Sapta hiv testing program - Request for ... - Nevada



Nevada Department of Health and Human ServicesDivision of Public and Behavioral HealthBureau of Behavioral Health, Wellness, and PreventionOffice of HIV/AIDSSAPTA HIV Testing ProgramAnnouncement Type: Request for Application 2019Funding Opportunity AnnouncementOctober 1, 2019 – September 30, 2020Release Date: June 3, 2019Application Due Date: July 5, 2019 at 5:00 PM (PST)Austin PorsborgHealth Program Specialist IOffice of HIV/AIDSEmail: aporsborg@health.Telephone: (702) 486-5665Fax: (702) 486-8101Authority: 45 CFR, PART 96 - BLOCK GRANTSTo our Current and Potential Subgrantees:The Division of Public and Behavioral Health, Bureau of Behavioral Health, Wellness, and Prevention, Office of HIV/AIDS and Substance Abuse Prevention & Treatment Agency (SAPTA) HIV Testing Program is accepting applications for grant year (GY) 2019-2020 (October 1, 2019 to September 30, 2020) for the SAPTA HIV Testing Program. The purpose of this Request for Application (RFA) is to assist SAPTA state certified residential and/or transitional treatment facilities in offering rapid HIV testing at treatment locations. This RFA supports the goals of the National HIV/AIDS Strategy (NHAS) by reducing HIV incidence, increasing access to care and optimizing health outcomes, and reducing HIV-related health disparities. It also supports the requirement of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) initiative to expand early intervention services for HIV by funding certified residential and/or transitional treatment facilities to offer and encourage rapid HIV testing (including confirmatory and diagnostic testing), HIV risk reduction education, linkages to care, and other ancillary services.Multiple SAPTA certified residential and/or transitional treatment programs will be selected statewide. The State will pay personnel, administrative fees, office supplies, the cost of lab/CLIA licenses, set-up costs related to lab/CLIA inspections, and the Alere Determine? HIV-1/2 Ag/Ab Combo. The budget period for this proposal is October 1, 2019 through September 30, pleted applications must be received no later than Friday, July 5, 2019 at 5:00 PM (PST).Thank you,Lyell S. Collins, MBAHIV Prevention Program ManagerNevada Department of Health and Human ServicesDivision of Public and Behavioral Health | Office of HIV/AIDS1840 East Sahara Avenue, Suite 111 Las Vegas, NV 89104T: (702) 486-8105Table of ContentsTechnical Requirement4Grant Objectives/Achievables……………………………………………………………………………………………………..5Request for Application (RFA) Timeline7Submittal Instructions8Application Evaluation Criteria9Subgrant Award Process11Terms, Conditions, and Exceptions12ATTACHMENT A: APPLICATION SUBMITTAL PACKAGE HYPERLINK \l "SAAppSubPackage" 14Cover Page15Agency Profile HYPERLINK \l "SAAgencyProfile" 16Contact Information17Agency Summary and Experience18Project Narrative19Scope of Work20Proposed Budget Template25Application Checklist26ATTACHMENT B: DETAILED INSTRUCTIONS27Instructions for Agency Profile28Instructions for Proposed Budget Plan (s)29ATTACHMENT C: The Nevada Integrated HIV Prevention and Care Plan 2017-2021 31ATTACHMENT D: Assurances32ATTACHMENT E: Conflict of Interest Policy Acknowledgement34ATTACHMENT F: Notification of Utilization of Current or Former State Employee ………………..………....35ATTACHMENT G: Budget Sheet ……………………………………………………………………………………………………..…36ATTACHMENT H: Subrecipient/Contractor Verification and Checklist ……………………………….………….….37ATTACHMENT I: Subrecipient Questionnaire ………………………………………………………………………………….…38ATTACHMENT J: Subrecipient Risk Questionnaire ……………………………………………………………………...…….39ATTACHMENT K: Definition & Acronyms……………………………………………………………………………………………40Technical RequirementsWho may apply?To apply for a subgrant from the DPBH, SAPTA HIV Testing Program, an organization must be SAPTA state certified residential and/or transitional treatment facilities.Excluded Parties – Excluded from Federal Procurement or Non-procurement Programs accessible at does an agency submit an application?Applications must be completed on the forms included in the application packet provided by the Office of HIV/AIDS. The application packet must be emailed to Austin Porsborg in original files (Word, Excel) and two required hard copies must be received on or before the deadline July 5, 2019 at 5:00 PM (PST). See Submittal Instructions for more information.What is the required format?Each proposal submitted must contain the following sections: Cover PageAgency ProfileContact InformationAgency Summary & ExperienceProject NarrativeScope of WorkBudget PlanRequired Supplements – Updated All Staff(s) ResumesOptional SupplementsYou can include relevant support materials, including samples of newspaper articles, letters of support, etc. In addition, any charts, graphs, statistical information or substantiating documentation of statements listed in the text of the proposal should be included in the list of attachments.Application ChecklistGrant ObjectivesThe primary grant objectives are to fund certified SAPTA residential and/or transitional treatment facilities to offer and encourage rapid HIV testing (including confirmatory and diagnostic testing), HIV risk reduction education, linkages to care, and other ancillary services. The applying agency must be able to meet the following objectives listed below. In the Scope of Work section of the application packet, the applicant will list activities to describe how the applicant plans to meet each objective and how the activities will be measured and evaluated. TrainingThe applicant must be able to complete the State approved Rapid HIV Testing, Counseling, Safety, and Certification plete blood borne pathogen plete additional training if required by the State of Nevada.SAPTA HIV Testing Site(s) Set-UpAll applicants must have the infrastructure to apply for a State lab license and The Clinical Laboratory Improvement Amendments (CLIA) waiver to offer rapid HIV testing.SAPTA certified residential and/or transitional treatment programs must apply for State lab license and The Clinical Laboratory Improvement Amendments (CLIA) waiver to offer rapid HIV testing.Applicants must be able to successfully pass a Bureau of Health Care Quality and Compliance (HCQC) site inspection for rapid HIV testing and maintain compliance throughout the grant cycle.HIV Testing / Linkages to CareThe applicant will administer ### rapid HIV opt-out test for clients accessing services through their facility or facilities.Applicant will address the number of clients expected to be served during the grant year (GY) 2019-2020 (October 1, 2019 to September 30, 