent for Services form and a consent for release/exchange of
        information for every individual/agency to whom client
        identifying information is disclosed, regardless of whether or not
        HIV status is revealed.
2.3     Grievance Procedure                                                   Agency Grievance Policy and Procedure clearly posted and
        Agency has Policy and Procedure regarding client grievances that      signed receipt of agency Grievance Procedure and HIV
        is reviewed with each client in a language and format the client      Services Grievance Procedure in client record.
        can understand and a written copy of which is provided to each

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                                  STANDARD                                                             MEASURE
        client.
2.4     Client Rights & Responsibilities                                      Agency Policy and Procedure and signed receipt of Clients
        Agency has a Client Rights & Responsibilities Statement that is       Rights & Responsibilities Statement in client record.
        reviewed with each client in a language and format the client can
        understand and a written copy of which is provided to each client.
3.0     Accessibility
3.1     Cultural Competence                                                   Availability of interpretive services, translated materials,
        Agency demonstrates a commitment to provision of services that        bilingual staff, and staff trained in cultural competence.
        are culturally sensitive and language competent.
3.2     Special Service Needs                                                 Agency compliance with the Americans with Disabilities
        Agency demonstrates a commitment to assisting individuals with        Act (ADA).
        special needs.




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                                  STANDARD                                                           MEASURE
4.0     Timeliness of Services/Documentation
4.1                                                                           Documentation of HIV+ status, residence and income in the
        Client Eligibility                                                    client record.
        IN ORDER TO BE ELIGIBLE FOR CASE MANAGEMENT SERVICES, INDIVIDUALS
        MUST MEET THE FOLLOWING:
         HIV+
         RESIDENCE IN THE HOUSTON EMA
           Proof/documentation of income
           Proof of identification
4.2                                                                           Documentation in client record.
        Initial Case Management Contact
        Contact with client and/or referring agent is attempted within one
        working day of receiving a case assignment. If the case manager is
        unable to make contact within one working day, this is
        documented and explained in the client record and the supervisor
        is notified. All subsequent attempts are documented.




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                                   STANDARD                                                         MEASURE
4.4     Proof of HIV Diagnosis                                                Documentation in client record as per HIV Services site
        Documentation of the client's HIV status is obtained at or prior to   visit guidelines.
        the initiation of services or registration services.
        An anonymous test result may be used to document HIV status
        temporarily (up to sixty [60] days) and such must contain
        identifying information sufficient to ensure a reasonable certainty
        as to the identity of the test subject.
4.5     Stage of Illness                                                      Documentation in client record as per HIV Services site
                                                                              visit guidelines.
        Documentation of client‟s stage of illness must be updated
        annually for case managed clients NOT receiving primary care
        from a RWI provider.
4.6     Case Management Assessment                                            Documentation in client record on the comprehensive
                                                                              client assessment forms, signed and dated, or agency‟s
        Assessment begins at intake.                                          equivalent forms. Updates to the information included in
        The comprehensive client assessment will include an evaluation of     the assessment will be recorded in the comprehensive
        the client‟s medical and psychosocial needs, strengths, resources,    client assessment.
        limitations and projected barriers to service within ten (10)
        working days.
4.7     Reassessment                                                          Documentation in client record on the comprehensive
                                                                              client assessment form or agency‟s equivalent form,
        Clients will be reassessed at six (6) month intervals following the
                                                                              signed and dated.
        initial assessment.




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                                   STANDARD                                                        MEASURE
4.8     Case Management Service Plan                                       Documentation in client record on the case management
        Service planning begins at admission to case management service service plan or agency‟s equivalent form.
        and is based upon assessment. A service plan signed by the client
        and the case manager will be completed no later than ten (10)
        working days following the comprehensive client assessment.
        The service plan will seek timely resolution to crises, short-term
        and long-term needs, and may document crisis intervention
        and/or short term needs met before full service plan is completed.
        Service plans reflect the needs and choices of the client and are
        consistent with the progress notes. A new service plan is
        completed at each six (6) month reassessment.
4.9     Progress Notes                                                     Legible, signed and dated documentation in client record.
        All case management activities, including but not limited to, all
        contacts and attempted contacts with or on behalf of clients are
        documented in the client record within one working day of their
        occurrence.




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                                               STANDARD                                                            MEASURE
4.10    Data Entry                                                                                      Timely data entry in the
        Intakes and changes in the client status are documented in the Centralized Patient Care         Centralized Patient Care Data
        Data Management System within 48 hours                                                          Management System.
        Documentation of direct case management services are documented in the Centralized
        Patient Care Data Management System within fifteen (15) days of their occurrence.
        DIRECT SERVICES INCLUDE:
           CPCDMS Client Registration
           Client intake
           Face to face contact with the client
           Face to face contact with client‟s friend, spouse/partner, family member, legal guardian,
            etc. or a service provider
           Phone contact with client or any of the above persons
           Comprehensive assessment
           Completion of service plan
           Client-specific supervision

       Indirect services (not entered into the Centralized Patient Care Data Management System)
       include:
        Travel without a client present
        Written/faxed/e-mail correspondence
        Messages left on answering machines/voice mail and phone not being answered at all
        Waiting for clients who are late and “no shows”
        Completing applications/forms (except assessments and service plans), writing
            progress notes, doing data entry, etc. without a client present




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                                    STANDARD                                                            MEASURE
4.11    Encounters: Open Clients – Active                                        Documentation in the progress notes and in the Centralized
        A minimum of one (1) face-to-face visit with the client will occur       Patient Care Data Management System.
        every thirty (30) days with all clients on active status. At least one
        (1) visit in the client‟s natural environment will occur every ninety
        (90) days. If unable to meet with the client, justification will be
        documented in the progress notes.
4.12    Encounters: Open Clients – Monitor                                       Documentation in the progress notes and in the Centralized
        A minimum of one (1) contact by phone every thirty (30) days for         Patient Care Data Management System.
        all clients who had been case managed prior to being placed on
        monitor status.
4.13    Client Transfers between Agencies: Open or Closed less than One          Documentation in client record.
        Year
        All clients are transferred in accordance with Case Management
        Policy and Procedure, which requires that a “consent for transfer
        and release/exchange of information” form be completed and
        signed by the client, the client‟s record be forwarded to the
        receiving care manager within five (5) days and a Request for
        Transfer form be completed for the client and submitted to HIV
        Services.




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                                    STANDARD                                                              MEASURE
4.16    Client Closure                                                        Documentation in client record and in the Centralized Patient Care Data
                                                                              Management System.
        A summary progress note is completed within three (3) days of
        closure.
5.0     Supervision
5.1     Supervisor Qualifications                                             Documentation of supervisor credentials is maintained by
        Supervision is provided by a licensed Master‟s level clinician        the agency.
        (LMSW, LPC, LMFT) with at least three (3) years supervisory
        experience and two (2) years HIV experience. Position description
        attached to this document.
5.2     Meeting Attendance                                                    Agency will maintain verification of attendance.
        Supervisors will attend a minimum of ten (10) monthly
        supervisor‟s meetings per year to be facilitated by the designated
        RWI provider.




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                                   STANDARD                                                            MEASURE
5.3    Clinical Supervision                                                     DOCUMENTATION IN SUPERVISION NOTES, WHICH MUST INCLUDE:
                                                                                         date
       The equivalent of a minimum of four (4) hours supervision per
                                                                                         name(s) of case manager(s) present
       month must be provided to each case manager by a licensed
                                                                                         topic(s) covered and/or client(s) reviewed
       Master‟s level clinician, one (1) of which must be individual
       supervision.                                                                      plan(s) of action
                                                                                         supervisor‟s signature
       Supervision includes, but is not limited to, one-to-one consultation
                                                                                Supervision notes are never maintained in the client
       regarding issues that arise in the case management relationship, case
                                                                                record.
       staffing meetings, group supervision, discussion of gaps in services
       or barriers to services, intervention strategies, case assignments,
       case reviews and caseload assessments.
5.4    Caseload Coverage                                                        Documentation of all client encounters in client record and
       Supervisor ensures that there is coverage of the caseload in the         in the Centralized Patient Care Data Management System.
       absence of the case manager or when the position is vacant.
5.6    Case Reviews                                                             DOCUMENTATION OF CASE REVIEWS IN CLIENT RECORD, SIGNED
                                                                                AND DATED BY SUPERVISOR AND/OR QUALITY ASSURANCE
       Supervisor reviews each active case with the case manager at least       PERSONNEL.
       once every ninety (90) days and ensures that all required record
       components are present, timely, legible, and that services provided
       are clinically appropriate.
5.7    Continuity of Care                                                       Documentation of supervisor‟s encounters in client record,
       The agency supervisor is responsible for ensuring that services are      signed and dated, and in the Centralized Patient Care Data
       provided and that the continuity of care is maintained for any clients   Management System.
       who are no longer able or willing to continue working with their
       current case manager.




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                                                            Position Description
                                                              Case Manager

I.      GENERAL DESCRIPTION

       Case management is a working agreement between a client and a case manager for a defined period of time based on the
       client‟s assessed needs. The purpose of case management is to assist clients with the procurement of needed services so that
       the problems associated with living with HIV disease are mitigated.

       The Ryan White Planning Council (RWPC) has adopted the National Social Work Code of Ethics as the professional ethical
       standard to be followed by case managers.

II.     CASE MANAGEMENT ACTIVITIES

       Activities of case management include, but are not limited to:

          Identifying and screening clients
          Assessing each client‟s medical and psychosocial history and current service needs
          Developing and regularly updating a service plan based upon the client‟s needs and choices
          Implementing the service plan in a timely manner
          Providing information, referrals and assistance with linkage to medical and psychosocial services as needed
          Monitoring the efficacy and quality of services through periodic reevaluation
          Advocating on behalf of clients to decrease service gaps and remove language barriers to services
          Helping clients develop and utilize independent living skills and strategies
          Interpreting and translating for clients as needed (Hispanic-targeted CM team and Bilingual Case Managers)

III.    PERFORMANCE STANDARDS

       Case Managers are required to comply with the current RWPC-approved Standards of Care, Outcome Measures, HIV/CMS
       policies and procedures, CPCDMS business rules and HIV Services‟ Site Visit Guidelines.
IV.     EDUCATION/EXPERIENCE



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       Required:
        A Bachelor‟s degree from an accredited college of university with a major in social or behavioral sciences. Bilingual
          (English/Spanish) targeted case managers must have written and verbal fluency in English and Spanish and
        A minimum of one (1) year paid work experience with People Living With HIV/AIDS.
        Bilingual targeted case managers must have experience providing services to monolingual (English/Spanish) persons.




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                                                           Position Description
                                                       Nurse/Medical Social Worker

I.      GENERAL DESCRIPTION

       A Registered Nurse (RN) or Licensed Master of Social Work (LMSW) to provide medical/psychosocial assessment and short-
       term intensive intervention to clients and consultation services to other members of the case management team.

II.     MEDICAL CASE MANAGEMENT ACTIVITIES

       Activities of medical case management include, but are not limited to:

          Ensure clinically appropriate medications are obtained
          Refer and follow-up with medical appointments
          Provide nutritional evaluation and education and referrals for appropriate supplements and supplies
          Monitor and support treatment compliance
          Serve as liaison between medical staff and client
          Coordinate services with case management team members
          Participate in discharge planning
          Perform client assessments
          Develop a medical service plan for each client
          Conduct home and hospital visits
          Interact and advocate with medical providers on behalf of clients
          Monitor medical services accessed by clients and follow-up as needed
          Transition clients to more independent status upon completion of service plan and medical stabilization
          Document all services provided in client record and CPCDMS




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III.    PERFORMANCE STANDARDS

       Case Managers are required to comply with the current RWPC-approved Standards of Care, Outcome Measures, HIV/CMS
       policies and procedures, CPCDMS business rules and HIV Services‟ Site Visit Guidelines.

IV.     EDUCATION/EXPERIENCE

       Required:
           A BSN/RN degree from an accredited college or university, or an MSW degree with LMSW licensure from the State of
             Texas and a minimum of two (2) years documented health care experience with Persons Living with HIV/AIDS.




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                                                           Position Description
                                                         Service Linkage Worker

I.      GENERAL DESCRIPTION

       Service Linkage is a working agreement between a client and a service linkage for a variable period of time based on the
       client‟s identified need, during which information, referrals, CPCDMS eligibility and service linkage are provided on as needed
       basis. The purpose of service linkage is to assist clients who do not require the same intensity as a case management
       relationship, as determined by service need level, with the procurement of needed services so that the problems associated with
       living with HIV disease are mitigated.

       The Ryan White Planning Council (RWPC) has adopted the National Social Work Code of Ethics as the professional ethical
       standard to be followed by case managers.

II.     CASE MANAGEMENT ACTIVITIES

       Activities of case management include, but are not limited to:

          Networking with Point of Entry (POE) sites and other entities for referrals
          Assessing each client‟s medical and psychosocial history and current service needs
          Providing information, referrals and assistance with linkage to medical and psychosocial services as needed
          Advocating on behalf of clients to decrease service gaps and remove language barriers to services
          Helping clients utilize independent living skills and strategies
          Interpreting and translating for clients as needed (Hispanic-targeted CM team and Bilingual Service Linkage Workers)

III.    PERFORMANCE STANDARDS

       Case Managers are required to comply with the current RWPC-approved Standards of Care, Outcome Measures, HIV/CMS
       policies and procedures, CPCDMS business rules and HIV Services‟ Site Visit Guidelines.




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IV.     EDUCATION/EXPERIENCE

       Required:
        A Bachelor‟s degree from an accredited college of university with a major in social or behavioral sciences. Bilingual
          (English/Spanish) targeted service linkage workers must have written and verbal fluency in English and Spanish and,
        A minimum of one (1) year paid work experience with People Living With HIV/AIDS (PLWHA) or two (2) years
          documented volunteer services to PLWH/A.
          Or
        Three years of uninterrupted full-time paid experience (must be through present day) as an outreach worker, service linkage
          worker and/or case manager with the Houston Regional HIV Case Management System may be substituted for the
          Bachelor‟s Degree with prior approval of HIV Services.




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                                                            Position Description
                                                                 Supervisor

I.      GENERAL DESCRIPTION

       The purpose of supervision is to ensure that case management services are provided to all clients in a timely, accountable and
       clinically appropriate manner.

       The Ryan White Planning Council (RWPC) has adopted the National Social Work Code of Ethics as the professional ethical
       standard to be followed by case managers.

II.     SUPERVISORY ACTIVITIES

       Activities of supervision include, but are not limited to:

          Providing a minimum of four (4) hours clinical supervision to each case manager, medical case manager or service linkage
           worker monthly, that includes one-on-one consultations regarding issues that arise in the case management relationship,
           case staffing meetings, group supervision, discussion and solution of barriers to services, intervention strategies, case
           reviews and caseload assessments
          Screening potential clients for service need level through dialogue with the potential client or referring party
          Assigning cases for contact by case management team staff
          Providing direct case management services to those clients determined as requiring clinical case management provided by a
           Master‟s level licensed clinician
          Monitoring the caseload of all team members at least once every 90 days and ensuring that all required clinical record
           components are present, timely and legible, and that services provided are clinically appropriate
          Ensuring caseload coverage in the absence of team members or when positions are vacant
          Ensuring that services are provided and that the continuity of care is maintained for clients who are no longer able or
           willing to continue with their current case manager, and process transfers to other team members or case management
           providers as clinically indicated




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III.    PERFORMANCE STANDARDS

       Supervisor are required to comply with RWPC-approved Standards of Care, Outcome Measures, HIV/CMS policies and
       procedures, CPCDMS business rules and HIV Services‟ Site Visit Guidelines.

