BACKGROUND ANNE ARUNDEL COUNTY DEPARTMENT OF HEALTH BUREAU OF DISEASE PREVENTION AND MANAGEMENT STI PROVIDER CONTRACT REQUEST FOR APPLICATIONS (RFA) FISCAL YEAR 2019 The Anne Arundel County Department of Health (AACDOH) is issuing this RFA to develop a contract with a provider/organization to provide sexually transmitted infection (STI) services, including but not limited to testing for gonorrhea, chlamydia, HIV and syphilis, to Anne Arundel County residents referred by the AACDOH. Funds will be awarded for the period of July 1, 2018 to June 30, 2019. A contract for fiscal year (FY) 2019 in the amount of up to $20,000 can be awarded. The contract amount will be strictly based on number of clients seen. A contract may be awarded to more than one provider/organization depending on location, hours of operation and accessibility of services to county residents. Subject to availability of Maryland Department of Health (MDH) and AACDOH funds, contract(s) may be extended to subsequent fiscal year(s) based on performance of STI services in FY19. Compensation for STI services will be at the rate of $55.00 per patient visit. All medications and required medical supplies will be provided to the contractor by the AACDOH. Laboratory specimens will be required to be processed by the Maryland State Laboratory and all procedures and documentation must be completed in accordance with Maryland State Laboratory requirements. 1
ELIGIBILITY To apply for the STI Provider Contract, a provider/organization must: Be a licensed provider/practice that renders medical services to Anne Arundel County residents. Be willing to collect extragenital, urine and blood specimens. Be willing to provide treatment presumptively based upon symptoms. Be located within an existing facility located in Anne Arundel County. Be in good standing with the Maryland Department of Assessments and Taxation, Maryland Board of Physicians and/or Maryland Board of Nursing, the Office of the Secretary of State s Charitable and Legal Services Division (if applicable), the Anne Arundel County Department of Inspections and Permits and all other applicable federal, State and local requirements. Maintain a minimum of $1,000,000 per incident and $3,000,000 aggregate professional liability insurance protection. CONTACT For more information contact: Kristy Frashure, B.S.N., R.N. Program Manager HIV/STI Prevention and Care Program Anne Arundel County Department of Health 1 Harry S. Truman Parkway Annapolis, Maryland 21401 hdfras00@aacounty.org 410-222-4113 2
GENERAL INFORMATION The organization or service provider (herewith known as Contractor) wishing to apply must: Meet the eligibility requirements listed above. Submit an application (Attachment 3). Designate one person to be the liaison with the AACDOH to provide information pertaining to reporting, supply and medication management, laboratory and specimen management, and evaluating the services provided. Commit to meet monthly, by phone or in-person, with the AACDOH s HIV/STI Prevention and Care Program staff to discuss operations and any concerns or needs. ANNE ARUNDEL COUNTY DEPARTMENT OF HEALTH RESPONSIBILITIES: 1. Provide medical and laboratory supplies sufficient for all AACDOH clients (as listed on the Medical Supply Requisition form). 2. Provide medication(s) needed to treat clients in accordance with the Centers for Disease Control and Prevention (CDC) 2015 STI Treatment Guidelines. 3. Arrange and pay for all courier services for lab specimens. 4. Process all invoices for payment within 30 days of receipt. CONTRACTOR REQUIREMENTS 1. Contractor will accept referrals by phone during normal business hours as determined by Contractor. 2. Contractor will provide STI evaluation and treatment to residents of Anne Arundel County by a licensed physician, a licensed nurse practitioner or a licensed physician assistant in accordance with the CDC s 2015 STI Treatment Guidelines within one week of request. 3. Contractor will view proof of Anne Arundel County residency prior to any visit unless otherwise approved by the AACDOH. Proof: Photo I.D. with address (Maryland State Driver s License, State I.D. or current bill, i.e., utility, mortgage) in the patient s name with an Anne Arundel County residence. 4. Contractor will record the evaluation and treatment (client visit notes) on the AACDOH Client Medical Record form. Contractor will additionally include any tests performed, specimens taken, vaccines administered, STI education and diagnosis provided as well as HIV testing services provided as designated by Maryland law. 5. Contractor will collect specimens (blood, urine, rectal, vaginal and pharyngeal) for HIV, syphilis, gonorrhea and chlamydia using AACDOH provided supplies; complete lab slips appropriately; and package specimens for transport following guidelines for pickup by an AACDOH supplied courier consistent with courier schedule. For both females and males, the combination gonorrhea/chlamydia Nucleic Acid Amplification Test (NAAT) will be used and submitted with an allocation sticker which will be provided by the AACDOH. Any other specimens collected are at the client s expense (except herpes cultures, which may be performed as indicated). 3
