Request for Qualifications _RFQ_ Schedule

Document Sample
Request for Qualifications _RFQ_ Schedule Powered By Docstoc
					                              City of Seattle
                      HUMAN SERVICES DEPARTMENT

                           to provide
                     HOME CARE SERVICES

                            Issued: January 10, 2011

Deadline for Request for Qualification Application Submittal:
        Tuesday, February 22, 2011 by 5:00 p.m.

                     Submit completed application to:

              City of Seattle Human Services Department
                      Aging and Disability Services

   Attention: Tamsen Spengler, Senior Grants & Contracts Specialist
                   Mailing address: PO Box 34215
                   Seattle, Washington 98124-4215

        Hand Delivery Office address: 700 5th Avenue, 51st Floor
                     Seattle, Washington 98104

                           Phone: (206) 684-0696

         City of Seattle

          Administered by the City of Seattle Human Services Department
          Co-Sponsored by King County and United Way of King County
                       Request for Qualifications (RFQ) Schedule

Release of Home Care RFQ: Monday, January 10, 2011

RFQ Information Meeting:

Wednesday, January 19, 2011 – 10:00 a.m. - 12:00 p.m.
Site: 2100 Building
2100 - 24th Avenue South, Seattle, WA 98144

RFQ Applications Due: Tuesday, February 22, 2011

Applications must be received by the Seattle Human Services Department (HSD) Aging and
Disability Services (ADS) no later than 5:00 p.m. on Tuesday, February 22, 2011. Any
proposals not received by this date and time will be ineligible and will not be considered.

RFQ Application Review: February 22, 2011 – February 28, 2011

Review of each application for completeness to ensure all items requested were included.
Notices sent to applicants who failed to meet qualifications and will not be considered.

RFQ Qualification Review Committee (QRC) rating: March 7, 2011 – March 28, 2011

Applications will be reviewed and ranked by a review committee consisting of representatives
from the State, Area Agencies on Aging, and other funders. Proposals will be scored and ranked
according to a weighted point system. King County, Aging and Disability Services staff will not
be on the committee.

Written Notification of Final Decision: April 4, 2011

Notification will be sent to all applicants.

New Contracted Provider(s) Services begin: July 1, 2011

                           TABLE OF CONTENTS

  I.     INTRODUCTION / BACKGROUND / SERVICES………………………………. Page 1

 II.     RFQ REQUIREMENTS…………………………………………………………….. Page 4

III.     APPEAL PROCESS AND PROCEDURES………………………………………… Page 8

IV.      ASSURANCES……………………………………………………………….……… Page 9

 V.      LIST OF RCW & WAC REFERENCES…………………………………...……… Page 10

         APPLICATION INSTRUCTION SHEET………………………………………… Page 11

RFQ APPLICATION……………………………………………………………….……….. Page 12








A. Issuing Agency/Authority:

   This Request for Qualifications (RFQ) is issued by City of Seattle, Human Services Department,
   Aging and Disability Services, herein after referred to as “ADS”. Medicaid in-home care
   services for seniors and persons with disabilities are administered by the Department of Social &
   Health Services (DSHS) Aging and Disability Services Administration (ADSA) and managed by
   the State’s thirteen Area Agencies on Aging (AAA). ADS, as a designated Area Agency on
   Aging serving Seattle/King County, has responsibility for contracting, monitoring, and oversight
   of Medicaid-funded home care agency providers.

B. Background:

   In 1995, the Washington State Legislature passed House Bill 1908 which significantly increased
   AAA responsibilities within the DSHS long-term care system. In addition to working with the 60+
   population, ADS case management assumed new responsibility for the under-60 functionally
   disabled population, assessment and re-assessment, and authorization of services. The Washington
   Department of Health (DOH) continues to conduct the initial licensure of home care agencies,
   which extends for two years.

   In 1998, the State legislature requested the Joint Legislative Audit and Review Committee,
   (JLARC) to review the State’s long term care system. Their report, issued January 8, 1999,
   recommended AAA and DSHS/ADSA strengthen accountability and increase quality assurance
   control, and monitoring oversight of in-home care service providers.

   JLARC recommendations for Washington State’s in-home care services have created an
   increased awareness of the need to set higher performance standards for agencies, and workers,
   as well as State and local administrators charged with ensuring accountability for public funds,
   and minimizing risk for vulnerable adults. The program goal is to ensure that high quality, safe,
   and dependable care is provided to functionally disabled adults in a private setting by trained
   workers who are supervised by qualified personnel.

   In 2008, the State gave AAA contracting and monitoring responsibility for agencies providing
   Division of Developmental Disabilities (DDD) in-home care services. DDD in-home care
   services are included in this RFQ for the first time.

C. Trends:

   The home care industry is in a period of transition. The state budget climate has impacted home
   care agencies causing a 30% decline in client load over the past three years. This trend will
   continue into 2011. Clientele will be increasingly more medically complex and cognitively
   impaired requiring a more skilled in-home care provider.

   Agencies currently serve clients in both urban and rural areas throughout King County. Ethnic
   minority populations speaking more than 30 languages represent a large percentage of this group.

                                     ADS HOMECARE RFQ 2011
D. Services Specific to RFQ:

   ADS Request for Qualifications for Medicaid funded in-home care services may result in the
   issuance of one or more, or no contracts to provide Medicaid funded in-home care services.
   Medicaid funded in-home care service provider contracts include DDD, Medicaid Personal Care
   (MPC), and Community Options Program Entry System (COPES) Personal Care services.
   Personal care services means both physical assistance and/or prompting and supervising the
   performance of direct personal care tasks and household tasks as listed in WAC 388-15-202.
   Such services may be provided for clients who are functionally unable to perform all or part of
   such tasks without specific instructions. Personal care services do not include assistance with
   tasks performed by a licensed health professional.