IV.     EDUCATION/EXPERIENCE

       Required:
        A Master‟s degree from an accredited to college or university. Bilingual (English/Spanish) targeted supervisor must have
          written and verbal fluency in English and Spanish.
        A current and in good standing State of Texas clinical license (LMSW, LPC, LMFT)
        A minimum of three (3) years paid supervisory experience
        A minimum of one (1) years paid experience with People Living With HIV/AIDS.
        Bilingual CM team targeted Supervisor must have experience providing services to monolingual (English/Spanish)
          persons.




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       RYAN WHITE TITLE I

                                                       STANDARDS FOR CARE
                                                      DRUG REIMBURSEMENT


I.     PURPOSE

                                       The purpose of the Ryan White Title I Standards for Care is to determine the minimal
                                       acceptable levels of quality in service delivery and to provide a measurement of the
                                       effectiveness of services.

II.    PROCESS STANDARDS

                              STANDARD                                                              MEASURE
1.0    Services are offered in such a way as to overcome barriers to access and utilization. Service is easily accessible to
       persons with HIV/AIDS.
1.1    Client Eligibility                                                        Documentation of HIV+ status, residence and income
       INORDER TO BE ELIGIBLE FOR SERVICES, INDIVIDUALS MUST
                                                                                  in the client record.
       MEET THE FOLLOWING:

           HIV+
           RESIDENCE IN THE HOUSTON EMA
           Income no greater than 500% of the Federal poverty level
1.2    Program Information                                                       Agency has a written annual dissemination plan.
       Broad-based dissemination of information regarding the
       availability of services.




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                              STANDARD                                                               MEASURE
1.3    Intake                                                                    Staff are present to answer incoming calls during
       Intake process is flexible and responsive, accommodating                   agency‟s operating hours.
       disabilities and health conditions.                                       Agency has procedures for communicating with
                                                                                  people with hearing impairments.
1.4    Cultural Competence                                                       Agency has procedures for obtaining translation
       Program is competent at delivering services to culturally and              services.
       linguistically diverse populations.
                                                                 Client satisfaction survey indicates compliance.
2.0    SERVICES ARE PART OF THE COORDINATED CONTINUUM OF HIV/AIDS SERVICES

2.1    Agency receives referrals from a broad range of HIV/AIDS                  Documentation of referrals received.
       service providers and makes appropriate referrals out when
                                                                                 Documentation of referrals out.
       necessary.
                                                                                 Staff reports indicate compliance.
3.0    Staff HIV/AIDS knowledge is based on solid training.
3.1    Orientation                                                               Review of training curriculum indicates compliance.
       Initial orientation includes 12 hours of HIV/AIDS basics,
                                                                                 Documentation of all training in personnel file.
       confidentiality issues, role of new staff and agency-specific
       information within 90 days of contract start date or hire date.           Specific training requirements are specified in the
                                                                                  staff guidelines.
3.2    Ongoing Training                                                          Materials for staff training and continuing education
       8 hours annually of continuing education in HIV/AIDS related or            are on file.
       other specific topics is required.                                        Staff interviews indicate compliance.
3.3    Staff Experience                                                          Documentation of work experience in personnel file.
       A minimum of one year documented HIV/AIDS work experience
       is preferred.
4.0    Service providers are knowledgeable, accepting and respectful of the needs of individuals with HIV/AIDS. Staff
       efforts are compassionate and sensitive to client needs.

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                                STANDARD                                                             MEASURE
4.1    Staff Screening                                                            Documentation of staff applications.
       Staff providing services to clients shall be screened for                  Staff interviews indicate compliance.
       appropriateness by provider agency as follows:
          Personal interview
                                                                                  Review of Policies and Procedures Manual indicates
          Written application                                                     compliance.
          Policies and Procedures exist for addressing criminal                      Review of personnel files indicates compliance
           background checks on staff and/or volunteers.
4.2    Client Feedback                                                            Client feedback mechanism is in place.
       Feedback from clients (or from client caregivers, in cases where           Documentation of clients‟ evaluation of services is
       clients are too young to give feedback) is regularly obtained               maintained.
       about quality of services.
4.3    Client Confidentiality                                                     Review of personnel files indicates compliance.
       There is a written policy statement regarding client
       confidentiality signed by each employee and included in the
       personnel file.




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                               STANDARD                                                              MEASURE
4.4    Professional Behavior                                                     Staff guidelines include standards of professional
       Staff agree to follow written standards of professional behavior.          behavior.
                                                                                 Review of personnel files indicates compliance.
                                                                                 Review of agency‟s complaint and grievance files.
5.0    Services utilize effective management practices such as cost effectiveness, human resources and quality improvement.
5.1    Service Evaluation                                                      Review of Policies and Procedures manual indicates
       Agency has a process in place for the evaluation of client               compliance.
       services.                                                               Staff interviews indicate compliance.
5.2    Accountability                                                          Documentation of staff time.
       There is a system in place to document staff work time.
5.3    Staff Guidelines                                                          Personnel file contains a signed statement
       Agency develops written guidelines for staff, which include, at a          acknowledging that staff guidelines were reviewed
       minimum, agency-specific policies and procedures (staff                    and that the employee understands agency policies
       selection, resignation and termination process, job descriptions);         and procedures.
       professional behavior standards; client confidentiality; health and
       safety requirements; complaint and grievance procedures;
       emergency procedures; and statement of client rights.




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                              STANDARD                                                             MEASURE
5.4    Staff Supervision                                                         Review of personnel files indicates compliance.
       Staff coordinator/manager is a paid position that supervises staff        Review of Policies and Procedures manual indicates
       services.                                                                  compliance.
5.5    Communication                                                             Review of Policies and Procedures manual indicates
       There are procedures in place regarding regular communication              compliance.
       with staff about the program and general agency issues.                   Mechanism for regular communication with staff is
                                                                                  in place.
                                                                                 Staff interviews indicate compliance.




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                                                        RYAN WHITE TITLE I

                                                  STANDARDS FOR CARE
                                             EMERGENCY FINANCIAL ASSISTANCE

I.     PURPOSE

                                       The purpose of the Ryan White Title I Standards for Care is to determine the minimal
                                       acceptable levels of quality in service delivery and to provide a measurement of the
                                       effectiveness of services.

II.    PROCESS STANDARDS

                               STANDARD                                                              MEASURE
1.0   Services are offered in such a way as to overcome barriers to access and utilization. Service is easily accessible to
persons with HIV/AIDS.
1.1    Program Information                                                       Agency has a written substantiated annual
Broad-based dissemination of information regarding the availability of            dissemination plan to targeted populations.
services.
1.2    Intake                                                                    When necessary, client is provided alternatives to
Intake process is flexible and responsive, accommodating disabilities and         office visits, such as conducting business by mail, fax
health conditions. Intake should be completed within 48 hours if there is         or other modes of communication.
critical need.                                                                   Staff is present to answer incoming calls during
                                                                                  agency‟s operating hours.
                                                                                 Agency has procedures for communicating with
                                                                                  people with hearing impairments.




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                                STANDARD                                                              MEASURE
1.3      Cultural Competence                                                      Agency has procedures for obtaining translation
Program is competent at delivering services to culturally and linguistically       services.
diverse populations.                                                              Client satisfaction survey indicates compliance.
2.0      Services are part of the coordinated continuum of HIV/AIDS services.
2.1      Referrals                                                                Documentation in client files of referrals made
Agency makes appropriate referrals out when necessary.                            Client satisfaction survey indicates compliance.
                                                                                  Staff interviews indicate compliance.
2.2      Agency Collaboration                                                     Letters of agreement are on file.
Agency maintains formal letters of agreement with other agencies that             An outline of specific programmatic role/function in
provide direct emergency financial assistance to avoid duplication and/or          collaboration exists (may be with letters).
supplanting of payments.
3.0      Services are provided in an efficient and timely manner
3.1                     Client Eligibility                                        Documentation of HIV+ status, residence and income
IN ORDER TO BE ELIGIBLE FOR SERVICES, INDIVIDUALS MUST MEET THE FOLLOWING:         in the client record.
     HIV+
     RESIDENCE IN THE HOUSTON EMA
     For utility assistance, income no greater than 200% of the Federal
      poverty level
     For rental assistance income no greater than 300% of the Federal
      poverty level.
3.2      Non-Critical Need Approval                                               Documentation is in client file
All completed requests for assistance shall be approved or denied within          Policies and Procedures Manual
three (3) working days.
                                                                                  Staff interviews



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                               STANDARD                                                              MEASURE
3.3    Non-Critical Need Check Issuance                                          Documentation is in client file
A check shall be issued for a non-critical need within five (5) working          Policies and Procedures Manual
days request.
                                                                                 Staff interviews
3.4    Critical Need Approval                                                    Documentation is in client file
The program must have an efficient system in place to process critical           Policies and Procedures Manual
need requests within 48 hours that includes a decision-making body
                                                                                 Staff interviews
responsible for the reviewing the applications.
3.5    Critical Need Check Issuance                                              Documentation is in client file
A check shall be issued in response to a critical need within three (3)          Policies and Procedures Manual
working days of approval of the request.
                                                                                 Staff interviews
3.6    Pledges                                                                   Documentation is in client file.
A pledge, when applicable, shall be made in response to a critical need
within one (1) working day of approval of request.
3.7    Fund Distribution                                                         Documentation is in client file
Program shall have in place protocols to ensure that funds are distributed       Policies and Procedures Manual
fairly and consistently.
                                                                                 Staff interviews




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                                 STANDARD                                                             MEASURE
4.0       FINANCIAL CONTROLS
The agency must comply with the scope of work as defined in its contract.
4.1       Payments                                                               Documentation is in client file
The agency must ensure that no payments are made directly to clients,            Staff interviews.
family or household members and that funds are not used for any expenses
associated with the ownership or maintenance of a privately owned motor
vehicle or for clothing. The invoice/bill which is to be paid with direct
emergency assistance funds must be in the client‟s name. An exception
may be made only in instances where it is documented that, although the
service (e.g. utility) is in another‟s name, it directly benefits the client.
4.2       Supportive Documentation                                               Documentation in the client file
The agency must maintain the following documents in each client’s case           Staff interviews.
file, in addition to any other documentation which may be required by
HIV Services site visit guidelines.
         Copy of the invoice/bill/lease/home tax receipt paid
         Copy of the check for payment
4.3       Authorization                                                          Documentation is in client file
The agency must also have a mechanism whereby authorization is given to          Agency Policies and Procedures
a back-up staff person to pay a bill or prepare check on behalf of the client
                                                                                 Staff interviews
in critical need.




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                               STANDARD                                                               MEASURE
4.4   Abuse of Program                                                           Agency Policies and Procedures
The program must have a procedure in place to ensure that client                 Staff interviews
misrepresentation of need or use of assistance funds for a purpose other
                                                                                 Review of client records
than that for which the funds were requested constitutes abuse. Any
infraction of direct emergency assistance services may result in the denial
of future assistance for a client within one year of infraction.
4.5    Denial Letters                                                            Copy of denial letter in client file
RWI eligible clients that have been denied financial assistance must be
provided a denial letter from the agency.
4.6    Agency Grievance Procedure                                                Signed acknowledgement in client file
The agency must ensure that clients are informed of all program policies         Program policies and procedures are clearly posted at
that includes information regarding appeals of denials of funding that may        the agency
be made by using the agency‟s grievance procedure.
5.0 Criminal Background Check
5.1   Background Check                                                         Review of Policies and Procedures Manual indicates
Policies and Procedures exist for addressing criminal background checks         compliance.
on staff and/or volunteers.                                                    Review of personnel files indicates compliance




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                                                        RYAN WHITE TITLE I

                                                       STANDARDS FOR CARE


                                             HEALTH INSURANCE REIMBURSEMENT


I.     PURPOSE

                                       The purpose of the Ryan White Title I Standards for Care is to determine the minimal
                                       acceptable levels of quality in service delivery and to provide a measurement of the
                                       effectiveness of services.

II.    PROCESS STANDARDS


                               STANDARD                                                            MEASURE
1.0    Services are offered in such a way as to overcome barriers to access and utilization. Service is easily accessible to
       persons with HIV/AIDS.
1.1    Client Eligibility                                                        Documentation of HIV+ status, residence and income
       IN ORDER TO BE ELIGIBLE FOR SERVICES, INDIVIDUALS MUST MEET THE            in the client record.
       FOLLOWING:

          HIV+
          RESIDENCE IN THE HOUSTON EMA
          Income no greater than 300% of the Federal poverty level
1.2    Program Information                                                       Agency has a written annual dissemination plan.
       Broad-based dissemination of information regarding the
       availability of services.




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                               STANDARD                                                             MEASURE
1.3    Intake                                                                    When necessary, client is provided alternatives to
       Intake process is flexible and responsive, accommodating                   office visits, such as conducting business by mail.
       disabilities and health conditions.                                       Staff are present to answer incoming calls during
                                                                                  agency‟s operating hours.
                                                                                 Agency has procedures for communicating with
                                                                                  people with hearing impairments.
1.4    Cultural Competence                                                       Agency has procedures for obtaining translation
       Program is competent at delivering services to culturally and              services.
       linguistically diverse populations.
                                                                                 Client satisfaction survey indicates compliance.
2.0    Services are part of the coordinated continuum of HIV/AIDS services.

2.1    Agency receives referrals from a broad range of HIV/AIDS                  Documentation of referrals received.
       service providers and makes appropriate referrals out when
                                                                                 Documentation of referrals out.
       necessary.
                                                                                 Staff reports indicate compliance.
3.0    Staff HIV/AIDS knowledge is based on solid training.
3.1    Orientation                                                               Review of training curriculum indicates compliance.
       Initial orientation includes 12 hours of HIV/AIDS basics,
                                                                                 Documentation of all training in personnel file.
       confidentiality issues, role of new staff and agency-specific
       information within 90 days of contract start date or hire date.           Specific training requirements are specified in the
                                                                                  staff guidelines.
3.2    Ongoing Training                                                          Materials for staff training and continuing education
       8 hours annually of continuing education in HIV/AIDS related or            are on file.
       other specific topics is required.                                        Staff interviews indicate compliance.
3.3    Staff Experience                                                          Documentation of work experience in personnel
       A minimum of one year documented HIV/AIDS work experience                  file.
       is preferred.

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                                STANDARD                                                            MEASURE
4.0    Service providers are knowledgeable, accepting and respectful of the needs of individuals with HIV/AIDS. Staff
       efforts are compassionate and sensitive to client needs.
4.1    Staff Screening                                                           Documentation of staff applications.
                                                                                 Staff interviews indicate compliance.
       Staff providing services to clients shall be screened for
       appropriateness by provider agency as follows:
        Personal interview                                                          Review of Policies and Procedures Manual
          Written application                                                        indicates compliance.

          Policies and Procedures exist for addressing criminal                     Review of personnel files indicates compliance
           background checks on staff and/or volunteers.
4.2    Client Feedback                                                           Client feedback mechanism is in place.
       Feedback from clients (or from client caregivers, in cases where          Documentation of clients‟ evaluation of services is
       clients are too young to give feedback) is regularly obtained about        maintained.
       quality of services.
4.3    Client Confidentiality                                                    Review of personnel files indicates compliance.
       There is a written policy statement regarding client confidentiality
       signed by each employee and included in the personnel file.
4.4    Professional Behavior                                                     Staff guidelines include standards of professional
       Staff agree to follow written standards of professional behavior.          behavior.
                                                                                 Review of personnel files indicates compliance.
                                                                                 Review of agency‟s complaint and grievance files.
5.0    Services utilize effective management practices such as cost effectiveness, human resources and quality improvement.
5.1    Service Evaluation                                                            Review of Policies and Procedures manual
       Agency has a process in place for the evaluation of client services.           indicates compliance.
                                                                                     Staff interviews indicate compliance.