2020). The number of proposed rapid HIV tests should be based on historical HIV testing data or the number of clients served at residential and/or transitional treatment facilitiesThe applicant must ensure 100% of clients receiving a rapid HIV test will be informed of their test results at the time of rapid HIV test administration.The applicant must ensure 100% of clients who receive a rapid HIV test will be provided client-centered counseling to address high-risk behavior(s) and provide strategies to mitigate the identified risks. Certified rapid HIV test counselors must conduct pre- and post-test counseling and HIV education for all clients’ accessing services at residential and/or transitional treatment programs.The applicant must ensure that all clients with a reactive rapid HIV test will receive a confirmatory HIV test within 48 hours, following CDC HIV testing guidelines. testing is to be referred to the Nevada State Health Division, local health authority, or completed by the applicant. Applicants must ensure an appropriate referral occurs. The applicant must work with the local health authority to ensure all clients with a confirmed HIV positive test result are provided Partner Services and are linked into HIV care services. The applicant must provide linkages to care for all newly identified HIV-positive clients.The applicant must follow the CDC Rapid HIV Testing Guidelines, federal, and state requirements, including, but not limited to the Nevada Revised Statutes 441a and the Nevada Administrative Codes 441a.Revised Statutes 441a - Administrative Codes 441a - Management / ReportingThe applicant will be responsible for the accurate collection of all rapid HIV testing data using the approved CDC recommended HIV Counseling and Testing Form.The applicant will submit all HIV Counseling and Testing Forms to the SAPTA HIV Testing Program, via mail or FedEx by the 3rd of each month.The applicant will submit to the Nevada Division of Public and Behavioral Health a monthly report of all activities, including any successes, challenges and/or struggles, using the approved monthly reporting form.Fiscal ManagementThe Subgrantee must submit a “Request for Reimbursement” monthly, not later than the 15th of the following month via mail or FedEx. Requests for Reimbursement must be on the approved form and include all back-up documentation.Failure to do so may result in the withholding of grant payments.Request for Application (RFA) TimelineTaskDue Date & TimeSAPTA HIV Testing Program distributes the Request for Application Guide with all submission formsJune 3, 2019Deadline for submission of applicationsJuly 5, 2019, 5:00 PM (PST)Evaluation Period: review of applicationsJuly 12, 2019 – July 19, 2019Selection notice to applicantsJuly 19, 2019Completion of subgrant awards and contractsSeptember 30, 2019Grant Contract Commencement of Project – Pending approved SAMHSA grant award and receipt of Notice of AwardOctober 1, 2019NOTE: These dates represent a tentative schedule of events. The State reserves the right to modify these dates at any time, with appropriate notice to prospective vendors.Submittal InstructionsFIRST: The proposal shall be prepared and submitted in original word and excel format on the forms provided in this guide and should be presented in the same order as the checklist. Applicants shall prepare their proposal responses written in Times New Roman 12-point font with one-inch margins immediately following the applicable question/section.SECOND: Applicants shall submit their entire application package electronically to SAPTA HIV Testing Program to Austin Porsborg at aporsborg@health. on or before the proposal submission deadline. An emailed reply will verify your submission has been received. Applicants may submit their proposal any time prior to the stated deadline.THIRD: In addition to the electronic submission, one (1) hard copy original proposal marked “MASTER” and one (1) identical copy, must be received on or before the deadline to the following location:To:Nevada Division of Public and Behavioral HealthATTN: Austin Porsborg1840 East Sahara Ave, Suite 111Las Vegas, NV 89117Proposals submitted shall be clearly labeled on the outside of a sealed envelope as follows: SAPTA Testing Program - Request for Application 2019PROPOSAL DEADLINE DATE: July 5, 2019 at 5:00 PM (PST)Please be advised: Proposals that do not arrive as instructed by deadline will not be reviewedThe State will not be held responsible for proposal envelopes mishandled as a result of the envelope not being properly prepared. Proposals may be modified by e-mail or written notice provided such notice is received prior to the opening of the proposals.For ease of evaluation, the proposal shall be submitted on the forms provided in this guide and should be submitted using the same order. Responses to each section and subsection should be complete, marking any section or sub-section as “N/A” for not applicable, so as to indicate that no item was missed or addressed. Exceptions to this will be considered during the evaluation process.If complete responses cannot be provided without referencing supporting documentation, such documentation must be provided with the proposal and specific references made to the tab, page, section, and/or paragraph where the supplemental information can be found.Proposals are to be prepared in such a way as to provide a straightforward, concise delineation of capabilities to satisfy the requirements of this RFA. Expensive bindings, colored displays, promotional materials, etc., are not necessary or desired. Emphasis should be concentrated on conformance to the RFA instructions, responsiveness to the RFA requirements, and completeness and clarity of content.Descriptions on how any and all equipment and/or services will be used to meet the requirements of this RFA shall be given, in detail, along with any additional documents that are appropriately marked.The proposal application must be signed by the individual(s) legally authorized to bind the applicant.Application Evaluation CriteriaApplicants shall be evaluated and scored based on material presented in the RFA application. Each application will be evaluated and scored using the following criteria:Agency Summary and Experience (25 Points)Applicant described the agency’s history and experience in the community and how it applies to the proposed project(s). Applicant described the mission and purpose of the agency including staff members, their expertise, and the structure of the agency including Board of Directors, hours of operation, and number of locations.Applicant provided a statement as to the