   The Department of Social and Health Services determines client eligibility based on financial
   and functional eligibility requirements. The initial Comprehensive Assessment establishes the
   basis for the type and amount of services for an eligible client who will select their provider(s).

   The ADS case management program, its subcontracted case management organizations, and the
   DDD case management program are responsible for the ongoing reauthorization of services,
   assessing the need for other services, service coordination, advocacy, and review of care
   provided. Contracted agency providers must perform the specific tasks as outlined in the client’s
   individualized Service Plan and may not exceed the monthly number of hours authorized.

   Home care contracted agency providers are responsible for ensuring trained, qualified personnel
   provide Medicaid, COPES, and/or DDD personal care to clients.

E. Service Area:

   ADS home care subcontractors are required to provide services throughout King County.

F. Payment/Billing:

   COPES, Medicaid, and DDD personal care services provided under contract are predicated upon:
   a) number of persons determined to be eligible for services; b) number of hours authorized; and
   c) client choice of provider. ADS does not guarantee referrals or service levels.

   Reimbursement for COPES, Medicaid Personal Care, and DDD is based on an hourly unit rate as
   determined by the Washington State Legislature. A unit of service is defined as one hour of
   service authorized by ADS or DDD case management programs performed by an employee of
   the contractor for an eligible client, usually in the client’s own home. Workers must receive
   compensation as legislated for home care and not less than the minimum wage.

   Monthly payment will be made for service hours provided, not to exceed hours authorized.
   Agencies must monitor the number of hours provided in relation to the number of hours
   authorized for each client and assure that services have been delivered. Contracted agency
   providers may not modify in any way the type and amount of authorized service.

   Agencies may not impose any additional fees for services performed for clients determined
   eligible by the authorizing case manager and will be responsible for collecting client
   participation payment as determined by DSHS. Client participation fees must be deducted from
   the amount requested for services provided during the reporting month.
                                      ADS HOMECARE RFQ 2011
   Payment for services in the COPES, MPC, and DDD programs will be made directly to the
   agency through the State of Washington Social Services Payment system.

   Training Wages & Health Insurance Reimbursement:

     I.   Reimbursement is provided for home care aide wages for state required training. Invoices
          are submitted directly to ADS as stipulated in the contract billing procedures.

    II.   Reimbursement for health insurance plan premiums is provided for eligible home care
          aides who work at least twenty (20) hours per week for state-funded clients. Invoices for
          medical insurance are submitted directly to ADS as stipulated in contract billing

G. Assessment/Audit Requirements:

   ADS may inspect, review, or audit, in the manner and at reasonable times it considers
   appropriate, all of the contractor’s facilities, activities, and all books, records, documents,
   reports, and other data maintained as it relates to the ADS Contract. (Section 4 of the ADS
   Human Services Department Master Agency Services Agreement.) Posted at:

   All records required to be maintained under contract with ADS, except medical and treatment
   records, shall be considered to be public records and must be maintained in accordance with
   applicable laws.

   ADS will annually conduct a full or abbreviated program assessment of the contractor’s
   compliance with State Department of Health Home Care Agency Rules Chapter 246-335 WAC,
   Aging and Disability Services Administration program standards and applicable Management
   Bulletins, and other requirements specified in ADS Home Care provider contract.

   ADS’ program assessment will address performance indicators, including verification of tasks
   performed as authorized in the client’s Service Plan; review of client case records and worker
   personnel files; review agency’s Policy and Procedure Manual; recruitment, hiring and training
   practices etc. Contractors are required to submit an annual financial statement at the close of the
   agency’s fiscal year and are required to have an independent audit by an outside accounting firm.

H. Labor Harmony Agreement:

   The City of Seattle, Human Services Department, Aging and Disability Services has adopted a
   Labor Harmony Policy. This policy applies to the finalists selected for the 2011 home care
   contract. If these contractors have been notified that a union seeks to organize their workers, they
   must submit an acceptable Labor Harmony Plan. The Labor Harmony Policy is posted on the
   Human Services website with the 2011 Home Care RFQ document at

                                      ADS HOMECARE RFQ 2011
                                 II: RFQ REQUIREMENTS:

A. Qualifications:

   To be eligible to respond to this RFQ, applicants (agency and owner/operator) must meet the
   following minimum qualifications:

   1. Have at least three years experience in Washington State as a licensed in-home service provider
      in the home care agency category.

   2. Have a staffed office located in King County and a telephone number with a local area code
      and/or a toll-free number to ensure client and worker access.

   3. Be able to provide home care services throughout the King County geographic area.

   4. Have an independent financial audit or financial review without findings covering the two-year
      period prior to contracting. The audit or review must be conducted by a licensed Certified Public
      Accountant or a recognized financial firm.

   5. Demonstrate performance as a quality provider of in-home services. This includes a review of
      Department of Health surveys, AAA monitoring reports, and other documents that provide
      objective information about the quality of care delivered to medically frail and disabled persons
      in Washington State.

   6. Have no findings of abuse, neglect, exploitation, abandonment nor have had any government
      issue license revoked or denied related to the care of medically frail and/or disabled persons
      suspended or revoked in any state.

   7. Have never been found guilty, including a plea of no contest, of any crime against medically frail
      and disabled persons in any court of law.