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                               STANDARD                                                             MEASURE
5.2    Accountability                                                                Documentation of staff time.
       There is a system in place to document staff work time.
5.3    Staff Guidelines                                                          Personnel file contains a signed statement
       Agency develops written guidelines for staff, which include, at a          acknowledging that staff guidelines were reviewed
       minimum, agency-specific policies and procedures (staff                    and that the employee understands agency policies
       selection, resignation and termination process, job descriptions);         and procedures.
       professional behavior standards; client confidentiality; health and
       safety requirements; complaint and grievance procedures;
       emergency procedures; and statement of client rights.
5.4    Staff Supervision                                                         Review of personnel files indicates compliance.
       Staff coordinator/manager is a paid position that supervises staff        Review of Policies and Procedures manual indicates
       services.                                                                  compliance.
5.5    Communication                                                             Review of Policies and Procedures manual indicates
       There are procedures in place regarding regular communication              compliance.
       with staff about the program and general agency issues.                   Mechanism for regular communication with staff is
                                                                                  in place.
                                                                                 Staff interviews indicate compliance.




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                                                                  2002-2003


                                                      RYAN WHITE TITLE I

                                                     STANDARDS FOR CARE


                                             HEALTH EDUCATION/RISK REDUCTION


I.     PURPOSE

                                       The purpose of the Ryan White Title I Standards for Care is to determine the minimal
                                       acceptable levels of quality in service delivery and to provide a measurement of the
                                       effectiveness of services.

II.    PROCESS STANDARDS

                            STANDARD                                                          MEASURE
1.0   Services are offered in such a way as to overcome barriers to access and utilization. Service is easily accessible to
persons with HIV/AIDS.
1.1    Client Eligibility                                            Documentation of HIV+ status, residence and income in the client
       IN ORDER TO BE ELIGIBLE FOR SERVICES, INDIVIDUALS MUST         record.
       MEET THE FOLLOWING:

          HIV+
          RESIDENCE IN THE HOUSTON EMA




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                       STANDARD                                                                  MEASURE
1.2    Program Information                                           Agency has a written annual dissemination plan.
       Broad-based dissemination of information regarding            Zip code data show provider is reaching clients throughout service
       the availability of services.                                  area.
                                                                     Agency log demonstrates broad-based dissemination of information.
1.3    Intake                                                        When necessary, client is provided alternatives to office visits, such
       Intake process is flexible and responsive,                     as home visits and/or conducting business by mail.
       accommodating disabilities and health conditions.             Staff are present to answer incoming calls during agency‟s operating
                                                                      hours.
                                                                     Agency has procedures for communicating with people with hearing
                                                                      impairments
1.4    Cultural Competence                                           Agency has procedures for obtaining translation services.
       Program is competent at delivering services to
                                                                     Client satisfaction survey indicates compliance.
       culturally and linguistically diverse populations.
       This should be reflective of the local epidemic.
2.0    Services are part of the coordinated continuum of HIV/AIDS services.
2.1    Agency receives referrals from a broad range of  Documentation of referrals received.
       HIV/AIDS service providers and makes appropriate
                                                         Documentation of referrals out.
       referrals out when necessary.
                                                         Staff reports indicate compliance.
3.0    Health Education/Risk Reduction program is based on solid training.
3.1    Training                                                          Review of training curriculum indicates compliance.
       Initial training includes 40 hours of orientation,                Documentation of all training in personnel file.
       which includes information on HIV/AIDS basics
                                                                         Specific training requirements are specified in the staff
       and confidentiality issues as well as agency-specific
                                                                          guidelines.
       training.


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                         STANDARD                                                                MEASURE
3.2    Ongoing Training                                                  Materials for staff training and continuing education are on file.
       8 hours of continuing education in HIV/AIDS                       Staff interviews indicate compliance.
       related or other specific topics is required annually.
3.3    Staff Experience                                                  Documentation of work experience in personnel file.
       A minimum of one year documented HIV/AIDS
       work and/or health education experience is
       preferred. RN/BSN must have a minimum of 2
       years documented HIV/AIDS work experience.
4.0    Service providers are knowledgeable, accepting and respectful of the needs of individuals with HIV/AIDS. Staff efforts
       are compassionate and sensitive to client needs.
4.1    Staff Screening                                               Documentation of staff applications.
       Staff providing services to clients shall be screened         Documentation of communication with personnel references.
       for appropriateness by provider agency as follows:
                                                                     Staff interviews indicate compliance.
        Personal references
                                                                     Review of Policies and Procedures Manual indicates compliance.
        Personal interview
                                                                     Review of personnel files indicates compliance
        Written application
          Policies and Procedures exist for addressing
           criminal background checks on staff and/or
           volunteers.
4.2    Client Feedback                                                   Client feedback mechanism is in place.
       Feedback from clients (or from client caregivers, in              Documentation of clients‟ evaluation of services is maintained.
       cases where clients are too young to give feedback)
       is regularly obtained about quality of services.




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                        STANDARD                                                                MEASURE
4.3    Client Confidentiality                                           Review of personnel files indicates compliance.
       There is a written policy statement regarding client
       confidentiality signed by each employee and
       volunteer and included in the personnel file.
4.4    Professional Behavior                                            Staff guidelines include standards of professional behavior.
       Staff and volunteers agree to follow written                     Review of personnel files indicates compliance.
       standards of professional behavior.
                                                                        Review of agency‟s complaint and grievance files.
5.0    Services utilize effective management practices such as cost effectiveness, human resources, and quality improvement.
5.1    Service Evaluation                                               Review of Policies and Procedures manual indicates compliance.
       Agency has a process in place for the evaluation of              Staff interviews indicate compliance.
       client services.
5.2    Accountability                                                   Documentation of staff time.
       There is a system in place to document staff work
       time.




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                           STANDARD                                                            MEASURE

5.4    Staff Guidelines                                                 Personnel file contains a signed statement acknowledging that
       Agency develops written guidelines for staff, which               staff guidelines were reviewed and that the employee
       include, at a minimum, agency-specific policies and               understands agency policies and procedures.
       procedures (staff selection, resignation and
       termination process, job descriptions); professional
       behavior standards; client confidentiality; health and
       safety requirements; complaint and grievance
       procedures; emergency procedures; and statement of
       client rights.
5.5    Staff Supervision                                                Review of personnel files indicates compliance.
       Staff coordinator/manager is a paid position that                Review of Policies and Procedures manual indicates compliance.
       supervises staff services.
5.6    Communication                                                    Review of Policies and Procedures manual indicates compliance.
       There are procedures in place regarding regular                  Mechanism for regular communication with staff is in place.
       communication with staff about the program and
                                                                        Staff interviews indicate compliance.
       general agency issues.




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                                                        RYAN WHITE TITLE I

                                                       STANDARDS FOR CARE


                                                  HOME HEALTH CARE SERVICES


I.     PURPOSE

                                       The purpose of the Ryan White Title I Standards for Care is to determine the minimal
                                       acceptable levels of quality in service delivery and to provide a measurement of the
                                       effectiveness of services.

II.    PROCESS STANDARDS



                            STANDARD                                                               MEASURE
1.1    Client Eligibility                                                    Documentation of HIV+ status, residence and income in the
       IN ORDER TO BE ELIGIBLE FOR SERVICES, INDIVIDUALS MUST MEET THE        client record.
       FOLLOWING:

          HIV+
          RESIDENCE IN THE HOUSTON EMA
          Income no greater than 300% of the Federal poverty level
1.2    Program Information                                                   Agency has a written annual dissemination plan.
       Broad-based dissemination of information regarding the                Zip code data show provider is reaching clients
       availability of services.                                              throughout service area.
                                                                             Agency log demonstrates broad-based dissemination of
                                                                              information.


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                            STANDARD                                                                MEASURE
1.3    Intake                                                                When necessary, client is provided alternatives to office
       Intake process is flexible and responsive, accommodating               visits, such as home visits.
       disabilities and health conditions.                                   Staff are present to answer incoming calls during agency‟s
                                                                              operating hours.
                                                                             Agency has procedures for communicating with people
                                                                              with hearing impairments.
1.4    Cultural Competence                                                   Agency has procedures for obtaining translation services.
       Program is competent at delivering services to culturally and
                                                                             Client satisfaction survey indicates compliance.
       linguistically diverse populations. This should be reflective of
       the local epidemic.
2.0    Services are part of the coordinated continuum of HIV/AIDS services
2.1    Agency receives referrals from a broad range of HIV/AIDS              Documentation of referrals received.
       service providers and makes appropriate referrals out when
                                                                             Documentation of referrals out.
       necessary.
                                                                             Staff reports indicate compliance.
3.0
       Home health services program is based on solid training
3.1    Training                                                              Review of training curriculum indicates compliance.
       Initial training includes 12 hours of HIV/AIDS basics and             Documentation of all training in personnel file.
       confidentiality issues.
                                                                             4 hours of advances in medications/ treatment training
                                                                              required for all direct nursing staff, to be provided by a
                                                                              source approved by HIV Services
3.2    Ongoing Training                                                      Materials for staff training and continuing education are
       8 hours of continuing education in HIV/AIDS related or                 on file.
       specific training is required.                                        Staff interviews indicate compliance.
                                                                             Documentation of all training in personnel file.

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                            STANDARD                                                                MEASURE
4.0    Service providers are knowledgeable, accepting and respectful of the needs of individuals with HIV/AIDS. Staff
       efforts are compassionate and sensitive to client needs.
4.1    Staff Screening                                                        Documentation of staff applications.
       Staff providing services to clients shall be screened for              Documentation of communication with personnel
       appropriateness by provider agency as follows:                          references.
          Personal references                                                A felony conviction may disqualify individuals from
          Personal interview                                                  employment.

          Written application                                                Staff interviews indicate compliance.

          Annual criminal background check for felonies                   Review of Policies and Procedures Manual indicates
           perpetrated against an individual for staff who engage in        compliance.
           unsupervised interaction with clients.                          Review of personnel files indicates compliance
          Policies and Procedures exist for addressing criminal
           background checks on staff and/or volunteers.
4.2    Client Feedback                                                        Client feedback mechanism is in place.
       Feedback from clients (or from client caregivers, in cases             Documentation of clients‟ evaluation of services is
       where clients are too young to give feedback) is regularly              maintained.
       obtained about quality of services.
4.3    Client Confidentiality                                                 Review of personnel files indicates compliance.
       There is a written policy statement regarding client
       confidentiality signed by each employee and included in the
       personnel file.
4.4    Professional Behavior                                                  Staff guidelines include standards of professional
       Staff agree to follow written standards of professional                 behavior.
       behavior.                                                              Review of personnel files indicates compliance.
                                                                              Review of agency‟s complaint and grievance files.

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                            STANDARD                                                              MEASURE
5.0    Services utilize effective management practices such as cost effectiveness, human resources and quality improvement.
5.1    Service Evaluation                                                 Review of Policies and Procedures manual indicates
       Agency has a process in place for the evaluation of client          compliance.
       services.                                                          Staff interviews indicate compliance.
5.2    Accountability                                                     Documentation of staff time.
       There is a system in place to document staff work time.
5.3    Work Conditions                                                    Necessary tools and space appropriate for each staff job
       Staff have the necessary resources to accomplish their work.        are available.
                                                                          Staff are trained to use tools/equipment necessary for their
                                                                           work.
                                                                          Staff interviews indicate compliance.
5.4    Staff Guidelines                                                      Personnel file contains a signed statement acknowledging
       Agency develops written guidelines for staff, which include,           that staff guidelines were reviewed and that the employee
       at a minimum, agency-specific policies and procedures (staff           understands agency policies and procedures.
       selection, resignation and termination process, job
       descriptions); professional behavior standards; client
       confidentiality; health and safety requirements; complaint and
       grievance procedures; emergency procedures; and statement
       of client rights.
5.5    Staff Supervision                                                     Review of personnel files indicates compliance.
       Staff coordinator/manager is a paid position that supervises          Review of Policies and Procedures manual indicates
       staff services.                                                        compliance.




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                            STANDARD                                                               MEASURE
5.6    Communication                                                         Review of Policies and Procedures manual indicates
       There are procedures in place regarding regular                        compliance.
       communication with staff about the program and general                Mechanism for regular communication with staff is in
       agency issues.                                                         place.
                                                                             Staff interviews indicate compliance.




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                                                        RYAN WHITE TITLE I

                                                        STANDARDS OF CARE


                                                         HOUSEHOLD ITEMS

I.     PURPOSE

                                       The purpose of the Ryan White Title I Standards for Care is to determine the minimal
                                       acceptable levels of quality in service delivery and to provide a measurement of the
                                       effectiveness of services.

II.    PROCESS STANDARDS

                               STANDARD                                                              MEASURE
1.0    Services are offered in such a way as to overcome barriers to access and utilization. Service is easily accessible to persons
       with HIV/AIDS.
1.1    Client Eligibility                                                        Documentation of HIV+ status, residence and income in
       IN ORDER TO BE ELIGIBLE FOR SERVICES, INDIVIDUALS MUST MEET THE            the client record.
       FOLLOWING:

          HIV+
          RESIDENCE IN THE HOUSTON EMA
          Income no greater than 300% of the Federal poverty level
1.2    Program Information                                                       Agency has a written substantiated annual plan to
       Broad-based dissemination of information regarding the                     targeted populations.
       availability of services.




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                               STANDARD                                                              MEASURE
1.3    Intake                                                                    When necessary, client is provided alternatives to
       Intake process is flexible and responsive, accommodating                   office visits, such as case manager or guardian visits
       disabilities and health conditions.                                        and other modes of communications.
                                                                                 Staff are present to answer incoming calls during
                                                                                  agency‟s operating hours.
                                                                                 Agency has procedures for communicating with
                                                                                  people with hearing impairments.
1.4    Cultural Competence                                                       Agency has written procedures for obtaining
       Program is competent at delivering services to culturally and              translation services.
       linguistically diverse populations.
                                                                                 Client satisfaction survey indicates compliance.
2.0    Services are part of the coordinated continuum of HIV/AIDS services.
2.1    Referrals                                                         Documentation of referrals received.
       Agency receives referrals from a broad range of HIV/AIDS
                                                                         Documentation of referrals out.
       service providers. Provider makes appropriate referrals out when
       necessary.
2.2    Collaboration                                                     Letters of agreement are on file
       Agency maintains formal letters of agreement outlining specific
                                                                         An outline of specific programmatic role/function in
       areas of service collaboration.
                                                                          collaboration exists (may be in letters).
                                                                                 A routine audit or check of contact sample as to nature
                                                                                  of relationship occurs.
3.0    Services are provided in an efficient and timely manner.
3.1    Critical Need                                                             Documentation in client file
       Household item(s) shall be issued for critical need clients – i.e.
                                                                                 Agency Policies and Procedures Manual
       those leaving the hospital/care facility and in need of a bed -
       within five (5) working days of approval of request.                      Staff interview



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                                STANDARD                                                               MEASURE
3.2    Non-Critical Need                                                          Documentation in client file
       Household item(s) shall be issued for non-critical need clients on a
       waiting list basis.                                                        Agency Policies and Procedures Manual
                                                                                  Staff interview
4.0    Services are provided in a safe and secure environment by screened staff and volunteers.
4.1    Staff Screening                                                            Documentation of staff applications.
       Staff providing services to clients shall be screened for                  Documentation of communication with personnel
       appropriateness by provider agency as follows:                              references.
          Personal references                                                    Staff interviews indicate compliance.
          Personal interview                                                     Review of Policies and Procedures Manual indicates
          Written application                                                     compliance.

