241.003 Subcontracting HIV Health and Support Services
| Policy Number | 241.003 |
| Effective Date | February 18, 2005 |
| Revision Date | January 14, 2025 |
| Subject Matter Expert | Planning Group Manager |
| Approval Authority | HIV/STD Section Director |
| Signed by | D’Andra Luna |
1.0 Purpose
To ensure the equitable and non-discriminatory selection of subcontractors, the Texas Department of State Health Services (DSHS), HIV/STD Section (Section) requires administrative agencies (AAs) to implement the processes outlined in this policy. An AA may enter into agreements with providers unless restricted or otherwise prohibited by State contract language.
2.0 Background
DSHS selects and contracts with AAs to administer and disburse funds on behalf of the DSHS. Following the guidelines in this policy, AAs select and subcontract with local agencies and individuals to provide client services in accordance with the service priorities and categorical funding allocations established in the area HIV service delivery plan.
3.0 Authority
Ryan White CARE Act, 42 U.S.C. §300ff; Uniform Grant Management Standards, Chapter III, State Uniform Administrative Requirements for Grants and Cooperative Agreements; Texas Health and Safety Code, §§85.031-85.044.
4.0 Definitions as Applied to Policy
Administrative Agency – Community-based organizations, governmental entities, and other organizations located within Texas and specifically deemed eligible in the State’s request contract responsible for ensuring a comprehensive continuum of care exists in their funded area(s). AAs accomplish this through the management, distribution, and oversight of federal and state funds and under contractual agreement with the Texas Department of State Health Services (DSHS). Administrative agencies disburse funds from DSHS through a subcontractor system to provide comprehensive services to HIV positive individuals and those affected within the HIV/AIDS Service Area(s).
Eight-Category Budget – A type of state budget that uses the following categories: Personnel, Fringe Benefits, Travel, Equipment, Supplies, Contractual, Other, Total Direct Costs, Indirect Costs, Total of Direct and Indirect Costs, and Program Income-Projected Earnings.
HIV Service Delivery Area (HSDA) – A geographic service area set by the Department of State Health Services for the purposes of allocating federal and state funds for HIV core medical and support services. The are 26 HSDAs in Texas.
Part A – Federal Ryan White HIV/AIDS Program funding for medical and support services to Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAs). EMAs and TGAs are cities/counties that are the most severely affected by the HIV epidemic. The five Part A cities in Texas are: Houston, Dallas, Fort Worth, Austin, and San Antonio.
Services – Program activities offered by a service provider on behalf of the Section for HIV or STD health, medical, and social services.
5.0 Exceptions to Policy for Ryan White Part A Cities
The Section recognizes HIV contractor solicitation and selection methods used by Part A and AAs may differ from the methods and principals in this policy. This is of particular concern for AAs responsible for both Part A and Part B funds. The Section gives these organizations an exception from the exact methodology contained in this policy but must use methods consistent with the principles of the policy. When methods used by these AAs differ from the approaches in this policy, the AA documents their contractor selection approach and informs the Section of how they accomplish the processes related in this policy in their area.
6.0 Role of the Administrative Agency
The AA has the role to distribute funds within their service area according to the declared priorities and allocations in the service delivery plan. AAs must write and sign subcontracts subject to the requirements of the primary contract with the DSHS and may be subject to approval by the Section. The AA must obtain written approval from the Section before entering into any subcontract for an administrative function. The AA has the responsibility to monitor subrecipient performance and must comply with the Universal Terms and Conditions for DSHS Contractors.
Agencies functioning in a dual role as an AA and as a direct service provider must have a formal, internal structure separating AA responsibilities from those of the service provider to eliminate conflict of interest. In addition, the AA must ensure the direct service provider does not have a competitive advantage in the selection or monitoring process. For more information regarding the roles of the AA, refer to HIV/STD Policy No. 241.001.
7.0 Provider Solicitation
7.1 Request for Proposal (RFP) development
The AA develops the RFP according to Section requirements. The Section may provide assistance or consultation in developing the RFP at the request of the AA.