agency’s knowledge and familiarity with the local community's needs and goals. Applicant described the client population currently served and the level of service provided. If the project is to be accomplished through a subcontract, applicant listed the names and address the subcontractor; a signed Memorandum of Understanding or agreement was furnished for each as an addendum.Project Narrative and Scope of Work (25 points) Applicant described the target population of the applicant’s facility and how the applicant will provide client-centered risk reduction education for the funds requested. The Project Narrative provided a detailed narrative of intended activities to meet the objectives listed in the Scope of Work.Activities listed in the Scope of Work were reasonable and achievable to meet the objectives as outlined in this RFA. Budget Plan (25 points)Applicant completed the budget form in the excel form provided. Follow the directions listed in the Budget Plan Instructions in Attachment B; provide detailed narrative for each line-item budget. Agency reapplying cannot request more funds than they received last grant cycle.Supplements (15 points)Staff Most Updated Resumes: Applicant provided the most updated resumes that included current position(s), qualifications credentials, educational background, and experience of persons that are included in the budget. Fiscal / Administrative Declarations: Applicant provided a Internal Revenue Service 501(c) 3 tax-exempt determination letter and copy of latest audit letter, if applicable.Disclosure of Ownership / Conflict of Interest: Applicant provided a list of the Board of Directors and Programmatic, Fiscal, and Administrative Officers and signed the Conflict of Interest Form; see Attachment E.Notification Of Utilization Of Current Or Former State Employee: For the purpose of State compliance with NRS 333.705, subrecipient represents and warrants that if subrecipient, or any employee of subrecipient who will be performing services under this subaward, is a current employee of the State or was employed by the State within the preceding 24 months, subrecipient has disclosed the identity of such persons, and the services that each such person will perform, to the issuing Agency.Memorandum of Understanding or Agreement (MOU): Applicants listed all agencies that it has developed a MOU with and a list of agencies it is currently working with to develop a MOU. Full MOU should be made available upon request. Not to exceed 15 pages, including attachments, with exceptions to resume and supplemental documents including these concepts for a total of (5 Points) Conflict Of Interest Policy AcknowledgmentNotification of Utilization Of Current Or Former State EmployeeBudget SheetSubrecipient/Contractor Verification And ChecklistSubrecipient QuestionnaireSubrecipient Risk QuestionnaireAccurate and Full Completion of Cover Page, Agency Profile, and Technical Proposal (5 points)Subgrant Award ProcessSAPTA HIV Testing Program staff may contact any vendor to clarify any response; contact any current consumer of a vendor’s services; solicit information from any available source concerning any aspect of a proposal; and seek and review any other information deemed pertinent to the evaluation process. The evaluation committee shall not be obligated to accept the lowest priced proposal, but shall make an award in the best interests of the State of Nevada NRS § 333.335(5)Discussions may, at the State’s sole option, be conducted with vendors who submit proposals determined to be acceptable and competitive NAC §333.165. Vendors shall be accorded fair and equal treatment with respect to any opportunity for discussion and/or written revisions of proposals. Such revisions may be permitted after submissions and prior to award for the purpose of obtaining best and final offers. In conducting discussions, there shall be no disclosure of any information derived from proposals submitted by competing vendors.Any award is contingent upon the successful negotiation of final subgrant terms. Negotiations shall be confidential until an agreement is reached. Any subgrant resulting from this RFA shall not be effective unless and until approved by the Nevada Division of Public and Behavioral Health; any subgrant resulting from this RFA shall not be effective unless and until approved by all parties.Terms, Conditions, and ExceptionsThe State reserves the right to alter, amend, or modify any provisions of this RFA, or to withdraw this RFA, at any time prior to the award of a contract pursuant hereto, if it is in the best interest of the State to do so.The State reserves the right to waive informalities and minor irregularities in applications received.The State reserves the right to reject any or all applications received prior to contract award (NRS §333.350).The State shall not be obligated to accept the lowest priced application, but will make an award in the best interests of the State of Nevada after all factors have been evaluated (NRS §333.335).Any irregularities or lack of clarity in the RFA should be brought to the Division designee’s attention as soon as possible so that corrective addenda may be furnished to prospective applicants.Alterations, modifications, or variations to an application may not be considered unless authorized by the RFA or by addendum or amendment.Applications which appear unrealistic in the terms of technical commitments, lack of technical competence, or are indicative of failure to comprehend the complexity and risk of this RFA may be rejected.Applications from employees of the State of Nevada will be considered in as much as they do not conflict with the State Administrative Manual, NRS Chapter §281 and NRS Chapter §284.Applications may be withdrawn by written or email notice received prior to the submission time.Prices offered by applicants in their applications are an irrevocable offer for the term of the contract and any contract extensions. The awarded applicant agrees to provide the project at the costs, rates, and fees set forth in their application in response to this RFA. No other costs, rates, or fees shall be payable to the awarded applicant for implementation of their application.The State is not liable for any costs incurred by applicants prior to entering into a formal contract. Costs of developing the applications or any other such expenses incurred by the applicant in responding to the RFA are entirely the responsibility of the applicant and shall not be reimbursed in any manner by the State.The awarded applicant will be the sole point of contract responsibility. The State will look solely to the awarded