          Policies and Procedures exist for addressing criminal                  Review of personnel files indicates compliance
           background checks on staff and/or volunteers.
5.0    Staff HIV/AIDS knowledge is based on solid training and experience.
5.1    Initial Training                                                           Review of training curriculum indicates compliance
       Initial training includes 8 hours of HIV/AIDS basics, safety issues
                                                                                  Documentation of all training in personnel file
       (fire & emergency preparedness, hazard communication, infection
       control, universal precautions), confidentiality issues, cultural          Specific training requirements are specified in the staff
       diversity, role of staff/volunteers and agency-specific information         guidelines
       (e.g. Drug Free Workplace policy). Initial Training must be
       completed within 30 days of hire.
6.0         Services are offered in such a way as to overcome barriers to access and utilization. Program provides deliveries of
                                                 household items as needed and as available.
6.1    Guidelines                                                             Guidelines are in Agency Policy and Procedure
       Written guidelines for deliveries of furniture include issues of          Manual.
       safety and are updated as necessary.


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                               STANDARD                                                               MEASURE
6.2    Options                                                                   Communication about transportation options is part of
       Clients are informed of transportation options.                            intake checklist.
6.3    Documentation                                                       Review of client file indicates compliance.
       Deliveries are documented in the client file.
6.4    Denial Letters                                                      Copy of denial letter in client file.
       RWI eligible clients that have been denied assistance must be
       provided a denial letter from the agency.
7.0    Services are part of the coordinated continuum of HIV/AIDS services. There is coordination of various staff and
       service providers as they interact with clients and families in meeting client need.
7.1    Appropriate staff meet regularly to coordinate services.                  Documentation of regular in-house meetings for the
                                                                                  purpose of coordination is on file.
                                                                                 Documentation of case conferences for the purpose of
                                                                                  coordination is on file.
7.2    Client services indicate coordination of agency activities.               Review of client file shows coordination of activities.
7.3    Documentation of referrals and linkages is in client file.                Review of client files indicate compliance.
8.0    Services are culturally sensitive and competent.
8.1    Agency demonstrates efforts to hire staff representative of the           Advertisements for staff positions appear in local
       community served.                                                          newspapers and other media.
                                                                                 Demographic profile of staff reflects that of the
                                                                                  community served.
                                                                                 Resumes on file reflect previous experience with and
                                                                                  education about diverse populations.
8.2    Training of agency staff and volunteers addresses cultural                Review of training agendas and attendance logs
       sensitivity and competence.                                                indicates compliance.




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                               STANDARD                                                                MEASURE
8.3    Services must accommodate client‟s health status. Designee (case           Review of Policies and Procedures manual indicates
       manager, guardian, family member) may act on behalf of client to            compliance.
       obtain household items.
                                                                                  Client satisfaction survey indicates compliance
9.0    Providers uphold client rights.
9.1    Documentation of receipt by client of eligibility criteria, statement      Review of client file indicates compliance.
       of client rights and responsibilities, grievance procedure, and
                                                                                  Facility tour indicates compliance.
       description of agency‟s services is in client file and are posted in
       areas visible to clients.                                                  Posted signs in visible areas.
9.2    Agency Grievance Procedure                                                 Signed acknowledgement in client file
       The agency must ensure that clients are informed of all program
                                                                                  Program policies and procedures are clearly posted at
       policies regarding appeals of denials of assistance that may be
                                                                                   the agency
       made by using the agency‟s grievance procedure.
9.3    There is a process for obtaining client input about satisfaction           Written documentation of process for obtaining input
       with and need for expanded and enhanced services.                           is on file.
                                                                                  Client is informed of input mechanisms at intake.




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                                                      RYAN WHITE TITLE I

                                                      STANDARDS OF CARE


                               HOUSING COORDINATION/EMERGENCY SHELTER VOUCHERS

I.     PURPOSE

                                       The purpose of the Ryan White Title I Standards of Care is to determine the minimal
                                       acceptable levels of quality in service delivery and to provide a measurement of the
                                       effectiveness of services.

II.    PROCESS STANDARDS


                       STANDARD                                                         MEASURE
1.0   Services are offered in such a way as to overcome barriers to access and utilization. Service is easily accessible to
persons with HIV/AIDS.




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1.1     Client Eligibility                                            Documentation of HIV+ status, residence and income in the client
        IN ORDER TO BE ELIGIBLE FOR SERVICES, INDIVIDUALS              record
        MUST MEET THE FOLLOWING:
                                                                      Documentation of the Certification of Need form in the client‟s
           HIV+                                                       chart
           RESIDENCE IN THE HOUSTON EMA
                                                                      Documentation from Case Managers/Referring Agency in the
           Income no greater than 300% of the Federal                 client‟s chart
            poverty level
           Certification of Need for Emergency Housing
            for the Purposes of Medical Care
           Client must have a current Case Management
            Assessment and Service Plan (Housing
            Coordination Clients Only)
1.2     Program Information                                           Agency has a written annual dissemination plan.
        Broad-based dissemination of information                      Zip code data show provider is reaching clients throughout
        regarding the availability of housing services                 service area
        within the Houston EMA.
                                                                      Agency log demonstrates broad-based dissemination of
        Housing staff shall establish contacts with HIV                information.
        testing sites, hospitals, substance abuse centers and
        other potential sources of HIV infected clients.


1.3     Staff Availability                                            Staff time sheets or other documentation indicate compliance.
                                                                      Review agency policy
        Staff is present to answer incoming calls during
        agency’s normal operating hours.




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                       STANDARD                                                                 MEASURE
1.4     Intake                                                          Agency Policy & Procedure
        Intake process is flexible and responsive,                      Client files indicate compliance
        accommodating disabilities and health condition.
                                                                        Client satisfaction survey indicates compliance
        When necessary, clients are provided alternatives
        to office visits.


1.5     Cultural Competence                                             Agency has procedures for obtaining translation services.
        Program is competent at delivering services to
                                                                        Agency has procedures for communicating with people with
        culturally and linguistically diverse populations.
                                                                         hearing impairments.
        This should be reflective of the target population
        to be served.                                                   Client satisfaction survey indicates compliance


2.0    Services are part of the coordinated continuum of HIV/AIDS services.
.1      Referrals                                                    Documentation of referrals received

        Agency receives referrals from a broad range of              Documentation of referrals out
        sources (client‟s case manager for Housing                   Staff interview indicates compliance
        Coordination) according to HRSA policy 99-02 and
        makes appropriate referrals out when necessary.




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2.1     Allowable Services                                           Documentation in client record of linkages made
        Services to be provided include advocacy for and
        assistance to clients in accessing temporary short-
        term emergency housing, linking clients with
        appropriate housing resources throughout the EMA,
        providing referrals to Emergency Assistance
        programs, linking clients with case managers,
        networking with other urban and rural housing
        resources and assisting clients in securing
        permanent housing
                                                                     Documentation in client record.
        Vouchering – Client is eligible to receive a
        maximum of 30 days of emergency housing per
        contract year.

2.2     Housing Assessment
                                                                     Documentation in client record.
        The comprehensive client assessment will include
        an evaluation of the client‟s housing needs,
        strengths, resources, limitations and projected
        barriers to service at time of intake.




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2.3     Housing Service Plan                                         Documentation in client record on the case management service plan or
                                                                      agency‟s equivalent form.
        An initial service plan signed by client, housing
        coordinator and case manager (if appropriate) will
        be completed at time of intake and updated as
        needed. The service plan will seek timely
        resolution to crises, short-term and long-term
        needs and may document crisis intervention and/or
        short term needs met before full service plan is
        completed.


2.4     Progress Notes                                            Legible, signed and dated documentation in client record.
        All coordination activities, including but not limited
        to, all contacts and attempted contacts with or on
        behalf of clients are documented in the client record
        within three (3) working days of their occurrence.
2.5     Client Closure                                               Documentation in client record
        A summary progress note is completed within
        three (3) days of closure.
3.0     Staff HIV/AIDS and housing referral knowledge is based on solid training and experience.




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                           STANDARD                                                                MEASURE
3.1     Initial Training                                                Review of training curriculum indicates compliance.
        Initial training includes HIV/AIDS basics, safety               Documentation of all training in personnel file.
        issues, confidentiality issues, cultural sensitivity, role
        of staff/volunteers and agency-specific information
        completed within 90 days of hire.


3.2     Other Training                                                  Documentation of training in personnel file.
        CPR, First Aid and non-violent crisis intervention
        training is required and must be completed within
        90 days of hire. In addition, housing coordinators
        may attend RWI case managers training.
3.3     Ongoing Education                                               Documentation of continuing education in personnel file.
        After the first year of employment, each housing
        coordinator will obtain a minimum of fifteen (15)
        hours per year additional education and/or training.
3.4     Experience – HIV/AIDS                                           Staff interviews indicate compliance.
        A minimum of 2 years documented HIV/AIDS                        Documentation of experience in personnel file
        experience is required


3.5     Experience – Housing Referral                                   Staff interviews indicate compliance.
        A minimum of 2 years documented housing referral                Documentation of experience in personnel file
        experience is required




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                       STANDARD                                                                 MEASURE
4.0    Service providers are knowledgeable, accepting, and respectful of the needs of individuals with HIV/AIDS. Staff efforts
       are compassionate and sensitive to client needs.
4.1     Staff Screening                                              Documentation of staff applications.
        Staff providing service to clients shall be screened         Documentation of communication with personal references.
        for appropriateness as follows:
                                                                     Staff interviews indicate compliance.
           Personal references
           Personal interview                                       Review of Policies and Procedures Manual indicates compliance.
           Written application                                      Review of personnel files indicates compliance
           Policies and procedures exist for addressing
            criminal background checks on staff and/or
            volunteers.
4.2     Client Confidentiality                                       Agency Policy & Procedure.
        There is a written policy statement regarding client         Review of personnel files indicates compliance.
        confidentiality signed by each employee and
        included in the personnel file.
4.3     Professional Behavior                                        Staff guidelines include standards of professional behavior.
        Staff follows written standards of professional              Review of personnel files indicates compliance.
        behavior.
                                                                     Review of agency‟s complaint and grievance file.




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                        STANDARD                                                                MEASURE
5.0    Services utilize effective management practices such as cost effectiveness, human resources, and quality improvement.
5.1    Service Evaluation                                            Agency Policy & Procedure.
       Agency has a mechanism in place for the internal              Staff interviews indicate compliance.
       evaluation of services.
5.2    Accountability                                                Staff time sheets or other documentation indicate compliance.
       There is a system in place to document staff work
       time.
5.3    Staff Guidelines                                              Personnel file contains a signed statement acknowledging that staff
       Agency develops written guidelines for staff,                  guidelines were reviewed and that the employee understands agency
       which include, at a minimum, agency-specific                   policies and procedures.
       policies and procedures (staff selection,
       resignation and termination process,
       Staff/volunteer job descriptions); professional
       behavior standards; client confidentiality; health
       and safety requirements; complaint and grievance
       procedures; emergency procedures; and statement
       of client rights.
5.4    Staff Supervision                                             Review of personnel files indicates compliance.
       Housing services are supervised by a paid staff               Agency Policy & Procedure.
       member.




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                       STANDARD                                                                 MEASURE
5.5    Communication                                                 Agency Policy & Procedure.
       There are procedures in place regarding regular               Documentation of regular staff meetings.
       communication with staff about the program and
                                                                     Staff interviews indicate compliance.
       general agency issues.




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                                                        RYAN WHITE TITLE I

                                                       STANDARDS FOR CARE


                                                         IN-HOME SUPPORT          (reference Emergency Financial Assistance RFP Category)



I.     PURPOSE

                                       The purpose of the Ryan White Title I Standards for Care is to determine the minimal
                                       acceptable levels of quality in service delivery and to provide a measurement of the
                                       effectiveness of services.

II.    PROCESS STANDARDS


                            STANDARD                                                              MEASURE
1.1    Client Eligibility                                                    Documentation of HIV+ status, residence and income in the
       In order to be eligible for services, individuals must meet the        client record.
       following:
          HIV+
          Residence in the Houston EMA
          Residence in permanent housing (non-transitional, non-
           nursing home).
          Income no greater than 300% of the Federal poverty level




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                            STANDARD                                                               MEASURE
1.2    Program Information                                                   Agency has a written annual dissemination plan.
       Broad-based dissemination of information regarding the                Zip code data show provider is reaching clients
       availability of services.                                              throughout service area.
                                                                             Agency log demonstrates broad-based dissemination of
                                                                              information.
1.3    Intake                                                                When necessary, client is provided alternatives to office
       Intake process is flexible and responsive, accommodating               visits, such as home visits.
       disabilities and health conditions.                                   Staff are present to answer incoming calls during agency‟s
                                                                              operating hours.
                                                                             Agency has procedures for communicating with people
                                                                              with hearing impairments.
1.4    Cultural Competence                                                   Agency has procedures for obtaining translation services.
       Program is competent at delivering services to culturally and
                                                                             Client satisfaction survey indicates compliance.
       linguistically diverse populations. This should be reflective of
       the local epidemic.
2.0    Services are part of the coordinated continuum of HIV/AIDS services
2.1    Agency Referrals                                              Review of Policies and Procedures Manual/agency records
       The agency must have a formal, written referral process with   indicates compliance.
       primary care, case management, home healthcare and TDH
       and DHS Community Service program providers to ensure         Documentation of referrals received.
       continuity of care and appropriate referrals.                 Documentation of referrals out.
2.2    Client Referrals                                              Documentation of referrals received.
       Clients must have a written referral for this service from a
                                                                     Staff reports indicate compliance.
       primary medical care provider, which includes a nurse
       practitioner or physician. Referral must be updated every 93
       days for continuation of services.



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                             STANDARD                                                              MEASURE
3.0
       Services are provided in an efficient and timely manner
3.1                                                                          Documentation is in client file
       Service Utilization
                                                                             Staff interviews indicate compliance
       Clients may receive a maximum of 10 hours of service per
       week
3.2                                                                          Documentation is in client file
       Reimbursement
                                                                             Staff interviews indicate compliance
       Reimbursement may be issued only to the individual who
       provides the support services. Reimbursement may not be
       issued to clients. Reimbursement must be issued within one
       month of receipt of service documentation.
4.0
       In-Home Support program is based on solid training
4.1    Staff Training                                                        Review of training curriculum indicates compliance.
       Initial training for program staff includes 12 hours of               Documentation of all training in personnel file.
       HIV/AIDS basics and confidentiality issues.

4.2    Ongoing Staff Training                                                Materials for staff training and continuing education are
       8 hours of continuing education in HIV/AIDS related or                 on file.
       specific training is required for program staff.                      Staff interviews indicate compliance.
                                                                             Documentation of all training in personnel file.
5.0    Service providers are knowledgeable, accepting and respectful of the needs of individuals with HIV/AIDS. Staff
       efforts are compassionate and sensitive to client needs.




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                            STANDARD                                                                MEASURE
5.1    Staff Screening                                                        Documentation of staff applications.
       Staff providing services to clients shall be screened for              Documentation of communication with personnel
       appropriateness by provider agency as follows:                          references.
          Personal references                                                A felony conviction may disqualify individuals from
          Personal interview                                                  employment.

          Written application                                                Staff interviews indicate compliance.