   8. Have no multiple cases of lost litigation related to service provision to medically frail and/or
      disabled persons.

   9. Have supervisory/administrative staff in each office in the service area who have demonstrated
      experience in the care of medically frail and/or disabled persons.

   10. Have an electronic time keeping system of recording an employee’s presence in the client’s
       home at the beginning and end of the employee’s client visit workday in place by July 1, 2011.

B. Deadline For Application Submittal:

   To be considered, applications must be received at the following address no later than 5:00 p.m.
   Tuesday, February 22, 2011

   Mail:                                                    Hand Delivered:
   City of Seattle HSD                                      Office Location ATTN: Tamsen Spengler
   ATTN: Tamsen Spengler                                    Seattle Municipal Tower
   PO Box 34215                                             700 5th Ave.     51st Floor
   Seattle, Washington 98124-4215                           Seattle, WA 98104

                                         ADS HOMECARE RFQ 2011
     Applications to this RFQ may not be submitted via electronic media, such as FAX or E-mail.
     Late responses will automatically be disqualified from consideration and will be promptly returned
     to the applicant. The method of delivery shall be at the discretion of the applicant, at the applicant's
     sole risk.

C. Period of Performance:

     The period of performance of any contract resulting from this process shall be for a one-year period
     beginning July 1, 2011. Contract extension for another 12 months will be contingent upon contractor
     performance (e.g. ability to accept referrals in a timely manner, provide adequate supervision, use
     applicable computer applications, comply with DOH Home Care regulations, prepare accurate
     service and billing reports, and generate sufficient funds to cover agency costs incurred serving ADS

D. Format:

     The RFQ application must contain a Letter of Submittal, signed by a person authorized to bind the
     organization to a contract. A Letter of Submittal includes a list of all materials and enclosures being
     sent with the proposal and any other statements the proposer intends to convey to the Qualification
     Review Committee (QRC).

     The RFQ application must be printed on singled-sided standard 8 1/2" x 11" white, bond paper and
     be stapled in the upper, left-hand corner. The font cannot be less than 12 characters per inch.
     Applicants must use the Application and Checklists provided in the RFQ on pages 11-23. Covers
     and three-ring binders should not be used. Forms may be downloaded from the Human Services
     Department website at:

E. Copies:

     Applicants must submit one (1) original application and six (6) copies.

F.   Authorship:

     The RFQ application developed with the assistance of organizations or individuals, including paid
     consultants, outside the applicant’s own organization must be identified by name, title, organization,
     address and phone number under Section A. Application Administrative Requirements,
     “Authorship”, item number 11 on page 15.

G. Public Notice:

     Failure of ADS to notify any party or parties directly regarding the availability of this RFQ shall not
     void the application process. Legal notices announcing the RFQ will appear in the Seattle Daily
     Journal of Commerce, the newspaper designated by the City of Seattle for such announcements.

H. Right to Select, Reject or Negotiate:

     ADS reserves the right to reject any or all proposals if such a rejection is in ADS’s best interest.
     This RFQ is a solicitation for offers and is not to be construed as an offer or a guarantee or promise
     that the services or goods referred to herein will be purchased by ADS.

                                            ADS HOMECARE RFQ 2011
   ADS retains full discretion to abandon the RFQ at any time, for any reason, without liability to
   applicants for any damages including, but not limited to, application preparation costs. Contracts will
   be awarded to the RFQ responses that have been rated as the most qualified. ADS reserves the right
   to negotiate with applicants and may request additional information or modification from an

I. Application/Proposal Costs:

   ADS is not liable for any costs incurred by the applicant prior to the issuance of a contract. All costs
   incurred in response to this RFQ, including travel costs, staff preparation time, contract negotiation
   sessions, licensing fees, office expenses, and so forth, are the sole responsibility of the applicant.

J. Acceptance of Terms:

   By submitting an application in response to this request, the applicant demonstrates a willingness to
   accept all terms and conditions of this request and all ADS, state, and federal regulations and
   requirements pertaining to the operation of the solicited services. If issued a contract, the applicant's
   proposal will become a part of the contract agreement. The applicant will be bound by the terms of
   the proposal, unless ADS agrees that specific parts of the proposal are not part of the agreement.
   ADS reserves the right to introduce different or additional terms and conditions during final contract

K. Proprietary Information/Public Disclosure:

   Proposals and other materials submitted in response to this request become the property of ADS,
   subject to public disclosure and RCW 17.250-340, and will not be returned. It is understood and
   agreed that applicants claim no proprietary rights to the ideas or approaches contained in their
   proposals. Any information in the application that the applicant desires to claim as proprietary and
   exempt from disclosure under the provisions RCW 42.17.250 to .340 must be clearly designated.

L. Qualification Process:

   The qualification process will include:

   1. Verification that the applicant is a legal entity in the State of Washington, and that the
      application is signed by a person with the legal authority to do so.

   2. Verification that the applicant holds a current, unrestricted Washington State Home Care license.

   3. Review of the application to determine that each of the service standards is met. Responses that
      do not fully address all areas requested by the RFQ will be deemed unresponsive and will not be

   4. Check of references to demonstrate agency capacity to provide services which will comply with

   5. Check for previous denial or revocation of personal care service or home care license application
      and any complaints on record regarding the agency.

