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					           HARRIS COUNTY
    REQUEST FOR PROPOSAL                                                                      Job No. 00/0370
                  Cover Sheet
                                                                               Date Due: November 21, 2000
                                                                               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 specifications. Fill out all forms properly and completely. Submit your proposal with all
appropriate supplements and/or samples.

Please return proposal in the envelope provided or in a comparable size envelope. Be sure that return envelope shows the Job Number,
Description and is 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: __________________________________________________________________________
[Your signature attests to your offer to provide the goods and/or services in this proposal according to the published provisions of this
Job. When an award letter is issued, it becomes a part of this contract. Contract is not valid until Purchase Order is issued.]

ACCEPTED BY:_____________________________________________                                    Date:______________________
            HARRIS COUNTY JUDGE ROBERT ECKELS
Revised 01/00

                                                                                                                                    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.

PROPOSAL COMPLETION
Fill out and return to Purchasing, ONE (1) complete proposal form, using the envelope provided. An 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.

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.




                                                                                                                                        Page 3
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.

All products and/or services furnished as part of this contract must be year 2000 compliant. This applies to all computers including
hardware and software as well as all other commodities with date sensitive embedded chips.



Revised 01/00




                                                                                                                                                   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




                                                                                                                      Page 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.




                                                                                                         Page 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.

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 8, 2000 from 1:00 to 4:00 pm in the Harris County Public Health
and Environmental Services Building, 5th floor Jensen-Jefferson Auditorium 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 either 1.5 or double-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
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
                                                                                                                  Page 9
                         SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

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.

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 SIGNED ORIGINAL AND TEN (10) COPIES. All signatures for all forms throughout this package
must be original on the copy 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.

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.




                                                                                                               Page 10
                         SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

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 which meet this criteria. Vendors may not use
       subcontractors to meet this 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)

       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)




                                                                                                                Page 11
       SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)


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.

L.   ABSTRACT - 5 points
     Using a maximum of one (1) typed, single spaced sheet, summarize the proposed project's scope of
     work (objectives, target audience, geographic area served) including the following.
     ABSTRACT - centered at top of page
     Legal Name of Organization
     Mailing Address
     Street Address (if different from mailing address)
     Telephone number and contact person
     Service Category
     Code Number
     Title of Service
     Summation of proposed project's scope of work (objectives, target audience, geographic area served)

M.   BUDGET - 25 points

     Complete the following tables as applicable. If the proposal is for a service category that requires a fee-
     for-service budget complete and include the three (3) budget forms for that category. If no
     subcontractors will be used to provide HIV-related services under this proposal include budget form
     I.D marked "n/a" (not applicable). For fee for service complete IA, IB and ID. For hybrid fee for
     service complete IA, IC & ID.

     Tables
     I.A. Budget Narrative
     I.B. Fee-for-Service Budget Form or
     I.C. Hybrid Fee-for-Service Budget Form
     I.D. Subcontractor Budget Form




                                                                                                        Page 12
                   SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

     The following documentation must be included in the appendices:
      Job description of each type of personnel position listed in the budget narrative, with a one (1) page
        limit per job description;
      Proof of Non-profit status and Articles of Incorporation; (to be removed prior to external review);
      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);
      Proof of Non-profit status and Articles of Incorporation of any subcontractors to be used in the
        provision of direct services (if applicable);

N.       ORGANIZATION - 30 points
         In a maximum of 15 pages (not including tables) address the following points:

        The history of applicant agency in providing services to Persons Living With HIV (PLWH) in the
         Houston EMA. Discuss the impact of new therapies (i.e., multiple drug regimens, etc.) on PLWH
         served by applicant agency and how applicant agency has adapted to the changes in demographics
         and treatment modalities in HIV. Discuss the role of PLWH in agency's program development,
         ongoing quality assurance activities and other aspects of organizational development. Include Tables
         II.A. and II.B. in this section. (10 points);
        The capacity of applicant agency to provide services to PLWH who are members of historically
         underserved/unserved populations and/or who are characterized by the following co-morbidities
         specifically cited in the C.A.R.E. Act: tuberculosis, homelessness, sexually transmitted diseases,
         substance abuse, severe mental illness. Specifically discuss issues relating to client access of
         agency's services (geographic location of services, hours of operation, availability of bilingual staff,
         ability to serve deaf and hard of hearing individuals, etc.). (10 points);
        The capacity of applicant agency to serve populations with special (severe) needs (as cited in the
         HRSA FY1999 Title I Grant Application Guidance). These populations are: 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), injecting drug users, and adolescents (13 - 19 years old). Specifically discuss how applicant
         agency proposes to implement processes that address the unique needs of PLWH who are members
         of the above described severe need groups. Clearly describe the processes to be utilized by
         applicant agency to address service needs of the above populations, including staffing patterns,
         geographic access, program design and related issues. Differentiate clearly between processes
         currently provided versus those that will be implemented if applicant agency receives funding as a
         result of this RFP. Include Table II.C. in this section. (10 points)

     Tables:
     II.A. Organization Information Table
     II.B. Current HIV/AIDS Related Funding
     II.C. Documented Services to PLWH by Gender, Age, Co-morbidity and Severe Need Category
           (1/1/99 - 12/31/99)




                                                                                                          Page 13
                   SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

     The following documentation must be included in the appendices:
      List of Board Members (including the name, address, phone and fax number of each Board member)
        (to be removed prior to external review);
      Copy of applicant's most recent fiscal year audit and/or certified financial statement (to be removed
        prior to external review);
      Letters from all administrative agencies listed in Table II.B. for the applicant
        agency's current City, County, State or Federal HIV/AIDS related HIV 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 (to be removed prior to external review);
      Outpatient/Ambulatory Primary Medical Care (Cat. Code MC-01 A, H, R, W) only –
        List of all current Medicaid HMO contracts.

O.       PROGRAM - 40 points
         In a maximum of 15 pages (not including tables) describe the specific program (service) applicant
         agency is proposing to provide.
        Goals and Objectives - Describe the goal(s) of the service you propose to provide. Discuss how
         applicant agency will operationalize (objectives, activities) these goals so that PLWH will receive
         quality services in a timely manner. Include Table III.A. in this section. (20 points)
         Proposed Clients to Be Served by Program During Contract Term - Discuss the proposed clients to
         be served in terms of access to services and frequency of services. Describe in detail the
         relationship of the proposed services in the overall continuum of care for PLWH. Clearly delineate
         where applicant agency expects clients (incoming referrals) to come from. Be specific in noting
         these referral sources, including information on current referral sources and numbers of clients
         expected from each specific source. Clearly delineate what services clients served by applicant
         agency under services proposed in this proposal will be referred to, the process of making
         appropriate referrals and what methods will be used to assure that clients receive those services they
         have been referred to. Clearly describe all collaborative agreements that these proposed services are
         contingent upon. Include Tables III.B. and III.C. in this section. (10 points)
        Evaluation Process - Describe the specific evaluative processes applicant agency will utilize to
         assure quantity and quality of services provided. Discuss in detail the specific processes to be used
         by applicant 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. Discuss what activities will be undertaken to
         assure that services provided to PLWH will be of the highest possible quality, consistent with all
         locally defined standards of care, Public Health Service guidelines and rules and regulations from all
         applicable licensing entities. Discuss how input from consumers and other PLWH will be
         integrated into program evaluation in order to monitor and improve quality of care. Delineate the
         frequency (how often each specific activity is conducted) of all listed monitoring and evaluative
         activities, including but not limited to, the job title of the staff persons responsible, the size of the
         sample (if sampling is used), and methodology (e.g., chart reviews, client satisfaction instruments,
         etc.).




                                                                                                           Page 14
               SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

     Include in the appendices a sample (in English and Spanish) of all client surveys to be used in
     evaluating the proposed services. Do not include surveys used for services not being proposed. Do
     not include results of any surveys which have been administered to clients in the past. Proposer may
     develop tables to illustrate the evaluative processes they propose to utilize. However, any Proposer
     developed tables are included in the page limit for this section. (10 points)

     Tables
     III.A. Goals and Objectives
     III.B. Proposed Clients to be Served by Program During Contract Term
     III.C. Collaborative Agreements With Other Service Providers

     The following documentation must be included in the appendices:
      Copies of signed and dated collaborative agreement(s) with other service providers;
      Copies (in a minimum of English and Spanish) of all client surveys/evaluations to be used in
        program and/or agency evaluation;

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 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 Director and any
     such decision by the 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.

     For the 2001 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

                                                                                                      Page 15
          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 and children. The EMA must assure that funds are allocated to women,
          infants and children with AIDS, based on the percentage that they represent in the total population of
          people living with AIDS. For FY 2001 grant year contracts in the Houston EMA that percentage is
          18%. All direct client services subcontractors for FY 2001 will be expected to provide no less than
          18% of their available RW Title I funded service units to women, infants and children. In service
          categories where that is not possible (e.g., case management services targeted to African American
          males) the County must assure an overall grant expenditure of no less than 18% on women, children
          and infants. Any contract which fails to provide at least 18% of expenditures (as determined by
          number of units provided to women, infants and children 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.

     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).

          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 (one original and ten copies) of the finished proposal has been prepared for delivery.

     B. GRIEVANCES


                                                                                                            Page 16
       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.

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 Assurance Program is intended to ensure that providers have a means in place to control for
       appropriateness of services including accordance with all applicable laws and regulations and quarterly

                                                                                                                Page 17
     documentation. Provider must have prior HIV/AIDS experience and/or on-going education programs which
     must be documented in the application and updated quarterly. HIV Services is currently facilitating the
     Planning Council approved Quality Assurance Implementation Plan. The result of these efforts will be
     mandatory Quality Assurance activities that all Ryan White Title I funded subrecipients must comply with.
     Agencies are encouraged to participate in this process. For more information contact HIV Services at 713-
     439-6069 and ask to speak to the Quality Assurance coordinator, Patrick Richoux.

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.

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.   Aggregate Level Reporting includes unduplicated numbers of clients served per provider, basic
     demographics (gender, ethnicity, age) regarding clients served, estimated percent of clients by transmission
     category (medical providers only), minority composition of entity's board and/or staff, amounts and types of
     services provided, estimated 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 Administrative Report.

H.   Annual Administrative Report is a data summary by each funded provider according to Aggregate Level
     Reporting prescribed by HRSA. Everyone receiving FY 2001 funds must submit this report to Harris County
     by 1-20-02 summarizing activities from the beginning of their contract through 12-31-01. The County will
     provide the required format for submission of these required annual reports.

I.   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 above described minimum data set. 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



                                                                                                              Page 18
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.

     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 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 2001 Ryan White CARE Act Title I
     award from HRSA. The Planning Council has approved the FY 2001 Ryan White Title I service priorities
     and funding allocations. These funding allocations include contingencies in the event that the total FY 2001
     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)
                                                                                                                Page 19
     201 to 300% of OPL                            7% or less of GIL
     300+% of OPL                                  10% or less of GIL

     "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 Houston Ryan White Title I Standards of Care. HIV Services 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.

                    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.
                                                                                                              Page 20
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 financial statement identifying total amounts of grant funds received and amounts expended
     for each category of services provided. 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 Aggregate Level Reporting
     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 a Centralized Patient Care Data Management System (CPCDMS). This will require 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 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.


                                                                                                        Page 21
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 2001 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.




                                                                                                        Page 22
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.

      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 2002):              ____________ 3-1-02 through 2-28-03

      Renewal Year 2 (FY 2002):              ____________ 3-1-03 through 2-28-04

      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.




                                                                                                        Page 23
                         SPECIAL REQUIREMENTS/INSTRUCTIONS - (Continued)

VI.    SPECIFICATIONS

SERVICE CATEGORIES:
The detailed description and specifications for each Service Category directly follow this listing.

Outpatient/Ambulatory Medical Care

       1.      Outpatient/Ambulatory Primary Medical Care Targeted to African American Code MC-01A
       2.      Outpatient/Ambulatory Primary Medical Care Targeted to Hispanic/Latino(a) Code MC-01H
       3.      Outpatient/Ambulatory Primary Medical Care Targeted to White/MSM Code MC-01W
       4.      Outpatient/Ambulatory Primary Medical Care Targeted to Rural PLWH/A Code MC-01R
       5.      Outpatient/Ambulatory Primary Medical Care Coordination Code MC-02
       6.      Outpatient/Ambulatory Primary Vision Care Code MC-03

Other Outpatient/Community-Based Healthcare Services

       1.      Rehabilitation Care Code HS-01

Home/Community-Based Support Services

       1.      Community-Based Outreach Targeting Rural Code SS-01
       2.      General Transportation with Taxi Vouchers - Urban Code SS-02
       3.      Food Pantry - Urban Code SS-03
       4.      Food Pantry – Rural Code SS-04
       5.      Adult Day Care Code SS-05
       6.      Client Advocacy Code SS-06




                                                                                                       Page 24
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
__________ BUDGET
       _________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
       _________Evaluation Process
__________ APPENDIX
       _________Job description of each type of personnel position
       _________Proof of Non-profit status and Articles of Incorporation
       _________Copy of all signed and dated contracts with subcontractors
       _________Proof of Non-profit status and Articles of Incorporation of any subcontractors
       _________Copies of signed and dated collaborative agreement(s)
       _________Copies of all client surveys/evaluations (English & Spanish)
       _________Copy of Agency’s Quality Assurance Plan (Healthcare and Medical Care providers only)
       _________List of Agency’s Medicaid HMO contracts (Primary Medical Care Providers Only)
       _________List of Board Members
       _________Copy of applicant’s most recent fiscal year audit and/or certified financial statement
       _________Letters from all administrative agencies listed in Table II.B.



                                                                                                      Page 25
                                    FOLLOWING ARE DESCRIPTIONS OF

                      OUTPATIENT/AMBULATORY MEDICAL CARE CATEGORIES

All Home Health Care Agencies must be licensed by the Texas Department of Health as a Home and Community
Support Services Agency. Proposers must include all applicable licenses or certifications in the appropriate section of
their response. (Refer to II. Evaluation Criteria and Award Process, Item C., for more information regarding this
requirement).

All contracting organizations submitting proposals on services listed in these categories must adhere to all
CDC/OSHA recommended guidelines for blood borne pathogens and infectious diseases, and document that in the
proposal.