          Annual criminal background check for felonies                      Review of Policies and Procedures Manual indicates
           perpetrated against an individual for staff who engage in           compliance.
           unsupervised interaction with clients.                             Review of personnel files indicates compliance
          Policies and Procedures exist for addressing criminal
           background checks on staff and/or volunteers.
5.2    Client Feedback                                                        Client feedback mechanism is in place.
       Feedback from clients (or from client caregivers, in cases             Documentation of clients‟ evaluation of services is
       where clients are too young to give feedback) is regularly              maintained.
       obtained about quality of services.
5.3    Client Confidentiality                                                 Review of personnel files indicates compliance.
       There is a written policy statement regarding client
       confidentiality signed by each employee and included in the
       personnel file.
5.4    Professional Behavior                                                  Staff guidelines include standards of professional
       Staff agree to follow written standards of professional                 behavior.
       behavior.                                                              Review of personnel files indicates compliance.
                                                                              Review of agency‟s complaint and grievance files.
6.0    Services utilize effective management practices such as cost effectiveness, human resources and quality improvement.


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                            STANDARD                                                               MEASURE
6.1    Service Evaluation                                                        Review of Policies and Procedures manual indicates
       Agency has a process in place for the evaluation of client                 compliance.
       services.                                                                 Staff interviews indicate compliance.
6.2    Accountability                                                            Documentation of staff time.
       There is a system in place to document staff work time.
6.3    Staff Guidelines                                                      Personnel file contains a signed statement acknowledging
       Agency develops written guidelines for staff, which include,           that staff guidelines were reviewed and that the employee
       at a minimum, agency-specific policies and procedures (staff           understands agency policies and procedures.
       selection, resignation and termination process, job
       descriptions); professional behavior standards; client
       confidentiality; health and safety requirements; complaint and
       grievance procedures; emergency procedures; and statement
       of client rights.
6.4    Staff Supervision                                                     Review of personnel files indicates compliance.
       Staff coordinator/manager is a paid position that supervises          Review of Policies and Procedures manual indicates
       staff services.                                                        compliance.
6.5    Communication                                                         Review of Policies and Procedures manual indicates
       There are procedures in place regarding regular                        compliance.
       communication with staff about the program and general                Mechanism for regular communication with staff is in
       agency issues.                                                         place.
                                                                             Staff interviews indicate compliance.




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                                                         RYAN WHITE TITLE I

                                                    STANDARDS FOR CARE

                                   FOOD SERVICES – NUTRITIONAL SUPPLEMENTS


I.     PURPOSE

                                       The purpose of the Ryan White Title I Standards for Care is to determine the minimal
                                       acceptable levels of quality in service delivery and to provide a measurement of the
                                       effectiveness of services.


II.    PROCESS STANDARDS

                               STANDARD                                                             MEASURE
1.0    Services are offered in a way as to overcome barriers to access and utilization. Service is easily accessible to persons with
       HIV/AIDS.
1.1    Client Eligibility                                                        Documentation of HIV+ status, residence and income in
       IN ORDER TO BE ELIGIBLE FOR SERVICES, INDIVIDUALS MUST MEET THE            the client record.
       FOLLOWING:

          HIV+
          RESIDENCE IN THE HOUSTON EMA
          Income no greater than 300% of the Federal poverty level




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                               STANDARD                                                               MEASURE
1.2    Program Information                                                       Documentation of a written plan to evidence agency
       Broad-based dissemination of information regarding the                     participation in collaborative efforts with other HIV
       availability of services.                                                  service providers to disseminate information regarding
                                                                                  availability to underserved and unserved areas.
1.3    Intake                                                                    When necessary, client is provided alternatives to
       Intake process is flexible and responsive, accommodating                   office visits, such as phone, and/or conducting
       disabilities and health conditions.                                        business by mail, fax, e-mail or through a case
                                                                                  manager.
                                                                                 Agency has procedures for communicating with
                                                                                  people with hearing impairment.
1.4    Service Information                                                       Significant information regarding program operation
       Responses to requests for services and information should be               which may include but not be limited to operating
       provided within two (2) business days.                                     hours, location (street address), directions to the
                                                                                  location, required documentation to be eligible for
                                                                                  services, are made available via telephone recordings.
                                                                                 Staff are present to answer incoming calls during
                                                                                  agency‟s operating hours.
                                                                                 Clients are notified of the food distribution schedule
                                                                                  and any scheduled changes at least fourteen (14)
                                                                                  calendar days ahead of the new date, except under
                                                                                  emergency situations.
2.0    Services are part of the coordinated continuum of HIV/AIDS services

2.1    Referrals                                                                 Client file indicates compliance.
       Agency receives written referrals from Physicians and/or
                                                                                 Client satisfaction survey indicates compliance.
       Registered Dieticians and makes appropriate referrals out when
       necessary.                                                                Staff interviews indicate compliance.



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                                  STANDARD                                                            MEASURE
2.2    Agency Collaboration                                                      Letters of agreement are on file.
       Agency maintains formal letters of agreement outlining specific           An outline of specific programmatic role/function in
       areas of service collaboration.                                            collaboration exists (may be with letters).
                                                                                 A routine audit or check of contact sample as to nature
                                                                                  of relationship occurs.
3.0    Services are culturally sensitive and competent.
3.1    Cultural Competence                                                       Agency has procedures for obtaining translation
       Program is competent at delivering services to culturally and              services.
       linguistically diverse populations.                                       Client satisfaction survey indicates compliance.
                                                                                 Review of menu catalog indicates compliance.
                                                                                 Policies and procedures demonstrate commitment to
                                                                                  the community and culture of the clients.
4.0    Services are individualized and tailored to client needs.

4.1    Education/Counseling – Clients Receiving New Supplements                  Client file indicates compliance
       All clients receiving a supplement for the first time will receive
       appropriate education/counseling. This may include information
       regarding supplement benefits, side effects and recommended
       dosage.

4.2    Education/Counseling – Follow-Up                                          Client file indicates compliance
       Clients are reassessed at follow-up



5.0    Services adhere to professional standards and regulations.



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                               STANDARD                                                               MEASURE
5.1    Inventory                                                                 Agency Policy and Procedures.
       Food inventory is updated and rotated as appropriate on a first-in,       Staff interviews.
       first-out basis, and shelf-life standards and applicable laws are
       observed.
5.2    Licensure                                                                 Documentation of current licensure.
       Providers/vendors maintain proper licensure. Supplements and
       education/counseling are provided by a registered and licensed
       dietician.

6.0    Services maximize and measure client satisfaction.
6.1    Client Satisfaction                                                       Annual formal client satisfaction surveys indicate
       Providers/vendors utilize formal and informal client feedback              compliance.
       mechanisms on an on-going basis.                                          Grievance procedures in place.
                                                                                 Suggestion box.
7.0    Staff are assessed for criminal background.
7.1    Background Check                                                              Review of Policies and Procedures Manual
       Policies and Procedures exist for addressing criminal background               indicates compliance.
       checks on staff and/or volunteers.
                                                                                     Review of personnel files indicates compliance




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                                                      RYAN WHITE TITLE I

                                                      STANDARDS OF CARE


                                                        OUTREACH SERVICES

I.     PURPOSE

                                       The purpose of the Ryan White Title I Standards of Care is to determine the minimal
                                       acceptable levels of quality in service delivery and to provide a measurement of the
                                       effectiveness of services.


II.    PROCESS STANDARDS

                        STANDARD                                                              MEASURE
1.0   Services are offered in such a way as to overcome barriers to access and utilization. Service is easily accessible to
persons with HIV/AIDS.
1.1    Client Eligibility                                             Documentation of HIV+ status, residence and income in the client
       IN ORDER TO BE ELIGIBLE FOR SERVICES, INDIVIDUALS               record within 10 days (anonymous test results are acceptable for 30
       MUST MEET THE FOLLOWING:                                        days).
          HIV+
          RESIDENCE IN THE HOUSTON EMA




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                         STANDARD                                                              MEASURE
1.2    Program Information                                             Agency has a written annual dissemination plan.
       Broad-based dissemination of information                        Zip code data show provider is reaching clients throughout
       regarding the availability of services.                          service area demonstrating broad-based dissemination of
       Outreach workers shall establish contacts with HIV               information.
       testing sites, hospitals, substance abuse centers and
       other potential sources of HIV infected clients.


1.3    Staff Availability                                              Staff time sheets or other documentation indicate compliance.

       Staff are accessible by phone or pager during work hours
                                                                       Review agency policy


1.4    Intake                                                          Agency Policy & Procedure
       Intake process is flexible and responsive,
       accommodating disabilities and health condition.
1.5    Cultural Competence                                             Agency has procedures for obtaining translation services.
       Program is competent at delivering services to
                                                                       Agency has procedures for communicating with people with
       culturally and linguistically diverse populations.
                                                                        hearing impairments.
       This should be reflective of the target population to
       be served.




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                           STANDARD                                                             MEASURE
2.0    Services are part of the coordinated continuum of HIV/AIDS services.
2.2     Outreach workers work with clients for a maximum             Documentation in client record.
        of 60 days.
2.3     Outreach workers bring new clients into care, link           Documentation in client record of linkages made
        clients to needed services and, if required, refer to
                                                                     CPCDMS client report
        case management services.
3.0     Staff HIV/AIDS knowledge is based on solid training and experience.
3.1     Initial Training                                             Review of training curriculum indicates compliance.
        Initial training includes HIV/AIDS basics and                Documentation of all training in personnel file.
        confidentiality issues. Initial training must be
        completed within 60 days of hire.
3.2     Other Training                                               Documentation of training in personnel file.
        CPR, First Aid and non-violent crisis intervention
        training is required and must be completed within
        90 days of hire.
3.3     Ongoing Education                                            Documentation of continuing education in personnel file.
        8 hours of continuing education in HIV/AIDS is
        required annually.
3.4     Experience – HIV/AIDS                                        Staff interviews indicate compliance.
        A minimum of 1 year documented HIV/AIDS
        experience is preferred




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                       STANDARD                                                                 MEASURE
4.0    Service providers are knowledgeable, accepting, and respectful of the needs of individuals with HIV/AIDS. Staff efforts
       are compassionate and sensitive to client needs.
4.1    Staff Screening                                               Documentation of staff applications.
       Staff providing service to clients shall be screened          Documentation of communication with personal references.
       for appropriateness as follows:
                                                                     Staff interviews indicate compliance.
          Personal references
          Personal interview                                        Review of Policies and Procedures Manual indicates compliance.
          Written application                                       Review of personnel files indicates compliance
          Policies and procedures exist for addressing
           criminal background checks on staff and/or
           volunteers.
4.2    Client Confidentiality                                        Agency Policy & Procedure.
       There is a written policy statement regarding client          Review of personnel files indicates compliance.
       confidentiality signed by each employee and
       included in the personnel file.
4.3    Professional Behavior                                         Staff guidelines include standards of professional behavior.
       Staff follows written standards of professional               Review of personnel files indicates compliance.
       behavior.
                                                                     Review of agency‟s complaint and grievance file.




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                        STANDARD                                                                MEASURE
5.0    Services utilize effective management practices such as cost effectiveness, human resources, and quality improvement.
5.1    Service Evaluation                                            Agency Policy & Procedure.
       Agency has a mechanism in place for the internal              Staff interviews indicate compliance.
       evaluation of services.
5.2    Accountability                                                Staff time sheets or other documentation indicate compliance.
       There is a system in place to document staff work
       time.
5.3    Staff Guidelines                                              Personnel file contains a signed statement acknowledging that staff
       Agency develops written guidelines for staff,                  guidelines were reviewed and that the employee understands agency
       which include, at a minimum, agency-specific                   policies and procedures.
       policies and procedures (staff selection,
       resignation and termination process,
       Staff/volunteer job descriptions); professional
       behavior standards; client confidentiality; health
       and safety requirements; complaint and grievance
       procedures; emergency procedures; and statement
       of client rights.
5.4    Staff Supervision                                             Review of personnel files indicates compliance.
       Outreach services are supervised by a staff                   Agency Policy & Procedure.
       member with a minimum of a bachelor‟s degree, 2
       years HIV experience and 3 years supervisory
       experience.




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                       STANDARD                                                                 MEASURE
5.5    Communication                                                 Agency Policy & Procedure.
       There are procedures in place regarding regular               Documentation of regular staff meetings.
       communication with staff about the program and
                                                                     Staff interviews indicate compliance.
       general agency issues.




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                                                        RYAN WHITE TITLE I

                                                       STANDARDS FOR CARE

                                                     PRIMARY MEDICAL CARE

I.     PURPOSE
                                       The purpose of the Ryan White Title I Standards for Care is to determine the minimal
                                       acceptable levels of quality in service delivery and to provide a measurement of the
                                       effectiveness of services.

II.    PROCESS STANDARDS

                            STANDARD                                                             MEASURE
1.0      Services are offered in such a way as to overcome barriers to access and utilization. Service is easily accessible to persons
         with HIV/AIDS
1.1      CLIENT ELIGIBILITY                                        Documentation of HIV+ status, residence and income in the client
         IN ORDER TO BE       ELIGIBLE FOR SERVICES,
                                                                  record.
         INDIVIDUALS MUST MEET THE FOLLOWING:


          HIV+
          Residence in the Houston EMA
          Income no greater than 300% of the Federal
         poverty level

1.2      PROGRAM INFORMATION                                         Agency has a written annual dissemination plan
         Broad-based dissemination of information
         regarding the availability of services.




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                            STANDARD                                                              MEASURE
1.3      STAFF AVAILABILITY                                          Published documentation of agency operating hours
         Staff are present to answer incoming calls during
         agency‟s normal operating hours
1.4      INTAKE                                                      Agency Policy & Procedure
         Intake process is flexible and responsive,
         accommodating disabilities and health conditions
1.5      CULTURAL COMPETENCE                                         Agency has procedures for obtaining translation services
         Program is competent at delivering services to
         culturally and linguistically diverse populations         Agency has procedures for communicating with people with hearing
                                                                  impairments
                                                                     Client satisfaction survey indicates compliance

2.0      Services are part of the coordinated continuum of care
2.1      REFERRALS                                                   Documentation of referrals out
         Agency receives referrals from a broad range of
         sources and makes appropriate referrals out when            Staff interviews indicate compliance
         necessary
3.0      Service providers are knowledgeable, accepting, and respectful of the needs of individuals with HIV/AIDS. Staff
         efforts are compassionate and sensitive to client needs.
3.1      STAFF SCREENING                                             Documentation of staff applications
         STAFF PROVIDING SERVICE TO CLIENTS SHALL BE
         SCREENED FOR APPROPRIATENESS AS FOLLOWS:                    Documentation of communication with personnel references
          Personal references
                                                                     Staff interviews indicate compliance
          Personal interview
          Written applications                                    Review of Policies and Procedures Manual indicates compliance.
          Policies and procedures exist for addressing
                                                                   Review of personnel files indicates compliance
         criminal background checks on staff and/or
         volunteers.



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                            STANDARD                                                             MEASURE
3.2      CLIENT FEEDBACK                                           Client feedback mechanism is in place
         Feedback from clients (or from client caregivers,
         in cases where clients are too young to give
         feedback) is regularly obtained about quality of
         services.
3.3      CLIENT CONFIDENTIALITY                                      Review of personnel files indicates compliance.
         There is a written policy statement regarding
         client confidentiality signed by each employee
         and included in the personnel file.
3.4      PROFESSIONAL BEHAVIOR                                     Staff guidelines include standards of professional behavior.
         STAFF AGREE TO FOLLOW WRITTEN STANDARDS OF
         PROFESSIONAL BEHAVIOR.                                    Review of personnel files indicates compliance.
                                                                   Review of agency‟s complaint and grievance files.

4.0      Services utilize effective management practices such as cost effectiveness, human resources, and quality improvement.
4.1      SERVICE EVALUATION                                          Review of Policies and Procedures manual indicates compliance
         Agency has a process in place for the evaluation
         of staff services                                           Staff interviews indicate compliance
4.2      ACCOUNTABILITY                                              Documentation of staff time.
         There is a system in place to document staff work
         time.