applicant for the performance of all subgrant obligations that may result from an award based on this RFA, and the awarded applicant shall not be relieved for the non-performance of any or all subgrantees. Each applicant must disclose any existing or potential conflict of interest relative to the performance of the contractual services resulting from this RFA. Any such relationship that might be perceived or represented as a conflict should be disclosed. By submitting an application in response to this RFA, applicants affirm that they have not given, nor intend to give at any time hereafter, any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant or any employee or representative of it in connection with this grant award. Any attempt to intentionally or unintentionally conceal or obfuscate a conflict of interest will automatically result in disqualification of the application. An award will not be made where a conflict of interest exists. The State will determine whether a conflict of interest exists and whether it may reflect negatively on the State’s selection of an applicant. The State reserves the right to disqualify any applicant on the grounds of actual or apparent conflict of interest.The State reserves the right to negotiate final subgrant terms with any applicant selected. The subgrant between the parties will consist of the RFA together with any modifications thereto, and the awarded application, together with any modifications and clarifications thereto that are submitted at the request of the State during the evaluation and negotiation process. In the event of any conflict or contradiction between or among these documents, the documents shall control in the following order of precedence: the final executed contract, the RFA, any modifications and clarifications to the awarded application. Specific exceptions to this general rule may be noted in the final, executed subgrant.Applicant understands and acknowledges that the representations above are material and important and will be relied on by the State in evaluation of the application. Any applicant misrepresentation shall be treated as fraudulent concealment from the State of the true facts relating to the application.Pursuant to NRS Chapter 613 in connection with the performance of work under this contract, the contractor agrees not to unlawfully discriminate against any employee or applicant for employment because of race, creed, color, national origin, sex, sexual orientation or age, including, without limitation, with regard to employment, upgrading, demotion or transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms of compensation, and selection for training, including, without limitation apprenticeship.The contractor further agrees to insert this provision in all subcontracts, hereunder, except subcontracts for standard commercial supplies or raw materials.It is expressly understood and agreed all work done by the contractor shall be subject to inspection and acceptance by the State.Any progress inspections and approval by the State of any item of work shall not forfeit the right of the State to require the correction of any faulty workmanship or material at any time during the course of the work and warranty period thereafter, although previously approved by oversight.If travel is required, the following processes must be followed:Requests for reimbursement of travel expenses must be submitted on the State Claim for Travel Expense Form with original receipts for all expenses.The Travel Expense Form, must be submitted with the vendor’s Request for Reimbursement (RFR).Providers will be reimbursed travel expenses and per diem at the rates allowed for State employees at the time travel occurs.No announcement concerning the award of a contract as a result of this RFA can be made without the prior written approval of the HIV Prevention Program Manager of the Office of HIV/AIDS.The awarded applicant must agree, whether expressly prohibited by federal, state, or local law, or otherwise, that no funding associated with this subgrant will be used for any purpose associated with or related to lobbying or influencing or attempting to lobby or influence for any purpose including the following:Any federal, state, county or local agency, legislature, commission, counsel, or board;Any federal, state, county or local legislator, commission member, council member, board member, or other elected official; orAny officer or employee of any federal, state, county or local agency, legislature, commission, counsel, or boardATTACHMENT A:APPLCIATION SUBMITTAL PACKAGECOVER PAGEAGENCY PROFILEAGENCY SUMMARY AND EXPEREINCEPROJECT NARRATIVESCOPE OF WORKBUDGET PLANSUPPLEMENTSAPPLICATION CHECKLIST(Instructions for completing the Application begins after the checklist)COVER PAGENevada Division of Public and Behavioral HealthBureau of Behavioral Health Prevention and WellnessOffice of HIV/AIDSRequest for Application 2019SAPTA HIV Testing Program 2019-2020Release Date: June 3, 2019Deadline for Submission and Time: July 5, 2019 @ 5:00 PM (PST)For additional information, please contact:Austin Porsborg | Health Program Specialist I (Contractor)1840 East Sahara Avenue, Suite 111 Las Vegas, NV 89104Telephone: (702) 486-6488 | Fax: (702) 486-8101Email: aporsborg@health.Agency Full Name:__________________________________________________________________Address:__________________________________________________________________________City:______________________________State:_____________________Zip:______Tel:______________________________Fax:___________________________________Website:__________________________________________________________________________Executive Director/CEO:Executive Director Email:Grant Writer:Grant Writer Email:I have read, understand, and agree to all terms and conditions herein.Signed:Date:Print Name:Print Title:Agency ProfileProject HD Number: (Assigned by DPBH)Application Number: (Assigned by DPBH)Organization Name:Organization EIN:Organization Vendor Number:Organization DUN & Bradstreet Number:Organization Gender Ledger (GL) Code:Employer ID Number (EIN):CCR Registered: Yes NoDate registered?Project Period: (Month/Day/Year)Start Date10/01/19End Date09/30/20Amount Requested:Additional Facility LocationsService Location:Address:Phone Number:Email:Service Location:Address:Phone Number:Email:Service Location:Address:Phone Number:Email:Service Location:Address:Phone Number:Email:Contact InformationName of Project Director:Title:Telephone:Fax:Email:□ Check, If same as Project DirectorName of Financial Officer:Title:Telephone:Fax:Email:Signature Authority□ Check, If same as Project DirectorName