7.2 Methods of notifying potential providers regarding the RFP
The Section requires AAs to publish written notice within the county or counties in which the majority of the clients whom the funds serve reside. The AA must use two or more of the following methods of notification:
- Public service announcements on radio and television
- Mail-outs via email to service providers, organizations appearing on bidders list, local chamber of commerce list, and past applicants
- Posting on the AA website or social media used by the AA to disseminate information
- Phone calls
The AA determines the content of each notice. The notice includes, but is not limited to, the following items:
- A description of eligible applicants
- A listing of categorical and eligible services included in the RFP
- Required services
- Deadline dates
- Notice of applicant meeting dates
- Contact point for the application and instructions
- The source of funding
7.3 Contract solicitation methods
A competitive RFP is an open competition in which anyone who meets the qualifications for the RFP may submit a proposal. In most cases, eligible applicants submit multiple proposals requesting funding considerations for particular service categories. An external review committee selected by the AA then reviews the proposals. The external review committee reviews and evaluates proposals and submits them to the AA for review and final funding decision. The AA must make a public announcement of the final funding decisions by service category for each HSDA. The AA determines the method of announcement.
A sole source RFP is an unusual situation in which AAs solicit a noncompetitive proposal due to one of the following circumstances:
- The requested services are only available from one source,
- An emergency need for the services does not permit the delay associated with competitive solicitation, or
- The AA determines competition as inadequate.
A single source RFP is a noncompetitive RFP, justified with restricted qualifications. The AA specifically or so narrowly defined what the item(s) or service(s) are that the AA could only procure item(s) or service(s) from a single source.
The AA must document justification and have it approved in advance by the Section for sole source and single source contracts.
7.4 Request for proposal content
The RFP contents must include the selection criteria tool AAs use to evaluate and score proposals. It must also contain the following information, depending on the type of the potential provider:
- For eight-category budget, the AA must include the following information in the proposal to provide services:
- Background of the agency
- Program objectives
- Experience delivering services to the targeted populations
- Timeline and activity plan
- Budget
- Other funding awarded or pending for similar HIV projects
- Letters indicating interagency collaboration
- Community outreach to target audience
- Project evaluation
- Quality management system description
- Assurances of licensure or certification (if applicable)
- Assurances of audit and other internal controls for funds
- All other assurances required of the primary contract with the DSHS
- For fee-for-service providers (e.g., an individual doctor, dentist, therapist, nutritionist, or home health agency), service units are reimbursable at a predetermined rate per unit including all associated costs relevant to the delivery of that service. To encourage participation of fee-for-service providers, the AA must ask for a detailed resume to include valid state licensure (if applicable) and background experience. The RFP may allow fee-for-service providers to submit a proposal which does not contain information the AA may expect of an eight-category budget provider (i.e., community outreach, project evaluation, agency background, etc.)
The RFP may also stipulate potential respondents should provide information about any special considerations that apply to the category for which the respondents submitted the proposal.
The AA must conduct RFP orientation meetings, to assist potential applicants with the application process.
AAs must:
- Announce and schedule orientation meetings in advance of the proposal submission deadline,
- Sufficiently broadcast announcements regarding orientation meetings and other pertinent information to ensure all potential applicants receive the notice in a timely manner, and
- Provide samples and examples of all information requested in the RFP.
7.5 Other suggested RFP contents
In some areas, the AA may find it difficult to attract service providers or receive only one bid for a particular service each year. These agencies may find funding services for a project period extending beyond a single year more beneficial. In this situation, the AA may consider wording the RFP to extend the project period for no more than an additional two years or a period equivalent to the project period defined in the corresponding State contract. For each year of the project period subcontractors must submit an annual negotiable budget and project plan. With such a proposal, the administrative agency makes the contract continuation dependent on such things as renewed funding, satisfactory contractor performance during the previous period, and submission of a second-year renegotiable budget.
8.0 External Review Committee
8.1 Purpose
The AA has responsibility for ensuring the external review process meets the standards set forth in this section. AAs must document actions related to the external review committee processes.
The external review committee exists to fairly and equitably evaluate proposals submitted bin response to the RFP using a selection criteria tool developed by the AA. AAs must include this selection criteria tool in the RFP. When the AA funds two or more agencies to deliver the same service, the AA decides funding amounts based on an objective and equitable process. The AA must document this process and provide it to Section staff upon request.
When the AA’s services arm also competes for services funding, the Section must approve the external review process (this includes reviewer criteria, reviewer profiles, reviewer guidance, confidentiality statements, and conflict of interest statements).