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                            STANDARD                                                             MEASURE
4.3      STAFF GUIDELINES                                            Personnel file contains a signed statement acknowledging that staff
         Agency develops written guidelines for staff,                guidelines were reviewed and that the employee understands agency
         which include, at a minimum, agency-specific                 policies and procedures.
         policies and procedures (staff selection,
         resignation and termination process, job
         descriptions); professional behavior standards;
         client confidentiality; health and safety
         requirements; complaint and grievance
         procedures; emergency procedures; and statement
         of client rights
4.4      STAFF SUPERVISION                                           Review of personnel files indicates compliance.
         Staff coordinator/manager is a paid position that
         supervises staff services.                                  Review of Policies and Procedures manual indicates compliance.
4.5      COMMUNICATION                                               Review of Policies and Procedures manual indicates compliance.
         There are procedures in place regarding regular
         communication with staff about the program and              Mechanism for regular communication with staff is in place.
         general agency issues.                                      Staff interviews indicate compliance.
5.0      Medical Care for persons with HIV disease should reflect competence and experience in both primary care and
         therapeutics known to be effective in the treatment of HIV infection




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                            STANDARD                                                             MEASURE
5.1      INITIAL MEDICAL EVALUATION                                  Documentation in patient record.
         An initial medical evaluation which contains a
         history/physical and additional documents:
          History of HIV positive status, including the
             location of the first or latest positive test
          Confirmation of HIV infection by laboratory
             means
          History of TB testing, exposure and/or
             prophylaxis
          PPD test results for those without a history of a
             positive test or a PPD result within the past
             year
          For women, a detailed reproductive history
             including history of menses, sexual frequency,
             contraception, pregnancy, childbirths, breast
             exams and previous PAP smear results; a
             pelvic examination with PAP smear and breast
             exam. If patient refuses such, document
             refusal.
          For men 40 years and older or who are
             receiving testosterone supplementation, a
             prostate exam shall be performed. If patient
             refuses such, document refusal.
          Mental status examination
          Neurological examination
          Baseline body weight and vital signs
          Laboratory data which includes recent CBC
             with platelets, chemistry panel, CD4,
             measurement of viral load, syphilis serology,
             and toxoplasmosis lgG
          Provision of HIV risk reduction information
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5.2   Follow-up Medical Visits                                  Documentation in patient record.
      Follow-up visits which record and address:
       Temperature, vitals signs and weight
       Problems list status and updates
       Compliance problems and documentation of
          referrals to appropriate resources (e.g. patient
          medication educator or mental health
          professional) when indicated
       Repeat assessments of CD4 and HIV viral load
          on at least a bi-annual basis.
       The provision of at least bi-annual HIV risk
          reduction information including perinatal risk
          reduction.
       Assessment and referral of oral-dental
          disorders
      For persons with CD4 < 500 OR viral load >
      5,000 RNA copies:
       Discussion or implementation of options of
          anti-retroviral therapy according to peer-
          reviewed published guidelines (See: JAMA;
          276:146–154, July 10, 1996 subsequent
          revision(s) or published university-based
          treatment guidelines)
      For persons with CD4 < 200 or who have had
      CD4 < 200 in the past:
      Discussion or implementation of options for PCP
      prophylaxis
      For persons with CD4 < 100 or who have had
      CD4 < 100 in the past:
       Documentation of baseline toxoplasmosis and
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              prophylaxis if sero-positive
             Discussion or implementation of options for
              toxoplasmosis
             Referral to an opthalmologist for clinical
              evaluation
             For persons with CD4 < 75, or who have had
                        CD4 < 75 in the past:
             Discussion of, clinical evaluation for, and/or
              implementation of prophylaxis against
              disseminated MAI infection.
         For all women:
             At least annual PAP smear or pelvic
              examination, with referral or further evaluation
              as per published treatment guidelines or as
              indicated.
         For men 40 years and older, or who are
         receiving testosterone supplementation:
             A prostate exam should be performed at least
              annually. Appropriate referrals should be made
              as indicated.
         For all:
             TB Screening
                  For CD4 over 200: annual PPD plus chest
         X-ray
                 For CD4 200 or less: annual AFB/Sputum
         plus chest X-ray and/or physician documentation
         detailing alternative procedure or why procedure

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         was not performed
         Prophylaxis with recommended agents or
         documentation that appropriate prophylaxis
         regiments had been completed.
5.3      Central Medical “Problems List”                             Documentation in patient record
         A central “Problems List” separate from progress
         notes which clearly prioritizes problems for
         primary care management and additionally
         identifies:
            History and activity of mental health and
             substance use/abuse disorders.
            The location/provider of ancillary continuing
             healthcare (e.g. mental health or substance
             abuse service provider, or other continuing
             specialty service).
          The status of vaccinations, including data of
             Pneumovax.

6.0      Psychiatric care for persons with HIV disease should reflect competence and experience in both mental health care and
         therapeutics known to be effective in the treatment of psychiatric conditions
         Initial Psychiatric Evaluation
6.1
         A standard psychiatric assessment, which includes:
                                                                     Documentation in patient record
            Reason for consultation/chief complaint
            Brief history of present illness
            Past psychiatric illness
            Past medical illness
            Family psychiatric history


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            Social history
            Mental status exam, including suicidal or
             homicidal ideation
            Diagnosis or differential diagnosis
            Treatment plan, including but not limited to,
             medications, labs, referrals
          Releases to be signed and follow up
           schedule
6.2      Follow-up Psychiatric Visits                                Documentation in Patient Record
            Monitoring and change in index visit target
             symptoms
            Update on visits scheduled and kept with
             Infections Diseases specialists
            Lab results if previously ordered
            Mental status examination, including suicidal
             or homicidal ideation
            Follow up consults obtained and kept, referrals
             made and progress in this regard
          Treatment plan as above
7.0
         Medical care coordination for persons with HIV disease should reflect competence and experience in the assessment of
         client medical need and the development and monitoring of medical service delivery plans.
7.1
         Qualifications/Training
          Minimum Qualifications - Medical care                     A file will be maintained on each medical care coordinator. Supportive
           coordinators must meet minimum                             documentation of coordinator credentials is maintained by the agency
           qualifications for positions as described in the           and in each coordinator file. Documentation may include, but is not

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             position description attached to the RFPs, and           limited to, transcripts, diplomas, certifications, and/or licensure.
             attached to this document.
                                                                     Documentation of certification by a certified trainer is maintained by
            Required Certifications - Within three (3)
                                                                      the agency and will appear in each coordinator‟s file.
             months of employment, coordinators obtain
             certification in first aid/CPR and non-violent
             crisis intervention. Coordinators will maintain
             first aid/CPR and non-violent crisis
             intervention certifications
            Required Training for New Employees -                   Certificates of completion are maintained by the agency and will
             Within the first six (6) months of employment,           appear in coordinator‟s file.
             coordinators will complete at least ten (10)
             hours medical, at least ten (10) hours
             psychosocial and at least eight (8) hours
             cultural competency training offered by the
             designated RWI Provider.
            Ongoing Education/Training - After the first
             year of employment, each coordinator will               Certificates of completion are maintained by the agency.
             obtain the minimum number of hours of
             continuing education to maintain their
             licensure.
7.2                                                               Documentation in client record.
         Initial Medical Care Coordination Contact
         Contact with client and/or referring agent is
         attempted within five working days of the client‟s
         entry into Primary Care Services. If the
         coordinator is unable to make contact within five
         working days, this is documented and explained in
         the client record and the supervisor is notified. All
         subsequent attempts are documented.




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7.3      Medical Care Coordination Assessment                     Documentation in client record on the agency‟s comprehensive client
                                                                  assessment forms, signed and dated, or agency‟s equivalent forms. Updates
         The comprehensive client assessment will include         to the information included in the initial assessment will be recorded in the
         but not be limited to an evaluation of the client‟s      comprehensive client assessment.
         medical and psychosocial needs, strengths,
         resources, limitations and projected barriers to
         service within ten (10) working days.
7.4      Medical Care Coordination Reassessment                   Documentation in client record on the comprehensive client assessment
                                                                  form or agency‟s equivalent form, signed and dated.
         Reassessment occurs at each encounter with the
         client.
7.5      Medical Care Coordination Service Plan                   Documentation in client record on the medical care coordination service
                                                                  plan or agency‟s equivalent form.
         Should be initiated at the time of the assessment.
         The plan will reflect the needs, choices, and goals
         of the client based upon their health care needs.
         Service plans are part of the assessment and
         continually reassessed with clients and noted in
         the progress notes.
7.6      Medical Care Coordination Progress Notes                 Legible, signed and dated documentation in client record.
         All medical care coordination activities, including
         but not limited to, all contacts and attempted
         contacts with or on behalf of clients are
         documented in the client record within three
         working days of their occurrence.
7.7                                                               Documentation in client record and in the Centralized Patient Care Data
         Medical Care Coordination Client Closure
                                                                  Management System.
         A summary progress note is completed within
         three (3) days of closure.
7.8      Clinical Supervision and Caseload Coverage               Review of the agencies policies and procedures.

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         Agencies policies and procedures account for
         clinical supervision and coverage of caseload in
         the absence of the Medical Care Coordinator or
         when the position is vacant.
8.0      In addition to demonstrating competency in the provision of HIV disease specific care, HIV clinical service programs
         must show evidence that their performance follows norms for ambulatory care.
                                                                     Documentation in personnel files.
8.1      Licensing, Knowledge, Skills and Experience
            Current organizational licensure (and/or
             applicable certification) and professional
             licensure of all staff
          Professional supervision of all staff
            Staff training and/or experience with the
             medical care of adults with HIV
 8.2     Patient Rights and Confidentiality                          Documentation in patient record
            The protection of patient rights and
             responsibilities
            Assurance of patient confidentiality with
             regard to medical information transmission,
             maintenance and security
            Release of information documentation to
             facilitate communication regarding care with
             mental health practitioner and/or any
             physician or licensed professional to whom
             patient is referred outside the agency.




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8.3      Access, Care and Provider Continuity                        Agency Policy and Procedure.
        The time-appropriate delivery of services,
        including 24 hour on-call coverage
            Mechanisms for urgent care evaluation and/or
             triage
            Mechanisms for in-patient care (or arranged by
             referral):
                Medical sub-specialties: Gastroenterology,
                 Neurology, Psychiatry, Opthalmology,
                 Dermatology, Obstetrics and Gynecology,
                 and Dentistry
                Social-work and case management services
                Substance Abuse treatment services
                Anti-retroviral counseling/therapy for
                 pregnant women
             (per most recent USPHS guidelines)
             Information for persons with inherited
             coagulopathies and referral to the local
             Federally funded hemophilia treatment center:
                Coordination with social work and case
                 management services
                Continuity with referring providers
            Access to clinical investigations
8.4      Quality Improvement/Assurance                               A quality improvement/assurance activity which identifies areas for
                                                                      improvement and the subsequent actions taken



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8.5      Recommended Format for Operational Standards                Ambulatory HIV clinical service should adopt and follow performance
         Detailed standards and routines for program                  standards for ambulatory care as established by the Joint Commission
         assessment are found in most recent                          on the Accreditation of Healthcare Organizations.
         Comprehensive Accreditation Manual for
         Ambulatory Care (CAMAC). Focus should be
         upon, chapters and standards on Patient Rights and
         Organizational Ethics, Assessment of Patients,
         Education of Patients and Families, and Continuity
         of Care.
         The following chapters are considered key:
         Improving Organizational Performance (Quality
         Assurance, Management of Information, Medical
         Information), Surveillance, Prevention and Control
         of Infection.




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                                                        RYAN WHITE TITLE I

                                                       STANDARDS FOR CARE


                                                    REHABILITATION SERVICES

I.     PURPOSE

                                       The purpose of the Ryan White Title I Standards for Care is to determine the minimal
                                       acceptable levels of quality in service delivery and to provide a measurement of the
                                       effectiveness of services.


II.    PROCESS STANDARDS

                        STANDARD                                                                MEASURE
1.0   Services are offered in such a way as to overcome barriers to access and utilization. Service is easily accessible to
persons with HIV/AIDS.
1.1    Client Eligibility                                            Documentation of HIV+ status, residence and income in the client
       IN ORDER TO BE ELIGIBLE FOR SERVICES, INDIVIDUALS              record.
       MUST MEET THE FOLLOWING:

          HIV+
          RESIDENCE IN THE HOUSTON EMA
          INCOME NO GREATER THAN 300% OF THE FEDERAL
           POVERTY LEVEL




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                      STANDARD                                                                     MEASURE
1.2    Program Information                                       Agency has a written annual dissemination plan.
       Broad-based dissemination of information                  Zip code data show provider is reaching clients throughout service area.
       regarding the availability of services.                   Agency log demonstrates broad-based dissemination of information.

1.3    Staff Availability                                        Staff time sheets or other documentation indicate compliance.
       Staff should be available for consultation during
       normal operating hours.
1.4    Intake                                                    Agency Policy and Procedure
       Intake process is flexible and responsive,
       accommodating disabilities and health                     Client files indicate compliance
       conditions. When necessary, clients are                   Client satisfaction survey indicates compliance.
       provided alternative to office visits, such as
       home visits and/or conducting business by mail.
1.5    Cultural Competence                                       Agency has procedures for obtaining translation services.
       Program is competent at delivering services to
                                                                 Agency has procedures for communicating with people with hearing
       culturally and linguistically diverse populations.
                                                                  impairments.
       This should be reflective of the local epidemic.
                                                                 Client satisfaction survey indicates compliance.
2.0    Services are part of the coordinated continuum of HIV/AIDS services.
2.1    Agency receives referrals from a broad range of           Documentation of referrals received.
       sources and makes appropriate referrals out
                                                                 Documentation of referrals out.
       when necessary.
                                                                 Staff interviews indicate compliance.




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                          STANDARD                                                               MEASURE
3.0    Staff HIV/AIDS knowledge is based on solid training and experience.
3.1    Initial Training                                              Proof of credentials in personnel file.
       Must have graduated from an accredited institution
       and have appropriate certification or accreditation
       in the field of expertise.


3.2    Other Pre-Service Training                                    Materials for staff training and continuing education are on file.
       12 hours of continuing education in HIV/AIDS                  Staff interviews indicate compliance.
       related or specific training is required within 90
                                                                     Documentation of all training in personnel file.
       days of hire.
3.3    Ongoing Training                                              Materials for staff training and continuing education are on file.
       12 hours of continuing education in HIV/AIDS                  Staff interviews indicate compliance.
       related or specific training is required.
                                                                     Documentation of all training in personnel file.
3.4    Cultural Sensitivity                                          Review of training agendas and attendance logs indicates
       Training of agency staff and volunteers addresses              compliance.
       cultural sensitivity and competence within 90 days
       of hire.




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                            STANDARD                                                            MEASURE

4.0    Service providers are knowledgeable, accepting, and respectful of the needs of individuals with HIV/AIDS. Staff
       efforts are compassionate and sensitive to client needs.
4.1    Staff Screening                                               Documentation of staff applications.
       Staff providing services to clients shall be screened         Documentation of communication with personnel references.
       for appropriateness by provider agency as follows:
                                                                     A felony conviction may disqualify individuals from employment.
          Personal references
                                                                     Staff interviews indicate compliance.
          Personal interview
                                                                     Review of Policies and Procedures Manual indicates compliance.
          Written application
                                                                     Review of personnel files indicates compliance
          Annual criminal background check for felonies
           perpetrated against an individual for staff who
           engage in unsupervised interaction with clients.
          Policies and Procedures exist for addressing
           criminal background checks on staff and/or
           volunteers.