of Organization’s Director:Title:Telephone:Fax:Email: Additional Point Of ContactsName // Title: Title:Telephone:Email:Name // Title: Title:Telephone:Email:Name // Title: Title:Telephone:Email:Agency Summary and ExperienceIn no more than 500 words, please describe the agency’s history and experience in the community and how it applies to the proposed project(s). Describe the mission and purpose of the agency including staff members, their expertise, and the structure of the agency including the Board of Directors, hours of operation, and number of locations.Provide a statement as to the agency’s knowledge and familiarity with the local community's needs and goals. Describe the client population the agency currently serves and the level of service provided. If the project is to be accomplished through a subcontractor, please list the names and address the subcontractor; a signed Memorandum of Understanding or agreement shall be furnished for each as an addendum.Project NarrativeIn no more than 650 words, please describe the target population of the applicant’s facility and how the applicant will provide client-centered risk reduction education for the funds requested. The Project Narrative should provide a detailed narrative of intended activities to meet the objectives listed in the Scope of Work. *Please reference the Nevada Integrated HIV Prevention and Care Plan 2017-2021 (Attachment C).SCOPE OF WORKPlease provide the following information for the Scope of Work using the provided template below.Objectives – Predesignated objectives outlined for the SAPTA HIV testing program following the requirement for the National HIV/AIDS Strategy (NHAS), Substance Abuse and Mental Health Services Administration’s (SAMHSA), State of Nevada Division of Public and Behavioral Health, Substance Abuse Prevention & Treatment Agency (SAPTA), and Office of HIV/AIDS.Activities – Describe the steps or activities that the program will use to accomplish the objective. Due Dates: The date by which activities can be completed.Documentation: Performance Measures – What are the measures by which you will evaluate the progress of achieving your goals and objectives through the activities? These are the items that should correlate with the National Monitoring Standards and the Nevada Integrated HIV Prevention and Care Plan 2017-2021 of what will be looked at for successful realization of the project. Evaluation and Outcome for this Objective – This is how your agency will qualify and quantify the selected performance measures. The measuring or evaluating of the work being done to ensure that the agency is on track to achieve the goals and objectives. What tools will the agency use to evaluate performance?[Insert Agency Name Here]Scope of WorkOperation of a SAPTA HIV Testing Program in [ ____ County], Nevada Health DivisionPlease utilize template below for Scope of WorkGoal: The applicant must complete training(s) to conduct HIV testing for the SAPTA HIV Testing Program. ObjectiveActivitiesDate Due ByDocumentationComplete the State approved Rapid HIV Testing, Counseling, Safety, and Certification Program.Received blood borne pathogen plete additional training required by the State of Nevada, as needed.N/AGoal: Facility(s) set-up to be in compliance for Lab Licensure and CLIA Waiver to offer rapid HIV testing.ObjectiveActivitiesDate Due ByDocumentationAll applicants must have the infrastructure to apply for a State lab license and The Clinical Laboratory Improvement Amendments (CLIA) waiver to offer rapid HIV testing.SAPTA certified residential and/or transitional treatment programs needs to apply for State lab license and The Clinical Laboratory Improvement Amendments (CLIA) waiver to offer rapid HIV testing.SAPTA certified residential and/or transitional treatment programs would need to obtain supplies for site inspection by the Bureau of Health Care Quality and Compliance (HCQC).Compliance with Bureau of Health Care Quality and Compliance (HCQC) site inspection requirement for Rapid HIV Testing.Successfully pass Health Care Quality and Compliance (HCQC) site inspection requirement for Rapid HIV Testing.Goal: The applicant will conduct opt-out rapid HIV testing and provide linkage-to-care for reactive/positive test.ObjectiveActivitiesDate Due ByDocumentationThe applicant will administer ___ rapid HIV opt-out test for clients accessing services through their facility or facilities. **Fill in the number of tests**Certified rapid HIV test counselors must conduct pre- and post-test counseling and HIV education for all clients’ accessing services at residential and/or transitional treatment programs.The applicant must ensure 100% of clients receiving a rapid HIV test will be informed of their test results.The applicant must ensure 100% of clients who receive Rapid HIV testing will be provided client-centered counseling to address High-Risk Behavior(s) and provide strategies to mitigate the identified risks.Will ensure that all clients with a reactive rapid HIV test will receive a confirmatory HIV test within 48 hours, following CDC HIV testing guidelines.Work with the local health authority to ensure all clients with a confirmed HIV positive test result are provided Partner Services and are linked into HIV care services. Provide linkages to care for all newly identified HIV-positive clients.Must follow the CDC Rapid HIV Testing Guidelines, federal, and state requirements, including, but not limited to the Nevada Revised Statutes 441a and the Nevada Administrative Codes 441a.Goal: The applicant will conduct quality management and monthly reporting.ObjectiveActivitiesDate Due ByDocumentationSubgrantee will be responsible for the collection of all rapid HIV testing data using the approved CDC recommended HIV Counseling and Testing Form.Subgrantee will be responsible accurately collect all rapid HIV testing data on approved CDC recommended HIV Counseling and Testing Form.The Subgrantee will submit to the Nevada Division of Public and Behavioral Health all HIV Counseling and Testing Form via mail or FedEx by the 1st of each month.The Subgrantee will submit to the Nevada Division of Public and Behavioral Health a monthly report of all activities, using the approved reporting template.The Subgrantee will inform the Nevada Division of Public and Behavioral Health any successes, challenges and/or struggles in the monthly reporting form.The Subgrantee is require to submit quarterly HIV testing numbers to the University of Nevada, Reno – Center for Program Evaluation, for the data reporting needs of the Nevada Integrated HIV Prevention and Care Plan.Goal: Engagement in Nevada Integrated HIV