1.01Introduction and Program Description
The Department of Health and Social Services (DHSS or Department), Division of Public Health, is requesting proposals from eligible applicants to provide Title X Clinical Family Planning Services for the State of Alaska in FY2021 through FY2023. One award will be issued from this solicitation. To be eligible, applicants must be from agencies proposing to serve any areas within the state of Alaska, except those communities located on the Southern Kenai Peninsula (SKP) (see section 1.05 below for more information). Program Services are authorized under 7 AAC 78 Grant Programs and Title X of the Public Health Service Act, (42 U.S.C. 300 et seq.). Additional governing federal statutes and regulations are detailed at https://opa.hhs.gov/grant-programs/title-x-service-grants. State of Alaska statutes and regulations are accessible at http://www.law.state.ak.us/doclibrary/doclib.html or through the contact person identified on the cover page of this Request for Proposals (RFP).
The intent of the federal Title X Family Planning Services Grant Program is to assist in the establishment and operation of voluntary family planning programs that must consist of the educational, comprehensive medical, and social services necessary to aid individuals to determine freely the number and spacing of their children, which promotes positive birth outcomes and healthy families. Sub-recipient agencies awarded under the DHSS Title X Project must provide the clinical family planning and related preventive health services necessary to achieve this intent.
1.02Program Goals and Anticipated Outcomes
Title X program priorities are determined by the federal funding agency, the Office of Population Affairs (OPA) and Congress for the Title X program each year. These Title X key issues can be found at: https://opa.hhs.gov/grant-programs/title-x-service-grants. The DHSS Title X Project goals, objectives, and activities (i.e., the DHSS Title X Work Plan) are developed by DHSS Title X Project staff each year for the following budget year, in collaboration with staff from sub-recipient agencies under this Title X Project. These goals and objectives are responsive to the federal priorities, legislative mandates and key issues. The Title X Work Plan submitted with the most current application for federal Title X funding is attached to this proposal in Appendix A for reference. In response to the RFP, the applicant’s proposal must demonstrate a thorough understanding and support of the grant program goals and outcomes anticipated by the Department. Proposed Title X Programs must meet or exceed anticipated minimum outcomes described in the Work Plan and this RFP. (See Section 1.04 below for further details.)
Note: Some federal Title X Program requirements are currently under litigation at the federal level. If this results in any changes to the federal requirements during the funded period of performance noted in this RFP, this will be communicated promptly to successful proposers, and DHSS Title X staff will collaborate closely with existing grantees at such time to modify their Title X Programs as needed to assure ongoing full compliance with federal requirements. In accepting this award, the grantor stipulates that the grantee, the award, and any activities thereunder are subject to all provisions of 42 CFR Part 59, Subpart A currently in effect or implemented during the period of the grant noted in Section 3.06 of this RFP.
Many regions of the state, rural and urban, contain communities with high rates of teen and unintended pregnancies, due in large part to lack of reliable access to affordable, comprehensive, confidential family planning and women’s health services. Title X funded agencies address this need by providing low-cost, confidential, clinical reproductive health and family planning services in compliance with the nationally-recognized, evidence-based clinical standards of care as set forth in the Providing Quality Family Planning Services (QFP) guidelines found at https://opa.hhs.gov/grant-programs/title-x-service-grants/about-title-x-service-grants/quality-family-planning.
Applicants must describe how they propose to address all of the clinical services and program components listed below as a part of their Title X-funded program. Furthermore, applicants must describe how they will assure that clinical components of their proposed Title X-funded programs will achieve and maintain compliance with all provisions of current federal program requirements, as described at https://opa.hhs.gov/grant-programs/title-x-service-grants. In addition to providing descriptive project narrative, each applicant will complete and upload the “Title X Scope of Services” form at Section 4.04,2, and the “Title X Family Planning Methods” list at Section 4.04,3.
Clinical Services components:
- Provision of comprehensive medical, informational, educational, social, screening, and referral services for family planning and related preventive health for all clients who want such services, including adolescents, with priority given to persons from low income families;
- Provision of a broad range of acceptable and effective family planning methods (including pharmaceutical contraceptives, and natural family planning or other fertility awareness-based methods) and contraceptive services, including client-centered, non-directive contraceptive counseling on the broad range of family planning methods available;
- Provision of social services related to family planning. This includes counseling, referral to and from other social and medical services agencies, and any ancillary services which may be necessary to facilitate clinic attendance;
- Processes for referral to other medical facilities when medically necessary (consistent with 42 CFR 59.14(a): Requirements and limitations with respect to Post-Conception Activities);
- Provision of comprehensive primary health services intended to promote holistic health and provide seamless care. The description must include details of how the services are provided onsite by the applicant agency; through a robust referral linkage with primary health provider(s) who are in close physical proximity to the Title X site; or through some other coordinated arrangement;
- Provision of other reproductive health and related preventive health services within the proposed Title X Program, such as Human Papilloma Virus (HPV) vaccination, provision of pre-exposure prophylaxis (PrEP) medication for HIV, and screening for obesity, smoking, mental health, and intimate partner violence;
- Provision of Title X services to all women, men, and teens with reproductive capacity, without regard to religion, race, color, national origin, handicapping condition, age, sex, number of pregnancies, marital status, or household income, while prioritizing Title X services for low-income clients.