4.2    Client Feedback                                               Agency Policy & Procedure.
       Feedback from clients (or from client caregivers, in          Documentation of clients‟ evaluation of services is maintained.
       cases where clients are too young to give feedback)
                                                                     Documentation of completed client satisfaction survey
       is regularly obtained about quality of services. A
                                                                      questionnaires.
       client satisfaction survey is conducted at least
       annually.                                                     Documentation of client satisfaction summary report.




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                            STANDARD                                                                MEASURE

4.3    Client Confidentiality                                        Agency Policy & Procedure.
       There is a written policy statement regarding client          Review of personnel files indicates compliance.
       confidentiality signed by each employee and
       included in the personnel file.




4.4    Professional Behavior                                         Staff guidelines include standards of professional behavior.
       Staff follow written standards of professional                Review of personnel files indicates compliance.
       behavior.
                                                                     Review of agency‟s complaint and grievance file.
5.0    Services utilize effective management practices such as cost effectiveness, human resources, and quality improvement.
5.1    Service Evaluation                                            Agency Policy & Procedure.
       Agency has a mechanism in place for the internal              Staff interviews indicate compliance.
       evaluation of services.
5.2    Accountability                                                Staff time sheets or other documentation indicate compliance.

       There is a system in place to document staff work
       time.
5.3    Work Conditions                                               Staff interviews indicate compliance.
       Staff/volunteers have the necessary resources to
       accomplish their work.
5.5    Staff Supervision                                             Review of personnel files indicates compliance.
       Staff services are supervised by a paid coordinator or        Agency Policy & Procedure.
       manager.



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                            STANDARD                                                           MEASURE
5.6    Communication                                                 Agency Policy & Procedure.
       There are procedures in place regarding regular               Documentation of regular staff meetings.
       communication with staff about the program and
                                                                     Staff interviews indicate compliance.
       general agency issues.




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                                                        RYAN WHITE TITLE I

                                                       STANDARDS FOR CARE


                                            VOLUNTEER SERVICES (Buddy/companion)


I.     PURPOSE

                                       The purpose of the Ryan White Title I Standards for Care is to determine the minimal
                                       acceptable levels of quality in service delivery and to provide a measurement of the
                                       effectiveness of services.



II.    PROCESS STANDARDS

                             STANDARD                                                              MEASURE
1.0    Services are offered in such a way as to overcome barriers to access and utilization. Service is easily accessible to persons
       with HIV/AIDS.
1.1    Client Eligibility                                                    Documentation of HIV+ status, residence and income in the
       IN ORDER TO BE ELIGIBLE FOR SERVICES, INDIVIDUALS MUST MEET THE        client record.
       FOLLOWING:

          HIV+
          RESIDENCE IN THE HOUSTON EMA
          Income no greater than 300% of the Federal poverty level




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                               STANDARD                                                                 MEASURE
1.2    Program Information                                                       Agency has a written annual dissemination plan.
       Broad-based dissemination of information regarding the                    Agency records demonstrate broad-based dissemination of
       availability of services.                                                  information.
1.3    Intake                                                                    When necessary, client is provided alternatives to office
       Client intake process is flexible and responsive,                          visits, such as home visits.
       accommodating disabilities and health conditions.                         Staff are present to answer incoming calls during agency‟s
                                                                                  operating hours.
                                                                                 Agency has procedures for communicating with people
                                                                                  with hearing impairments.
1.4    Cultural Competence                                                       Agency has procedures for obtaining translation services.
       Program is competent at delivering services to culturally and
                                                                                 Client satisfaction survey indicates compliance.
       linguistically diverse populations.
2.0    Services are part of the coordinated continuum of HIV/AIDS services.
2.1    Agency receives referrals from a broad range of the HIV/AIDS service      Documentation of referrals received exists.
       providers and makes appropriate referrals out when necessary.
                                                                                 Documentation of referrals out exists.
                                                                                 Staff reports indicate compliance.
3.0    Volunteer program is based on solid training.
3.1    Training                                                                  Review of training curriculum indicates compliance.
       Initial training includes HIV/AIDS basics, confidentiality                Documentation of all training in volunteer file.
       issues, role of volunteers and agency-specific information (e.g.
                                                                                 Specific training requirements are specified in the
       Drug Free Workplace Policy).
                                                                                  volunteer guidelines.
3.2    Ongoing Training                                                          Materials for volunteer training, continuing education are
       Opportunities are available for ongoing training and/or                    on file.
       continuing education for volunteers.                                      Staff and/or volunteer interviews indicate compliance.

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                             STANDARD                                                               MEASURE
3.3    Curriculum                                                            Updated literature on volunteer training programs is
       Training materials and content are regularly updated.                  available at the agency.
                                                                             Existing training outlines reflect up-to-date practices.
3.4    Training Evaluation                                                   Review of volunteer evaluations and training materials
       Volunteers are asked for their evaluation of training, and their       indicates compliance.
       feedback is used in revising training material and content.           Staff and/or volunteer interviews indicate compliance.
4.0    Service providers are knowledgeable, accepting and respectful of the needs of individuals with HIV/AIDS. Volunteer
       efforts are compassionate and sensitive to client needs.
4.1    Volunteer Screening                                                   Documentation of volunteer applications.
       Volunteers providing service to clients shall be screened for         A felony conviction may disqualify individuals from
       appropriateness by provider agency as follows:                         employment and volunteering.
          Personal interview                                                Volunteer interviews indicate compliance.
          Written application                                               Staff interviews indicate compliance.
          Volunteers who engage in unsupervised interaction will be         Review of Policies and Procedures Manual indicates
           checked annually for felonies perpetuated against an               compliance.
           individual.
                                                                             Review of personnel files indicates compliance
          Policies and Procedures exist for addressing criminal
           background checks on staff and/or volunteers.
4.2    Client Feedback                                                       Client feedback mechanism is in place.
       Feedback from clients (or from client caregivers, in cases            Documentation of clients‟ evaluation of volunteer services
       where clients are too young to give feedback) is regularly             is maintained.
       obtained about quality of volunteer services.




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                             STANDARD                                                              MEASURE
4.3    Client Confidentiality                                                Review of volunteer files indicates compliance.
       There is a written policy statement regarding client
       confidentiality signed by each volunteer and included in
       volunteer file.
4.4    Professional Behavior                                                 Volunteer guidelines include standards of professional
       Volunteers agree to follow written standards of professional           behavior.
       behavior.                                                             Review of volunteer files indicates compliance.
                                                                             Review of agency‟s complaint and grievance files.
5.0    Services utilize effective management practices such as cost effectiveness, human resources and quality improvement.
5.1    Service Evaluation                                                    Review of Policies and Procedures manual indicates
       Agency has a process in place for the evaluation of volunteer          compliance.
       services.                                                             Staff and/or volunteer interviews indicate compliance.
5.2    Accountability                                                        Documentation of volunteer time.
       There is a system in place to document volunteer work time.
5.3    Volunteer Guidelines                                                  Volunteer file contains a signed statement acknowledging
       Agency develops written guidelines for volunteers, which               that volunteer guidelines were reviewed and that the
       includes, at a minimum, agency-specific policies and                   volunteer understands agency policies and procedures.
       procedures (volunteer selection, resignation and termination
       process, volunteer job descriptions); professional behavior
       standards; client confidentiality; health and safety
       requirements; complaint and grievance procedures; emergency
       procedures; and statement of client rights.
5.4    Volunteer Supervision                                                 Review of staff files indicates compliance.
       Volunteer coordinator/ manager is a paid staff position that          Review of Policies and Procedures manual indicates
       supervises volunteer services.                                         compliance.

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                             STANDARD                                                              MEASURE
5.5    Communication                                                         Review of Policies and Procedures manual indicates
       There are procedures in place regarding regular                        compliance.
       communication with volunteers about volunteer program and             Mechanism for regular communication with volunteers is
       general agency issues.                                                 in place.
                                                                             Staff and/or volunteer interviews indicate compliance.
5.6    Volunteer Appreciation                                                Regular and formal events are organized to recognize
       There are regular occasions on which volunteers are                    volunteers and are documented.
       recognized and appreciated.                                        




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                                                                  2002 – 2003

                                                            Ryan White Title I

                                                        OUTCOME MEASURES


Case Management

   I.      Purpose: The purpose of the Ryan White Title I Outcome Measures is to provide a measurement of the effectiveness of
           services in terms of health, quality of life, cost-effectiveness, and knowledge, attitudes, and practices (KAP), where
           applicable.

   II.       Outcome Measures:

              Outcome                                        Indicator                             Data Collection Method

1.0 Knowledge, Attitudes, and Practices

1.1. Increased utilization of           Change in the percent of clients who utilize          CPCDMS
primary care services                   primary care over a six month period
1.2 Increased utilization of support    Change in the percent of clients who utilize          CPCDMS
services                                support services over a six month period

2.0 Health

2.1 Slowing/prevention of disease       a. Improved or maintained CD-4 counts over            CPCDMS
progression                                 time
                                        b. Improved or maintained viral loads over time
2.2 Stabilized stage of illness         Change in the percent of clients who do not           CPCDMS
                                        progress from current stage of illness over time
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             Outcome                                         Indicator                           Data Collection Method

3.0 Quality of Life

3.1 Reduction in HIV/AIDS-related       Change in the percent of clients who report a      Self-Administered Client Survey
stress/increased hope                   reduction in HIV/AIDS-related stress and
                                        increased hope over a six month period

4.0 Cost-Effectiveness




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                                                                  2002-2003


                                                                  2002 – 2003

                                                            Ryan White Title I

                                                        OUTCOME MEASURES

                                                          Drug Reimbursement

   I.      Purpose: The purpose of the Ryan White Title I Outcome Measures is to provide a measurement of the effectiveness of
           services in terms of health, quality of life, cost-effectiveness and knowledge, attitudes, and practices (KAP), where
           applicable.

   II.       Outcome Measures:

         Outcome Measure                                     Indicator                              Data Collection Method

1.0 Knowledge, Attitudes, and Practices

1.1. Increased adherence to             Change in the percent of clients who report they      Self-Administered Client Survey
medication therapy                      are more adherent to their medication therapy
                                        regimen over time

2.0 Health

2.1 Slowing/prevention of disease           a. Improved or maintained CD-4 counts over        CPCDMS
progression                                    time
                                            b. Improved or maintained viral loads over
                                               time

3.0 Quality of Life




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                                                                  2002-2003


        Outcome Measure                                      Indicator                                Data Collection Method
3.1 Decreased stress related to         Change over time in the percent of clients who         Self-Administered Client Survey
obtaining HIV medications               report decreased stress related to obtaining HIV
                                        medications

4.0 Cost-Effectiveness

4.1 Decreased financial burden          Change over time in the percent of clients who         Self-Administered Client Survey
upon clients                            report a decrease in out-of-pocket medication
                                        expenses and/or the percent of clients who report
                                        never sustaining costs for HIV medication
                                        expenses




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                                                                  2002-2003


                                                                  2002 – 2003

                                                            Ryan White Title I

                                                        OUTCOME MEASURES


Emergency Financial Assistance

   I.      Purpose: The purpose of the Ryan White Title I Outcome Measures is to provide a measurement of the effectiveness of
           services in terms of health, quality of life, cost-effectiveness, and knowledge, attitudes, and practices (KAP), where
           applicable.

   II.       Outcome Measures:

         Outcome Measure                                     Indicator                             Data Collection Method

1.0 Knowledge, Attitudes, and Practices

1.1. Increased knowledge of             Change in the percent of clients who report         Self-Administered Client Survey
financial planning/budgeting skills     increased knowledge of financial
                                        planning/budgeting skills over time
1.2 Continued access to medical         Change in the percent of clients who report         Self-Administered Client Survey
care and HIV/AIDS medications              a. Continued access to primary medical care      CPCDMS
                                           b. Continued ability to pay for HIV/AIDS
                                              medications

2.0 Health


3.0 Quality of Life



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                                                                  2002-2003


         Outcome Measure                                    Indicator                                Data Collection Method
3.1 Improved/stabilized living          Change in the percent of clients who report an        Self-Administered Client Survey
situation                               improvement or stabilization in living situation
3.2 Decreased stress related to         Change in the percent of clients who report           Self-Administered Client Survey
financial burdens                       decreased stress due to financial burdens

4.0 Cost-Effectiveness




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                                                                  2002-2003


                                                                  2002 – 2003

                                                            Ryan White Title I

                                                        OUTCOME MEASURES

Health Insurance

   I.      Purpose: The purpose of the Ryan White Title I Outcome Measures is to provide a measurement of the effectiveness of
           services in terms of health, quality of life, cost-effectiveness, and knowledge, attitudes, and practices (KAP), where
           applicable.

   II.       Outcome Measures:

         Outcome Measure                                     Indicator                                Data Collection Method

1.0 Knowledge, Attitudes, and Practices

1.1. Increased/maintained client        Change in the percent of clients who report             Self-Administered Client Survey
utilization of primary health care      increased/maintained utilization of primary health
services                                care services over time
1.2 Maintained primary care             Change in the percent of clients who report             Self-Administered Client Survey
provider continuity                     maintained primary care provider continuity over
                                        time

2.0 Health


3.0 Quality of Life

3.1 Decreased stress related to         Change in the percent of clients who report a           Self-Administered Client Survey
meeting health insurance expenses       reduction in stress related to meeting health
                                        insurance expenses
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                                                                  2002-2003


         Outcome Measure                                     Indicator                             Data Collection Method
3.2 Increased self-esteem due to        Change over time in the percent of clients who      Self-Administered Client Survey
continued financial responsibility      report increased self-esteem due to continued
for care                                financial responsibility for care

4.0 Cost-Effectiveness

4.1 Decrease in the utilization of      Change over time in the number of clients who       CPCDMS
Ryan White Title I-funded primary       access Ryan White Title I-funded primary care
care services                           services after having insurance co-pays and
                                        deductibles paid




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                                                                  2002-2003


                                                                  2002 – 2003

                                                            Ryan White Title I

                                                        OUTCOME MEASURES


Health Education/Risk Reduction

   I.      Purpose: The purpose of the Ryan White Title I Outcome Measures is to provide a measurement of the effectiveness of
           services in terms of health, quality of life, cost-effectiveness, and knowledge, attitudes, and practices (KAP), where
           applicable.

   II.       Outcome Measures:

         Outcome Measure                                     Indicator                              Data Collection Method

1.0 Knowledge, Attitudes, and Practices

1.1. Increased knowledge about          Change over time in the percent of clients who        Self-Administered Client Survey
reducing HIV transmission risk          report increased knowledge about reducing HIV
                                        transmission risk
1.2 Increased utilization of primary    Change over time in the percent of clients who        CPCDMS
care                                    access and utilize primary care
1.3 Increased practice of safer sex     Change over time in the percent of clients who        Self-Administered Client Survey
behaviors                               report increased practice of safer sex behaviors
                                        (such as abstinence and condom usage).
1.4 Increased knowledge about           Change over time in the percent of clients who        Self-Administered Client Survey
HIV-related support services            report increased knowledge about HIV-related
                                        support services.

2.0 Health


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                                                                  2002-2003


        Outcome Measure                                   Indicator                              Data Collection Method
2.1 Slowing/prevention of disease           c. Improved or maintained CD-4 counts over      CPCDMS
progression                                    time
                                            d. Improved or maintained viral loads over
                                               time

3.0 Quality of Life

3.1 Improved interpersonal relations Change in the percent of clients who report            Self-Administered Client Survey
                                     improved interpersonal relations over time

4.0 Cost-Effectiveness




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                                                                  2002-2003


                                                                  2002 – 2003

                                                            Ryan White Title I

                                                        OUTCOME MEASURES


Home Health Care

   I.      Purpose: The purpose of the Ryan White Title I Outcome Measures is to provide a measurement of the effectiveness of
           services in terms of health, quality of life, cost-effectiveness, and knowledge, attitudes, and practices (KAP), where
           applicable.