Prevention and Care PlanObjectiveActivitiesDate Due ByDocumentationThe Subgrantee is required to participate in the HIV Prevention Planning Groups for their respected jurisdiction. They may participate via conference call or in person.The subgrantee should contact the following to participate in the HIV Prevention Planning Groups:Southern Nevada - Cheryl Radeloff at radeloff@ AND Joyce Castro at castro@Northern Nevada - Jennifer Howell at Jhowell@washoecounty.usThe Subgrantee is require to submit quarterly HIV testing numbers to the University of Nevada, Reno – Center for Program Evaluation, for the data reporting needs of the Nevada Integrated HIV Prevention and Care Plan.Proposed Budget Template Please use Excel template provided with the announcement package to complete and submit.Review and complete the attached budget form (provided separately from this RFA document). Please refer to the Instructions for Proposed Budget Plan(s) and/or Subcontracting Budget Plan provided in Attachment B. Agency reapplying cannot request more funds than they received last grant cycle.Develop a line item budget for the project. For each itemized category, specify the total project costs (including subcontracting cost), description of expense, and the amount requested from Nevada Division of Public and Behavioral Health (DPBH) funding. **A line item expense under a category must include a description of the line item expense.**APPLICATION CHECKLISTSAPTA HIV Testing Program, 2019 - 2020RFA Cover Page completed and signed________Agency Profile Completed________Contact Information Completed________Agency Summary & Experiences Completed________Project Narrative Completed________Scope Of Work Completed________Proposed Budget Plan(s) Completed________Required Supplements – Resume(s), Fiscal / Administrative Declarations, Conflict of Interest________Application package submitted via email to Austin Porsborg at aporsborg@health.(Microsoft Word or Excel only for items 2-7; PDFs Allowable for items 1 and 8)________Original plus one (1) copy of RFA mailed via US Postal Service________All applications must use the following format:Single Spaced.12- point Times New Roman font.Not to exceed 15 pages, including attachments.All pages must be numbered.Resumes must be current and up-to-date, not counted in the page limit.Supplemental documents, not counted in the page limit.ATTACHMENT B:DETAILED INSTRUCTIONSINSTRUCTIONS FOR AGENCY PROFILEINSTRUCTIONS FOR PROPOSED BUDGET PLANNEVADA INTEGRATED HIV PREVENTION AND CARE PLAN 2017-2021ASSURANCESCONFLICT OF INTEREST POLICY ACKNOWLEDGMENTNOTIFICATION OF UTILIZATION OF CURRENT OR FORMER STATE EMPLOYEEBUDGET SHEETSUBRECIPIENT/CONTRACTOR VERIFICATION AND CHECKLISTSUBRECIPIENT QUESTIONNAIRESUBRECIPIENT RISK QUESTIONNAIREDEFINITIONS & ACRONYMSInstructions for Agency ProfileProject Number – Leave blank (Assigned by SAPTA HIV Testing Program)Application Number – Leave blank (Assigned by SAPTA HIV Testing Program)Project Name – Provide a short descriptive name for the proposed project (No more than 15 words)Organization Name – Applicant’s legal nameOrganization Website – If applicable, provide the applicant’s website addressOrganization Address – Street and floor or suite numberOrganization City/State – City and StateOrganization Zip Code – five or nine digit zip codeEmployer ID Number – Provide employer identification number (EIN)DUNS Number – Provide Data Universal Numbering System (DUNS) numberType of Applicant – Select the type of applicant (i.e., Non-profit, Religiously-Affiliated Agency, Residential and/or transitional facilities).Locations – Service Location (i.e. Fallon, Clark, Elko, Carson), Provide Full Address, Phone Number, and FaxProject Director – This will be the main programmatic contact person for this projectFinancial Officer – This will be the main fiscal contact person for this projectOrganization Director – This will be the main administrative contact person for this projectInstructions for Proposed Budget Plan(s)Budget Itemization SectionsAgency reapplying cannot request more funds than they received last grant cycle. Itemize costs for the project under the following categories:Personnel:Salaries and WagesPersonnel costs include listing each staff member who is providing direct client services. Include the staff name (if possible), position title, percent of full time equivalency (FTE), and annual salary/hourly rate. Example of the Detail Description: Coordinator (.5 FTE)- Annual Salary $50,000 x .5 FTE = $25,000 (also provide a position description) In the description section, write a detailed position narrative and the job duties as it relates to the SAPTA HIV testing Program. Do this for each position to be funded.If a portion of a supervisor’s time is devoted to providing professional oversight and direction then include in this sectionFringe BenefitsList components that comprise the fringe benefit rate; for example: health insurance, taxes, unemployment insurance, life insurance, retirement plan. The fringe benefits should be directly proportional to the amounts listed in personnel costs.Indicate the applicant’s fringe benefit rate. After completing the list of positions, multiply the subtotal of personnel costs by the organization’s standard percentage for fringe benefit costs, and enter the amounts in the appropriate lines on the “Fringe Benefits” row.No Rounding of Salaries, Wages, and Fringe.TravelLine-item budget travel costs according to “In-State Travel.” Please include the following: mileage, rate (current GSA rate), reason for travel, staff member names, and number of trips. Travel is allowed only for staff listed in the personnel costs section and/or contractors.No Per Diem (hotel & meals) for travel less than 50 miles.Registrations is included in the Training category.Example: 3 employees X 50 miles/month X 12 months X $0.535/mile = $963Cost resources include Nevada’s State Administrative Manual (SAM) and US General Services Administration (GSA).OperatingLine-item includes: Alere Determine? HIV-1/2 Ag/Ab Combo ($10/per test), Alere Determine? External Controls (1 needed per grant year), Fingerstick Sample Collection Kit (1 needed per 100 Alere Determine HIV tests), general office supplies, medical supplies, and educational supplies. Office supplies could include paper, pen, pencils, binders, ink, copier paper, etc. Medical supplies are plastic gloves, biohazard containers, Biohazard disposal, etc. Educational supplies may be pamphlets related to Rapid HIV Testing, HIV/AIDS medical care, etc. Cost associated to Lab Licensure.The applicant must address the number of clients expected to be served during the grant