   6. Review of the application by a Qualification Review Committee to rate and rank each
      application according to the criteria set forth in the RFQ.
                                          ADS HOMECARE RFQ 2011
M. Qualification Review Committee:

   A Qualification Review Committee shall be appointed by the ADS Director to review and evaluate
   eligible applications. The QRC may consist of representatives from DSHS Aging and Disability
   Services Administration, Department of Health, Washington State Area Agencies on Aging, United
   Way, ADS Advisory Council, and other individuals knowledgeable of home care services

   The QRC members shall independently evaluate and rate each proposal. The QRC shall then
   determine the most highly rated proposals as a group.

   Based upon the evaluation criteria and content of the proposals, the QRC shall rank them in order of
   preference to provide the required services. The QRC shall make recommendations to the Seattle
   Human Services Department Director in regard to contracting with the applicant(s) who has
   submitted the most advantageous application. The final decision will be made by the HSD Director,
   guided by the QRC recommendations.

N. Application rating:

   Responses will be rated based upon a weighted point system at the following percentages:

      Administrative Requirements                                  30%
      Technical/Program Requirements                               55%
      Fiscal Requirements                                          15%

O. Unacceptable Applications:

   ADS staff will determine if applications are not responsive to the RFQ and must be deemed
   unacceptable. Unacceptable applications are those which meet one or more of the following criteria:

   1. Application does not address the essential requirements of the RFQ.

   2. Application does not meet the qualification requirements outlined on page 4.

   3. Application demonstrates insufficient understanding of service delivery and/or the service area.

   4. Application contains inappropriate or unreasonable costs.

   5. Application did not meet the deadline.

P. Misrepresentation:

   Misrepresentation includes failure to differentiate between current capacity and capacity to be
   developed. Be specific when describing current program readiness and capacity. Applications must
   clearly describe reasonable timelines for implementation when program readiness, capacity, and
   policies/procedures are to be developed. Applicants must indicate any limitations to providing
   services as specified in the RFQ.

   Any misrepresentation within an application is grounds for disqualification of the entire proposal. It
   is also grounds for termination of any contract resulting from an application that contains
                                         ADS HOMECARE RFQ 2011

Q. Contract Award/Notification to Select Applicant(s):

   The authority to enter into a contract rests with the Director of HSD. HSD/ADS shall be guided by
   the scores awarded by the evaluators.

   Decisions regarding contract awards for services solicited by this RFQ will be finalized during the
   weeks of March 7 – March 28, 2011.

   All applicants shall be provided the results of the RFQ process at the same time an offer and award
   is/are made to the successful applicant(s). Notification to applicant(s) will be made by U.S. Postal

   Contracts awarded under this application process are subject to standard contract conditions
   contained in the Human Services Department’s Master Agency Services Agreement and the policies
   and procedures of both DSHS/ADSA and ADS.

R. Cancellation:

   ADS reserves the right, with or without cause, to cancel any contract resulting from this RFQ with a
   30-day written notice sent by certified mail, return receipt requested, to the applicant’s address of

                        III. APPEAL PROCESS AND PROCEDURES:

  An applicant is any legal entity that has responded to a formal process (Request For Investments,
  Request For Qualifications, bid requests, notice of funding availability or similar process) conducted
  by HSD in soliciting applications for the provision of defined services.

  HSD will notify all proposers in writing of the acceptance or rejection of the proposal, and, if
  appropriate, the level of funding to be allocated.

  Within ten (10) working days from the date of the written notification, the applicant may submit a
  written appeal to the Director of HSD. The basis for the appeal must address one or more of the
  following criteria:

      1. Violation of policies or guidelines established in the RFQ.

      2. Failure to adhere to published criteria and/or procedures.

  The HSD Director will review the written appeal and may request additional oral or written
  information from the appellant organization. A written decision of the HSD Director will be made
  within ten (10) working days of the receipt of the appeal. The HSD Director’s decision is final.

  If an appeal is filed, no new contracts resulting from the solicitation may be finalized until the appeal
  process is completed or the appeal resolved. An appeal may not prevent HSD from issuing an interim
  contract for services to meet critical client needs.

                                         ADS HOMECARE RFQ 2011
                                        IV. ASSURANCES:

Applicants must indicate their intentions to comply with all terms and conditions of this RFQ and the
terms and conditions of any contract awarded by HSD. These conditions include, but are not limited to:

A.     Compliance with Chapter 49.60.30 RCW – Freedom from discrimination – Declaration of civil
       rights. Item # 1 listed below and including all other sections:

       (1) The right to be free from discrimination because of race, creed, color, national origin, sex,
       honorably discharged veteran or military status, sexual orientation, or the presence of any
       sensory, mental, or physical disability or the use of a trained dog guide or service animal by a
       person with a disability is recognized as and declared to be a civil right.

B.     Compliance with Section 504 of the Rehabilitation Action of 1973 and the Americans with
       Disabilities Act (Public Law 101-336).

C.     Compliance with federal and state laws and regulations relating to the prevention of
       discriminatory employment practices.

D.     Compliance with federal and state laws and requirements for safeguarding information and the
       confidentiality of persons served, including the requirements set forth in the Health Insurance
       Portability and Accountability Act of 1996 (HIPAA). Additional information about HIPAA is
       available at:

E.     Assurances that all current and prospective employees, interns, or volunteers who will or may
       have unsupervised access to vulnerable adults, shall have criminal background checks conducted
       in accordance with RCW 43.43.830-842 and WAC 388-805-200 (2) as applicable.

F.     Indication applications were developed with the assistance of organizations or individuals
       outside the applicant's own organization, as described in Section VII. Item number 10
       “Authorship”. No contingent fees for such services can be paid under any resulting contract.