8.2 Membership
The AA selects the members of the external review committee. The AA must set up the external review committee to provide a balance of service expertise and consumer concerns. AAs can achieve a balanced membership by using the following guidelines:
- AA sets the maximum membership prior to soliciting members but must have at least three members
- The committee must include at least one person living with HIV
- The committee must include an experienced health care professional when reviewing RFP respondent responses for ambulatory medical care or case management services (this includes both medical and non-medical case management)
- The committee must include persons who have expertise in the services the respondent applies to deliver under the RFP
In addition to these requirements, the AA should consider including business professionals, representatives of faith-based organizations, and members whom HIV affects; however, appointing affected members does not relieve the AA of the obligation to seat at least one person living with HIV on the committee. The AA strives for a diverse membership in terms of race, ethnicity, sex, and age. When the selection includes more than one person living with HIV, the AA strives for a diverse representation of the customer perspective.
If the AA cannot create a committee meeting the requirements, it must document how it attempted to meet these requirements and submit this documentation to the Section for review prior to convening the external review committee.
8.3 Process
The AA develops the selection criteria tool used to evaluate proposals submitted in response to the RFP. The AA includes the tool in the RFP and must not discriminate against any class of provider. Criteria should address, but are not limited to the following topics:
- Fiscal management (e.g., qualified financial management staff, accounting system which allows for funds tracking by source, board adopted financial management procedures, incorporation as legal business entity).
- Administrative management (e.g., well defined, measurable goals and objectives, client grievance policies, clear and easily understood evaluation methods, quality management systems, relevance to service priorities).
- Service capabilities (e.g., access to target population; service delivery experience in HIV/AIDS or in providing services to similar populations; qualified staff; adequate facilities to deliver the services covered under the funding; history of cooperation and collaboration with other service providers; ability to meet national, state, or community level standards of care, service, and quality).
- Other areas deemed appropriate to ensure selected providers deliver quality services to those in need.
8.4 Conflict of Interest
Members of the external review committee have a conflict of interest if they serve as a director, trustee, salaried employee, volunteer, or otherwise materially benefit from association with any agency currently receiving funds or that may seek funds. This conflict of interest must be declared and documented, and such individuals may not serve on the external review committee.
A committee member who has awareness of an undeclared conflict of interest on the part of another member must report the conflict to the committee as a whole. The committee must disqualify the member with the conflict and dismiss the member for failure to declare the conflict of interest.
Note: Conflict of interest does not refer to a person living with HIV whose sole relationship to a Part B funded provider is as a client receiving services. To lessen concerns about bias in the process, the AA may partner with another AA to locate a client out of the area for the review committee or engage a client within their area who does not receive the services currently under review by the AA.
9.0 Subcontractor Information
The AA must submit the following to the Section as required by the Section’s RFP or renewal application:
- The Administrative Agency Contractor Data Sheet
- The Subcontractor Data Sheet
- Detailed budget information
- Other documentation as requested by the Section for all providers
10.0 Documentation
The AA must maintain all documentation supporting the selection process described in this policy as specified in the Uniform Terms and Conditions (UTC) for DSHS Contracts. The AA must keep documentation on file and available for inspection by state or federal officials upon request.
The required supporting documentation includes the following information:
- Copies of the service priorities allocations set in the plan
- Announcements published in area newspapers or other media
- Copies of RFPs and requests for renewal applications, formats for competitive proposals and documentation for sole source and single source proposals and awards
- Documentation of the criteria selection tool used to review and score proposals
- Copies of scoring sheets, minutes of meetings in which they discussed determination of funding recommendations, and resulting scores
- Lists of the external review committee membership, including a brief description of each member and their expertise or experience justifying their participation
- All waivers requested
11.0 Grievances
The respondent must submit grievances concerning service category funding allocation decisions to the AA in a manner consistent with the AA’s grievance process. The respondent must submit grievances concerning funding award decisions in writing to the AA in a manner consistent with the AA’s grievance process.
12.0 Revision History
| Date | Action | Section |
|---|---|---|
| 1/14/2025 | Extensive revision to all sections. | All |
| 10/1/2014 | Converted format (Word to HTML) | - |
| 8/10/2007 | Added note under conflict of interest | 8.4 |
| 2/10/2007 | Policy created | - |