An existing Quality Assurance Program must be in operation to assure: 1) appropriateness of service; 2) accordance
with all applicable laws and regulations; and 3) be documented quarterly. Provider must have prior HIV/AIDS
experience and/or on-going education programs, all documented in the proposal and updated quarterly. Provider must
be culturally sensitive and language competent. A copy of the agency’s existing Quality Assurance plan must be
included in the appendices.




                                                                                                                 Page 26
SERVICE CATEGORY:                    OUTPATIENT/AMBULATORY MEDICAL CARE

TITLE OF SERVICE:                    Community-Based        Primary     Medical     Care    Targeted     to   African
                                     Americans

CODE:                                MC-01 A

AMOUNT AVAILABLE:                    $810,517.00 – Total award made under this category designated to provide
                                     services to African American clients located within the Houston EMA. For
                                     each award made under this category 18% of the available units must be
                                     provided to women, children and infants.

BUDGET:                              Hybrid - Fee for Service
                                     Proposer must have two (2) separate fee schedules. These are: 1) physician
                                     office visit, and 2) psychiatry visit. Proposer must submit a hybrid fee for
                                     service budget (Table I.C) that represents the unit cost of the service (e.g., the
                                     cost of providing one physician office visit or one psychiatric visit).
                                     Approved diagnostic procedures will be reimbursed at invoice cost.
                                     The proposer must provide at least 2,652 units for no more than $729,465 (90%
                                     of budget). The remaining $81,052 (10% of budget) must be allocated to the
                                     cost of the approved diagnostic procedures.
                                     Proposer must serve at least 300 unduplicated clients per contract term, as
                                     documented by the Centralized Patient Care Data Management System
                                     (CPCDMS).

DEFINITIONS/SERVICES

1) Primary care office/clinic visit: A single office visit wherein the client is examined 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)

Maximum reimbursement allowable for a single primary care office/clinic visit may not exceed $275.00. This
fee includes clinically indicated laboratory work, nutritional counseling, outpatient Ob/Gyn procedures, radiology
and also includes eligibility screening as necessary to ensure Ryan White is the payer of last resort. In the event
patient returns for follow-up ancillary services and/or information with the RN, LMSW or Patient Educator, those
visit(s) wherein the patient is not seen by the Physician/PA/NP are considered to be a component of the original
primary care office/clinic visit with the physician that was billed to the County.




                                                                                                               Page 27
2) A single Diagnostic Procedure (limited to procedures below without prior County approval). Approved
   diagnostic procedures will be reimbursed at invoice cost and includes:
      HEP C RNA                          ECHO
      Bronchoscopy                       Stress EKG/EKG 12 lead
      EGD                                CT Scans as dictated by exam/clinical course
      Flexible Sigmiodoscopy             MRI Scans as dictated by exam/clinical course
      Barium Studies                     Upper & Lower GI
      Colposcopies                       KS Lesion – punch biopsies
      Echocardiograms                    Lumbar Punctures
      Liver Biopsies                     Incision/removal of cysts
      Gastroscopies                      Mammograms
      Sonograms                          Lumpectomies
      Specialized radiological procedures: I.V.P. -Intravenous Pyleograms; Barium Swallows; KUB abdomen

3) Psychiatry visit. A single office 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. Maximum
reimbursement allowable for a psychiatry visit may not exceed $120.00 per visit. The maximum fee for a group
psychiatry visit may not exceed $40.00 per patient.

TARGET POPULATION
At least 75% of clients served under this service category must be African American.

CLIENT ELIGIBILITY
Client must have an income equal to or less than 300% of the Federal Poverty Level. (See Attachment B for a copy
of the FY 2001 RW Title I Financial Eligibility Guidelines).

SERVICES TO BE PROVIDED
Primary health care services include on site physician, physician extender, nursing, phlebotomy, radiographic,
laboratory, pharmacy, intravenous therapy, psychiatry, 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).

The program must be able to 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);
    On-site pelvic and prostate exams as needed with appropriate treatment and referral;
    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);
    Must provide literature and access to HIV related research protocols (either directly or through established
      referral systems);
    At a minimum, must comply with the attached Adult Standards for HIV Primary Medical Care Components
      of Medical Practice. Providers 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)
                                                                                                            Page 28
       HIV treatment guidelines. The recent rapid advances in HIV treatment protocols require that all funded
       providers be able to 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.

The 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.

PERSONNEL QUALIFICATIONS
Services must be provided by State licensed physicians and psychiatrists, registered nurses, nurse practitioners,
vocational nurses, pharmacists, physician assistants, x-ray technologists, 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.

AGENCY QUALIFICATIONS:
The providers and system must be Medicaid/Medicare certified. A copy of the appropriate certifications must be
included in the proposal. The acceptable documentation for Medicaid enrollment is a copy of the agency’s licensure
or physician’s Medicaid enrollment/participation letter from National Heritage Insurance Corporation. The acceptable
documentation for Medicare participation is a copy of the agency’s or physician’s Medicare enrollment/participation
letter from the Health Care Financing Administration. No exceptions to this requirement will be accepted.

Proposers must also include in the Appendices a list of their current (as of the date of submission of their
proposal) Managed Care contracts (name and address of the HMO organization and contact person). Do not
list the amount or other specifics of those HMO contracts.

STANDARDS OF CARE
Proposers must adhere to the attached Ryan White Title I – Standards of Care for Primary Medical Care.




                                                                                                             Page 29
SERVICE CATEGORY:                    OUTPATIENT/AMBULATORY MEDICAL CARE

TITLE OF SERVICE:                    Community-Based Primary Medical Care Targeted to Hispanic/Latinos

CODE:                                MC-01 H

AMOUNT AVAILABLE:                    $355,642.00 – Total award made under this category designated to provide
                                     services to Hispanic/Latino clients located within the Houston EMA. For each
                                     award made under this category at least 18% of the available units must be
                                     provided to women, children and infants.

BUDGET:                              Hybrid - Fee for Service
                                     Proposer must have two (2) separate fee schedules. These are: 1) physician
                                     office visit, and 2) psychiatry visit. Proposer must submit a hybrid fee for
                                     service budget (Table I.C) that represents the unit cost of the service (e.g., the
                                     cost of providing one physician office visit or one psychiatric visit).
                                     Approved diagnostic procedures will be reimbursed at invoice cost.
                                     The proposer must provide at least 1,163 units for no more than $320,078 (90%
                                     of budget). The remaining $35,564 (10% of budget) must be allocated to the
                                     cost of the approved diagnostic procedures.
                                     Proposer must serve at least 150 unduplicated clients per contract term, as
                                     documented by the Centralized Patient Care Data Management System
                                     (CPCDMS).

DEFINITIONS/SERVICES

1) Primary care office/clinic visit: A single office visit wherein the client is examined 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)

Maximum reimbursement allowable for a single primary care office/clinic visit may not exceed $275.00. This
fee includes clinically indicated laboratory work, nutritional counseling, outpatient Ob/Gyn procedures, radiology
and also includes eligibility screening as necessary to ensure Ryan White is the payer of last resort. In the event
patient returns for follow-up ancillary services and/or information with the RN, LMSW or Patient Educator, those
visit(s) wherein the patient is not seen by the Physician/PA/NP are considered to be a component of the original
primary care office/clinic visit with the physician that was billed to the County.




                                                                                                               Page 30
2) A single Diagnostic Procedure (limited to procedures below without prior County approval). Approved
diagnostic procedures will be reimbursed at invoice cost and include:
      HEP C RNA                          ECHO
      Bronchoscopy                       Stress EKG/EKG 12 lead
      EGD                                CT Scans as dictated by exam/clinical course
      Flexible Sigmiodoscopy             MRI Scans as dictated by exam/clinical course
      Barium Studies                     Upper & Lower GI
      Colposcopies                       KS Lesion – punch biopsies
      Echocardiograms                    Lumbar Punctures
      Liver Biopsies                     Incision/removal of cysts
      Gastroscopies                      Mammograms
      Sonograms                          Lumpectomies
      Specialized radiological procedures: I.V.P. -Intravenous Pyleograms; Barium Swallows; KUB abdomen

3) Psychiatry visit. A single office 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. Maximum
reimbursement allowable for a psychiatry visit may not exceed $120.00 per visit. The maximum fee for a group
psychiatry visit may not exceed $40.00 per patient.

TARGET POPULATION
At least 75% of clients served under this service category must be Hispanic/Latino.

CLIENT ELIGIBILITY
Client must have an income equal to or less than 300% of the Federal Poverty Level. (See Attachment B for a copy
of the FY 2001 RW Title I Financial Eligibility Guidelines).

SERVICES TO BE PROVIDED
Primary health care services include on site physician, physician extender, nursing, phlebotomy, radiographic,
laboratory, pharmacy, intravenous therapy, psychiatry, 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).

The program must be able to 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);
    On-site pelvic and prostate exams as needed with appropriate treatment and referral;
    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);
    Must provide literature and access to HIV related research protocols (either directly or through established
      referral systems);
    At a minimum, must comply with the attached Adult Standards for HIV Primary Medical Care Components
      of Medical Practice. Providers 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)
                                                                                                            Page 31
       HIV treatment guidelines. The recent rapid advances in HIV treatment protocols require that all funded
       providers be able to 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.

The 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.

PERSONNEL QUALIFICATIONS
Services must be provided by State licensed physicians and psychiatrists, registered nurses, nurse practitioners,
vocational nurses, pharmacists, physician assistants, x-ray technologists, 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.

AGENCY QUALIFICATIONS:
The providers and system must be Medicaid/Medicare certified. A copy of the appropriate certifications must be
included in the proposal. The acceptable documentation for Medicaid enrollment is a copy of the agency’s or
physician’s Medicaid enrollment/participation letter from National Heritage Insurance Corporation. The acceptable
documentation for Medicare participation is a copy of the agency’s or physician’s Medicare enrollment/participation
letter from the Health Care Financing Administration. No exceptions to this requirement will be accepted.

Proposers must also include in the Appendices a list of their current (as of the date of submission of their
proposal) Managed Care contracts (name and address of the HMO organization and contact person). Do not
list the amount or other specifics of those HMO contracts.

STANDARDS OF CARE
Proposers must adhere to the attached Ryan White Title I – Standards of Care for Primary Medical Care.




                                                                                                            Page 32
SERVICE CATEGORY:                     OUTPATIENT/AMBULATORY MEDICAL CARE

TITLE OF SERVICE:                     Community-Based Primary Medical Care Targeted to White and/or
                                      MSM (Men Who have Sex With Men) PLWH/A

CODE:                                 MC-01 W/MSM

AMOUNT AVAILABLE:                     $901,505.00 – Total award made under this category designated to provide
                                      services to White/MSM clients located within the Houston EMA. For each
                                      award made under this category at least 18% of the available units must be
                                      provided to women, children and infants.

BUDGET:                               Hybrid - Fee for Service
                                      Proposer must have two (2) separate fee schedules. These are: 1) physician
                                      office visit, and 2) psychiatry visit. Physician office visit is defined as a visit
                                      wherein the client is examined by a qualified Medical Doctor, Nurse
                                      Practitioner, and/or Physician’s Assistant. Proposer must submit a hybrid fee
                                      for service budget (Table I.C) that represents the unit cost of the service (e.g.,
                                      the cost of providing one physician office visit or one psychiatric visit).
                                      Approved diagnostic procedures will be reimbursed at invoice cost.
                                      The proposer must provide at least 2,950 units for no more than $811,355 (90%
                                      of budget). The remaining $90,150 (10% of budget) must be allocated to the
                                      cost of the approved diagnostic procedures.
                                      Proposer must serve at least 300 unduplicated clients per contract term, as
                                      documented by the Centralized Patient Care Data Management System
                                      (CPCDMS).


DEFINITIONS/SERVICES

1) Primary care office/clinic visit: A single office visit wherein the client is examined 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)

Maximum reimbursement allowable for a single primary care office/clinic visit may not exceed $275.00 This fee
includes clinically indicated laboratory work, nutritional counseling, outpatient Ob/Gyn procedures, radiology and
also includes eligibility screening as necessary to ensure Ryan White is the payer of last resort. In the event patient
returns for follow-up ancillary services and/or information with the RN, LMSW or Patient Educator, those visit(s)
wherein the patient is not seen by the Physician/PA/NP are considered to be a component of the original primary
care office/clinic visit with the physician that was billed to the County.



                                                                                                                 Page 33
2) A single Diagnostic Procedure (limited to procedures below without prior County approval). Approved
diagnostic procedures will be reimbursed at invoice cost and includes:
      HEP C RNA                          ECHO
      Bronchoscopy                       Stress EKG/EKG 12 lead
      EGD                                CT Scans as dictated by exam/clinical course
      Flexible Sigmiodoscopy             MRI Scans as dictated by exam/clinical course
      Barium Studies                     Upper & Lower GI
      Colposcopies                       KS Lesion – punch biopsies
      Echocardiograms                    Lumbar Punctures
      Liver Biopsies                     Incision/removal of cysts
      Gastroscopies                      Mammograms
      Sonograms                          Lumpectomies
      Specialized radiological procedures: I.V.P. -Intravenous Pyleograms; Barium Swallows; KUB abdomen

3) Psychiatry visit. A single office 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. Maximum
reimbursement allowable for a psychiatry visit may not exceed $120.00 per visit. The maximum fee for a group
psychiatry visit may not exceed $40.00 per patient.

TARGET POPULATION
At least 75% of clients served under this service category must be White, MSM.

CLIENT ELIGIBILITY
Client must have an income equal to or less than 300% of the Federal Poverty Level. (See Attachment B for a copy
of the FY 2001 RW Title I Financial Eligibility Guidelines).

SERVICES TO BE PROVIDED
Primary health care services include on site physician, physician extender, nursing, phlebotomy, radiographic,
laboratory, pharmacy, intravenous therapy, psychiatry, 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).

The program must be able to 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);
    On-site pelvic and prostate exams as needed with appropriate treatment and referral;
    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);
    Must provide literature and access to HIV related research protocols (either directly or through established
      referral systems);
    At a minimum, must comply with the attached Adult Standards for HIV Primary Medical Care Components
      of Medical Practice. Providers 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)
                                                                                                            Page 34
       HIV treatment guidelines. The recent rapid advances in HIV treatment protocols require that all funded
       providers be able to 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.