6. Contractor will dispense or administer AACDOH supplied medication for the treatment of syphilis, gonorrhea and/or chlamydia, if indicated and recorded on the AACDOH Client Medical Record form. Any other medicine is at client s expense. A provider should treat presumptively based on symptoms during the initial visit. 7. Contractor will provide prescriptions to AACDOH clients, if applicable, for Expedited Partner Therapy (EPT) per the State of Maryland s EPT REGULATIONS 10.06.07 Sexually Transmitted Infections EPT for Chlamydia and Gonorrhea to any partner within 60 calendar days of the patient s diagnosis; or the most recent partner of a patient if the patient has not had sex in the 60 days before diagnosis. 8. Contractor will accept referrals from the AACDOH and provide Pre-Exposure Prophylaxis (PrEP) services, within one week, to clients in accordance with the 2014 CDC practice guidelines. 9. Contractor will order replacement medications and supplies based on number of patients seen using the AACDOH Medical Supply Requisition forms. 10. Contractor will notify the AACDOH in advance of unusual, unexpected or holiday/vacation related office closings. 11. Contractor will provide documentation to the AACDOH of all treatment and nontreatment provided for diagnosed or suspected STIs on the State of Maryland Confidential Morbidity Report (DHMH1140), to include date of treatment and race. Positive syphilis and/or HIV will be referred to the AACDOH for Disease Intervention Specialist (DIS) services. FACILITY REQUIREMENTS The Contractor will provide a safe, welcoming and clean facility that is compliant with all county building and environmental codes, including guidelines for accessibility established by the Americans with Disabilities Act (ADA). The Contractor will agree to monitoring and inspection by the AACDOH, in addition to all other inspections required by the county. The facility must be open for services at least five days a week. Normal operating hours must be at minimum from 9:00 a.m. until 5:00 p.m. Preference will be given to a facility that Is in close proximity to public transportation. Is open six or more days a week. Offers extended operating hours. Employs bilingual medical staff. MINIMUM REQUIREMENTS FOR SERVICES AND PROGRAMS 1. The Contractor will agree that no subcontractor(s) shall be hired to provide services. 2. The Contractor will identify how STI services will be integrated or incorporated into the existing structure and activities of the facility and organization. 3. The Contractor will identify a process to ensure clients who may require multiple visits are compliant with returning for treatment. 4. The Contractor will provide culturally competent, nonjudgmental care to STI clients. 4
REPORTING Contractor will record the evaluation and treatment (client visit notes) on the AACDOH Client Medical Record form. Contractor will additionally include any tests performed, specimens taken, vaccines administered, STI education and diagnosis provided as well as, HIV testing services provided as designated by Maryland law. Contractor will provide documentation to the AACDOH of all treatment and non-treatment provided for diagnosed or suspected STIs on the State of Maryland Confidential Morbidity Report (DHMH1140), to include date of treatment and race. Positive syphilis and/or HIV will be referred to AACDOH for Disease Intervention Specialist (DIS) services. Completed AACDOH Client Medical Record forms will be faxed to the HIV/STI Prevention and Care Program within three days of client visit. AGREEMENT AND TERMINATION FOR NON-PERFORMANCE The Contractor shall enter into an Agreement with the AACDOH. Any Agreement resulting from this RFA may be terminated by either the AACDOH or the Contractor by giving 60 days written notice to the other party. If the Contractor shall fail to fulfill in a timely and proper manner its obligations under the Agreement, or if the Contractor shall violate any terms of the Agreement, within the sole discretion of the AACDOH, the AACDOH may immediately terminate the Agreement by giving written notice to the Contractor. INVOICING Contractor will submit an invoice within 10 days after the end of the month or end of provider's billing period. Bills submitted more than six months in arrears will not be considered for payment. Contractor will submit all monthly bills to: Anne Arundel County Department of Health Attn: HIV/STI Prevention and Care Program, MS #3103 1 Harry S. Truman Pkwy, Suite 200 Annapolis, MD 21401 Compensation for STI services will be at the rate of $55.00 per patient visit. The AACDOH Client Medical Record form received for the contractor will be used to ensure accurate invoicing. Contractor shall be compensated under Federal Identification Number 46-5462980 according to the fee schedule above, not to exceed a total of $20,000 during this contract period. Compensation shall be paid per client visit and for required services actually performed. 5