   II.       Outcome Measures:

              Outcome                                        Indicator                              Data Collection Method

1.0 Knowledge, Attitudes, and Practices

1.1. Increased independence in      Change in the percent of clients who report               Client Survey
medication administration/increased adherence to medication therapies over time
adherence to medication therapy

2.0 Health

2.1 Slowing/prevention of disease          a. Improved or maintained CD-4 counts over         CPCDMS
progression                                    time
                                           b. Improved or maintained viral loads over
                                               time
2.3 Stabilized stage of illness         Change in the percent of clients who do not           CPCDMS
                                        progress from current stage of illness over time

3.0 Quality of Life
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                                                                  2002-2003


             Outcome                                         Indicator                                Data Collection Method

3.1 Increased ability to perform        Change in the percent of clients with increased         Client Telephone Survey
activities of daily living              ability to perform activities of daily living over
                                        time
3.2 Enhanced quality of life            Change in the percent of clients who feel that the      Client Telephone Survey
                                        home health services they receive are enhancing
                                        their overall quality of life

4.0 Cost-Effectiveness

4.1 Decreased number of days of         Change over time in the number of days of               Client Record Review
HIV/AIDS-related hospitalization        HIV/AIDS-related hospitalization after initiation
                                        of home health care




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                                                                  2002-2003


                                                                  2002 – 2003

                                                            Ryan White Title I

                                                        OUTCOME MEASURES


Household Items

   I.      Purpose: The purpose of the Ryan White Title I Outcome Measures is to provide a measurement of the effectiveness of
           services in terms of health, quality of life, cost-effectiveness, and knowledge, attitudes, and practices (KAP), where
           applicable.

   II.       Outcome Measures:

         Outcome Measure                                     Indicator                               Data Collection Method

1.0 Knowledge, Attitudes, and Practices


2.0 Health


3.0 Quality of Life

3.1 Improved/stabilized living          Change in the percent of clients who report an         Self-Administered Client Survey
conditions                              improvement or stabilization in living conditions
                                        due to receiving furniture or household items

4.0 Cost-Effectiveness




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                                                                  2002-2003


        Outcome Measure                                    Indicator                              Data Collection Method
4.1 Decreased financial burden on       Change in the percent of clients who report a      Self-Administered Client Survey
client                                  decrease in the amount of money spent on
                                        household items




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                                                                  2002-2003


                                                                  2002 – 2003

                                                            Ryan White Title I

                                                        OUTCOME MEASURES


Housing Coordination/Emergency Shelter Vouchers

   I.      Purpose: The purpose of the Ryan White Title I Outcome Measures is to provide a measurement of the effectiveness of
           services in terms of health, quality of life, cost-effectiveness, and knowledge, attitudes and practices (KAP), where
           applicable.

   II.       Outcome Measures:

         Outcome Measure                                     Indicator                            Data Collection Method

1.0 Knowledge, Attitudes, and Practices

1.1. Increased/maintained               Change over time in the percent of clients who      CPCDMS
utilization of primary medical care     maintain or increase utilization of primary
                                        medical care

2.0 Health

2.1 Slowing/prevention of disease           c. Improved or maintained CD-4 counts over      CPCDMS
progression                                    time
                                            d. Improved or maintained viral loads over
                                               time

3.0 Quality of Life



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                                                                  2002-2003


        Outcome Measure                                      Indicator                              Data Collection Method
3.1 Reduction in stress related to      Change in the percent of clients who report a        Self-Administered Client Survey
securing housing                        reduction in stress related to securing housing
                                        over time
3.2 Improved/maintained sense of        Change in the percent of clients who report an       Self-Administered Client Survey
independence                            increased sense of independence over time
3.3 Reduction in time spent living      Change in the percent of clients who report a        Self-Administered Client Survey
exposed to the elements                 reduction in time spent living exposed to the
                                        elements

4.0 Cost-Effectiveness

4.1 Decreased burden upon hospital      Change in the percent of clients who report          Self-Administered Client Survey
emergency rooms                         accessing emergency rooms over time for the
                                        purpose of receiving shelter




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                                                                  2002-2003


                                                                  2002 – 2003

                                                            Ryan White Title I

                                                        OUTCOME MEASURES


In-Home Support

   I.      Purpose: The purpose of the Ryan White Title I Outcome Measures is to provide a measurement of the effectiveness of
           services in terms of health, quality of life, cost-effectiveness, and knowledge, attitudes and practices (KAP), where
           applicable.

   II.       Outcome Measures:

              Outcome                                        Indicator                              Data Collection Method

1.0 Knowledge, Attitudes, and Practices


2.0 Health


3.0 Quality of Life

3.1 Improved/stabilized living          Change in the percent of clients who report           Self-Administered Client Survey
conditions                              improved or stabilized living conditions over time
3.2 Improved/stabilized ability to      Change in the percent of clients who report           Self-Administered Client Survey
complete activities of daily living     improved or stabilized ability to complete
                                        activities of daily living over time

4.0 Cost-Effectiveness

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                                                                  2002-2003


             Outcome                                       Indicator                                 Data Collection Method
4.1 Decreased utilization of more       Change in the percent of clients who utilize Title I    CPCDMS
costly support services                 Adult Day Care and/or Home Health Care
                                        services.




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                                                                  2002-2003


                                                                  2002 – 2003

                                                            Ryan White Title I

                                                        OUTCOME MEASURES


Nutritional Supplements

   I.      Purpose: The purpose of the Ryan White Title I Outcome Measures is to provide a measurement of the effectiveness of
           services in terms of health, quality of life, cost-effectiveness, and knowledge, attitudes, and practices (KAP), where
           applicable.

   II.       Outcome Measures:


         Outcome Measure                                     Indicator                               Data Collection Method

1.0 Knowledge, Attitudes, and Practices

1.1. Increased client knowledge of      Change in the percent of clients who report            Self-Administered Client Survey
the usage, dosing and side effects of   increased knowledge of the usage, dosing and
prescribed supplement(s)                side effects of the prescribed supplement(s) over
                                        time.

2.0 Health

2.1 Decreased/maintained severity       Change in the percent of clients who report            Self-Administered Client Survey
of HIV and/or HIV-medication-           decreased or maintained severity in their HIV
related side effects and symptoms       and/or HIV-medication-related side effects and
                                        symptoms over time.

3.0 Quality of Life
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                                                                  2002-2003


        Outcome Measure                                      Indicator                           Data Collection Method


4.0 Cost-Effectiveness

4.1 Decreased financial burden on       Change in the percent of clients who report a      Self-Administered Client Survey
client                                  decrease in the amount of money spent on
                                        nutritional supplements over time.




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                                                                  2002-2003


                                                                  2002 – 2003

                                                            Ryan White Title I

                                                        OUTCOME MEASURES


Outreach

   I.      Purpose: The purpose of the Ryan White Title I Outcome Measures is to provide a measurement of the effectiveness of
           services in terms of health, quality of life, cost-effectiveness, and knowledge, attitudes, and practices (KAP), where
           applicable.

   II.       Outcome Measures:


         Outcome Measure                                     Indicator                             Data Collection Method

1.0 Knowledge, Attitudes, and Practices

1.1 Increased knowledge of care         Change in the percent of clients who report         Client Self-Administered Survey
system and how to access care           increased knowledge over time of the health care
system                                  and support service system and how to access it
1.2 Entrance into system of care        Percent of clients who enter primary care, case     CPCDMS
                                        management, and other services within the system
                                        of care
1.3. Increased utilization of           Change in the percent of clients who access         CPCDMS
primary care and support services       primary care and support services over time


2.0 Health



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                                                                  2002-2003


       Outcome Measure                                       Indicator        Data Collection Method
3.0 Quality of Life


4.0 Cost-Effectiveness




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                                                                  2002-2003


                                                                  2002 – 2003

                                                            Ryan White Title I

                                                        OUTCOME MEASURES


Outpatient Medical Care

   I.      Purpose: The purpose of the Ryan White Title I Outcome Measures is to provide a measurement of the effectiveness of
           services in terms of health, quality of life, cost-effectiveness, and knowledge, attitudes, and practices (KAP), where
           applicable.

   II.       Outcome Measures:


              Outcome                                        Indicator                             Data Collection Method

1.0 Knowledge, Attitudes, and Practices


2.0 Health

2.1 Slowing/prevention of disease          a. Improved or maintained CD-4 counts over         CPCDMS
progression                                     time
                                           b. Improved or maintained viral loads over
                                                time
2.2 Reduced rates of perinatal          Change in the percent of infants born to HIV+         CPCDMS
transmission                            mothers who are HIV+ 3-6 months after birth
                                        over time
2.3 Stabilized stage of illness         Change in the percent of clients who do not           CPCDMS
                                        progress from current stage of illness over time


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                                                                  2002-2003


             Outcome                                         Indicator        Data Collection Method

3.0 Quality of Life


4.0 Cost-Effectiveness




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                                                                  2002-2003


                                                                  2002 – 2003

                                                            Ryan White Title I

                                                        OUTCOME MEASURES


Rehabilitation

   I.      Purpose: The purpose of the Ryan White Title I Outcome Measures is to provide a measurement of the effectiveness of
           services in terms of health, quality of life, cost-effectiveness, and knowledge, attitudes, and practices (KAP), where
           applicable.

   II.       Outcome Measures:


         Outcome Measure                                     Indicator                               Data Collection Method

1.0 Knowledge, Attitudes, and Practices


2.0 Health

2.1 For those diagnosed with            Change in the percent of clients diagnosed with        Client Record
wasting syndrome, improved or           wasting syndrome with improved or maintained
maintained lean body mass.              bioelectric impedance analysis (BIA) over time.
2.2 For those diagnosed with            Change in the percent of clients diagnosed with        Provider Assessment
lipodystrophy, improved or              lipodystrophy with improved or maintained
maintained symptoms/conditions          symptoms/conditions over time.
2.3 Improved ability to perform         Change in the percent of clients who report an         Self-Administered Client Survey
activities of daily living              improvement in the ability to perform activities of
                                        daily living over time


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                                                                  2002-2003


       Outcome Measure                                       Indicator                                Data Collection Method
3.0 Quality of Life

3.1 Decreased perception of pain        Change in the percent of clients with a history of      Self-Administered Client Survey
                                        pain issues who report a decreased perception of
                                        pain over time
3.2 Improved quality of life            Change in the percent of clients who report an          Self-Administered Client Survey
                                        improvement in quality of life over time (such as
                                        improved ability to sleep, improved energy level,
                                        improved appetite).

4.0 Cost-Effectiveness




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                                                                  2002-2003


                                                                  2002 – 2003

                                                            Ryan White Title I

                                                        OUTCOME MEASURES


Volunteerism

   I.      Purpose: The purpose of the Ryan White Title I Outcome Measures is to provide a measurement of the effectiveness of
           services in terms of health, quality of life, cost-effectiveness, and knowledge, attitudes, and practices (KAP), where
           applicable.

   II.       Outcome Measures:

         Outcome Measure                                     Indicator                             Data Collection Method

1.0 Knowledge, Attitudes, and Practices

1.1. Increased knowledge of             Change over time in the percent of volunteers       Self-Administered Volunteer Survey
HIV/AIDS disease                        who report increased knowledge of HIV/AIDS
                                        disease
1.2 Increased access to and             Change over time in the percent of volunteers       CPCDMS
utilization of primary care             who increase utilization of primary care

2.0 Health


3.0 Quality of Life

3.1 Increased sense of independence Change in the percent of volunteers who report an       Self-Administered Volunteer Survey
                                    increased sense of independence over time


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                                                                  2002-2003


         Outcome Measure                                    Indicator                              Data Collection Method
3.2 Increased self-esteem/self-         Change in the percent of volunteers who report      Self-Administered Volunteer Survey
confidence                              increased self-esteem/self-confidence

4.0 Cost-Effectiveness




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                                                                   2002-2003


                                                                  Attachment D

The information below is for use by entities submitting proposals for the case management and Adult Primary Medical Care service
categories only. Refer to the instructions for Table III.D for more information. The entities listed below may implement specific criteria
for determining those entities with which they will enter into POE agreements. HIV Services will not intercede on behalf of any applicant
concerning POE agreements.

                                                 GROUP A – Governmental Organizations

Must list and attach a copy of a minimum of two (2) formal POE agreements from Group A (minimum of one if applicant agency is
included in this group).
Harris County Hospital District              Counseling and Testing
HIV Projects Office                          Emergency Rooms
Nancy Miertschin, Director
nancy_miertschin@hchd.tmc.edu

713-566-6510 office
713-566-6521 fax
City of Houston                                 Counseling and Testing
DHHS/Bureau of HIV and STD                      Ryan White Title I outreach program
Glenda Gardner, Bureau Chief                    Testing at Harris County Jail (Harris County Sheriff‟s Department facility)
glenda.gardner@cityofhouston.net

713-794-9164 office
713-794-9295




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                                                                  2002-2003



Harris County Public Health and                 Provides counseling and testing at multiple sites, including:
Environmental Services
Health Education Section                        HC-PHES clinics
Leo Nosser, Program Manager
lnosser@harriscountyhealth.com                  Harris County Boot Camp
                                                Corrections Corporation of America
713-439-6295 office                             Ben Reid Facility
713-439-6080 fax                                South Texas Intermediate Sanctions
                                                Texas Southern University Student Clinic
                                                New Directions Center
                                                Make Ready, Inc.
                                                Senior’s We Are
                                                Southwest Key
                                                Harris County Juvenile Probation Dept.
                                                Liberty Island
                                                Open Door Mission
                                                Nikki’s Children’s Home
                                                The Bridge
                                                San Jacinto Junior College




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                                                                  2002-2003


                                                        Attachment D
                                            GROUP B – Community Based Organizations

Must list and attach a copy of a minimum of three (3) formal POE agreements from Group B (minimum of two if applicant
agency is included in this group).
Donald R. Watkins Foundation                 CDC and City of Houston funded prevention efforts
Steven Walker, Executive Director
713-528-1748
The Life Center                              City of Houston funded prevention efforts
Lucy Reyna, Executive Director
713-691-5433
Montrose Clinic                              City of Houston funded prevention efforts
Katy Caldwell, Executive Director
713-830-3000
AAMA                                         City of Houston and TCADA funded prevention efforts
Gilbert Moreno, Executive Director
713-926-4756
Baylor Teen Clinic                           City of Houston funded prevention efforts
(obtain contact information from City of
Houston)
Houston Recovery Campus                      City of Houston funded prevention efforts
713-331-2500
Saint Hope Foundation                        Ryan White Title I Outreach Provider
Rodney Goodie, Executive Director
713-778-1300
Family Services                              Ryan White Title I Outreach Provider
Paz Guerra, Senior Vice President
713-867-7710
Montrose Counseling Center                   Ryan White Title I Outreach Provider
Ann Robison, Executive Director              TCADA funded prevention efforts
713-529-0037
New Hope Counseling Center                   Ryan White Title I HE/RR Provider
Samuel Osueke, Program Director
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                                                                  2002-2003


713-776-8006
The BLOCK                                       Ryan White Title I HE/RR Provider
Melvin Lewis, Executive Director
713-734-2117
Houston Area Community Services                 Ryan White Title I HE/RR Provider
Joe Fuentes, Executive Director                 City of Houston funded prevention efforts
713-526-0555                                    CDC funded prevention efforts




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