year (GY) 2019-2020 (October 1, 2019 to September 30, 2020). This number of proposed rapid HIV tests should be based on historical HIV testing data or client served at residential and/or transitional treatment facilities.All detailed cost should match the budget and financial reporting requirements.TrainingThis category includes required training that SAPTA HIV Testing HIV Program personnel may need during the grant period.Applicant personnel must complete the State approved Rapid HIV Testing, Counseling, Safety, and Certification Program. (3 day training in Las Vegas, NV [multiple times throughout the year] or Reno, NV [once a year] )Applicant personnel must complete all additional training required by the State of Nevada.Travel portion is added to the Travel category.Indirect CostsThis category includes all administrative or indirect costs that do not apply to any of the above categories. This category is capped up to 10% administrative costs allowance.As stated in the SAMHSA, the 10% administrative cap includes:Routine grant administration and monitoring activities, including the development of applications and the receipt and disbursal of program funds;Development and establishment of reimbursement and accounting systems;Preparation of routine programmatic and financial reports;Compliance with grant conditions and audit requirements;All activities associated with the recipient’s (grantee's) contract award procedures, including the development of requests for proposals, subgrantee and contract proposal review activities, negotiation and awarding of contracts;Reporting on contracts, and funding reallocation activities;Related payroll, audit and general legal services;Generating monthly progress reports.ATTACHMENT C:Nevada Integrated HIV Prevention and Care Plan 2017-2021In preparing your proposal, please reference The Nevada Integrated HIV Prevention and Care Plan 2017-2021 and all supplemental documents. The integrated plan, including the Statewide Coordinated Statement of Need, was developed in response to the guidance provided by the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA) in June 2015.The HIV Prevention and Care Integrated Plan includes strategies for ongoing monitoring and improvement. The HIV Prevention and Care Integrated Plan Internal Workgroup will meet every six months to review progress on plan implementation. The Ryan White Part A, Ryan White Part B and HIV Prevention programs have contracted the School of Community Health Sciences (SCHS) at the University of Nevada, Reno to oversee the evaluation and monitoring of the plan.?SCHS will collaborate with the workgroup and planning bodies throughout the evaluation and monitoring process. An evaluation report will be produced annually to document the implementation process as well as progress towards the plan goals and objectives. The workgroup, community planning groups, and Part A Planning Council will review current epidemiological data on an annual basis and use it to make adjustments to the plan as needed.Website links: NEVADA HIV PREVENTION PROGRAM: D:AssurancesAs a condition of receiving subgranted funds from the Nevada State Division of Public and Behavioral Health, the Subgrantee agrees to the following conditions:Grant funds may not be used for other than the awarded purpose. In the event Subgrantee expenditures do not comply with this condition, that portion not in compliance must be refunded to the Division.To submit reimbursement requests only for expenditures approved in the spending plan. Any additional expenditure beyond what is allowable based on approved categorical budget amounts, without prior written approval by the Division, may result in denial of reimbursement.Approval of subgrant budget by the Division constitutes prior approval for the expenditure of funds for specified purposes included in this budget. Unless otherwise stated in the Scope of Work the transfer of funds between budgeted categories without written prior approval from the Division is not allowed under the terms of this subgrant. Requests to revise approved budgeted amounts must be made in writing and provide sufficient narrative detail to determine justification.Recipients of subgrants are required to maintain subgrant accounting records, identifiable by subgrant number. Such records shall be maintained in accordance with the following:Records may be destroyed not less than three years (unless otherwise stipulated) after the final report has been submitted if written approval has been requested and received from the Administrative Services Officer (ASO) of the Division. Records may be destroyed by the Subgrantee five (5) calendar years after the final financial and narrative reports have been submitted to the Division. In all cases an overriding requirement exists to retain records until resolution of any audit questions relating to individual subgrants.Subgrant accounting records are considered to be all records relating to the expenditure and reimbursement of funds awarded under this subgrant award. Records required for retention include all accounting records and related original and supporting documents that substantiate costs charged to the subgrant activity.To disclose any existing or potential conflicts of interest relative to the performance of services resulting from this subgrant award. The Division reserves the right to disqualify any subgrantee on the grounds of actual or apparent conflict of interest. Any attempt to intentionally or unintentionally conceal or obfuscate a conflict of interest will automatically result in the disqualification of funding.To comply with the requirements of the Civil Rights Act of 1964, as amended, and the Rehabilitation Act of 1973, P.L. 93-112, as amended, and any relevant program-specific regulations, and shall not discriminate against any employee or offeror for employment because of race, national origin, creed, color, sex, religion, age, disability or handicap condition (including AIDS and AIDS-related conditions).To comply with the Americans with Disability Act of 1990, P.L. 101-136, 42 U.S.C. 12101, as amended, and regulations adopted thereunder contained in 28 C.F.R. 26.101-36.999 inclusive and any relevant program-specific regulationsTo comply with the requirements of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, 45 C.F.R. 160, 162 and 164, as amended. If the subgrant award includes functions or activities that involve the use or disclosure of protected health information (PHI) then the subgrantee agrees to enter into a Business Associate Agreement with the Division as required by 45 C.F.R. 164.504(e). If PHI will not be disclosed