The 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.

PERSONNEL QUALIFICATIONS
Services must be provided by State licensed physicians and psychiatrists, registered nurses, nurse practitioners,
vocational nurses, pharmacists, physician assistants, x-ray technologists, 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.

AGENCY QUALIFICATIONS:
The providers and system must be Medicaid/Medicare certified. A copy of the appropriate certifications must be
included in the proposal. The acceptable documentation for Medicaid enrollment is a copy of the agency’s or
physician’s Medicaid enrollment/participation letter from National Heritage Insurance Corporation. The acceptable
documentation for Medicare participation is a copy of the agency’s or physician’s Medicare enrollment/participation
letter from the Health Care Financing Administration. No exceptions to this requirement will be accepted.

Proposers must also include in the Appendices a list of their current (as of the date of submission of their
proposal) Managed Care contracts (name and address of the HMO organization and contact person). Do not
list the amount or other specifics of those HMO contracts.

STANDARDS OF CARE

Proposers must adhere to the attached Ryan White Title I – Standards of Care for Primary Medical Care.




                                                                                                            Page 35
SERVICE CATEGORY:                    OUTPATIENT/AMBULATORY MEDICAL CARE

TITLE OF SERVICE:                    Community-Based Primary Medical Care Targeted to Rural Clients

                                     Agency must provide 100% of this service at facilities located in one or
                                     more of the Houston EMA County’s other than Harris County.

CODE:                                MC-01 R

AMOUNT AVAILABLE:                    $252,394.00 – Total award made under this category designated to provide
                                     services to rural clients within the Houston EMA. For each award made under
                                     this category at least 18% of the available units must be provided to women,
                                     children and infants.

BUDGET:                              Hybrid - Fee for Service
                                     Proposer must have two (2) separate fee schedules. These are: 1) physician
                                     office visit, and 2) psychiatry visit. Physician office visit is defined as a visit
                                     wherein the client is examined by a qualified Medical Doctor, Nurse
                                     Practitioner, and/or Physician’s Assistant. Proposer must submit a hybrid fee
                                     for service budget (Table I.C) that represents the unit cost of the service (e.g.,
                                     the cost of providing one physician office visit or one psychiatric visit).
                                     Approved diagnostic procedures will be reimbursed at invoice cost.
                                     The proposer must provide at least 825 units for no more than $227,155 (90%
                                     of budget). The remaining $25,239 (10% of budget) must be allocated to the
                                     cost of the approved diagnostic procedures.
                                     Proposer must serve at least 100 unduplicated clients per contract term, as
                                     documented by the Centralized Patient Care Data Management System
                                     (CPCDMS).


DEFINITIONS/SERVICES

1) Primary care office/clinic visit: A single office visit wherein the client is examined 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)

Maximum reimbursement allowable for a single primary care office/clinic visit may not exceed $275.00. This
fee includes clinically indicated laboratory work, nutritional counseling, outpatient Ob/Gyn procedures, radiology
and also includes eligibility screening as necessary to ensure Ryan White is the payer of last resort. In the event
patient returns for follow-up ancillary services and/or information with the RN, LMSW or Patient Educator, those
visit(s) wherein the patient is not seen by the Physician/PA/NP are considered to be a component of the original

                                                                                                                Page 36
primary care office/clinic visit with the physician that was billed to the County. Agency must provide 100% of
this service at facilities located in one or more of the Houston EMA County’s other than Harris County.

3) A single Diagnostic Procedure (limited to procedures below without prior County approval). Approved
   diagnostic procedures will be reimbursed at invoice cost.
      HEP C RNA                          ECHO
      Bronchoscopy                       Stress EKG/EKG 12 lead
      EGD                                CT Scans as dictated by exam/clinical course
      Flexible Sigmiodoscopy             MRI Scans as dictated by exam/clinical course
      Barium Studies                     Upper & Lower GI
      Colposcopies                       KS Lesion – punch biopsies
      Echocardiograms                    Lumbar Punctures
      Liver Biopsies                     Incision/removal of cysts
      Gastroscopies                      Mammograms
      Sonograms                          Lumpectomies
      Specialized radiological procedures: I.V.P. -Intravenous Pyleograms; Barium Swallows; KUB abdomen

3) Psychiatry visit. A single office 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. Maximum
reimbursement allowable for a psychiatry visit may not exceed $120.00 per visit. The maximum fee for a group
psychiatry visit may not exceed $40.00 per patient.

TARGET POPULATION
At least 75% of clients served under this service category must be rural residents. “Rural” is defined as the client
having residence in any zip code area located outside of Beltway 8. If a zip code area straddles Beltway 8, it is
considered rural.

CLIENT ELIGIBILITY
Client must have an income equal to or less than 300% of the Federal Poverty Level. (See Attachment B for a copy
of the FY 2001 RW Title I Financial Eligibility Guidelines).

SERVICES TO BE PROVIDED
Primary health care services include on site physician, physician extender, nursing, phlebotomy, radiographic,
laboratory, pharmacy, intravenous therapy, psychiatry, 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).

The program must be able to 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);
    On-site pelvic and prostate exams as needed with appropriate treatment and referral;
    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);


                                                                                                             Page 37
      Must provide literature and access to HIV related research protocols (either directly or through established
       referral systems);
      At a minimum, must comply with the attached Adult Standards for HIV Primary Medical Care Components
       of Medical Practice. Providers 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 all funded
       providers be able to 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.

The 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.

PERSONNEL QUALIFICATIONS
Services must be provided by State licensed physicians and psychiatrists, registered nurses, nurse practitioners,
vocational nurses, pharmacists, physician assistants, x-ray technologists, 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.

AGENCY QUALIFICATIONS:
Agency must provide 100% of this service at facilities located in one or more of the Houston EMA County’s
other than Harris County. The providers and system must be Medicaid/Medicare certified. A copy of the
appropriate licensure must be included in the proposal. The acceptable documentation for Medicaid enrollment is a
copy of the agency’s or physician’s Medicaid enrollment/participation letter from National Heritage Insurance
Corporation. The acceptable documentation for Medicare participation is a copy of the agency’s or physician’s
Medicare enrollment/participation letter from the Health Care Financing Administration. No exceptions to this
requirement will be accepted.

Proposers must also include in the Appendices a list of their current (as of the date of submission of their
proposal) Managed Care contracts (name and address of the HMO organization and contact person). Do not
list the amount or other specifics of those HMO contracts.

STANDARDS OF CARE

Proposers must adhere to the attached Ryan White Title I – Standards of Care for Primary Medical Care.




                                                                                                            Page 38
SERVICE CATEGORY:                   OUTPATIENT/ AMBULATORY MEDICAL CARE

TITLE OF SERVICE:                   Medical Care Coordination - Untargeted


CODE:                               MC-02

AMOUNT AVAILABLE:                   $100,000.00 – For each award made under this category at least 18% of the
                                    available units must be provided to women, children and infants. A minimum
                                    of two (2) full time equivalent (FTE) Licensed Master of Social Work
                                    (LMSW) positions based on full funding of $100,000. Proposers can
                                    minimally apply for ½ FTE (e.g., ½ FTE = $25,000 maximum funding
                                    request, 1 FTE = $50,000 maximum funding request).

BUDGET:                             Fee-for-service. Proposer must serve at least 60 clients per contract term
                                    (based on request of $100,000), as documented by the Centralized Patient
                                    Care Data Management System (CPCDMS). Maximum unit cost allowable
                                    is $18.00/unit.

DEFINITION/SERVICES:                One unit of service is defined as 15 minutes of direct client services. Medical
                                    care coordination services consist of 1) medical assessment, 2) education, 3)
                                    consultation, 4) referral to case management (if appropriate), and/or 5)
                                    general psychosocial client services by a LMSW.

TARGET POPULATION
HIV/AIDS-infected individuals residing within the Houston Eligible Metropolitan Area (EMA).

CLIENT ELIGIBILITY
Client must have an income equal to or less than 300% of the Federal Poverty Level. (See Attachment B for a
copy of the FY 2001 RW Title I Financial Eligibility Guidelines).

SERVICES PROVIDED
Services must include:
    Performing medical needs assessments;
    Developing medical service plans for clients;
    Monitoring plan implementation;
    Educating client regarding wellness, medication and health care compliance issues;
    Acting as an advocate and liaison with medical staff on behalf of client;
    Transition client into case management, service linkage and/or general client services.

PERSONNEL QUALIFICATIONS
Minimum requirement is a State of Texas LMSW with two years of paid health care experience, with at least one
year of paid experience in the field of HIV/AIDS.




                                                                                                            Page 39
AGENCY QUALIFICATIONS
Agency must be a current provider of Outpatient/Ambulatory Primary Medical Care Services to HIV-infected
patients. Agency’s primary care medical services must be consistent with 076 and Ryan White Title IV protocols.
Proposer must document their history of providing comprehensive primary care services and document in the
proposal their plan for supporting an LMSW Medical Care Coordinator within the organization. Proposers must
describe their history of working with underserved/unserved HIV/AIDS populations and must describe their plans
for coordinating services with other agencies providing HIV/AIDS services. Agency must also document in the
proposal their capability to serve these populations in a culturally competent manner. 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 underserved/unserved populations.

STANDARDS OF CARE
Proposers must adhere to the Ryan White Title I – Standards of Care for Medical Care Coordination.




                                                                                                            Page 40
SERVICE CATEGORY:                    OUTPATIENT/ AMBULATORY MEDICAL CARE

TITLE OF SERVICE:                    Vision Care

CODE:                                MC-03

AMOUNT AVAILABLE:                    $150,000.00 – For each award made under this category at least 18% of the
                                     available units must be provided to women, children and infants.

BUDGET:                              Hybrid - Fee for Service
                                     Proposer must submit a hybrid fee for service budget (Table I.C) that
                                     represents the unit cost of the service (e.g., the cost of providing one vision
                                     care visit). Eye glasses will be reimbursed at invoice cost.
                                     The proposer must provide at least 2,010 units for no more than $100,500 (67%
                                     of budget). The remaining $49,500 (33% of budget) must be allocated to the
                                     cost of providing eye glasses.
                                     Proposer must serve 800 unduplicated clients per contract term, as
                                     documented by the Centralized Patient Care Data Management System
                                     (CPCDMS).

DEFINITION/SERVICE:                  A unit of service is defined as one (1) vision care visit.
                                     Each patient is limited to three (3) patient visits per year and one (1) pair of
                                     glasses per year.

TARGET POPULATION
HIV/AIDS-infected individuals residing within the Houston Eligible Metropolitan Area (EMA).

CLIENT ELIGIBILITY
Client must have an income equal to or less than 300% of the Federal Poverty Level. (See Attachment B for a
copy of the FY 2001 RW Title I Financial Eligibility Guidelines).

SERVICES TO BE PROVIDED
Services must be provided at a eye care clinic or Optometrist’s office. Services must include but are not limited to
external/internal eye health evaluations; refractions; dilation of the pupils; glaucoma and cataract evaluations;
CMV screenings; prescriptions for eye glasses and over the counter medications; provision of eye glasses (contact
lenses are not allowable); and referrals to other service providers (i.e. Primary Care Physicians, Ophthalmologists,
etc.) for treatment of CMV, glaucoma, cataracts, etc.

Vendor must provide a written plan for ensuring that collaboration occurs with other providers (Primary Care
Physicians, Ophthalmologists, etc.) to ensure that patients receive appropriate treatment for CMV, glaucoma,
cataracts, etc.

PERSONNEL QUALIFICATIONS
The service provider must have a Doctorate of Optometry on staff who is licensed by the Texas Optometry Board
as a Therapeutic Optometrist.

STANDARDS OF CARE
Proposers must adhere to the attached Ryan White Title I – Standards of Care for Vision Care.


                                                                                                              Page 41
               OTHER OUTPATIENT/COMMUNITY-BASED HEALTHCARE SERVICES

All contracting organizations submitting proposals on services listed in these categories must adhere to all
CDC/OSHA recommended guidelines for blood borne pathogens and infectious diseases, and document that in the
proposal.

An existing Quality Assurance Program must be in operation to assure: 1) appropriateness of service; 2)
accordance with all applicable laws and regulations; and 3) be documented quarterly. Provider must have
prior HIV/AIDS experience and/or on-going education programs, all documented in the proposal and updated
quarterly. Provider must be culturally sensitive and language competent. A copy of the agency’s existing
Quality Assurance plan must be included in the appendices.




                                                                                                     Page 42
SERVICE CATEGORY:                   OTHER OUTPATIENT/COMMUNITY-BASED SUPPORT SERVICES

TITLE OF SERVICE:                   Rehabilitation Care

CODE:                               HS-01

AMOUNT AVAILABLE:                   $75,000 - For each award made under this category at least 18% of the
                                    available units must be provided to women, children and infants.

BUDGET:                             Fee for Service: Proposer(s) must serve 50 clients per contract term, as
                                    documented by the Centralized Patient Care Data Management System
                                    (CPCDMS).

DEFINITION/SERVICES:                A unit of service is a Physician-ordered physical therapy and/or skilled
                                    rehabilitation service provided to HIV-infected patients at community-based
                                    organizations or clinics, or in the patient's place of residence.

TARGET POPULATION
HIV/AIDS infected persons residing within the Houston Eligible Metropolitan Area (EMA).

CLIENT ELIGIBILITY
Client must have an income equal to or less than 500% of the Federal Poverty Level. (See Attachment B for a copy
of the FY 2001 RW Title I Financial Eligibility Guidelines).

SERVICES TO BE PROVIDED
Services must include:
    Diagnostic evaluations of pain, flexibility, body composition, endurance, cardiovascular capacity, strength
       and functional capacity (activities of daily living);
    Pain management and functional capacity rehabilitation with physical therapy, neuromuscular rehabilitation,
       chiropractic therapy and/or acupuncture, as ordered by a Physician;
    Resistance exercise therapy to: a) replenish lean body mass (LBM) for those patients who have sub-optimal
       amounts as determined by Bio-electrical Impedance Analysis (BIA) (this service is to be provided along
       with nutritional counseling), and b) increase strength in the upper and lower body for those patients with
       impaired functional capacity as determined in 1 above;
    Low impact cardiovascular exercise therapy for patients with low endurance (as determined in 1 above),
       reduced cardiovascular capacity (as determined in 1 above) and/or significant HIV medication induced
       increases in visceral fat (over 2 inches in waist circumference) and/or serum cholesterol (> 300 mg/dl),
       triglycerides (>500 mg/dl) and glucose (>160 mg/dl) refractory to medication;
    Speech therapy.