G.     Guarantee that the applicant's proposal has been arrived at independently, without consultation,
       communication, or agreement with other proposers for the purpose of restricting competition.
       This condition does not preclude or impede the formation of a consortium of agencies for the
       purpose of bidding on this RFQ.

H.     Assurance that a disaster plan is in place for use in the event of a disaster, which conforms to the
       requirements of WAC 440-22.

J.     Provision of access for authorized ADS officials, DSHS representatives, or officials of the
       federal government to financial and program records pertaining to contract performance,
       compliance, or quality assurance.

K.     Maintenance of financial and program records for audit review and compliance with record
       retention policies as outlined in the City of Seattle’s “Project Services Agreement”, II.
       Compensation And Records, Section 215: Inspection: Maintenance of Records.

                                          ADS HOMECARE RFQ 2011
L.    Submission of service and fiscal reports required by ADS.

M.    Contractors may be required, at the sole discretion of ADS, to obtain an independent audit, at the
      Contractor’s expense, based upon the type of contract, amount of revenue generated under
      contract with ADS, and associated risk factors.

                                V. RCW & WAC REFERENCES

      Applicants for a COPES, Medicaid Personal Care, and/or DDD contract with the City of Seattle
      should be familiar with the following Washington State laws and administrative regulations.
      They may be accessed at the following website operated by the Washington State Legislature:

Revised Code of Washington (RCW):

RCW 43.43.830 – Background Checks-Access to Children or Vulnerable Persons-Definitions
RCW 43.43.832 – Background Checks-Disclosure of Information-Sharing of Criminal
 Background Information by Health Care Facilities
RCW 43.43.8321 – Background Checks-Dissemination of Conviction Record Information
RCW 49.60.030 – Freedom from Discrimination-Declaration of Civil Rights
RCW 70.122 – Natural Death Act (Advanced Medical Directives)
RCW 70.127 – In-home Services Agencies – Electronic Timekeeping and Family Members as IP
RCW 74.34 – Abuse of Vulnerable Adults
RCW 74.39 – Long Term Care Service Options
RCW 74.39A – Long Term Care Services Options – Expansion
RCW 74.09.240 - Kickback and Anti Fraud

Washington Administrative Code (WAC):

▪ WAC 246-335 – In-home Service Agencies
▪ WAC 246-840-910 through 990 – Delegation of Nursing Care Tasks in Community-based and
   In-home Care Settings
▪ WAC 246-888 – Medication Assistance
▪ WAC 257-10 – Referral Registry
▪ WAC 388-06 – Background Checks
▪ WAC 388-71 – Home and Community Services and Programs – Training requirements
▪ WAC 388-106 – Long-term Care Services
▪ WAC 388-440 – Exception to Rule
▪ WAC 388-472 – Rights and Responsibilities

                                        ADS HOMECARE RFQ 2011
     The following pages 12 - 24 contain the information
         required to complete the RFQ application

                     The RFQ application must include:

1. Homecare 2011 RFQ Application                              Page 12

2. Written responses to section A.                            Page 14

3. Completed Checklist for section A.                         Page 17

4. Written responses to section B.                            Page 18

5. Completed Checklist for section B.                         Page 22

6. Written responses to section C.                            Page 23

7. Completed Checklist for section C.                         Page 24

 These documents are also available in electronic format at the King County AAA

                                 ADS HOMECARE RFQ 2011
                       King County Aging and Disability Services

                       2011 Home Care RFQ Application



MAILING ADDRESS (if different than above):








  Private Propriety             Private Not-for Profit

  Public Agency                 Other (Specify)

TYPE OF SERVICE PROVIDER: (Check all that apply)
  ADS Subcontractor           Social Service Provider       Home Care Agency

  Home Health Agency          Residential Care Facility     Other (specify)

SERVICES CURRENTLY PROVIDED: (check all that apply)

  COPES                        Chore Title XIX /Personal Care      DDD Personal Care

  COPES Ancillary              DDD Respite                         Other (specify)

  In Home Respite              Out of Home Respite

                                    ADS HOMECARE RFQ 2011
                           Home Care 2011 RFQ Application – Page 2






Total Direct Service Staff: Number of FTEs              Number of Part-time employees:

Current Number of Clients:               Ratio of Direct Service Staff to Clients:


Total Supervisory Staff:            Ratio of Supervisors to Direct Service Staff:


    COPES/MPC Personal Care                           DDD Personal Care

Agency Certification Statement:
I have read the State Funded Home Care Request for Qualifications application packet and all
attachments to it, and agree to all the conditions contained therein. I certify that I have legal authority to
commit this agency to a contractual agreement. I also certify that the responses provided on the
proposal attached are true and correct to the best of my knowledge and belief.

Signature: _______________________________ Date: ________________________________

Name (typed or printed):



This application requires an original signature. Fill out this form electronically, print, and sign by
the agency executive officer.

                                           ADS HOMECARE RFQ 2011
A. Application Administrative Requirements:                           QRC Rating will be: 30%

1. Licensing/Certification Requirements:

   Attach a copy of your current home care license.

   Home health and/or home care agencies that wish to qualify as an ADS Home Care subcontractor
   must be licensed for home care services in the home care agency category and have provided
   services for a minimum of three years in Washington State under the same ownership.

2. Insurance Requirements:

   Please provide your agency’s Certificate of Liability Insurance.

   Contractors will be required to comply with the Terms and Conditions of the Human Services
   Department’s Master Agency Service Agreement (MASA). These requirements shall be included in
   any contract awarded as a result of the RFQ and are not negotiable. A copy of the MASA is
   available at:

3. Legal Documentation:

   Attach appropriate documentation that verifies your organization is an incorporated legal entity that
   is eligible to operate in the State of Washington. (Examples: IRS Tax exempt determination letter,
   Certificate of Incorporation, Articles of Incorporation, Washington Business License, etc.).