- Maintenance of a perpetual pharmaceutical inventory system, maintained and reconciled with periodic documentation, which is detailed in written policy and procedures and in accordance with federal and State laws relating to security and record keeping for drugs and devices.
In their narrative addressing the components above, applicants must describe the ways in which their proposal aligns with program intent. The narrative will identify agency resources available to the Title X program; describe Title X activities; and clearly state the program’s anticipated goals, outputs, and outcomes. In addition, applicants will be required to sign the Title X grant assurances located in section 4.02.
Upon award, DHSS Title X Project staff will work closely with awarded agencies (i.e., “Title X Grantees”) to implement the “Title X Onboarding Plan”, a systematic program implementation plan that prioritizes all major program requirements and places those required components on a semi-flexible timeline for completion in order to achieve full compliance with all Title X Program Requirements on a reasonable start-up schedule (usually not more than 1 year). It is anticipated that the DHSS Title X Project will undergo a comprehensive federal program review in 2021, and the results of the review will provide further guidance to the DHSS Title X Project on areas for program improvement. All grantees funded under the DHSS Title X Project at that time are required to participate in the federal review.
1.04Program Evaluation Requirements and Reporting
Results Based Budgeting Framework
Results based budgeting provides a framework in which allocated resources support, and are justified by, a set of outputs and expected results. Within this framework, actual performance and achieved outcomes are measured by objective performance measures.
Proposed Title X Programs are required to align with program objectives expressing Department priorities and core services. Programs will use performance measures to evaluate progress toward meaningful outcomes, and to initiate data collection and reporting consistent with Department priorities.
The Department Priorities, Core Services, Objectives, and Performance Measures of Effectiveness and Efficiency for this program are:
- 1 Health & Wellness Across the Life Span
- 2 Health Care Access, Delivery & Value
Department Core Services
- 1.1 Protect and Promote the Health of Alaskans
- 2.2 Facilitate Access to Affordable Health Care For Alaskans
- 1.1.1. Improve the Health Status of Alaskans
- 2.2.1. Improve Access to Healthcare
- Number of unduplicated individuals who receive Title X family planning and related preventive health services.
The current, federally-approved DHSS Title X Work Plan is attached to this proposal for reference (Appendix A). In response to this RFP, the applicant's proposal must demonstrate a thorough understanding and support of the grant program goals and outcomes anticipated by the Department. Applicants must describe how they intend to address objectives and outcomes described in the Work Plan and this RFP within the first 6 month funding period.
Grant Reporting: Title X-specific program evaluation and reporting requirements
Required reporting will include:
- Cumulative Fiscal Reports (CFR), reported quarterly by budget line item:
- Grant award expenditures
- All non-federal expenditures in support of the Grantee's Title X Program, including required match and additional program support.
- All program income (receipts) generated by Title X services and activities, will be reported in the "Notes" section of the quarterly CFR, for the following categories:
- Client collections/self-pay
- Client donations
- Private Health Insurance
- Narrative Progress Reports in the format prescribed by the DHSS Title X Project.
- In addition to the federal program review described above, all Grantees under this Title X Project will be required to participate in site visits and program reviews: State Family Planning (FP) Program staff performs monitoring and technical assistance visits during each fiscal year as needed to assure on-going compliance with program requirements and progress toward meeting established annual program objectives. Visit schedules will be determined by the Grantee and Project staffs together.
- For accurate and timely completion of federally-required reports and grant applications, all clinical service sites must be responsive to any requests for clarification or additional information from State FP Program staff.
- Maintenance of an electronic data system that captures encounter-level data on all clinical services, family planning methods, and counseling and education provided to Title X clients for required Title X reporting (see https://opa.hhs.gov/evaluation-research/title-x-services-research/family-planning-annual-report for more details and information regarding data collection requirements for the “Family Planning Annual Report” (FPAR) (including "FPAR 2.0")). Applicants must describe the practice management and Electronic Health Record system(s) used to capture encounter-level client services data, including the brand name(s) of the system(s). Applicants must describe briefly how they will assure the collection of all client services data identified in the Family Planning Annual Report, and collected for ongoing oversight and quality assurance purposes.
1.05Target Population and Service Area
This solicitation is seeking applications from agencies proposing to serve any areas within the state of Alaska, except those communities located on the Southern Kenai Peninsula (SKP), since there is currently a Title X-funded agency serving the SKP. It is anticipated that one new agency will be awarded from the eligible applicants. Applicants must clearly describe the population in the proposed service areas to be served by their Title X Program, including the area or communities that will be served. Proposals will be evaluated for compatibility with the program’s intended target population identified in this solicitation.
Target Population: The target population for this program is all low-income women and men of reproductive age and capacity, with an increased focus on underserved/high risk populations (e.g., uninsured, individuals < 25 years of age, persons with limited English proficiency, and homeless and/or incarcerated individuals). However, no individual may be denied services based on their financial status or ability (or inability) to pay.