                                                                                                            Page 43
PERSONNEL QUALIFICATIONS

Skilled rehabilitation shall be provided by a Licensed Physical Therapist (PT), Licensed PT Assistants, PT Aides,
Registered Occupational Therapists, Certified Occupational Therapy Assistants or Licensed Speech Pathologists,
Doctor of Chiropractic or Doctor of Acupuncture. Providers must have documented expertise in providing HIV-
specific therapies.

AGENCY QUALIFICATIONS
The provider agency must be capable of billing Medicare and Medicaid for eligible services. A copy of the
agency’s licenses and certification must be included in the proposal.

STANDARDS OF CARE

Proposers must adhere to the attached Ryan White Title I – Standards of Care for Rehabilitation Services.




                                                                                                          Page 44
HOME/COMMUNITY-BASED SUPPORT SERVICES




                                        Page 45
SERVICE CATEGORY:                      HOME/COMMUNITY-BASED SUPPORT SERVICES

TITLE OF SERVICE:                      Outreach Targeting Rural Clients

CODE:                                  SS-01

AMOUNT AVAILABLE:.                     $50,000.00 – For the award made under this category at least 18% of the
                                       available units must be provided to women, children and infants. Funding is to
                                       support one full time equivalent (FTE) outreach worker. Proposer may opt to
                                       use two ½ FTE outreach positions in order to more efficiently provide coverage
                                       of the rural area.

BUDGET:                                Fee-for-service. Agency must provide at least 2,941 units and serve 63
                                       clients per contract term, as documented by the Centralized Patient Care Data
                                       Management System (CPCDMS). Maximum allowable unit cost is
                                       $17.00/unit.

DEFINITION/SERVICE:                    One unit of service is defined as 15 minutes of direct client services. A new
                                       client intake and registration into the CPCDMS will be reimbursed at 15 units.

TARGET POPULATION
HIV/AIDS infected individuals residing within the rural Houston Eligible Metropolitan Area (EMA) who are not
currently accessing medical and support services. Clients currently registered in the CPCDMS are not eligible for
outreach services. At least 75% of clients served under this service category must be residing in rural areas. Rural is
defined as the client’s residence being located in any area outside of Beltway 8. If a zip code area straddles Beltway 8,
it is considered to be rural.

CLIENT ELIGIBILITY
Client must have an income equal to or less than 500% of the Federal Poverty Level. Individuals not infected
with HIV are not eligible for this service.

SERVICES TO BE PROVIDED
To identify HIV+ individuals so that they may become aware of and may be enrolled in care and treatment services
(not HIV counseling and testing, nor prevention education). To assist clients in securing and completing required
documentation to become eligible for medical, prescription/drug and other support services. To register clients into
the CPCDMS and link to case management and/or primary care provider for ongoing services.

PERSONNEL QUALIFICATIONS
Agency must document staff training regarding cultural-sensitivity and dealing with the special needs of adolescents,
women and children (i.e. transportation, daycare, & power issues within relationships) and rural barriers. Funded
agencies must utilize the County’s training provider for required training. Staff must have documented HIV work
experience.

AGENCY QUALIFICATIONS
The agency must target the rural areas with high incidence of HIV infection among clients as per most current
Houston EMA epidemiological data.

STANDARDS OF CARE
Proposers must adhere to the attached Ryan White Title I Standards of Care for Outreach.
                                                                                                                 Page 46
SERVICE CATEGORY:                            HOME/COMMUNITY-BASED SUPPORT SERVICES

TITLE OF SERVICE:                            General Transportation with Taxi Vouchers - Urban

CODE:                                        SS-02

AMOUNT:                                      $681,614.00 – 7% of the award must be made available for taxi
                                             vouchers. For each award made under this category, at least 18% of
                                             funding must be utilized to provide services for women, children and
                                             infants.

BUDGET:                                      Hybrid Fee for Service:
                                             Proposer must submit a hybrid fee for service budget (Table I.C) that
                                             represents the unit cost of the service (e.g., the cost of transporting an
                                             individual client one mile). Taxi vouchers will be reimbursed at
                                             actual cost.
                                             The proposer must provide at least 511,210 units for no more than
                                             $613,482 (93% of budget). The remaining $68,161 (7% of budget)
                                             must be allocated to the cost of providing taxi vouchers. The
                                             maximum reimbursement per unit of service is $1.20.

DEFINITION/SERVICES:                         A unit of service is defined as one (1) mile driven with an eligible client
                                             as passenger. Only actual mileage driven transporting eligible clients
                                             will be reimbursed by the County.

TARGET POPULATION
HIV/AIDS infected persons residing within Beltway 8 of the Houston Eligible Metropolitan Area (EMA). Clients
living in zip code areas outside of Beltway 8 or in zip code areas that straddle Beltway 8 are ineligible for urban
transportation services. Caregivers must be allowed to accompany the HIV/AIDS infected client. Provider may
not bill the County for transporting caregivers.


CLIENT ELIGIBILITY
Clients must have income no greater than 300% of the Federal Poverty Level (See Attachment B for a copy of the FY
2001 RW Title I Financial Eligibility Guidelines). Documentation of the above eligibility criteria must be obtained by
the Agency prior to client receiving services and must be documented in accordance with HIV Services – Site Visit
Guidelines.

SERVICES TO BE PROVIDED
General urban transportation service is defined as transportation services provided through the use of individual
EMPLOYEE or CONTRACT drivers by means of vehicles/vans. The intent of this funding is to provide general
transportation services to access medical and/or psychosocial support services. Urban transportation is targeted to
eligible clients residing in areas with zip codes inside of Beltway 8. If a zip code area straddles Beltway 8 or is
outside of Beltway 8, it is considered to be a rural zip code. Clients eligible for urban transportation may not be
transported to destinations outside of Beltway 8. Transportation will include round trips to single destinations and
round trips to multiple destinations.

There is a mandated cap of twenty (20) one-way trips per month per client. Prior approval from HIV
Services AND certification by a medical professional (physician, nurse, social worker, or HIV/AIDS case
                                                                                                                Page 47
manager) are required to exceed monthly cap. Documentation of both requirements must be in client’s file.
Taxi vouchers will be provided to clients only for identified emergency (non-life threatening) situations, or those
exigent situations where the provider cannot provide scheduled service in a timely manner (e.g., vehicle
breakdown, inclement weather). General transportation services must be provided between 7 am - 10 pm on
weekdays (non-holidays) and on Saturdays for RW Title I funded psychosocial services only (i.e. food pantries,
rehabilitation services, support groups and counseling).

Clients may not be transported to entertainment or social events under this contract.

Upon Planning Council recommendation, as documented via a letter to HIV Services from the Chair of the
Planning Council (or designee) prior to the activity, clients may be transported to Planning Council and Planning
Council Subcommittee meetings (including focus groups and public hearings) with prior approval of HIV Services.
All trips count against the 20 one-way trip per month per client cap.


DRIVER QUALIFICATIONS
Drivers (Employee or Contract) providing these services must have a valid Texas Driver’s License, have completed
a State approved “Safe Driving” course, maintain current automobile liability insurance, and only operate a vehicle
with a current Texas State Inspection. The minimum acceptable limit of automobile liability insurance is $300,000
combined single limit coverage per vehicle. A picture identification of each driver must be posted in the vehicle
utilized to transport clients. Criminal background checks must be performed on all direct service transportation
personnel prior to transporting any clients. Drivers who have received traffic violations (speeding ticket, reckless
driving, and/or DWI) within the past year are not qualified to provide transportation services funded by RWI.

Proposers must indicate in Table III.A. (goals and objectives) of their proposal the number of drivers and vehicles
that will be utilized to transport eligible clients.

AGENCY QUALIFICATIONS
 Agency must have a separate toll-free telephone line from their main number so that clients can access
  transportation services directly without cost to clients.
 Agency must have a fax machine with a dedicated line.
 Agency must be able to transport eligible children to medical appointments and support services.
 Agency must insure authorized adult supervision other than the driver when transporting children. The parent
  or legal guardian can determine who is authorized to ride with the child. This must be documented in
  writing prior to the transportation being provided.
 Agency must assure eligible clients utilize Medicaid transportation service to the maximum extent
  possible. This is subject to audit by the County and vendor may be required to reimburse the County
  for transportation services billed to the County for clients who were at the time of the service eligible for
  Medicaid supported transportation.

STANDARDS OF CARE
Proposers must adhere to the attached Ryan White Title I – Standards of Care for Transportation Services.




                                                                                                             Page 48
SERVICE CATEGORY:                    HOME/COMMUNITY-BASED SUPPORT SERVICES

TITLE OF SERVICE:                     Food Pantry - Urban

CODE:                                 SS-03

AMOUNT AVAILABLE:                     $444,384.00 - For each award made under this category at least 18% of the
                                      available units must be provided to women, children and infants.

BUDGET:                               Fee for Service Budget – Proposers must serve at least 1,500 clients per
                                      contract term, as documented by the Centralized Patient Care Data
                                      Management System (CPCDMS). Maximum allowable unit cost is
                                      $25.00/unit.

DEFINITION/SERVICES:                  A visit or delivery where one week’s worth of groceries is provided to a client.
                                      A single client may receive a maximum of five (5) units per month. Under no
                                      circumstances may a client receive more than 52 units per contract year.

TARGET POPULATION
HIV/AIDS infected persons residing within Beltway 8 of the Houston Eligible Metropolitan Area (EMA). Clients
living in zip code areas outside of Beltway 8 or in zip code areas that straddle Beltway 8 are ineligible for urban
pantry services.

CLIENT ELIGIBILITY
In order to be eligible for urban food pantry services, individuals must be HIV+ and have an income no greater than
300% of the Federal Poverty Level (See Attachment B for a copy of the FY 2001 RW Title I Financial Eligibility
Guidelines).

SERVICES TO BE PROVIDED
   Provision of food and related grocery items to include personal hygiene, paper products, cleaning supplies and
     diapers.
   Food products must be reviewed by a licensed dietician for appropriateness for PLWH/A within three
     months of start of contract or contract renewal date.
   Vendor must use at least 10% of their award for a food vouchering system and have a system for delivering
     food to clients. Food vouchers must be issued and recorded in the name of the client only. Vendor must
     provide the County a copy of written guidelines for the issuance, recording and safeguarding of food vouchers
     and receive approval of these guidelines prior to issuing food vouchers.
   Up to 90% of funds can be used for the wholesale purchase of food and specialty items.
   Tobacco, liquor and pet food or pet products may not be purchased with Ryan White Title I funds.
   This service does not provide food to affected persons and individuals who are caregivers for
     HIV/AIDS infected clients.

AGENCY QUALIFICATIONS
Agency must operate out of a primary quadrant and have a satellite location in a secondary quadrant (see definition of
quadrants below). Primary food pantry location must have flexible service hours to meet the needs of clients served.
Secondary satellite location must be open for a minimum of two days per week. Food pantry locations must have the
following permits: Food Dealer’s Permit, Occupancy Permit, and Fire Marshall’s Permit. Copies of permits in the
agency’s name must be included in the proposal.


                                                                                                               Page 49
There are eight (8) quadrants. See diagram below for graphic representation.

   Quadrant           Quadrant Name                                       Boundaries
     No.
      1        Southwest Inner (SW-I)         The area bounded on the north by Interstate 10, on the east by
                                              Interstate 45 and inside of Loop 610.
       2       Southwest Outer (SW-O)         The area bounded on the north by Interstate 10, on the south by
                                              Beltway 8, on the east by Interstate 45 and outside of Loop 610.
       3       Northwest Inner (NW-I)         The area bounded on the south by Interstate 10, on the east by
                                              Interstate 45 and inside of Loop 610.
       4       Northwest Outer (NW-O)         The area bounded on the south by Interstate 10, on the east by
                                              Interstate 45, on the north and west by Beltway 8 and outside of Loop
                                              610.
       5       Northeast Inner (NE-I)         The area bounded on the south by Interstate 10, on the west by
                                              Interstate 45 and inside of Loop 610.
       6       Northeast Outer (NE-O)         The area bounded on the south by Interstate 10, on the west by
                                              Interstate 45, on the north and east by Beltway 8 and outside of Loop
                                              610.
       7       Southeast Inner (SE-I)         The area bounded on the north by Interstate 10, on the west by
                                              Interstate 45 and inside of Loop 610.
       8       Southeast Outer (SE-O)         The area bounded on the north by Interstate 10, on the west by
                                              Interstate 45, on the south and east by Beltway 8 and outside of Loop
                                              610.


                                                                                             N
                                   NW-O (4)             NE-O (6)


               I-10                            NW-I   NE-I
                                               (3)    (5)

                                               SW-I   SE-I
                                               (1)    (7)


                                   SW-O (2)              SE-O (8)

               Beltway 8                                               Loop 610


                                                                I-45


STANDARDS OF CARE

Proposers must adhere to the attached Ryan White Title I – Standards of Care for Food Services.




                                                                                                                Page 50
SERVICE CATEGORY:                     HOME/COMMUNITY-BASED SUPPORT SERVICES

TITLE OF SERVICE:                     Food Pantry - Rural

CODE:                                 SS-04

AMOUNT AVAILABLE:                     $111,096.00 - For each award made under this category at least 18% of the
                                      available units must be provided to women, children and infants.

BUDGET:                               Fee for Service Budget – Proposers must serve at least 100 clients per
                                      contract term, as documented by the Centralized Patient Care Data
                                      Management System (CPCDMS). Maximum allowable unit cost is
                                      $25.00/unit.

DEFINITION/SERVICES:                  A visit or delivery where one week’s worth of groceries is provided to a client.
                                      A single client may receive a maximum of five (5) units per month or may opt
                                      to receive the maximum of ten (10) units once every two (2) months. Under
                                      no circumstances may a client receive more than 52 units per contract
                                      year.