4. Branch Offices & Affiliates:

   Applicants are required to maintain an office in King County which has a local area code or toll-free
   number. List the location(s) of your main administrative office and branch offices in which the
   program operates. Include addresses, administrative telephone numbers, hours of operation, staffing
   levels for each site, and the month and year that each site was established (opened for business).

5. Governing Board/Advisory Council/Partners:

   Provide a list of names, addresses, occupation, and a description of the composition (e.g. geographic
   distribution, affiliations, area of expertise, etc.) of the applicant agency’s Board of Directors,
   Advisory Council, and/or partners or investors in the agency. Identify officers and length of term, as
   applicable. Include examples of Board or Council’s decision-making policy and fiscal responsibility
   to the agency.

   Provide a copy of the Agency’s board minutes for the last three board meetings.

6. Personnel Policies:

   Provide a copy of the agency’s current personnel policies, which must include provisions concerning
   non-discrimination in employment and client services, (See Section 320 of the Master Agency
   Services Agreement), drug free workplace policy, criminal background checks, Americans with
   Disabilities Act, and employee grievances.

                                         ADS HOMECARE RFQ 2011
7. Organizational Structure:

   Provide a copy of the agency’s current organizational chart. The organizational chart should
   indicate lines of authority for personnel involved in the performance of the contract. This section
   should also explain the relationship of project staff to other staff in the agency.

8. Additional Service Provision and Experience:

   Describe other services provided by your organization, targeted populations, fund source(s), and
   length of time providing the service(s). Indicate which are available to older adults and/or disabled

9. References:

   Provide two business references or regulatory organizations knowledgeable of your experience in
   providing home care services who are without financial or other interest or investment in the
   organization. They will be requested to submit a letter of reference concerning the applicant agency.
   Provide the following: agency name, contact person, address, phone number, and email.

10. Monitoring/Assessment Reports:

   Provide all program and fiscal assessment reports conducted within the past two years if your agency
   has a contract with other Area Agencies on Aging in the state, and/or Department of Health licensure
   survey. Also provide Medicaid/Medicare audits of home health agencies. Due to the nature of risk
   involved in home care service provision, past performance considerations will be a critical factor in
   the selection process.

11. Authorship:

   Please identify any organization or individual who assisted with the proposal outside of the
   applicant’s own organization by name, title, organization, address, and phone number. See section II:
   RFQ Requirements, item F. Authorship on page 5.

12. Administrative Quality Assurance:

   Provide the following for your agency:

      a. Specify if the agency has any pending local, state, federal, or other regulatory body’s
         administrative findings, administrative hearings, inspections, organization and/or program
         assessments, monitoring visits, audits, Department of Health surveys, and other surveys.
      b. Specify if the agency has ever had a contract suspended and/or is pending suspension for any
         reason. If so, state the date and circumstance of the suspension.
      c. Specify if the agency has ever terminated a contract as a result of the agency’s request or the
         request of other parties in the contract prior to the end of the contract period. If so, provide
         date and circumstances surrounding the contract termination.
      d. Specify if the agency has ever had a contract not renewed. If so, provide date and
         circumstances surrounding the non-renewal.
      e. Specify if the agency has pending any contract terminations or renewals. If so, please provide
         the reason for the pending contract termination or non-renewal.

                                         ADS HOMECARE RFQ 2011
f. Specify if the agency has been a party in any claim, suit, judgment, or bankruptcy. If so,
   provide date and circumstances surrounding the claim, suit, judgment, or bankruptcy.
g. Specify if the agency has pending any claim, suit, judgment, or bankruptcy. If so, provide
   circumstances surrounding the pending claim, suit, judgment, or bankruptcy.
h. Specify if the agency and parent organization has been a party in (or if pending) any Adult
   Protective Services, law enforcement, and other enforcement authority investigation. If so,
   please provide date, description of events, and outcomes.
i. Specify if the agency has ever had or has pending denial or revocation of any license. If so,
   provide the name of licensing authority, type of license, date and circumstances of denial, or
j. Specify if the agency has ever gone out of the home care business for any reason and started
   another home care business. If so, specify date and circumstances.

                                  ADS HOMECARE RFQ 2011
                  A. Application Administrative Requirements – Checklist

Please submit all items listed as required in this section, following the numbering sequence below.
                     Include this completed checklist with the RFQ application.

1. ________ Licensing requirements (Home Care per WAC 246-335, Home Health)

2. ________ Insurance requirements (i.e. Certificate of Insurance and Endorsement page)

3. ________ Legal documentation (i.e. business license, IRS Tax Exemption Letter, etc)

4. ________ Branch offices and affiliates

5. ________ Agency’s Board of Directors, Board minutes

6. ________ Personnel policies and procedures

7. _______ Current organizational chart

8. ________ Additional service provision and experience.

9.   ________ Two references

10. _________Attach two recent monitoring/assessment reports and responses to corrective actions
    cited, if applicable.

11. _________Identify organization or individual who assisted with the proposal.