Applicants must describe how they will assure the following: 1) that persons with household incomes that fall at or below 100% of the current Federal Poverty Level (FPL) will not be charged except where third parties are authorized or legally obligated to pay; 2) application of a Schedule of Discounts for Title X services and methods/supplies for household incomes between 101% and 250% of the Federal Poverty Level (FPL) (updated annually) that slides to zero charges to the client based on income and family size; and 3) a financial management system for billing and collection of all applicable charges to Title X clients and/or all third parties legally responsible for paying those charges (e.g., Medicaid, private or public insurance).
The applicant must identify the minimum number of unduplicated Title X clients (male and female) they anticipate serving in the first year of participation in the Title X Program. (See Title X Family Planning Annual Report (FPAR) Forms and Instructions, rev. 10/2016: https://opa.hhs.gov/evaluation-research/title-x-services-research/family-planning-annual-report/family-planning-annual for the definitions of “Family Planning User” and “Family Planning Encounter” in determining the number of clients to be served.) The proposal must provide data and justification to support the proposed number of clients to be served in the first year, including a breakdown of the age groups and income levels of the population to be served (See FPAR Tables 1 and 4 for data formats). If general conditions of section 3.05 are met, DHSS Title X Project staff will work with Grantees to determine minimum targets for Title X clients to be served in future funding periods.
Funds available for this program are anticipated to total $90,000 for the period of January 1 - June 30, 2021, and up to $280,000 total for the duration, for one new agency. The State receives funding from the federal Department of Health and Human Services (DHHS), Office of Public Health and Science, Office of Population Affairs, Office of Family Planning, Title X Program. Funding available for this procurement is contingent upon final federal and state appropriations.
DHSS Title X Project staff will allocate available funds to one successful applicant taking into account client and community needs; the number of unduplicated family planning clients served each year – including the proportion of low income clients to be served; sufficient justification of need for Project support for start-up costs in the first 6 months; and ongoing, overall agency performance under the Title X Project.
Match Requirement: The budget must include matching funds equal to 10.00% of the proposed DHSS funds. Calculate required match with the following formula.
Total Requested Grant Award x Required Match Percentage = Required Match
Federal grant funds may not be used to match federal funds awarded through this grant program, and State grant funds may not be used to match State funds awarded through this grant program.
Eligible sources of matching funds include:
- Local Cash: local sources, including local tax receipts, municipal revenue sharing, cash donations
- Local In-Kind: donated items of value for which the applicant incurs no cost, including volunteer labor and donations of supplies, equipment, space
- Other Sources: government and non-government grant awards, third party receipts, direct receipts such as gaming or sales of goods
- Grant Income: Title X Grant income earnings anticipated as a result of this proposal receiving award, including Medicaid reimbursements, as well as other third party receipts.
- Medicaid: includes Medicaid which is not Grant Income
Reminder: As described in Section 1.04 above, all matching and additional program support funds must be reported to DHSS Title X Project via the Grantee's quarterly Cumulative Fiscal Report.
Proposed Budget: The applicant must submit a budget proposal for the first six months of their proposed Title X program. The proposed budget detail and narrative (including required match) will support the program’s results-based service delivery and staffing requirements stated in this RFP.
The proposed budget will be fully compliant with the limitations described in this RFP, and those detailed in 7 AAC 78.160 (Costs). Regulations are provided under the GEMS Documents tab.
Resources specific to budgeting are also available under the GEMS Documents tab. DHSS Grant Budget Preparation Guidelines provide information and guidance about budget lines, cost detail groupings, and narrative requirements. Grantee User Manual Part I provides detailed instructions for entering a budget proposal in the chapter "Responding to a Solicitation."
Note: Although the federal Title X Program does not restrict the amount of funds awarded under this grant to be used for administrative costs, the proposed budget must demonstrate allocation of adequate funds (from either this award or with other allowable funds, or a combination of both) for the purchase and continuous maintenance of a sufficient inventory of the contraceptive pharmaceutical methods and supplies proposed by the applicant to meet the needs of the client population proposed to be served (see Section 1.03 above for details on required documents to be submitted by the applicant).
Other Agency Funding: Prior to submitting a proposal, applicants are required to list all other agency funding received and applied for. This task must be completed by an Agency Power User in the Other Funding section of the Agency Administration tab. This is part of the pre-award risk assessment required under Uniform Guidance 2 CFR 200.
Indirect Costs: If the proposed budget includes indirect costs, 7 AAC 78.160(p) requires a copy of the agency’s current federally approved Indirect Cost Rate Agreement. The agreement is to be uploaded in the Agency Administration tab. Lapsed agreements can be used if uploaded with the negotiating federal agency’s written approval to continue using the rate until a new agreement is negotiated.
Payment for Services/Grant Income: Awarded Grantees must have a Medicaid Provider Number or apply to obtain one, and will make reasonable efforts to bill all eligible services to Medicaid and any other available sources of payment before seeking grant support for delivery of the proposed services. DHSS funds are the payer of last resort.
In the applicant’s proposed budget, anticipated receipts and expenditures for all grant income must be evident in the detail and narrative. Fiscal reports for awarded income generating programs will include the receipts and expenditure of all grant income as described in Section 1.04 above.