TARGET POPULATION
HIV/AIDS infected individuals residing within the rural area of the Houston Eligible Metropolitan Area (EMA). At
least 75% of clients served under this service category must be residing in rural areas. “Rural” is defined as any area
outside of Beltway 8. If a zip code area straddles Beltway 8, it is considered to be rural.

CLIENT ELIGIBILITY
In order to be eligible for food pantry services, individuals must be HIV+ and have an income no greater than
300% of the Federal Poverty Level (See Attachment B for a copy of the FY 2001 RW Title I Financial Eligibility
Guidelines).

SERVICES TO BE PROVIDED
   Provision of food and related grocery items to include personal hygiene, paper products, cleaning supplies and
     diapers.
   Food products must be reviewed by a licensed dietician for appropriateness for PLWH/A within three
     months of start of contract or contract renewal date.
   Vendor must use at least 10% of their award for a food vouchering system and have a system for delivering
     food to clients. Food vouchers must be issued and recorded in the name of the client only. Vendor must
     provide the County a copy of written guidelines for the issuance, recording and safeguarding of food vouchers
     and receive approval of these guidelines prior to issuing food vouchers.
   Up to 90% of funds can be used for the wholesale purchase of food and specialty items.
   Tobacco, liquor and pet food or pet products may not be purchased with Ryan White Title I funds.
   This service does not provide food to affected persons and individuals who are caregivers for
     HIV/AIDS infected clients.

AGENCY QUALIFICATIONS
Agency must operate out of a rural county and have a satellite location in a non-adjoining rural county. Primary food
pantry location must have flexible service hours to meet the needs of clients served. Secondary satellite location must
be open for a minimum of two days per week. Food pantry locations must have the following permits: Food Dealer’s

                                                                                                                Page 51
Permit, Occupancy Permit, and Fire Marshall’s Permit (if pantry is located in a jurisdiction that issues such permits).
Copies of permits in the agency’s name must be included in the proposal.

STANDARD OF CARE
Proposers must adhere to the attached Ryan White Title I – Standards of Care for Food Services.




                                                                                                                Page 52
SERVICE CATEGORY:                    HOME/COMMUNITY-BASED SUPPORT SERVICES

TITLE OF SERVICE:                    Adult Day Care

CODE:                                SS-05

AMOUNT AVAILABLE:                    $108,136.00 – Of the total award made under this category, 18% of funding
                                     must be utilized to provide services for women.

BUDGET:                              Fee for Service: Proposer(s) must provide at least 1,351 units of service and
                                     serve 100 clients per contract term, as documented by the Centralized Patient
                                     Care Data Management System (CPCDMS).

DEFINITION/SERVICES:                 A unit of service is defined as one (1) day of care for one (1) client. Services
                                     consist of social services in a supervised day program for HIV/AIDS infected
                                     individuals who are at least 18 years of age. Maximum allowable unit cost is
                                     $80.00.

TARGET POPULATION
HIV/AIDS infected persons residing within the Houston Eligible Metropolitan Area (EMA).

CLIENT ELIGIBILITY
Client must have an income equal to or less than 300% of the Federal Poverty Level. (See Attachment B for a copy
of the FY 2001 RW Title I Financial Eligibility Guidelines).

SERVICES TO BE PROVIDED
  Services must include:
      Hot meals
      Nutritional counseling
      Social activities
      Information referral
      Peer support
      Physical therapy
      Instructional workshops on HIV-related issues
      Services must be provided at least Monday through Friday for a minimum of 10 hours/day.

PERSONNEL QUALIFICATIONS
Staff must include individuals with experience in HIV day programming, including food service preparation. The
nutrition and physical therapy programs must be supervised by licensed Dietitian/Nutritionist and licensed Physical
Therapist, respectively.

AGENCY QUALIFICATIONS
The agency must be licensed by the Texas Department of Human Services as an Adult Day Care Center. The
agency must have the following permits: Food Dealer’s Permit, Occupancy Permit, and Fire Marshall’s Permit. A
copy of the agency’s licenses and permits must be included in the proposal.

STANDARDS OF CARE
Proposers must adhere to the attached Ryan White Title I - Standards of Care for Adult Day Care Services.

                                                                                                              Page 53
SERVICE CATEGORY:                     HOME/COMMUNITY-BASED SUPPORT SERVICES

TITLE OF SERVICE:                     Client Advocacy (Legal Assistance)

CODE:                                 SS-06

AMOUNT AVAILABLE:                     $352,631.00 – Total award made under this category, 18% of funding must be
                                      utilized to provide services for women, infants and children.

BUDGET:                               Fee for Service. Proposer(s) must provide 4,701 units and serve 500 clients
                                      per contract term, as documented by the Centralized Patient Care Data
                                      Management System (CPCDMS). Maximum allowable unit cost is
                                      $75.00/unit.

DEFINITIONS/SERVICES:                 A unit of comprehensive legal service is defined as one (1) hour of services
                                      provided to HIV/AIDS infected individuals and/or their legal representatives by
                                      an Attorney licensed to practice in Texas. Only time spent by the Attorney
                                      working on a client’s case may be billed to contracts issued under this RFP.
                                      Travel time to and from a client’s residence is not billable under this RFP.
                                      Client Advocacy Workshops are defined as one (1) course lasting a minimum
                                      of two (2) hours in client advocacy and provided to a minimum of three (3)
                                      HIV/AIDS infected individuals. The maximum cost for a single Client
                                      Advocacy Workshop is $150.00 (2x$75.00/unit), regardless of the number of
                                      participants.

TARGET POPULATION
HIV/AIDS infected persons residing within the Houston Eligible Metropolitan Area (EMA).

CLIENT ELIGIBILITY
Client must have an income equal to or less than 300% of the Federal Poverty Level. (See Attachment B for a copy
of the FY 2001 RW Title I Financial Eligibility Guidelines).

SERVICES TO BE PROVIDED
Comprehensive legal services directly necessitated by an individual’s HIV/AIDS status.
Services must include:
    Preparation of Powers of Attorney, Do Not Resuscitate (DNR) Orders, wills, trusts, etc.;
    Bankruptcy proceedings;
    Interventions necessary to ensure access to benefits for which an individual may be eligible, including
       discrimination or breach of confidentiality litigation as it relates to services eligible for funding under the
       CARE Act.

Permanency planning may be provided to an individual or family where the responsible adult is expected to pre-
decease a dependent (usually a minor child) due to HIV/AIDS. Permanency planning includes the provision of social
service counseling or legal counsel regarding drafting of wills or delegating powers of attorney, and preparation for
custody options for legal dependents including standby guardianship, joint custody, or adoption.

Client Advocacy Workshops must include:
     Distribution of written materials pertaining to clients’ rights and HIV/AIDS issues;
     Information about client advocacy services;
                                                                                                               Page 54
      Information on how to effectively access legal services.

Work on criminal defense or class action suits are not eligible for reimbursement under this RFP.


PERSONNEL QUALIFICATIONS
Staff attorney must be licensed by the State of Texas, have a minimum educational level of a doctorate in
Jurisprudence and have at least three years experience working directly with HIV- infected clients.

STANDARDS OF CARE
Proposers must adhere to the attached Ryan White Title I – Standards of Care for Legal Services.




                                                                                                    Page 55
                                         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.




                                                                                                            Page 56
                                                              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                        the Age Discrimination Act of 1975, as
                   assistance, and the institutional, managerial                       amended (42 U.S.C. 6101-6107), which
                   and financial capability (including funds                           prohibits discrimination on the basis of age;
                   sufficient to pay the non-Federal share of                          (e) the Drug Abuse Office and Treatment Act
                   project costs) to ensure proper planning,                           of 1972 (P.L. 92-255, as amended, relating to
                   management and completion of the project                            nondiscrimination on the basis of drug abuse;
                   described in this application.                                      (f) the Comprehensive Alcohol Abuse and
                                                                                       Alcoholism Prevention, Treatment and
         2.        Will give the awarding agency, the                                  Rehabilitation Act of 1970 (P.L. 91-616, as
                   Comptroller General of the United States, and                       amended, relating to nondiscrimination on the
                   if appropriate, the State, through any                              basis of alcohol abuse or alcoholism; (g) 523
                   authorized representative, access to and the                        and 527 of the Public Health Service Act of
                   right to examine all records, books, papers, or                     1912 (42 U.S.C. 290 dd-3 and 290 ee-3), as
                   documents related to the award; and will                            amended, relating to confidentiality of alcohol
                   establish a proper accounting system in                             and drug abuse patient records; (h) Title VII
                   accordance     with      generally    accepted                      of the Civil Rights Act of 1968 (42 U.S.C.
                   accounting standards or agency directives.                          3501 et seq.) as amended, relating to
                                                                                       nondiscrimination in the sale, rental or
         3.        Will establish safeguards to prohibit                               financing of housing; (i) any other
                   employees from using their positions for a                          nondiscrimination provisions in the specific
                   purpose that constitutes or presents the                            statute(s) under which application for Federal
                   appearance of personal or organizational                            assistance is being made; and (j) the
                   conflict of interest, or personal gain.                             requirements of any other nondiscrimination
                                                                                       statute(s) which may apply to the application.
         4.        Will initiate and complete the work within the
                   application time frame after receipt of                   7.        Will comply, or has already complied, with
                   approval of the awarding agency.                                    the requirements of Titles II and III of the
                                                                                       Uniform Relocation Assistance and Real
         5.        Will comply with the Intergovernmental                              Property Acquisition Policies Act of 1970
                   Personnel Act of 1970 (42 U.S.C. 4728-4763)                         (P.L. 91-646) which provide for fair and
                   relating to prescribed standard for merit                           equitable treatment of persons displaced or
                   systems for programs funding under one of                           whose property is acquired as a result of
                   the nineteen statutes of regulations specified                      Federal or federally assisted programs. These
                   in Appendix A of OPM's Standards of a Merit                         requirements apply to all interests in real
                   System of Personnel Administration (5 C.F.R.                        property acquired for project purposes
                   900, Subpart F).                                                    regardless of Federal participation in
                                                                                       purchases.
         6         Will comply with all Federal statutes relating
                   to nondiscrimination. These include but are               8.        Will comply with the provisions of the Hatch
                   not limited to: (a) Title VI of the Civil Rights                    Act (5 U.S.C. 1501-1508 and 7324-7328)
                   Act of 1964 (P.L. 88-352) which prohibits                           which limit the political activities of
                   discrimination on the basis of race, color, or                      employees whose principal employment
                   national origin; (b) Title IX of the Educational                    activities are funded in whole or in part with
                   Amendments of 1972, as amended (20 U.S.C.                           Federal funds.
                   1681-1683, and 1685-1686), which prohibits
                   discrimination on the basis of sex; (c) Section           9.        Will comply, as application, with the
                   504 of the Rehabilitation Act of 1973, as                           provisions of the Davis-Bacon Act (40 U.S.C.
                   amended (29 U.S.C. 794), which prohibits                            276a to 276a-7), the Copeland Act (40 U.S.C.
                   discrimination on the basis of handicaps; (d)                       276c and 18 U.S.C 874, and the Contract
      Work House and Safety Standards Act (40                  amended, (P.L. 93-523); and (h) protection of
      U.S.C. 327-333), regarding labor standards               endangered species under the Endangered
      for    federally   assisted   construction               Species Act of 1973, as amended, (P.L. 93-
      subagreements.                                           205).

10.   Will comply, if applicable, with flood             12.   Will comply with the Wild and Scenic Rivers
      insurance purchase requirements of Section               Act of 1968 (16 U.S.C. 1271 et seq.) related
      102(a) of the Flood Disaster Protection Act of           to protecting components or potential
      1973 (P.L. 93-2343) which requires recipients            components of the national wild and scenic
      in a special flood hazard area to participate in         rivers system.
      the program and to purchase flood insurance
      if the total cost of insurable construction and    13.   Will assist the awarding agency in assuring
      acquisition is $10,000 or more.                          compliance with Section 106 of the National
                                                               Historic Preservation Act of 1966, as
11.   Will comply with environmental standards                 amended (16 U.S.C. 470), EO 11593
      which may be prescribed pursuant to the                  (identification and protection of historic
      following (a) institution of environmental               properties), and the Archaeological and
      quality control measures under the National              Historical Preservation Act of 1974 (16
      Environmental Policy Act of 1969 (P.L. 91-               U.S.C. 469a-1 et seq.).
      190) and Executive Order (EO 11514; (b)
      notification of violating facilities pursuant to   14.   Will comply with P.L. 93-348 regarding the
      EO 11738; (c) protection of wetlands                     protection of human subjects involved in
      pursuant to EO 11990; (d) evaluation of flood            research, development, and related activities
      hazards in flood plains in accordance with EO            supported by this award assistance.
      11988; (e) assurance of project consistency
      with the approved State management program         15.   Will comply with the Laboratory Animal
      developed under the Coastal Zone                         Welfare Act of 1966 (P.L. 89-544, as
      Management Act of 1972 (16 U.S.C. 1451 et                amended, 7 U.S.C. 2131 et seq.) pertaining to
      seq.); (f) conformity of Federal actions to              the care, handling, and treatment of warm-
      State (Clear Air) Implementation Plans under             blooded animals held for research, teaching,
      Section 176(c) of the Clear Air Act of 1955,             or other activities supported by this award of
      as amended (42 U.S.C. 7401 et seq.); (g)                 assistance.
      protection of underground sources of drinking
      water under the Safe Drinking Water Act of         16.   Will comply with the Lead-Based Paint
      1974, as                                                 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 2001 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.
                                      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 %)




                                             $
       (             /mo. x 12 months x %)




                                             $
       (             /mo. x 12 months x %)




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




                                              $
       (              /mo. x 12 months x %)




                                              $
       (              /mo. x 12 months x %)




                                              $
       (              /mo. x 12 months x %)




                                              $
       (              /mo. x 12 months x %)




                                              $
       (              /mo. x 12 months x %)




                                              $
       (              /mo. x 12 months x %)




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

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

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

4.   EQUIPMENT                                            $
     Description:                               $
                                                $
                                                $

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

                                         $
     ($     /hr. x         hours)

                                         $
     ($     /hr. x         hours)

7.   OTHER                                   $
                                         $
                                         $
                                         $
                                         $
                                         $
                                         $
                                         $
                                         $
                                         $
                                         $
                                         $
                                         $
                                         $
                                         $
                                         $
                                         $
     TOTAL                               $

     Note: Include all other expenses.