then a Confidentiality Agreement will be entered into.Subgrantee certifies, by signing this notice of subgrant award, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency. This certification is made pursuant to regulations implementing Executive Order 12549, Debarment and Suspension, 28 C.F.R. pr. 67 § 67.510, as published as pt. VII of May 26, 1988, Federal Register (pp. 19150-19211). This provision shall be required of every subgrantee receiving any payment in whole or in part from federal funds.Sub-grantee agrees to comply with the requirements of the Title XII Public Law 103-227, the “PRO-KIDS Act of 1994,” smoking may not be permitted in any portion of any indoor facility owned or regularly used for the provision of health, day care, education, or library services to children under the age of 18, if the services are funded by federal programs either directly or through state or local governments. Federal programs include grants, cooperative agreements, loans and loan guarantees, and contracts. The law does not apply to children’s services provided in private residences, facilities funded solely by Medicare or Medicaid funds, and portions of facilities used for inpatient drug and alcohol treatment.Whether expressly prohibited by federal, state, or local law, or otherwise, that no funding associated with this subgrant will be used for any purpose associated with or related to lobbying or influencing or attempting to lobby or influence for any purpose the following:Any federal, state, county or local agency, legislature, commission, council, or board;Any federal, state, county or local legislator, commission member, council member, board member, or other elected official; orAny officer or employee of any federal, state, county or local agency, legislature, commission, council or board.Division subgrants are subject to inspection and audit by representative of the Division, Nevada Department of Health and Human Services, the State Department of Administration, the Audit Division of the Legislative Counsel Bureau or other appropriate state or federal agencies to:Verify financial transactions and determine whether funds were used in accordance with applicable laws, regulations and procedures; Ascertain whether policies, plans and procedures are being followed; Provide management with objective and systematic appraisals of financial and administrative controls, including information as to whether operations are carried out effectively, efficiently and economically; andDetermine reliability of financial aspects of the conduct of the project.Any audit of Subgrantee’s expenditures will be performed in accordance with generally accepted government auditing standards to determine there is proper accounting for and use of subgrant funds. It is the policy of the Division, as well as federal requirement as specified in the Office of Management and Budget (2 CFR § 200.501(a)), revised December 26, 2013, that each grantee annually expending $750,000 or more in federal funds have an annual audit prepared by an independent auditor in accordance with the terms and requirements of the appropriate circular. A COPY OF THE FINAL AUDIT REPORT MUST BE SENT TO:Nevada State Division of Public and Behavioral HealthAttn: Contract Unit4150 Technology Way, Suite 300Carson City, NV 89706-2009ATTACHMENT E:CONFLICT OF INTEREST POLICY ACKNOWLEDGMENTVendor must have a conflict of interest policy designed to foster public confidence in our integrity and to protect our interest when we are contemplating entering a transaction or arrangement that might benefit the private interest of a director, a corporate officer, our top management official, and top financial official, any of our key employees, or other interested persons. I hereby acknowledge that [INSERT NAME OF AGENCY], has a conflict of interest policy on file and that all employees, contractors, and volunteers have read and understood it, and agree to comply with its terms._____________________________________________________________________Authorized Agency SignatureDateATTACHMENT F:NOTIFICATION OF UTILIZATION OF CURRENT OR FORMER STATE EMPLOYEEFor the purpose of State compliance with NRS 333.705, subrecipient represents and warrants that if subrecipient, or any employee of subrecipient who will be performing services under this subaward, is a current employee of the State or was employed by the State within the preceding 24 months, subrecipient has disclosed the identity of such persons, and the services that each such person will perform, to the issuing Agency. Subrecipient agrees they will not utilize any of its employees who are Current State Employees or Former State Employees to perform services under this subaward without first notifying the Agency and receiving from the Agency approval for the use of such persons. This prohibition applies equally to any subcontractors that may be used to perform the requirements of the subaward. The provisions of this section do not apply to the employment of a former employee of an agency of this State who is not receiving retirement benefits under the Public Employees’ Retirement System (PERS) during the duration of the subaward.Are any current or former employees of the State of Nevada assigned to perform work on this subaward?YES If “YES”, list the names of any current or former employees of the State and the services that each person will perform. NOSubrecipient agrees that if a current or former state employee is assigned to perform work on this subaward at any point after execution of this agreement, they must receive prior approval from the Division.NameServiceATTACHMENT GBUDGET SHEETPlease see attached external document: K:Definitions & AcronymsAcronymDefinitionHIVHuman Immunodeficiency VirusAIDS Acquired Immunodeficiency SyndromeSAPTASubstance Abuse Prevention & Treatment AgencySAMHSASubstance Abuse and Mental Health Services AdministrationNHASNational HIV/AIDS StrategyCDCCenters for Disease Control and PreventionNRSNevada Revised StatutesNACNevada Administrative CodesIDUInjection Drug Use / Intravenous Drug UserFQHC Federally Qualified Health CenterHDHealth DistrictsCLIAThe Clinical Laboratory Improvement Amendments HCQCBureau of Health Care Quality and ComplianceApplicantSubstance Abuse Prevention & Treatment Agency (SAPTA) certified residential and/or transitional treatment facilities applying for SAPTA HIV Testing funding.SubcontractorA contract between the applicant of the grant and an outside agency to perform tasks identified in the RFA, such as rapid HIV test administration and counseling. ................
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