REVIEW PROCESS A panel of reviewers will conduct the application review process using the attached rating scale (Attachment 2). The decision to award a contract(s) will be based on the merits of the application. The decision of the reviewers will be final. Applications will be examined for: 1. Organizational Capacity (30 points) 2. Approach to Service Delivery (30 points) 3. Implementation and Operations Strategy (30 points) 4. Appendices/Documentation (10 points) APPLICATION DEADLINE Five copies of the application for the STI provider contract must be mailed or handdelivered to Kristy Frashure, Anne Arundel County Department of Health, 1 Harry S. Truman Parkway, Suite 200, Annapolis, Maryland 21401 by May 25, 2018. Applications received after 4:00 p.m. on Friday, May 25, 2018 will not be considered for review. Faxed applications will not be accepted. STI PROVIDER CONTRACT APPLICATION TIMELINE STEPS TO COMPLETION COMPLETION DATE Advertise/Email 5/7/2018 Application Submission Deadline 5/25/2018 Delivered to: Anne Arundel County Department of Health Attn: Kristy Frashure 1 Harry S. Truman Parkway, Suite 200 Annapolis, MD 21041 Review Committee 5/29/2018 Letters of Award mailed 6/1/2018 6
ANNE ARUNDEL COUNTY DEPARTMENT OF HEALTH STI PROVIDER CONTRACT APPLICATION FY2019 STI provider contract applications must be typed in English single-spaced on 8 1/2 by 11 paper and include page numbers. Applications must not exceed five pages, excluding appendices, and should include six labeled sections as identified under Review Process of this document. Five copies should be submitted. Applications MUST follow the format below. 1.) COVER PAGE (See Attachment 3) 2.) ABSTRACT/SUMMARY PAGE The abstract provides a brief overview of the entire contract for services. It provides information, which enables the reader to quickly identify the overall goal. The abstract should not exceed one page in length and should include: Name of applicant organization. Type of organization. Organization description. Location of facility. 3.) ORGANIZATION DESCRIPTION Summary of relevant experience. Brief overview of the applicant organization and previous work or capabilities with the targeted population. Organizational structure, including how STI services would fit into existing structure. Staffing. 4.) APPROACH TO SERVICE DELIVERY Attachment 1 Applicant s philosophy of STI care. Knowledge of current trends and treatment recommendations related to STIs. Importance of client education. Importance of ensuring client compliance with follow up visits. Importance of EPT and current prescribing practices. 7
5.) IMPLEMENTATION AND OPERATIONS STRATEGY Commitment and plan to adhere to the July 1, 2018 deadline for service implementation. o Plan of action that describes how STI services will be delivered. o Plan on how supplies and medications will be managed. o Plan on how documentation will be completed and sent to the AACDOH. 6.) APPENDICES The appendices should include: Proof of nonprofit status, if applicable. Resumes and license verifications for key staff and consultants. Proof of liability insurance. Proof of good standing with the Maryland Department of Assessments and Taxation. Proof of good standing with the Maryland Department of Charitable Organizations, if applicable. Do not enclose any photographs, exhibits or other materials that you want returned. The AACDOH cannot be responsible for these materials. All materials submitted under the application become the property of the Bureau of Disease Prevention and Management. All applications must follow the format described above. 8
Attachment 2 STI PROVIDER CONTRACT RATING SHEET 1.) COVER PAGE Score i) Cover page signed by authorized official. (0-30 TOTAL) 2.) ABSTRACT/SUMMARY PAGE i) Organization name, type, location, organization description, etc. 3.) ORGANIZATION DESCRIPTION i) Summary of relevant experience. ii) Brief overview of the applicant organization and previous work or capabilities with the targeted population. iii) Organizational structure, including how STI services would fit into existing structure. iv) Staffing. 4.) APPROACH TO SERVICE DELIVERY Score i) Philosophy on STI care. (0-30 TOTAL) ii) Knowledge of current trends and treatment recommendations. iii) Importance of client education. iv) Importance of ensuring client compliance with follow up visits. v) Importance of EPT and current prescribing practices. 5.) IMPLEMENTATION AND OPERATIONS STRATEGY Score i) Importance of EPT and current prescribing practices. (0-30 TOTAL) ii) Ability to meet July 1, 2018 deadline. iii) Clear and concise work plan that describes how STI services will be incorporated. iv) Plan on how supplies and medications will be managed. v) Plan on how documentation will be completed and sent to AACDOH. 6.) APPENDICES Score i) Copy of 501c (3) status. (0-10 TOTAL) ii) Resumes and license verifications for key staff and consultants. iii) Copy of liability insurance. iv) Proof of good standing with Maryland Department of Assessments and Taxation. v) Proof of good standing with Maryland Department of Charitable Organizations, if applicable. Total score Note: Please highlight each item in each category that is provided and rate final points on line item. Minimum of 75 total points needed to qualify 9
ORGANIZATION FY 2019 ANNE ARUNDEL COUNTY STI PROVIDER GRANT APPLICATION COVER PAGE Attachment 3 CONTACT PERSON (1) TITLE CONTACT PERSON (2) TITLE ADDRESS CITY, STATE, ZIP PHONE NUMBER FAX EMAIL ADDRESS IS YOUR ORGANIZATION COMMUNITY-BASED? YES NO DOES YOUR ORGANIZATION HAVE NONPROFIT STATUS? YES NO DATE OF NONPROFIT STATUS FEDERAL IDENTIFICATION NUMBER I DO SOLEMNLY DECLARE AND AFFIRM THAT THE CONTENTS OF THIS APPLICATION ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE, INFORMATION, AND BELIEF. PRINTED NAME TITLE SIGNATURE DATE 10