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 bidder as stated on the proposal must be the same as the name stated on any required
licenses and/or certifications). Any bidder who proposes subcontracting any portion of the services to be provided must include a copy of the executed contract between the bidder
and their (proposed) subcontractor in the Appendices. In the case where the bidder 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 in the appendices (these letters will be removed
from the proposal by the County prior to external review). 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 1999
             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 of Color who
have Sex with Men (MSM)
Number of Men who have Sex
with Men (MSM)


Provide the number of clients who received any Ryan White eligible service in calendar year
1999 (1/1/99 – 12/31/99) 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 1999 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 must 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, 2000. Any collaborative agreement not dated September 1, 2000, 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:
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%)
        Supervise schedule and coordinate
        Day care activities

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

       Clerical                                    $14,675.00
       (1300.00/mo. x 5 months x75 %)
       (1400.00/mo. X 7 months x100%)
       Provide clerical support to the coor-
       dinator. Maintain accurate
       Records.

       Accountant                                  $9,765.00
       (3,255.00/mo. x 12 months x 25 %)
       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

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

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

4.   EQUIPMENT                                                $1,080.00
     Description: 1 Personal Computer             $1,080.00
                                                  $
                                                  $

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

                                               $
     ($     /hr. x          hours)

                                               $
     ($     /hr. x          hours)

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.

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%)
        Dispense Nutritional Supplements



                Pharmacy Clerk                       $       6,000.00
        (2,000.00/mo. x 12 months x 25%)
        Order supplies and process requests for
         Services


                                                     $
        (              /mo. x 12 months x %)




                                                     $
        (              /mo. x 12 months x %)
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

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


4.   EQUIPMENT                                                       $ 2,500.00
     Description: Computer                        $1,500.00
                  Printer                         $ 500.00
                  Fax Machine                     $ 500.00

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

                                                  $
     ($     /hr. x           hours)

                                                  $
     ($     /hr. x           hours)
7.   OTHER                                                      $ 38,759.00
     Rent______                                    $1,200.00
     Phone services to facilitate processing $ 600.00
     for services and to order supplements
                                                   $
                                                   $
                                                   $
     Nutritional Supplements                       $36,959.00
                                                   $
                                                   $
                                                   $
     TOTAL                                         $38,759.00

     Note: Include all other expenses.

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 2001 Financial Eligibility for Houston EMA Services
                                               ATTACHMENT B

          FY 2001 FINANCIAL ELIGIBILITY for HOUSTON EMA SERVICES
    (PERCENTAGE OF INCOME COMPARED TO 2000 HHS POVERTY GUIDELINES)
                                                                                                            300%
OUTPATIENT/AMBULATORY PRIMARY CARE
COMMUNITY-BASED CASE MANAGEMENT                                                                             300%
DENTAL CARE                                                                                                 500%
DRUG REIMBURSEMENT PROGRAM      HIV MEDS                                                                    500%
                           NON-HIV MEDS                                                                     200%
HEALTH INSURANCE CO-PAYMENTS and DEDUCTIBLES                                                                350%
HOME HEALTH CARE                                                                                            350%
HOSPICE CARE                                                                                                500%
MENTAL HEALTH THERAPY/COUNSELING                                                                            500%
SUBSTANCE ABUSE TREATMENT/COUNSELING                                                                        500%
VOLUNTEER SERVICES                                                                                          300%
CLIENT ADVOCACY                                                                                             300%
COUNSELING/OTHER (including Peer Counseling)                                                                300%
OUTREACH                                                                                                    500%
ADULT DAY CARE                                                                                              300%
CHILD DAY CARE                                                                                              300%
DIRECT EMERGENCY ASSISTANCE                                                                                 200%
FOOD BANK/HOME DELIVERED MEALS                                                                              300%
NUTRITIONAL SUPPLEMENTS                                                                                     400%
HEALTH EDUCATION/RISK REDUCTION                                                                             500%
HOUSING                 COORDINATION                                                                        300%
                        EMERGENCY RENTAL                                                                    300%
                        VOUCHERS                                                                            300%
REHABILITATION                                                                                              500%
TRANSPORTATION                                                                                              300%

       2000 HHS Poverty Guidelines (source, Federal Register, Vol. 65, No. 31, February 15, 2000, pp. 7555 –7557)

                                      Percent of Poverty         48 Contiguous States and
      Size of Family Unit
                                                                   District of Columbia
               1                            100%                                  $ 8,350
               2                            100%                                    11,250
               3                            100%                                    14,150
               4                            100%                                    17,050
               5                            100%                                    19,950
               6                            100%                                    22,850
               7                            100%                                    25,750
               8                            100%                                    28,650
      For each additional
                                                                                       2,900
         person, add:
                            Attachment C

                Ryan White Title I Standards of Care


 Adult Day Care
 Client Advocacy (legal assistance)
 Food Bank
 Outreach Service
 Outpatient/Ambulatory Primary Medical Care
 Rehabilitation
 Transportation
 Outpatient/Ambulatory Medical Care – Vision Care
 Outpatient/Ambulatory Medical Care Coordination (not included)
                                                           RYAN WHITE TITLE I

                                                           STANDARDS OF CARE

                                                               ADULT DAY 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
      INORDER TO BE ELIGIBLE FOR SERVICES, INDIVIDUALS                             client record.
      MUST MEET THE FOLLOWING:

          HIV+
          RESIDENCE IN THE HOUSTON EMA
          Income no greater than 300% of the Federal poverty
           level
                        STANDARD                                                             MEASURE
1.2   Program Information                                            Agency has a written substantiated annual plan to targeted
      Broad-based dissemination of information regarding the          populations.
      availability of services.                                      Zip code data show provider is reaching clients throughout
                                                                      service area.
1.3   Intake                                                         When necessary, client is provided alternatives to office
      Intake process is flexible and responsive, accommodating        visits, such as home visits, phone, and/or conducting
      disabilities and health conditions.                             business by mail, fax, email or other modes of
                                                                      communication.
                                                                     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 translation
      Program is competent at delivering services to culturally       services.
      and linguistically diverse populations. This should be
                                                                     Client satisfaction survey indicates compliance.
      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.
2.2   Collaboration                                                  Letters of agreement are on file
      Agency maintains formal letters of agreement outlining
                                                                     An outline of specific programmatic role/function in
      specific areas of service collaboration.
                                                                      collaboration exists (may be in letters).
                                                                     A routine audit or check of contact sample as to nature of
                                                                      relationship occurs.
                         STANDARD                                                               MEASURE
3.0   Services are provided in accordance with Texas State regulations.
3.1   Licensure                                                         Documentation of license and/or certification is available at
      Agency has and maintains a valid Texas State license               the site where services are provided to clients.
      and/or certification for facilities and personnel if
      applicable.
4.0   Services are offered in such a way as to overcome barriers to access and utilization.

4.1   Reasonable Accommodations                                         Facility tour indicates compliance.
      Service site is physically accessible to persons living with
      HIV/AIDS, and reasonable accommodations to the
      Americans with Disabilities Act is in place.
5.0   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.
5.1   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.
5.2   Client services indicate coordination of activities.              Review of client files shows coordination of activities.
5.3   Documentation of referrals and linkages is in client file.        Review of client files indicates compliance.
6.0   Services are culturally sensitive and competent.
                         STANDARD                                                            MEASURE
6.1   Staff Demographic Profile                                       Advertisements for staff positions appear in local newspapers
      Agency demonstrates efforts to hire staff representative of      and other media.
      the community served.
                                                                      Demographic profile of staff reflects that of the community
                                                                       served.
                                                                      Resumes on file reflect previous experience with and
                                                                       education about diverse populations.
6.2   Staff Training                                                  Review of training agendas and attendance logs indicates
      Training of agency staff and volunteers addresses cultural       compliance.
      sensitivity and competence.
6.3   Translation Services                                            Program must have written plan that indicates compliance.
      Translation services are accessible for all clients, and
                                                                      Client satisfaction survey indicates compliance.
      accommodations are made for persons with special needs.
6.4   Programming (i.e. menus, special events, equipment,             Review of documentation of programming indicates
      curriculum) addresses issues of cultural diversity.              compliance.
                                                                      Client satisfaction survey indicates compliance.
7.0   Services adhere to professional, clinical, and programmatic standards and regulations. Nutritionally sound meals
      will be provided in compliance with federal, state, and local regulations and program hours.
7.1   Latest compliance documentation for applicable                  Documentation is on file and posted in serving area.
      regulations is available.
7.2   Each program will maintain an adequate written meal             Written documentation of plans is on file.
      plan, if appropriate.
8.0   Services are offered in a safe and secure environment.
8.1   A family’s right to privacy is respected and reflected in       Review of confidentiality policy indicates compliance.
      the agency’s confidentiality policy.
                          STANDARD                                                              MEASURE
8.2    Private meeting space is available for client and/or             Facility tour indicates compliance.
       caretakers for consultation.
8.3    Maintenance and upkeep of facility are in compliance             Documentation of compliance with appropriate regulations is
       with appropriate laws and regulations.                            on file.
                                                                        Facility tour indicates compliance.
8.4    Agency policies address client, staff and volunteer safety       Review of Policies and Procedures Manual indicates
       during both on-site and agency-sponsored off-site                 compliance.
       activities.
8.5    Procedures exist for obtaining background checks,                Review of Policies and Procedures Manual indicates
       physical examination (including TB tests), and other              compliance.
       required documentation of all staff and volunteers.
                                                                        Review of personnel files indicates compliance.
9.0    Providers uphold client rights. Appropriate records will be maintained for all clients and standards of
       confidentiality will be upheld.
9.1    Staff and clients are notified of confidentiality policy.        Written policy about client record keeping is on file.
                                                                        Client receipt of confidentiality policy is documented in
                                                                         client file.
9.2    Locked files are kept in a central location.                     Facility tour indicates compliance.
9.3    Documentation of receipt by client of eligibility criteria,      Review of client file indicates compliance.
       statement of client rights and responsibilities, grievance
                                                                        Facility tour indicates compliance.
       procedure, and description of agency’s services is in
       client file and are posted in areas visible to clients.          Posted signs in visible areas.
10.0   Day care program will provide social, occupational/life skills, educational, recreational, and wellness (e.g. physical
       therapy) activities as appropriate to specific program objectives.
                         STANDARD                                                               MEASURE
10.1   Means of assessing client needs is incorporated in the           Documented policy for assessment of client needs indicates
       program design and structure.                                     compliance.
10.2   Written plans incorporate individual needs of client             Review of client files indicates compliance.
       and/or client base.
                                                                        Documentation of plans indicates compliance.
10.3   Written plans for activities are completed on a regular          Supervisory oversight of plans is noted on a regular basis.
       basis.
10.4   There is a procedure for informing clients of the                Written documentation of procedure and written statements
       availability and accessibility of services, including written     are on file and available.
       statements of program offerings and options.
                                                                        Written and posted documentation is available upon request.
10.5   Comprehensive set of services is available on-site or by         List of services on-site and/or review of referral
       referral.                                                         arrangements indicates available services.
                                                                        Consumer service access interview indicates compliance.
11.0   Services will be offered by client choice or by a program monitored and regularly reviewed treatment plan.
11.1   There is a process for obtaining client and family input         Written documentation of process for obtaining input is on
       about satisfaction with and need for expanded and                 file.
       enhanced services.
                                                                        Client is informed of input mechanisms at intake.
                                                                        Quarterly meeting with consumers.
12.0   Individual and group counseling are provided as necessary and/or a system is in place for referral for such
       services.
                          STANDARD                                                               MEASURE
12.1   Counselor is on staff and/or written referral process is in      Employment files and/or staff schedules demonstrate
       place.                                                            availability of counseling.
                                                                        Client files indicate counseling activity or use of referrals.
                                                                        Written documentation of referral process and listed referrals
                                                                         confirm compliance.
13.0   Referrals to support groups for clients and families will be provided as appropriate.
13.1   Each provider will make referrals to support groups based        Written referrals in client files.
       on client need and interest.
                                                                        Process is in place for referral.

III.   THRESHOLDS

During the first year of implementation of the QA Program, the measurement thresholds will be set at 100%.

IV.    IMPLEMENTATION & REPORTING

Agencies will be required to adhere to the QA guidelines provided by the RWPC Quality Assurance Committee
                                                            RYAN WHITE TITLE I

                                                          STANDARDS FOR CARE

                                                              CLIENT ADVOCACY


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                              in the client record.
      THE FOLLOWING:

         HIV+
         RESIDENCE IN THE HOUSTON EMA
         Income no greater than 300% of the Federal poverty level
                              STANDARD                                                          MEASURE
1.2   Program Information                                                   Documentation of a written plan to evidence agency
      Broad-based dissemination of information regarding the                 participation in collaborative effort with other legal
      availability of services.                                              services providers to disseminate information
                                                                             regarding availability of services in underserved and
                                                                             unserved areas.
1.3   Intake                                                                When necessary and appropriate, client is provided
      Intake process is flexible and responsive, accommodating               alternatives to office visits, such as home visits
      disabilities and health conditions.                                    and/or conducting business by mail.
                                                                            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 service      Documentation of referrals received.
      providers and makes appropriate referrals out when necessary.

3.0   Legal services adhere to professional standards and regulations.

3.1   Licensure                                                             Staff records indicate compliance.
      Attorneys are licensed to practice law in the state of Texas.
3.2   Non-Licensed Staff                                                    Agency policies indicate compliance.
      Non-licensed staff members are supervised by attorneys.
                               STANDARD                                                             MEASURE
4.0   Service providers are knowledgeable, accepting, and respectful of the needs of individuals with HIV/AIDS.