12. _________Provide specific information on your agency’s record of quality assurance

                                        ADS HOMECARE RFQ 2011
B. Application Technical / Program Requirements:                   QRC Rating will be: 55%

1. Service Description:

   Describe your agency’s current capability as a licensed home care provider including:
      a) The total number and monthly average of clients served
      b) The total service hours provided in years 2008, 2009, and 2010
      c) The number of workers hired in years 2008, 2009, and 2010

   Indicate the percentage of services that were:
       a) State-funded
       b) Private pay
       c) Other – please describe

2. Service Implementation:

   Describe the following aspects of your agency’s service implementation:
      a) How the agency will accept all referrals within the defined service area. How the agency will
          provide and expand services to underserved areas including East King County and rural areas
          in South King County.
      b) How the agency will respond to personal care referrals for medically frail and/or disabled
      c) How the agency will employ a staff sufficient in size to ensure that authorized clients receive
          services in a timely manner.
      d) How the agency will communicate and coordinate services with DSHS/DDD case

3. Cultural Competence and Client Centered Services:

   Describe your expertise in providing home care services to people from a variety of cultural
   backgrounds and those who speak languages/dialects other than English.

   Describe your expertise in providing home care services to other populations such as those who
   identify as lesbian, gay, bi-sexual, transgender, or questioning (LGBTQ) and those with
   developmental disabilities.

4. Provision of Quality Care:

   Provide a copy of your agency’s Quality Assurance Plan. Describe two examples of successful
   quality assurance activities your agency designed and implemented to assess and improve quality of
   care to COPES, Medicaid Personal Care, and/or DDD clients (e.g. Client Satisfaction Survey).

5. Timely Delivery of Services:

   Explain how the agency will assume full responsibility for the timely delivery or availability of
   services to eligible clients. Service must be provided within three (3) working days of the agency’s
   receipt of the authorization form from the Case Management program.

                                         ADS HOMECARE RFQ 2011
6. Substitute Worker Policy:

   Describe the agency’s procedures to ensure the availability of a substitute in-home care provider
   when a provider has been scheduled and fails to arrive at the client’s home.

7. Staffing:

   Describe the agency’s procedures for recruiting and screening employees to ensure an adequate pool
   of trained workers are available to serve all clients authorized to receive service in a timely manner.
   Include in your response:
       a) Recruitment policy
       b) Screening procedures used during the hiring process
       c) Staffing plan for office(s) including supervisory roles and functional areas of responsibility
       d) Staff job descriptions

8. Family Hire Policy:

   Home care agencies may not employ the family member of a client to provide care as per SHB 2361.
   Describe how the agency hiring procedures and personnel records will comply with this legislation.

9. Supervision:

   Explain your agency’s Policies and Procedures to assure:
      a) Adequate supervisory ratio to workers and clients
      b) Supervisors’ experience in the provision of services to elderly and/or disabled individuals
      c) Supervisors’ demonstrated ability to supervise staff, ensure client’s care plan is followed, and
          identify areas where additional training for homecare aides is needed.

10. Performance Evaluations:

   Explain the agency’s process to insure an evaluation of worker performance will be completed after
   six months initially and thereafter at least annually, including on-site observation of personnel
   providing direct participant care.

11. Criminal Background Check Policy:

   Department of Health Home Care regulations require workers who will or may have unsupervised
   access and direct contact with vulnerable adults must have a criminal background check conducted
   in accordance with RCW 43.43.830 – 840. Attach your agency’s procedures for:

      a) Completed disclosure statement,
      b) Washington State Patrol Criminal History Background inquiry (WATCH), and
      c) Background Check Central Unit (BCCU) and FBI Fingerprint checks.

12. Employee/Worker Salary Schedule:

   Explain the agency’s procedure for documenting worker wage increases mandated by the legislature.
   Explain how records of compensable time will be kept for verification that time is recognized and
   home care aides are compensated as required by federal and state law. Use of an electronic
   timekeeping system is mandated by the legislature. Describe the system you will use and the policies
   and procedures for implementation.

                                         ADS HOMECARE RFQ 2011
13. Training & Certification:

   Orientation, safety training, basic training, and continuing education of worker/aides is required to
   ensure clients receive services in a safe, appropriate manner within the client’s home.

   As of January 1, 2011, new training and certification requirements for home care aides were
   implemented as mandated by Initiative 1029. New workers/aides must receive the minimum number
   of hours of training as mandated by the State (WAC 388-71-05923) totaling 75 hours for most
   workers. New workers must also maintain the Homecare Aide Certification through the Department
   of Health. Homecare aides who worked in 2010 and completed the training required at their date of
   hire are exempt from the certification requirement.

   All training must be completed through a State-approved provider and training must be documented
   in the worker’s personnel files. Dates and content of orientation, formal training sessions,
   continuing education and on-the-job training must be documented.

   Submit your agency’s Policies and Procedures for:
      a) Orientating new employees
      b) Verification of training and experience at time of hire
      c) Completion of training and certification requirements by state mandated timelines will be
         tracked and enforced

14. Case Records and Reporting:

   Describe the agency’s procedure for maintaining worker and client individual records, which
   includes standardized formats and written policies.

   A. The following documentation must be maintained by the agency for workers/aides:

       a)   Employee application, two reference checks, and criminal background/fingerprint checks;
       b)   Evidence of completion of required trainings;
       c)   Evidence of any special certifications and /or relevant work experience;
       d)   Evidence of current Washington State driver’s license and auto insurance, if appropriate;
       e)   Formal performance evaluations performed at six (6) months from start of employment and
            annually thereafter.

   B. The following documentation must be maintained by the agency for client case records:

       a)   DSHS Authorization Forms, CARE Assessment;
       b)   Agency Plan of Care with schedule and task information;
       c)   Client consent for services;
       d)   Client Participation/Co-payment (if applicable);
       e)   Progress notes; documentation of complaints, accidents, or incidents.