4.1   Compassionate Service Delivery                                            Client satisfaction survey indicates compliance
      Services are provided in a sensitive, compassionate, non-
      judgmental and comprehensible manner so that trust can be
      established
4.2   Staff Knowledge                                                           Staff have access to updated HIV/AIDS information
         Staff are trained and remain knowledgeable about current              Agency maintains system for internal information
          HIV/AIDS legal issues                                                  dissemination.
                                                                                Staff interviews indicate compliance.
4.3   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.
4.4   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.
4.5   Professional Behavior                                                     Review of personnel files indicates compliance.
      Staff agree to follow written 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
      Agency has a process in place for the evaluation of client services.           indicates compliance.
                                                                                    Staff interviews indicate compliance.
                             STANDARD                                                               MEASURE
5.2   Accountability                                                                Documentation of staff time.
      There is a system in place to document staff work time.
5.3   Staff Screening                                                               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

5.4   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 selection,         and that the employee understands agency policies
      resignation and termination process, job descriptions); professional       and procedures.
      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 staff        Review of Policies and Procedures manual indicates
      services.                                                                  compliance.
5.6   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.
6.0   Client is kept informed and participates in decisions about his/her case.
                             STANDARD                                                              MEASURE
6.1   Service Evaluation                                                           Copy of service agreement between client and
      Clients are kept informed and work together with staff to determine           agency is in client file.
      the objective of the representation and to achieve goals.
7.0   Legal services are professional and effective.

7.1   Effective Management Practices                                               Legal service providers review cases on a regular
      Program utilizes effective management practices to ensure that                basis.
      services are timely and are delivered competently.                           Annual staff evaluations are conducted.
7.2   Staff Training                                                           Agency has orientation program for new hires.
      Staff have access to appropriate training and resources needed to        Staff has access to law library.
      deliver services.
                                                                               Staff has access to manuals and regulations.
                                                                               Staff has attended and has continued access to
                                                                                training activities.
                                                                               Agency uses standard forms and checklists which are
                                                                                available to staff.


V.    THRESHOLDS

      During the first year of implementation of the QA Program, the measurement thresholds will be set at 100%.


VI.   IMPLEMENTATION & REPORTING

      Agencies will be required to adhere to the QA guidelines provided by the RWPC Quality Assurance Committee and HIV
      Services.
                                                    RYAN WHITE TITLE I

                                                  STANDARDS FOR CARE

                                                       FOOD 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
        IN ORDER TO BE ELIGIBLE FOR SERVICES, INDIVIDUALS MUST MEET             income in the client record.
        THE FOLLOWING:

           HIV+
           RESIDENCE IN THE HOUSTON EMA
           Income no greater than 300% of the Federal poverty level
                            STANDARD                                                       MEASURE
1.2   Program Information                                               Documentation of a written plan to evidence
      Broad-based dissemination of information regarding the             agency participation in collaborative efforts with
      availability of services.                                          other HIV 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
      Responses to requests for services and information should be       operation which may include but not be limited to
      provided within two (2) business days.                             operating 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.
                             STANDARD                                                         MEASURE
2.1   Referrals                                                            Client satisfaction survey indicates compliance.
      Agency receives referrals from a broad range of the HIV/AIDS         Staff interviews indicate compliance.
      service providers and makes appropriate referrals out when
      necessary.
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
      areas of service collaboration.                                       in 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. Food services are community based and supported, which includes
      incorporation of cultural traditions.
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.
                             STANDARD                                                           MEASURE
4.0   Services are individualized and tailored to client needs such as economic need, functional ability and disease progression.
4.1   Assessment of Need                                                     Relevant information is part of client file/database;
      There is a mechanism for ongoing assessment of need, including          client file/database includes intake and update
      cultural and dietary restrictions.                                      information.
                                                                             Agency Policy and Procedure.
                                                                             Agency list of nutritional/healthy products.
                                                                             Client satisfaction survey.
4.2   Client Options                                                         Relevant information is part of client file/database;
      There is opportunity for clients to make selections of foods            client file/database includes intake and update
      necessary due to health conditions.                                     information.
                                                                             Agency Policy and Procedure.
                                                                             Agency list of nutritional/healthy products.
                                                                             Client satisfaction survey.
4.3   Delivery Options                                                       Relevant information is part of client file/database;
      There is a mechanism for alternative ways of shopping.                  client file/database includes intake and update
                                                                              information.
                                                                             Agency Policy and Procedure.
                                                                             Agency list of nutritional/healthy products.
                                                                             Client satisfaction survey.
5.1   Temperature                                                            Agency has Policies and Procedures to document
      Proper temperature is maintained at point of delivery and during        proper temperatures.
      storage, based on food products provided and applicable laws as        Review of temperature log indicates compliance.
      designated by the appropriate local government agency.                  Documentation of appropriate external compliance
                                STANDARD                                                            MEASURE
                                                                                is in file.
5.2   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.
5.3   Equipment                                                                Review of temperature logs indicates compliance.
      Facilities providing refrigerated/                                       Policies and Procedures Manual documents
      frozen food products have working equipment for proper storage            methods for proper food handling and storage.
      and safe handling.
5.4   Food Safety                                                              Policies and Procedures manual documents
      A procedure for rejecting/discarding unsafe and expired foods             procedure for rejecting/discarding unsafe food.
      exists.                                                                  Staff training and knowledge is documented in file.
                                                                               Staff interviews.
5.5   Licensure                                                                Documentation of current licensure.
      Providers/vendors maintain proper licensure.
 5.0    SERVICES ADHERE TO PROFESSIONAL STANDARDS AND REGULATIONS. PROVIDERS STORE, PREPARE, SERVE AND/OR DELIVER/DISPENSE FOOD CONSI
        STANDARDS AND LAWS.


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.
                                                                               Ongoing informal surveys.
6.2     Volunteer Feedback                                                     Mechanism for gaining appropriate volunteer
        If volunteers are used, mechanism is in place for obtaining             feedback is documented and implemented annually.
        volunteer perspectives annually about observations of client
        satisfaction.
7.0             P.     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
                                                                                    O.

VII.   THRESHOLDS

       During the first year of implementation (2000-2001) of the QA Program, the measurement thresholds will be set at 100%.

 VIII. IMPLEMENTATION & REPORTING
Agencies will be required to adhere to the QA guidelines provided by the RWPC Quality Assurance Committee and HIV Services.
                                                  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 record
       IN ORDER TO BE ELIGIBLE FOR SERVICES, within 10 days (anonymous test results are acceptable for 30 days).
       INDIVIDUALS MUST MEET THE FOLLOWING:

          HIV+
          RESIDENCE IN THE HOUSTON EMA
          Income no greater than 500% of the Federal
           poverty level
                     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.
      Outreach workers shall establish contacts with HIV      Agency log demonstrates broad-based dissemination of information.
      testing sites; hospital 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           Review agency policy
      work hours


1.4   Intake                                                     Agency Policy & Procedure
      Intake process is flexible and responsive,                     P.
      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
      culturally and linguistically diverse populations.          with hearing impairments.
      This should be reflective of the target population to
      be served.
                         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 register new clients, link clients      Documentation in client record of linkages made CPCDMS client
      to needed services and, if required refers to case        report
      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 30 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.
3.3   Experience – HIV/AIDS                                    Staff interviews indicate compliance.
      A minimum of 1 year documented HIV/AIDS
      experience is preferred
                     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.
4.3   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 follows written standards of professional           Review of personnel files indicates compliance.
      behavior.
                                                                Review of agency’s complaint and grievance file.
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.
5.4   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.
5.5   Staff Supervision                                       Review of personnel files indicates compliance.
      Outreach services are supervised by a paid staff.       Agency Policy & Procedure.
                     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.

IX.   THRESHOLDS

      During the contract year, the measurement thresholds will be set at 100%.

X.    IMPLEMENTATION & REPORTING

      Agencies will be required to adhere to the QA guidelines provided by the RWPC Quality Assurance Committee and HIV
      Services.
                                                      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                                                          Documentation of HIV+ status, residence and income in the client
       CLIENT ELIGIBILITY                                    record.

       IN  ORDER TO BE ELIGIBLE FOR SERVICES,
       INDIVIDUALS MUST MEET THE FOLLOWING:


        HIV+
        Residence in the Houston EMA
        Income no greater than 300% of the Federal
       poverty level
                           STANDARD                                                        MEASURE
1.2                                                           Agency has a written annual dissemination plan
      PROGRAM INFORMATION

      Broad-based dissemination of information
      regarding the availability of services.
1.3                                                           Published documentation of agency operating hours
      STAFF AVAILABILITY

      Staff are present to answer incoming calls during
      agency’s normal operating hours
1.4                                                           Agency Policy & Procedure
      INTAKE

      Intake process is flexible and responsive,
      accommodating disabilities and health conditions
1.5                                                           Agency has procedures for obtaining translation services
      CULTURAL COMPETENCE
                                                           Agency has procedures for communicating with people with hearing
      Program is competent at delivering services to      impairments
      culturally and linguistically diverse populations       Client satisfaction survey indicates compliance

2.0   Services are part of the coordinated continuum of care
2.1                                                           Documentation of referrals out
      AGENCY RECEIVES REFERRALS FROM A BROAD RANGE OF
      SOURCES AND MAKES APPROPRIATE REFERRALS OUT             Staff interviews indicate compliance
      WHEN NECESSARY
                         STANDARD                                                            MEASURE

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                                                             Documentation of staff applications
      STAFF SCREENING
      STAFF PROVIDING SERVICE TO CLIENTS SHALL BE               Documentation of communication with personnel references
      SCREENED FOR APPROPRIATENESS AS FOLLOWS:
                                                                Staff interviews indicate compliance

       Personnel references                                        Review of Policies and Procedures Manual indicates compliance.
       Personal interview                                          Review of personnel files indicates compliance
       Written applications
       Policies and procedures exist for addressing
      criminal background checks on staff and/or
      volunteers.

3.2                                                                 Client feedback mechanism is in place
      CLIENT FEEDBACK

      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                                                             Review of personnel files indicates compliance.
      CLIENT CONFIDENTIALITY

      There is a written policy statement regarding client
      confidentiality signed by each employee and
      included in the personnel file.
                         STANDARD                                                            MEASURE
3.4                                                                 Staff guidelines include standards of professional behavior.
      PROFESSIONAL BEHAVIOR
                                                                    Review of personnel files indicates compliance.
      STAFF AGREE TO FOLLOW WRITTEN STANDARDS OF
      PROFESSIONAL BEHAVIOR.                                        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                                                             Review of Policies and Procedures manual indicates compliance
      SERVICE EVALUATION
                                                                Staff interviews indicate compliance
      Agency has a process in place for the evaluation of
      staff services
4.2                                                             Documentation of staff time.
      ACCOUNTABILITY

      There is a system in place to document staff work
      time.
4.3                                                           Personnel file contains a signed statement acknowledging that staff
      STAFF GUIDELINES                                       guidelines were reviewed and that the employee understands agency
                                                             policies and procedures.
      Agency develops written guidelines for staff, which
      include, at a minimum, agency-specific 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
                          STANDARD                                                       MEASURE
4.4                                                          Review of personnel files indicates compliance.
      STAFF SUPERVISION
                                                             Review of Policies and Procedures manual indicates compliance.
      Staff coordinator/manager is a paid position that
      supervises staff services.
4.5                                                          Review of Policies and Procedures manual indicates compliance.
      COMMUNICATION
                                                             Mechanism for regular communication with staff is in place.
      There are procedures in place regarding regular        Staff interviews indicate compliance.
      communication with staff about the program and
      general agency issues.
5.0   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
                         STANDARD                                                       MEASURE
5.1                                                         Documentation in patient record.
      INITIAL MEDICAL EVALUATION

      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
                         STANDARD                                                          MEASURE
5.2   Follow-up 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:
                         STANDARD                                                        MEASURE
5.3   Central “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   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.
6.1   Licensing, Knowledge, Skills and Experience            Documentation in personnel files.

       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
                         STANDARD                                                          MEASURE
6.2   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.
                         STANDARD                                                  MEASURE
6.3   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, Ophthalmology,
            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
                        STANDARD                                                           MEASURE
6.4    Quality Improvement/Assurance                          A quality improvement/assurance activity which identifies areas for
                                                               improvement and the subsequent actions taken

6.5    Recommended Format for Operational                   Ambulatory HIV clinical service should adopt and follow
       Standards                                             performance standards for ambulatory care as established by
       Detailed standards and routines for program           the Joint Commission on the Accreditation of Healthcare
       assessment are found in most recent                   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.

XI.    THRESHOLDS
       During the first year of implementation of the QA Program the measurement thresholds will be set at 100%

XII.   IMPLEMENTATION & REPORTING: Agencies will be required to adhere to the QA guidelines provided by the RWPC
       Quality Assurance Committee and HIV Services.
                                                   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,                  record.
       INDIVIDUALS MUST MEET THE FOLLOWING:

           HIV+
           RESIDENCE IN THE HOUSTON EMA
           Income no greater than 500 % of the Federal
            poverty level
                   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.

                     STANDARD                                                                MEASURE
3.0   Staff HIV/AIDS knowledge is based on solid training and experience.
3.1   Initial Training                                          Proof of licensure in personnel file.
      Must have graduated from an accredited institution
      and have a current, Texas license in the appropriate
      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.
      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.
         Personnel 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.
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.



      STANDARD                                               MEASURE

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.
5.4   Staff Guidelines                                            Personnel file contains a signed statement acknowledging that staff
      Agency develops written guidelines for staff, which          guidelines were reviewed and that the employee understands agency
      include, at a minimum, agency-specific policies and          policies and procedures.
      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.
      STANDARD                                                                              MEASURE
5.5   Staff Supervision                                           Review of personnel files indicates compliance.
      Staff services are supervised by a paid coordinator or      Agency Policy & Procedure.
      manager.
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.


XIII. THRESHOLDS

      During the contract year, the measurement thresholds will be set at 100%.

XIV. IMPLEMENTATION & REPORTING

      Agencies will be required/requested to adhere to the QA guidelines provided by the RWPC Quality Assurance Committee and
      HIV Services.
                                                                       RYAN WHITE TITLE I

                                                                      STANDARDS FOR CARE

                                                                  TRANSPORTATION 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 ELIGIBILITY
portation services are offered to eligible clients to ensure individuals most in need have access to services.
                1.1     Client Eligibility                                            Documentation of HIV+ status, residence and income in the
                        INORDER TO BE ELIGIBLE FOR SERVICES, INDIVIDUALS               client record.
                        MUST MEET THE FOLLOWING:

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

1.2   Medicaid                                                       Documentation in client record of ongoing Medicaid
      Agency has Policy and Procedure that documents                  verification.
      client’s Medicaid eligibility status on an ongoing basis.
      If client is eligible for Medicaid transportation,
      documentation of the referral is maintained.
1.3   Voucher Guidelines                                             Client record indicates guidelines were followed; if not, an
      AGENCY MUST FOLLOW THESE GUIDELINES:                            explanation is documented.
         Bus Tokens: provided for minimal need and wait             Documentation of the type of voucher(s) issued.
          periods for METRO passes and emergencies                   Non-medical    Emergency necessitating     taxi   voucher   is
          (Clients with bus passes are not eligible for bus           documented.
          tokens)


         BUS PASS:    PROVIDED FOR      MULTIPLE    NEED   OF
          TRANSPORTATION SERVICES.


         Gas Voucher: provided for multiple need in short
          time frame when bus or general transportation is
          impractical. Gas vouchers can be accessed four
          times per year per rural clients only.
         Taxi Voucher: for non-medical emergencies only.
2.0   ACCESSIBILITY
      Transportation services are offered in such a way as to overcome barriers to access and utilization.
2.1                                                                   Program information is clearly publicized.
      NOTIFICATION OF SERVICE AVAILABILITY                            Availability of services, prioritization policy and eligibility
                                                                       requirements are defined in the information publicized.
      Prospective and current clients are informed of service
      availability, prioritization and eligibility requirements.
2.2   Direct Access                                                   Agency’s policies and procedures for transportation services
      Clients must be able to initiate and coordinate their own        describe how the client can access the service.
      services with the transportation providers without the          Review of agency’s complaint and grievances log.
      need for a case manager or third party. This does not
      mean an advocate (e.g. social worker) for the client
      cannot assist the client in accessing transportation
      services.

2.3   Handicap Accessible                                             Agency compliance with the Americans with Disabilities Act
      Transportation services are handicap accessible.                 (ADA).

2.4   EMA Accessibility                                               Review of agency’s Transportation Log and Monthly Activity
      Services are available throughout the Houston EMA as             Reports for compliance
      contractually defined in the RFP.
2.5   Service Availability                                            Transportation services must be available from 7 a.m. to 10
      Services must be available during the hours of medical           p.m. during weekdays (non-holidays)
      appointments on weekdays. Weekend transportation                Review of Transportation Logs
      services must be considered for psychotherapy and food
      pantry appointments.                                            Transportation services shall be available on Saturdays, by pre-
                                                                       scheduled appointment for RWI funded support services.
2.6   Service Capacity                                                    HIV Services will be contacted by phone/fax no later than
      AGENCY WILL NOTIFY HIV SERVICES, AND OTHER RYAN                      twenty (24) working hours after services are maximized.
      WHITE PROVIDERS WHEN TRANSPORTATION RESOURCES                       Agency will document all clients who were denied
      ARE CLOSE TO BEING MAXIMIZED*. AGENCY WILL                           transportation or a voucher.
      MAINTAIN DOCUMENTATION OF CLIENTS WHO WERE
      REFUSED SERVICES.

      * maximized means the agency will not be able to
      provide service to client within the next 72 hours.
2.7   Grievance Procedures                                            Agency Grievance Policy and Procedure clearly posted in all
      Agency has Policy and Procedure regarding client                 vehicles and signed receipt of agency Grievance Procedure and
      grievances that is reviewed with each client in a language       HIV Services Grievance Procedure in client record.
      and format the client can understand and a written copy of
      which is provided to each client.
3.0 TIMELINESS AND DELAYS
      Transportation services are provided in a timely manner.
3.1           Q.       Timeliness                                Waiting times longer than 60 minutes will be documented in
                                                                  Delay Incident Log.
      THERE IS MINIMAL WAITING TIME FOR VEHICLES AND VANS;       Waiting times longer than 2 hours will also be documented in
      APPOINTMENTS ARE KEPT.                                      the client record.
                                                                 If cumulative incidents of clients kept waiting for more than 2
                                                                  hours reaches 75, this must be reported within twenty-four (24)
                                                                  hours to the administrative agent.
                                                                 Review of agency’s complaint and grievance logs.
                                                                 Client interviews and client satisfaction survey.




3.2   Immediate Service Problems                                     Review of Delay Incident Log, Transportation Refusal Log
      Clients are made aware of problems immediately. (e.g.           and client record indicates compliance.
      vehicle breakdown) and notification documented.                Review of agency’s complaint and grievance logs.
                                                                     Client interviews and client satisfaction survey.
3.3   Future Service Delays                                      Review of Delay Incident Log, Transportation Refusal Log and
      Clients and Ryan White providers are notified of future     client record indicates compliance.
      service delays, changes in appointment or schedules as  Review of agency’s complaint and grievance logs.
      they occur. Document in client record.
                                                              Client interviews and client satisfaction survey.
3.4   Confirmation of Appointments                                    Review of agency’s transportation policies and procedures
      AGENCY   MUST     ALLOW    CLIENTS    TO   CONFIRM               indicates compliance.
      APPOINTMENTS AT LEAST 48 HOURS IN ADVANCE.                      Review of agency’s complaint and grievance logs.
                                                                      Client interviews and client satisfaction survey.
3.5   “No Shows”                                                          Review of agency’s transportation policies and procedures
      “No Shows” are documented in Transportation Log and                  indicates compliance.
      client file. Passengers who do not cancel scheduled rides
      for three (3) consecutive times or who “no show” for
      three (3) consecutive times will be removed from the
      van/vehicle roster for 30 days. If client is removed from
      the roster, he or she must be referred to other
      transportation services. In order to be reinstated, client
      must be reassessed for transportation needs.
4.0   SAFETY/VEHICLE MAINTENANCE
      TRANSPORTATION SERVICES ARE SAFE.
4.1                                                             A file will be maintained on each vehicle and shall
      VEHICLE MAINTENANCE                                        include but not be limited to: description of vehicle
                                                                 including year, make, model, mileage, as well as general
                                                                 condition and integrity and service records.
      Vehicles are in good repair and equipped for adverse
      weather conditions.                                       Current vehicle State Inspection sticker.
                                                                 Inspections of vehicle should be routine, and
                                                                 documented not less than quarterly. Seat belts/restraint
                                                                 systems must be operational, child car seats must be
                                                                 operational, all lights and turn signals must be
                                                                 operational, brakes must be in good working order, tires
                                                                 must be in good condition, air conditioning/heating
                                                                 system must be fully operational
                                                                Any or all files may be reviewed randomly, and all files
                                                                 will be reviewed annually.
4.2   Driver Qualifications                                     A file will be maintained on each driver and shall include but
      Drivers are licensed and insured.                         not be limited to:
                                                                     valid Texas State Driver’s License
                                                                         satisfactory completion of State approved “Safe Driving”
                                                                          course
                                                                         annual background check which will screen for criminal
      Background Check                                                    history felony or misdemeanors
      Policies and Procedures exist for addressing criminal              annual proof of a safe driving record, which shall include
      background checks on staff and/or volunteers.                       history of tickets, DWI, or other traffic violations. Any
                                                                          violations within the past year will disqualify the driver
                                                                         proof of current automobile liability and personal injury
                                                                          insurance in the amount of at least $300,000.00.
                                                                         drivers will be in-serviced annually on emergency
                                                                          procedures with completion documented in file
                                                                         drivers’ personnel files may be reviewed randomly and all
                                                                          files will be reviewed annually
                                                                         Review of Policies and Procedures Manual indicates
                                                                          compliance.
                                                                         Review of personnel files indicates compliance
4.3                                                                     Written procedures are developed and implemented to
      EMERGENCY PROCEDURES                                               handle emergencies.
                                                                        Each driver will be instructed in how to handle emergencies
      Transportation emergency procedures are in place. (e.g.            before commencing service, and will be in-serviced
      breakdown of agency vehicle).                                      annually.
                                                                        Agency will maintain a copy of each in-service and sign-in
                                                                         roster with names both printed and signed.
4.4        Transportation of Children                                              When transporting to daycare, children under the age of two
           Children must be transported safely.                                     (2)1, operational car seats are made available. Necessity of a
                                                                                    car seat should be documented on the Transportation Log by
                                                                                    staff when appointment is scheduled.
                                                                                   When the child is 12 years old or younger, the agency must
                                                                                    provide adult supervision in addition to the driver. When
                                                                                    such an appointment is scheduled, it must be documented in
                                                                                    the Transportation Log.
                                                                                   An exception to this rule may be made if the parent or
                                                                                    caregiver notifies agency that they or another adult of their
                                                                                    choice will accompany child. Exceptions must be
                                                                                    documented in both Transportation Log and client record.
5.0        RECORDS ADMINISTRATION
           Transportation services are documented consistently and appropriately.
5.1        Client Files                                                            Annual review of agency’s policy and procedure for records
           Provider shall maintain all client files.                                administration.

5.2        Transportation Consent                                                  Review of client records indicates compliance.
           Prior to receiving transportation services, clients must read
           and sign the Transportation Consent.
5.3        Client Rights                                                           Review of client record indicates compliance.
           Prior to receiving transportation services, clients must                Interviews with clients.
           acknowledge they have read and received a copy of their
           client rights.




1
    Texas Department of Public Safety, Texas Traffic Law Handout TRC545.412 Child Passenger Safety Seat Systems.
5.4             R.     Grievance Procedure                                      Agency Grievance Policy and Procedure clearly posted and
       Agency has Policy and Procedure regarding client grievances that is       signed receipt of agency Grievance Procedure and HIV
       reviewed with each client in a language and format the client can
                                                                                 Services Grievance Procedure in client record.
       understand and a written copy of which is provided to each client.

5.5    Intake                                                                   Review of client record indicates compliance.
       Prior to initiating transportation services for the client,
       agency must complete the Intake form.
5.6    Van/Vehicle Transportation                                               Review of agency files indicates compliance.
       AGENCY MUST DOCUMENT DAILY TRANSPORTATION SERVICES                       Log must contain client’s name or identification number,
       ON THE TRANSPORTATION LOG.                                                date, destinations, mileage and type of appointment.


5.7    Voucher Transportation                                                   Review of client record indicates compliance.
       AGENCY  MUST DOCUMENT ALL VOUCHER SERVICES                               Agencies must have a log for each client to whom bus
       PROVIDED IN THE CLIENT’S RECORD. DATE/TIME OF                             tokens have been disbursed. Client’s signature, date and
       REQUEST AND DATE/TIME OF APPROVAL MUST BE                                 number of bus tokens given must be included on each log.
       DOCUMENTED IN THE CLIENT’S RECORD.

       EXCEPTION:
       Bus token distribution           must    be    documented       by
       cooperating agencies.
6.0   DATA ENTRY
                                        Transportation services are entered within established timeframes into the CPCDMS.
6.1   Voucher Data Entry                                                        Review of voucher documentation and the transportation
      Gas or Taxi Vouchers provided to a client must be entered                  database indicates compliance
      on the transportation database as soon as possible.
      Bus passes provided to clients must be entered on the
      Centralized Patient Care Data Management System within 72
      hours.
6.2           S.      Van/Vehicle Data Entry                           Review of Transportation Log and the transportation
      Services must be entered on the Centralized Patient Care Data     database indicates compliance
      Management System (CPCDMS) no later than 72 hours after
      the delivery of service.
6.3          T.      Service History                                   Review of voucher documentation and transportation
      Prior to releasing bus passes, gas and taxi vouchers,             database indicates compliance
      agency must query the Centralized Patient Care Data
      Management System to analyze the transportation services
      received by the client and document the same.


XV.    THRESHOLDS

       During the first year of implementation of the QA Program, the measurement thresholds will be set at 100%.


XVI. IMPLEMENTATION & REPORTING

       Agencies will be required to adhere to the QA guidelines provided by the RWPC Quality Assurance Committee and HIV
       Services.


                                                  RYAN WHITE TITLE I

                                                 STANDARDS FOR CARE

                                                        VISION 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
      INORDER TO BE ELIGIBLE FOR SERVICES, INDIVIDUALS              client record.
      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.


                           STANDARD                                                       MEASURE
1.3    Intake                                                      Staff are present to answer incoming calls during agency’s
       Intake process is flexible and responsive, accommodating     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 services.
      Program is competent at delivering services to culturally
                                                                   Client satisfaction survey indicates compliance.
      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 out.
      HIV/AIDS service providers and makes appropriate
                                                                   Staff reports indicate compliance.
      referrals out when necessary.
3.0      Staff HIV/AIDS knowledge is based on solid training.
3.1   Training                                                     Review of training curriculum indicates compliance.
      Initial training for new staff includes 16 hours of          Documentation of all training in personnel file.
      HIV/AIDS basics, confidentiality issues and agency-
                                                                   Specific training requirements are specified in staff guidelines.
      specific information.
3.2   Ongoing Training                                             Materials for staff training and continuing education are on
      16 hours of continuing education in HIV/AIDS related or       file.
      other specific topics is required.                           Staff interviews indicate compliance.
                        STANDARD                                                                MEASURE
3.3   Staff Experience                                                    Documentation of work experience in personnel file.
      Minimum of one year preferred HIV/AIDS work
      experience for paid staff (optometry interns exempt.).
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 will be screened for        Documentation of communication with personnel references.
      appropriateness by provider agency as follows:
                                                                      Staff interviews indicate compliance.
           Personnel references
                                                                      Review of     Policies   and   Procedures    Manual   indicates
           Personal interview                                         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 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.
                        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 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 indicates
      Agency has a process in place for the evaluation of staff       compliance.
      services.                                                      Staff interviews indicate compliance.
5.2   Accountability                                                 Documentation of staff time.
      There is a system in place to document staff work time.
                         STANDARD                                                           MEASURE
5.4   Staff Guidelines                                                  Personnel file contains a signed statement acknowledging
      Agency develops written guidelines for staff, which                that 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
      supervises staff services.
                                                                         compliance.
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.
III.   THRESHOLDS

       During the first year of implementation of the QA Program, the measurement thresholds will be set at 100%.


IV.    IMPLEMENTATION & REPORTING

Agencies will be required to adhere to the QA guidelines provided by the RWPC Quality Assurance Committee and HIV Services.

				
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