15. Service Plans:

   Describe the agency’s policy for documenting that workers/aides have received and understand the
   client’s Plan of Care. The plan must provide a detailed description of specific tasks to be performed
   by the worker, in addition to pertinent health, medical, family, and other significant client
   information and reflect tasks as authorized by case managers on the CARE Assessment.
                                          ADS HOMECARE RFQ 2011
16. Task Documentation:

   Describe procedures for documentation of tasks performed by workers. Workers are required to
   document tasks performed. The agency must maintain a system for reporting tasks provided as well
   as a review process for determining if the tasks specified in the client’s Service Plan have been
   provided as authorized.

17. Client Confidentiality:

   Describe the agency’s policy for protection of sensitive, personal client information as well as the
   policy for obtaining and releasing information on records related to the health, medical care,
   financial, psycho-social and other related background materials pertinent to the client’s plan of care.

   Agency confidentiality policies must comply with federal and state laws and requirements for
   safeguarding information and the confidentiality of persons served, including the requirements set
   forth in the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

18. Grievance Procedure:

   Explain the agency’s procedure for clients and/or caregivers to express dissatisfaction with services
   that they receive. Include how the agency will inform the client of the process for expressing
   concerns or submitting formal complaints, and for receiving explanations about services provided.
   Explain how the agency will document findings and maintain complaint records for ADS review
   during annual program assessment.

19. Incidents/Accidents:

   Describe the agency’s procedure to be followed in the event a participant becomes ill, is injured, or
   dies while being served. Describe the agency’s system of reporting and documenting all accidents,
   injuries, significant incidents and unusual occurrences, action taken, potential training needs, and
   evaluation. Attach any log used for accidents or incidents that occurred during calendar year 2010
   directly related to in-home care clients and/or their workers. Include any records of all Adult
   Protective Services referrals.

20. Disaster Preparedness Plan:

   Provide a copy of agency’s emergency preparedness plan. Contractors must have written procedures
   to be followed in the event of weather-related emergencies, disasters, or any other situation that may
   interrupt personal care service delivery. The plan should include a list of current authorized clients
   indicating clients who are at acute risk and whose safety would be in jeopardy. Contractors are
   expected to coordinate with the Seattle Human Services Department, Aging and Disability Services
   Division, throughout the emergency/disaster period.

21. Technology Capabilities:

   Explain the agency’s technological capability to receive, transmit, and respond to faxes, word-
   processed documents, spreadsheets, electronic mail, invoices and supporting documentation, worker
   timesheets, criminal background checks, electronic client referrals, client assessments, and any other
   forms, documents, databases, web-based systems, and online processes utilized.

                                         ADS HOMECARE RFQ 2011
            B. Application Technical/Program Requirements – Checklist

Please submit all information listed, following the number sequence below. Include this
completed checklist with the RFQ application.

1. ____   Service Description

2. _____ Service Implementation

3. _____ Cultural Competence & Client Centered Services

4. _____ Provision of Quality Care

5. _____ Timely Delivery Services

6. _____ Substitute Worker Policy

7. _____ Staffing

8. _____ Family Hire Policy

9. _____ Supervision

10. _____ Performance Evaluations

11. _____ Criminal Background Check

12. _____ Employee/Worker Salary Schedule

13. _____ Training & Certification

14. _____ Case Records & Reporting

15. _____ Service Plans

16. _____ Task Documentation

17. _____ Client Confidentiality

18. _____ Grievance Procedures

19. _____ Incidents/Accidents

20. _____ Disaster Preparedness Plan

21. _____ Technology Capabilities

                                     ADS HOMECARE RFQ 2011
  C. Application Fiscal Requirements:                          QRC rating will be: 15%

1. Accounting/Finance:

   Describe your accounting operations system and/or provide a copy of the Agency’s Accounting
   and Finance manual. The manual or fiscal management system shall:

    a) Identify the source and application of all funds received for contracted services; reasonably
       distinguish costs of contracted services delivered under the terms of the contract from all
       other costs; and provide for accounting separation of all funds received.
    b) Report all revenue and expenditures in a manner consistent with generally accepted
       accounting principles.
    c) Describe the accounting system that will be used to track income, expenditures, wages,
       compensation, and all other accounting processes related to the fiscal management of the
       agency’s home care program. Include the type of accounting system used (cash, accrual, or
       modified accrual), journals used, a chart of accounts, and name and description of
       accounting software used.

2. Private Pay Services:

   Agencies may offer services to non-Medicaid eligible clients on a private pay basis. Explain the
   agency’s system for tracking private pay hours and Medicaid hours separately.

3. Accountability measures:

   Describe the agency’s process for:

      a.   Verification that authorized service hours do not exceed hours billed
      b.   Client payment of participation responsibility
      c.   Resolving discrepancies between amount(s) billed and actual reimbursement
      d.   Ensuring compliance with ADS billing and reporting requirements.

4. Audit Requirements:

      a. Attach a copy of your agency’s 2008 and 2009 Independent Financial Audit or financial
         review conducted by a licensed Certified Public Accountant or a recognized financial

                                     ADS HOMECARE RFQ 2011
                    C. Application Fiscal Requirements - Checklist

Please submit all information listed, following the number sequence below. Include this
completed checklist with the RFQ application.

1 _____ Accounting System

2._____ Private Pay in-home service

3._____ Agency accountability measures

4.______ Audit Requirements

                                      ADS HOMECARE RFQ 2011

Shared By: