Statewide Youth Leadership Network

REQUEST FOR APPLICATIONS (RFA) RFA NO. 3953 PROJECT TITLE: STATEWIDE YOUTH LEADERSHIP NETWORK FOR WASHINGTON STATE PROPOSAL DUE DATE: October 11, 2019 by 2:00 p.m. Pacific Time Applications must be received via email and electronically date/time stamped on or before the due date to the following inbox: contracts@hca.wa.gov. Faxed bids will not be accepted. RFA, Exhibits, Amendments to RFA, Question/Answer process and ASB award notice will be posted in the Washington Electronic Business Solutions (WEBS) system. ESTIMATED TIME PERIOD FOR CONTRACT: November 16, 2019 to June 30, 2020. The Contract may be extended up to five (5) years in increments to be decided by HCA. APPLICANT ELIGIBILITY: This procurement is open to those Applicants that satisfy the minimum qualifications stated herein and that have or will be licensed for work in Washington State. mailto:

href="mailto:contracts@hca.wa.gov">contracts@hca.wa.gov Washington State Health Care Authority Page 2 of 38 RFA #3953 1. INTRODUCTION ........................................................................................................................................................ 4 PURPOSE AND BACKGROUND .............................................................................................................................. 4 BACKGROUND ...................................................................................................................................................... 6 SCOPE OF WORK ................................................................................................................................................... 7 MINIMUM QUALIFICATIONS .............................................................................................................................. 11 FUNDING ............................................................................................................................................................ 12 PERIOD OF PERFORMANCE................................................................................................................................. 12 GENERAL DEFINITIONS ....................................................................................................................................... 12 2. PROPOSAL INFORMATION ...................................................................................................................................... 15 2.1 RFA COORDINATOR ............................................................................................................................................ 15 2.2 ESTIMATED SCHEDULE OF PROCUREMENT ACTIVITIES ...................................................................................... 15 2.3 LETTER OF INTENT TO APPLY (M) MANDATORY ..................................................................................................... 16 2.4 ORAL INTERVIEW (OPTIONAL) ............................................................................................................................ 17 2.5 APPLICATION CONTENTS .................................................................................................................................... 17 3. EVALUATION AND CONTRACT AWARD ................................................................................................................... 19 3.1 EVALUATION PROCEDURE .................................................................................................................................. 19 4. GENERAL APPLICATION INFORMATION .................................................................................................................. 20 CONTRACTING WITH CURRENT OR FORMER STATE EMPLOYEES ....................................................................... 20 ADA ..................................................................................................................................................................... 21 PROPRIETARY INFORMATION / PUBLIC DISCLOSURE ......................................................................................... 21 REVISIONS TO THE RFA ....................................................................................................................................... 22 ACCEPTANCE PERIOD ......................................................................................................................................... 22 NOTIFICATION TO APPLICANTS .......................................................................................................................... 22 COMPLAINT PROCESS ......................................................................................................................................... 22 RESPONSIVENESS ............................................................................................................................................... 23 CONTRACT AND GENERAL TERMS & CONDITIONS ............................................................................................. 23 COSTS TO APPLY ................................................................................................................................................. 23 RECEIPT OF INSUFFICIENT NUMBER OF APPLICATIONS ...................................................................................... 23 NO OBLIGATION TO CONTRACT .......................................................................................................................... 23 REJECTION OF PROPOSALS ................................................................................................................................. 23 COMMITMENT OF FUNDS .................................................................................................................................. 23 INSURANCE COVERAGE (ADD OTHER INSURANCE AS REQUIRED) ...................................................................... 24 WOKERS’ COMPENSATION COVERAGE .............................................................................................................. 24 DEBRIEFING OF UNSUCCESSFUL APPLICANTS .................................................................................................... 24 PROTEST PROCEDURE......................................................................................................................................... 24 EXHIBIT A ....................................................................................................................................................................... 27 LETTER OF SUBMITTAL .............................................................................................................................................................. 27 EXHIBIT B ....................................................................................................................................................................... 28 PROJECT NARRATIVE ................................................................................................................................................................ 28 EXHIBIT C ....................................................................................................................................................................... 30 BUDGET 30 EXHIBIT D ....................................................................................................................................................................... 33 REFERENCES OF SIMILAR WORK AND LETTERS OF SUPPORT ............................................................................................................. 33 EXHIBIT E ........................................................................................................................................................................ 34 Washington State Health Care Authority Page 3 of 38 RFA #3953 CERTIFICATIONS AND ASSURANCES ............................................................................................................................................. 34 EXHIBIT F ........................................................................................................................................................................ 35 DIVERSE BUSINESS INCLUSION PLAN ........................................................................................................................................... 35 EXHIBIT G ....................................................................................................................................................................... 36 FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT DATA FORM ....................................................................................... 36 EXHIBIT H ....................................................................................................................................................................... 38 EXECUTIVE ORDER 18-03 – WORKER’S RIGHTS ............................................................................................................................ 38 Washington State Health Care Authority Page 4 of 38 RFA #3953 1. INTRODUCTION PURPOSE AND BACKGROUND The Washington State Health Care Authority (HCA), Division of Behavioral Health and Recovery (DBHR) is seeking a qualified, Community-Based Consumer-Ran Organization (CBCRO) or a Community Based Organization to develop and maintain a Statewide Youth Leadership Network (Youth Network) for Washington State. The intent of this network is to enhance the state’s capacity and youth-driven infrastructure, in an effort to be responsive to the needs and youth (ages 13-25) experiencing Serious Emotional Disturbances (SED) and their families. The Youth Network will also be responsive to the needs of the behavioral health system, including workforce development. It will reduce and remove barriers to youth voice and engagement by providing the resources and support for youth and youth leaders to participate in stakeholder groups and committees, leadership development opportunities, policy development, and in state and local service planning. Washington State Children’s Behavioral Health Principles are a set of standards, grounded in the System of Care (SOC) values and principles, which guide how the children’s behavioral health system delivers services to youth and families. These principles include: • Family and Youth Voice and Choice: Family and youth voice, choice and preferences are intentionally elicited and prioritized during all phases of the process, including planning, delivery, transition, and evaluation of services. Services and interventions are family-focused and youth-centered from the first contact with or about the family or youth. • Team based: Services and supports are planned and delivered through a multi- agency, collaborative teaming approach. Team members are chosen by the family and the youth and are connected to them through natural, community, and formal support and service relationships. The team works together to develop and implement a plan to address unmet needs and work toward the youth’s and family’s vision. • Natural Supports: The team actively seeks out and encourages the full participation of team members drawn from the youth’s and family members’ networks of interpersonal and community relationships (e.g. friends, neighbors, community and faith-based organizations). The care plan reflects activities and interventions that draw on sources of natural support to promote recovery and resiliency. • Collaboration: The system responds effectively to the behavioral health needs of involved youth in multiple systems and their caregivers, including youth in the child welfare, juvenile justice, developmental disabilities, substance abuse, primary care, and education systems. • Home and Community-based: Youth are first and foremost safely maintained in, or returned to, their own homes. Services and supports strategies take place in the most Washington State Health Care Authority Page 5 of 38 RFA #3953 inclusive, most responsive, most accessible, most normative, and least restrictive setting possible. • Culturally Relevant: Services are culturally relevant and provided with respect for the values, preferences, beliefs, culture, and identity of the participant/youth and family and their community. • Individualized: Services, strategies, and supports are individualized and tailored to the unique strengths and needs of each youth and family. They are altered when necessary to meet changing needs and goals or in response to poor outcomes. • Strengths Based: Services and supports are planned and delivered in a manner that identifies, builds on, and enhances the capabilities, knowledge, skills, and assets of the youth and family, their community, and other team members. • Outcome-based: Based on the youth and family’s needs and vision, the team develops goals and strategies, ties them to observable indicators of success, monitors progress in terms of these indicators, and revises the plan accordingly. Services and supports are persistent and flexible so as to overcome setbacks and achieve their intended goals and outcomes. Safety, stability, and permanency are priorities. • Unconditional: A youth and family team’s commitment to achieving its goals persists regardless of the youth’s behavior, placement setting, family’s circumstances, or availability of services in the community. The team continues to work with the family toward their goals until the family indicates that a formal process is no longer required. It is expected that the work completed under this proposal will be youth driven, meaning that the contractor is dedicated to authentic youth involvement, listens to youth and makes changes accordingly, creates a safe place for youth to be heard throughout the community, and compensates youth leaders and youth for their work. It is also expected that the work will be community based and not only culturally and linguistically competent, but completed through a lens of awareness around racial disparities in the behavioral health system and other youth serving systems. The purpose of the work completed, as a result of this proposal, will be to create a youth driven environment in which youth and youth leaders from across the state have a platform to bring their voice forward and become part of workgroups, committees, etc. to bring youth voice forward to affect policies. This will include partnering with DBHR in assisting and supporting systems and communities in bringing forward youth voice and leadership in Washington State through various methods The Youth Network will demonstrate a commitment to developing a SOC community that works toward being family-driven and youth guided in all areas from practice to policy. According to the Cooperative Agreements for Comprehensive Community Mental Health Services for Children and Their Families Program Request for Applications (RFA), “Youth Guided means that young people have the right to be empowered, educated, and given a Washington State Health Care Authority Page 6 of 38 RFA #3953 decision making role in the care of their own lives as well as the policies and procedures governing care for all youth in the community, state and nation.” HCA intends to award one contract to a Community-Based Consumer-Ran Organization (CBCRO) or a Community Based Organization licensed to do business in Washington State who have demonstrated experience engaging youth and/or families and can also demonstrate their commitment to a youth driven approach to meeting the requirements of the contract awarded as a result of this RFA and can demonstrate SOC Values in their current work and in their bid for the work outlined in this Request for Application. The selected applicant will be expected to complete deliverables from a youth driven approach to maintain a quality and culturally competent Youth Network. Any contract awarded as a result of this procurement is contingent upon grant Notice of Award at the time of contracting. BACKGROUND In 2012, the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services, awarded a four-year Cooperative Agreement to Washington State, the SOC Grant, to improve the behavioral health outcomes of children and youth with serious emotional disturbances and their families. Washington State’s specific goals for this SOC Grant were to: • Infuse SOC values statewide in all child-serving systems. • Expand and sustain leadership roles for families, youth, and system partners. • Establish an appropriate array of services and resources statewide, including home and community based services. • Develop and strengthen a workforce that will operationalize SOC values. • Build a data management system for decision making and tracking outcomes. • Develop sustainable financing and align funding to ensure services are seamless for children, youth, and families. The Youth Network will be part of the sustainability of this SOC grant awarded in 2012 and also be vital to the current SOC grant awarded in September 2018. In 2014, to be responsive to the needs of youth experiencing Serious Emotional Disturbances (SED) or Serious Mental Illness (SMI) and their families, the Division of Behavioral Health and Recovery (DBHR) developed and rolled out Wraparound with Intensive Services (WISe). WISe is a set of intensive behavioral health services, in the last stages of implementation phase. The model provides intensive behavioral health services using a wraparound approach with a requirement that youth and/or family partners be a part of the WISe team. Services are provided in both home and community settings and are accessible to all Washington State Health Care Authority Page 7 of 38 RFA #3953 children and youth experiencing SED up to age 21 who receive or qualify for Medicaid. Through the implementation of this approach, DBHR also created a WISe Quality Plan and the Children’s Behavioral Health Governance Structure (the Governance Structure) that requires youth and family leadership and participation throughout and at all stages of implementation. A Youth Network will be paramount in enhancing and contributing to the delivery of WISe, the WISe Quality Plan, and the Governance Structure through its support of youth engagement, youth voice and youth leadership. DBHR intends to grant up to $232,000 to develop and maintain the Youth Network. HCA/DBHR reserves the right to negotiate with applicants for project scope and funding amounts. Any Contract awarded as a result of this procurement is contingent upon Grant Notice of Award at time of contracting. The estimated award period for this grant is from November 16, 2019 to June 30, 2020. Funding will be distributed on an annual schedule. Funding for the second fiscal year is contingent on satisfactory completion of all contract requirements and project success. Selected Applicant is required to submit an updated Action Plan and Budget to DBHR at the end of the contract year in order to receive funding for the next contract year. If the contractor is found to not have completed all requirements identified in the RFA and subsequent contract, the contractor may not be awarded funds for the next contract year. Funding for the next contract year is contingent on continued federal funding. HCA reserves the right to negotiate with Applicants for project scope and funding amounts. SCOPE OF WORK The awarded Applicant will, at a minimum, do the following: Develop and maintain the Youth Network for Washington State. Hold at least one (1) Face-to-Face event for a minimum of forty (40) attendees to work with Washington youth and youth leaders to support the vision created by a group of youth and youth leaders in May 2018 and develop mission, purpose, annual goals, long term strategic plan and work plan on how best to network (for example, frequency of face to face meetings, webinars, trainings or meetings via the use of technology, etc.) that honors this vision and takes it to the next step. Engage youth, families, and youth serving system partners in a community mapping activity and develop a professional, easily readable document or platform to share with the youth network and community members to identify already developed youth led programs, groups or organizations in Washington. Develop social media and modern technology plan used to continually recruit, engage and sustain youth and young person voice and leadership in the Youth Behavioral Health System as well as youth-serving cross systems such as foster care and juvenile justice. Washington State Health Care Authority Page 8 of 38 RFA #3953 Hold two (2) large events, with a minimum of forty (40) attendees, designed by youth for youth with the purpose of enhancing and growing youth leadership and workforce development. Events will also serve the purpose of recruiting, engaging and sustaining youth for regional FYSPRT’s and other venues that will benefit from youth voice and leadership to include WISe youth partner requirements. Provide consultation to youth serving systems (i.e. foster care, juvenile justice, education, etc.) connected to Youth Behavioral Health to include the creation of youth friendly resource guide as requested. Develop a process to select participants to attend national, state and local conferences to include, but not limited to, the Federation of Families for Children Mental Health Conference, and/or the iNAPS (International Association of Peer Support) conference and/ or the Peer Alternatives Conference. Develop and maintain a current distribution list with the eventual goal of having a data base to support the work. Participation support including travel support and compensation to youth or youth leaders for attendance and participation in meetings and workgroups. This would include a mechanism for providing compensation for the Statewide FYSPRT Youth Tri-Lead for their role in planning and facilitating Statewide FYSPRT meetings. Provide all reports, documentation and deliverables required and submit to DBHR on or prior to their due date. Participate in monthly check in meetings with DBHR (more frequent meetings can be requested if needed). Performance Statement of Work The Contractor shall provide the services and staff, and otherwise do all things necessary for or incidental to the performance of work, as set forth below: a. Establish an interim .5 Full Time Employee (FTE) within the organization dedicated to this project. Interim Period is estimated from November 16, 2019 through March 31, 2020. b. In collaboration with DBHR Youth Liaison, create a process to select three (3) candidates who are individuals who have relevant lived-experience as a youth experiencing behavioral health needs and/or youth-serving systems to attend a youth related conference or event. Include a chaperone policy in this process. Submit selection process, including chaperone information, and timeline for the process. c. Ensure that travel is consistent with Washington State Office of Financial Management mileage, food and travel per diem current rates as of October 1, 2019 located at following link: https://ofm.wa.gov/accounting/administrative- https://ofm.wa.gov/accounting/administrative-accounting-resources/travel Washington State Health Care Authority Page 9 of 38 RFA #3953 accounting-resources/travel. Arrange all travel by pre-paying for all expenses whenever possible. d. In collaboration with DBHR Youth Liaison, create a job description and hiring selection process for minimum of .5 FTE to be selected no later than March 31, 2020 with a start date no later than April 1, 2020. In the selection process please articulate a plan to have individuals with lived experience as a youth who have experienced behavioral health needs and/or child-serving system(s) involved in the hiring process. e. Create a sign in sheet/roster template that can be collected electronically to reflect the name, region or zip code, role (youth, family, system partner, etc.), phone number and email address of all participants in attendance at all network meetings, events, and activities related to this project. f. Create a paper and electronic evaluation form to be utilized for quality improvement purposes for network meetings and events. g. In February of 2020 host network meeting webinar #1 to collect and assess needs that are identified by the Youth Network in collaboration with DBHR Youth Liaison. Targeted participants are individuals who have relevant lived experience as a youth experiencing behavioral health needs and/or child-serving systems and may also include others who are interested in the success of the network. h. In March 2020 host network meeting webinar #2 to collect and assess needs that are identified by the Youth Network, in collaboration with DBHR Youth Liaison. Targeted participants are individuals who have relevant lived experience as a youth experiencing behavioral health needs and/or child-serving systems and may also include others who are interested in the success of the network. i. Develop a process for compensation for the Statewide FYSPRT Youth Tri-Lead for their role in planning and facilitating Statewide FYSPRT meetings. Upon approval by DBHR, provide compensation to the Statewide FYSPRT Youth Tri-lead for participating in planning and facilitating Statewide FYSPRT meetings during this contract period. j. Participation support (e.g. travel, child care services) will be provided by pre- payment or reimbursement. On a quarterly basis, submit all participant support for travel and other expenses to be determined during the contract negotiation for participation, and as requested by DBHR, and using the Participant Support Reimbursement Form. Form provided to the awarded Contractor. k. Ensure .5 FTE Project Director to complete deliverables and tasks outlined in this Performance Work Statement. The candidate in this .5 FTE position must be able to demonstrate relevant lived experience as a youth experiencing behavioral health needs. Submit the name and all information collected during the application process to DBHR Youth Liaison for approval prior to final offer. l. Submit the name of the candidate selected for the position as well as all other applicants and their resumes. m. In collaboration with DBHR Youth Liaison, develop a series of surveys to be distributed by email or other electronic method using technology to collect and assess needs that are identified by the Youth Network. Targeted participants are individuals who have relevant lived experience as a youth experiencing behavioral https://ofm.wa.gov/accounting/administrative-accounting-resources/travel Washington State Health Care Authority Page 10 of 38 RFA #3953 health needs and/or child-serving systems and may also include others who are interested in the success of the network. n. Create a draft policy and procedure for the Youth Network to ensure that the steering committee for the work of this contract consists of more than 51% of individuals who have relevant lived experience as a youth experiencing behavioral health needs. The draft policy and procedure should focus on payment of Steering Committee members. Please include constituents of the Youth Network in the development. Submit draft policy and procedure and include the detailed process used to create the policy and procedure to DBHR for approval. o. After April 1, 2020 and before May 31, 2020, host a face to face event that includes a training component relevant to the youth movement and includes training related to infrastructure development (i.e. communication strategies, necessary technology outreach, outreach, policies and procedures) of the Youth Network. This training event must also include activities to collect and assess needs that have been identified by the Youth Network. Targeted participants are individuals who have relevant lived experience as a youth experiencing behavioral health needs and/or child-serving systems and may also include others who are interested in the success of the network. p. Submit the names of three (3) participants who were selected to attend a youth related conference or event and identify the event selected, include the date and description of the event/conference. q. The following categories must be included in the assessment and collection of needs that are identified by the Youth Network as outlined in this statement of work. Submit a final report that includes outcomes of all activities and includes the following components categorized with these headings:  Education needs for Youth Network, please categorize in a proposed timeline.  Education needs for Community (i.e. stakeholders, youth serving systems, etc.) please categorize in a proposed timeline.  Internal communication needs/plan for the Youth Network.  External communication needs/plan for the larger community.  Support (i.e. travel and child care, etc.) that is needed to participate in the network and in external activities to ensure youth voice in policy and decision making to enhance quality system improvement.  Identifying current initiatives youth are interested in.  Connection, networking, and sustained engagement of the Youth Network  Skill building to enhance leadership within the Youth Network  Technical assistance needs the Youth Network identifies that would be helpful for supporting the work and sustainability of the Youth Network  Recommendations for structure (infrastructure) for the Youth Network for the next two years. Washington State Health Care Authority Page 11 of 38 RFA #3953  Selection process for steering committee members  Proposed design of an annual large event (a portion of this event must include training for the Youth Network)  Submit roster/electronic table (word or excel) of names, contacts and demographics of participants for network meetings and other events.  Community mapping activity. r. Utilizing input from activities for collecting and assessing needs, ASA will develop a youth driven selection process to establish a steering committee members for the Youth Network ensuring that membership consists of more than 51% of individuals who have relevant lived experience as a youth experiencing behavioral health needs. The steering committee will continue to be a required element of this project throughout its entirety. Submit the names and roles of steering committee members with a description of each role to DBHR for approval. Submit the youth driven selection process used to select members. s. In June 2020, host a joint webinar with WA State Children’s Behavioral Health Statewide Family Network to explore ways to connect, collaborate, and partner. MINIMUM QUALIFICATIONS The following are the minimum qualifications for Applicants: a. Be licensed to do business in the state of Washington and has been issued, or will provide a commitment that it will become licensed in Washington within thirty (30) calendar days of being selected as the Apparently Successful Applicant (ASA). b. Comply with the Washington State Office of the Chief Information Office (OCIO) safety standards. c. Community-Based Consumer-Ran Organizations (CBCROs) or a Community Based Organization. d. A minimum of one (1) year experience working with youth who have participated in youth serving systems, including but not limited behavioral health, juvenile justice system, foster care. e. Community-Based Consumer-Ran Organizations (CBCROs) or a Community Based Organization whose purpose includes youth engagement as demonstrated by mission/vision statements or other contractual documents that lend to that experience. f. Community-Based Consumer-Ran Organizations (CBCROs) or a Community Based Organization with an existing youth ran/led/driven programming that has been in operation for at least one (1) year. Washington State Health Care Authority Page 12 of 38 RFA #3953 g. Applicant must be a non-profit organization. FUNDING HCA intends to award up to $232,000 to one selected applicant to develop and maintain a Statewide Youth Leadership Network. HCA reserves the right to negotiate with applicants for project scope and funding amounts. Payment will be approved upon completion and acceptance of deliverables, see Exhibit C. Special consideration during selection will include community geographic location(s) to provide for project distribution statewide and overall risk ranking. Funding for future amendments for the next federal contract year is contingent upon future federal funding awards and on satisfactory completion of all contract requirements and project success. The selected applicant is required to submit an updated Action Plan and Budget to HCA in order to receive an Amendment to the Contract and funding for the next contractual period. If the selected applicant is found to not have completed all requirements identified in the RFA and subsequent contract, the grantee may not be awarded funds for the next contract period. PERIOD OF PERFORMANCE The initial period of performance of any contract resulting for this RFA is tentatively scheduled to begin on or about November 16, 2019 through June 30, 2020. The contract may be extended up to five (5) years in increments to be decided by HCA. No changes in terms or conditions will be permitted during these extensions unless specifically agreed to in writing. Extending the period of performance, if any, will be at the sole discretion of HCA. For administrative purposes, HCA reserves the right to distribute award of funds across multiple contracts over the time period of the grant. Any contract awarded as a result of this RFA is contingent upon the availability of funding. GENERAL DEFINITIONS Allowable Costs means costs that may be reimbursed with the funding that is provided under a Contract awarded pursuant to this Request for Application. Allowable costs shall be those costs allowed under the cost principles of Part 200—Uniform Administrative Requirements, Cost Principles, And Audit Requirements for Federal Awards. Washington State Health Care Authority Page 13 of 38 RFA #3953 Applicant means an entity or organization that submits a Proposal in response to this Request for Application. Application or Application Package or Proposal means a set of completed information submitted by an Applicant in response to this RFA. Apparent Successful Applicant (ASA) means the Applicant selected as the entity to perform the anticipated services under this RFA, subject to completion of contract negotiations and execution of a written contract. Children’s Behavioral Health Governance Structure means the inter-agency members on an Executive Team of state administrators, the Statewide Family, Youth, System Partner Round Table (FYSPRT), Regional FYSPRTs, an advisory team, and various policy workgroups who collaborate to inform and provide oversight for high-level policy-making, program planning, and decision-making in the design, development, and oversight of behavioral health care services and for the implementation of the T.R. v. Strange and Birch (originally Dreyfus and Porter) Settlement Agreement. Community-Based Organization or CBO means a public or private nonprofit organization of demonstrated effectiveness that is representative of a community, or of significant segments of a community, and that provides educational or related services to individuals in the community. This includes faith-based and religious organizations. Community-Based Consumer-Ran Organization or CBCRO means a community-based organization in which the board is made up of at least 51% of members with lived experience. Complaint means a process that may be followed by a prospective Applicant that alerts HCA of certain types of asserted deficiencies in the Request for Application. Contract or Funded Program Contract means an agreement between HCA and a Selected Applicant to carry out the Selected Applicant’s Proposal. Contractor means [Contractor Name], its employees and agents. Contractor incudes any firm, provider, organization, individual or other entity performing services under this Contract. It also includes any Subcontractor retained by Contractor as permitted under the terms of this Contract. DBHR means Washington State Health Care Authority - Division of Behavioral Health and Recovery. Debriefing means a meeting process where an Applicant who is not selected for a Contract may request with the Coordinator following the announcement of the Selected Applicants, for the purpose of receiving information regarding the review and evaluation of that Applicant’s Proposal. Effective Date means the first date this Contract is in full force and effect. It may be a specific date agreed to by the parties; or, if not so specified, the date of the last signature of a party to this Contract. Washington State Health Care Authority Page 14 of 38 RFA #3953 Health Care Authority or HCA Means the Washington State Health Care Authority, any division, section, office, unit or entity of HCA, or any officers or other officials lawfully representing HCA, and is the executive agency of the state of Washington that is issuing this RFA. Project Narrative means a requirement to provide written answers to the questions on Exhibit B titled; Project Narrative, that describe the programs an Applicant seeks to carry out if awarded a Contract. Proposal/Application means a formal offer submitted in response to this solicitation. Proprietary Information means information owned by Contractor to which Contractor claims a protectable interest under law. Proprietary Information includes, but is not limited to, information protected by copyright, patent, trademark, or trade secret laws. Protest means a process described in this RFA whereby an Applicant who is not selected for a Contract and has participated in a Debriefing may alert HCA to specific types of alleged errors in the evaluation of the Application. RCW means the Revised Code of Washington. All references in this Contract to RCW chapters or sections include any successor, amended, or replacement statute. Pertinent RCW chapters can be accessed at: https://apps.leg.wa.gov/rcw/ Regional Family Youth System Partner Round Table or Regional FYSPRT means an essential part of the Governance Structure that meaningfully engages families and youth, system partners, governmental partners, tribal governments, tribal organizations and others who are interested in and committed to the success of youth and families in an equitable forum to identify regional needs, review regional data, problem-solve and address issues at the regional levels to improve outcomes, and bring unresolved needs forward to the Statewide FYSPRT with recommendations about how to meet those needs. Regional FYSPRTs are grounded in the Washington State Children’s Behavioral Health Principles. One of their primary responsibilities is to meaningfully engage youth and families in the implementation of the T.R. v Strange and Birch (originally Dreyfus and Porter) Settlement Agreement. Request for Applications (RFA) means a formal procurement document in which a service or need is identified but no specific method to achieve it has been chosen. The purpose of an RFA is to permit the applicant community to suggest various approaches to meet the need at a given price. RFA Coordinator means an employee of the HCA who is designated on the cover page of this RFA and is who responsible for conducting this RFA Process. RFA Notification Websites – Washington Electronic Business Solutions (WEBS) means an electronic state government website listed at the bottom of page 1 of this RFA, on which notifications relating to this RFA shall be posted. HCA encourages all Applicants to participant in the WEBS system. RFA will also be posted in the HCA website. https://apps.leg.wa.gov/rcw/ Washington State Health Care Authority Page 15 of 38 RFA #3953 Subrecipient means a contractor operating a federal or state assistance program receiving federal funds and having the authority to determine both the services rendered and disposition of program. See OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501, “Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards for additional detail. Wraparound with Intensive Services or WISe means a program model that provides intensive mental health services and supports, in home and community settings, for Medicaid eligible individuals, up to twenty-one (21) years of age, with complex behavioral health needs and their families, in compliance with the T.R. v Strange and Birch (originally Dreyfus and Porter) Settlement Agreement. 2. PROPOSAL INFORMATION 2.1 RFA COORDINATOR The RFA Coordinator is the sole point of contact in HCA for this procurement. All communication between the Applicant and HCA upon release of this RFA must be with the RFA Coordinator, as follows: Name Laura Shayder E-Mail Address contracts@hca.wa.gov Mailing Address P O Box 42702 Olympia, WA 98501 Physical Address for Delivery 626 8th Avenue SE Olympia, WA 98501 Any other communication will be considered unofficial and non-binding on HCA. Applicants are to rely on written statements issued by the RFA Coordinator. Communication directed to parties other than the RFA Coordinator may result in disqualification of the Applicant. 2.2 ESTIMATED SCHEDULE OF PROCUREMENT ACTIVITIES Issue Requests for Application August 22, 2019 Letter of Intent to Apply Due September 13 at 2:00pm Pacific Time Applicants Questions Due September 20 at 2:00pm Pacific Time HCA Responses to Questions Posted September 27, 2019 Washington State Health Care Authority Page 16 of 38 RFA #3953 Applications Due October 11, at 2:00 pm Pacific Time Evaluate Written Applications October 11 - 18, 2019 Remaining Time if Oral Interviews are NOT Conducted Announce “Apparent Successful Applicant” and send notification via e-mail to unsuccessful Applicants October 24, 2019 Holding Debriefing Deadline (if requested) October 29, 2019 Contract Negotiations October 24 – November 15, 2019 Contract Start Date November 16, 2019 Remaining Timeline if Oral Interviews are Conducted Conduct Oral Interviews October 24 – 25, 2019 Announce “Apparent Successful Applicant” and send notification via e-mail to unsuccessful Applicants October 29, 2019 Debrief Request Deadline (if requested) November 1, 2019 Contract Negotiation November 1 – 15, 2019 Contract Start Date November 16, 2019 HCA reserves the right in its sole discretion to revise the above schedule. 2.3 LETTER OF INTENT TO APPLY (M) Mandatory To be eligible to submit an Application, an Applicant must submit a Letter of Intent to Apply. The Letter of Intent to Apply must be emailed to the RFA Coordinator, listed in Section 2.1, and must be received by the RFA Coordinator no later than the date and time stated in the Procurement Schedule, Section 2.2. The subject line of the email must include the following: [RFA #] – Letter of Intent to Apply – [Your entity’s name]. The Letter of Intent to Apply is preferred to be attached to the email as a separate document, in Word or PDF, or the information may be contained in the body of the email. Information in the Letter of Intent to Apply should be placed in the following order:  Applicant’s Organization Name; Washington State Health Care Authority Page 17 of 38 RFA #3953  Applicant’s authorized representative for this RFA (who must be named the authorized representative identified in the Applicant’s Application);  Title of authorized representative;  Address, telephone number, and email address;  Statement of intent to propose; and  A statement of how the Applicant meets ALL of the minimum requirements specified in Section 1.4 of this RFA. HCA may use the Letters of Intent to Apply as a pre-screening to determine whether Minimum Qualifications are met. 2.4 ORAL INTERVIEW (OPTIONAL) After evaluating the Project Narrative, HCA may elect to schedule Oral Interviews to be made by up to the top three (3) Applicants to HCA representatives to provide additional details on specific services or capabilities of the Applicant. Successful Applicants moving to the Oral Interview phase will be contacted by the RFA Coordinator. The location of these mandatory scored oral interviews will be held at the Washington State Health Care Authority, located at 626 8th Avenue, Olympia, Washington, 98501. All prospective Applicants should arrange their schedule to attend at HCA. However, if unable to attend, Applicant must schedule a web-conference for their designated timeframe. A copy of the questions will be emailed to each prospective Applicant prior to the oral interview. Interview times will be approximately 1 to 1.5 hours in length and the schedule is to be determined. HCA will be bound only to HCA written answers to questions. Questions arising from these oral interviews or in subsequent communication with the RFA Coordinator will be documented and answered in written form. 2.5 APPLICATION CONTENTS The application must be received by the RFA Coordinator no later than the Proposal Due deadline in Section 2.2, Estimated Schedule of Procurement. Applications must be submitted electronically as an attachment to an e-mail to the RFA Coordinator at the e-mail address listed in Section 2.1. Attachments to e-mail should be in Washington State Health Care Authority Page 18 of 38 RFA #3953 Microsoft Word format or PDF. Zipped files cannot be received by HCA and cannot be used for submission of proposals. The cover submittal letter and the Certifications and Assurances form must have a scanned signature of the individual within the organization authorized to bind the Applicant to the offer. HCA does not assume responsibility for problems with Applicant’s e-mail. If HCA e-mail is not working, appropriate allowances will be made. Proposals may not be transmitted using facsimile transmission. Applicants should allow sufficient time to ensure timely receipt of the proposal by the RFA Coordinator. Late proposals will not be accepted and will be automatically disqualified from further consideration, unless HCA e-mail is found to be at fault. All proposals and any accompanying documentation become the property of HCA and will not be returned. Application submission shall include the following: Exhibit A Letter of Submittal Exhibit B Project Narrative Exhibit D References of Similar Work and Letters of Support Exhibit E Certifications and Assurances Exhibit F Diverse Business Inclusion Plan Exhibit G Federal Funding Accountability Form (FFATA) Exhibit H Executive Order 18-03 If you need technical assistance using or accessing these documents, please email contracts@hca.wa.gov. HCA will not accept late Applications, nor grant time extensions for individual Applicants. HCA will disqualify any Application and withdraw it from consideration if it is received after the Response submission due date and time. a. Exhibit A: Letter of Submittal. (Mandatory - Not Scored) Contractor must complete this form and be signed and dated by a person authorized to legally bind Applicant to a contractual relationship. b. Exhibit B: Project Narrative (Mandatory - Up to 200 points available). The Project Narrative will be scored according to how well the Applicant answers each question using the criteria below. Each narrative question will be assessed when determining the score for each question. If an applicant cannot answer a specific question, then the reason for this must be explained within the answer to the question. Responses to the questions in the Project Narrative should be no longer than ten (10) pages total. If the Project Narrative is incomplete or includes federally unallowable costs, the application may be disqualified. c. Exhibit D: References of Similar Work and Letters of Support (Mandatory – Not Scored). Applicant must provide letters from Coalition or Community representatives demonstrating support for the proposed Program. d. Exhibit E: Certifications and Assurances. (Mandatory – Not Scored) Contractor must complete this form. mailto:contracts@hca.wa.gov Washington State Health Care Authority Page 19 of 38 RFA #3953 e. Exhibit F: Diverse Business Inclusion Plan (Mandatory - Not Scored) f. Exhibit G: FFATA Form (Mandatory - Not Scored) Contractor must complete this form, and indicate its selection of the Programs it proposes to carry out. g. Exhibit H: Executive Order (Mandatory – Scored) Pursuant to RCW 39.26.160(3) and consistent with Executive Order 18-03 – Supporting Workers’ Rights to Effectively Address Workplace Violations (dated June 12, 2018), HCA will evaluate Applications for best value and provide a bid preference in the amount of 10 points to any Applicant who certifies, pursuant to the certification attached as Exhibit H, that their firm does NOT require its employees, as a condition of employment, to sign or agree to mandatory individual arbitration clauses or class or collective action waiver. Applicant that do require their employees, as a condition of employment, to sign or agree to mandatory individual arbitration clauses or class or collective action waiver will not be disqualified evaluation of this RFA, however they will receive 0 points for this section. 3. EVALUATION AND CONTRACT AWARD 3.1 EVALUATION PROCEDURE Scoring Criteria Responsive Applications will be evaluated strictly in accordance with the requirements stated in this RFA and any addenda issued. The evaluation of Applications will be accomplished by an evaluation team(s), to be designated by HCA, which will determine the ranking of the Applications. Evaluations will only be based upon information provided in the Applicant’s Application. All Applications received by the stated deadline, Section 2.2, Estimated Schedule of Procurement Activities, will be reviewed by the RFA Coordinator to ensure that the Applications contain all of the required information requested in the RFA. Only responsive Applications that meet the requirements will be evaluated by the evaluation team. Any Applicant who does not meet the stated qualifications or any Application that does not contain all of the required information will be rejected as non-responsive. The RFA Coordinator may, at his or her sole discretion, contact the Applicant for clarification of any portion of the Applicant’s Application. Applicants should take every precaution to ensure that all answers are clear, complete, and directly address the specific requirement. Responsive Applications will be reviewed and scored by an evaluation team using a weighted scoring system, Section 3.1, Evaluation Procedure. Applications will be evaluated strictly in accordance with the requirements set forth in this RFA and any addenda issued. HCA, at its sole discretion, may elect to select the top three (3) scoring Applicants as finalists for an oral interview. Washington State Health Care Authority Page 20 of 38 RFA #3953 Place all responses and required information under the correct question. Do not direct reviewers to information related to one question in another question or section. Each question must be answered in its entirety within the numbered question’s answer. All pertinent information must be included in the response in the respective section for appropriate scoring. The following weighting and points will be assigned to the proposal for evaluation purposes: Maximum Points Exhibit B – Project Narrative 200 Executive Order 18-03 10 Total if Oral Interviews are NOT Conducted 210 Oral Interviews (OPTIONAL) 200 Total if Oral Interviews are Conducted 410 Scoring Points and Point Standards: Total points available are as follows: Score Qualifier Description for Project Narrative 4 Exceptional The Applicant has provided an innovative, detailed, outstanding, efficient approach or established, by presentation of material, far superior capability in this area. 3 Above Average The Applicant has demonstrated an elevated, better than average, capability of solution to meet this criterion and has described its approach in sufficient detail “as substantially” meeting minimum requirements. 2 Average The Applicant has established the “baseline starting point” showing some mode of capability to perform the requirement but descriptions regarding their approach are not sufficient to grade a higher score. 1 Substantially Below Minimum The Applicant has not established the capability to perform the requirement, has marginally described its approach, or has simply restated the requirement. 0 No Value Failing The Applicant has omitted any discussion of this requirement or the information provided is of no value. 4. GENERAL APPLICATION INFORMATION CONTRACTING WITH CURRENT OR FORMER STATE EMPLOYEES Washington State Health Care Authority Page 21 of 38 RFA #3953 Specific restrictions apply to contracting with current or former state employees pursuant to chapter 42.52 of the Revised Code of Washington (RCW). Applicants should familiarize themselves with the requirements prior to submitting a proposal that includes current or former state employees. ADA HCA complies with the Americans with Disabilities Act (ADA). Applicants may contact the RFA Coordinator to receive this RFA in Braille or on tape. PROPRIETARY INFORMATION / PUBLIC DISCLOSURE Applications submitted in response to this RFA will become the property of HCA. All Applications received will remain confidential until the Apparently Successful Applicant is announced; thereafter, the Applications will be public records available to the public under chapter 42.56 of the RCW. Any information in the Application that the Applicant desires to claim as proprietary and exempt from disclosure under chapter 42.56 RCW, or other state or federal law that provides for the nondisclosure of a document or information, must be clearly designated. In a cover letter to the Application, the specific information must be clearly identified in a table or list and the particular exemption from disclosure upon which the Applicant is making the claim must be cited. In addition, each page containing the information claimed to be exempt from disclosure must be clearly identified by the words “Proprietary Information,” “Confidential Information,” or the like, printed on the page. Marking the entire proposal exempt from disclosure or as Proprietary Information will not be honored. If a public records request is made for the information that the Applicant has marked as “Proprietary Information,” HCA will notify the Applicant of the request and of the date that the records will be released to the requester unless the Applicant obtains a court order enjoining that disclosure. If the Applicant fails to obtain the court order enjoining disclosure, HCA will release the requested information on the date specified. If the Applicant obtains a court order from a court of competent jurisdiction enjoining disclosure pursuant to chapter 42.56 RCW, or other state or federal law that provides for nondisclosure, HCA will maintain the confidentiality of the Applicant’s information per the court order. A charge will be made for copying and shipping, as outlined in chapter RCW 42.56. No fee will be charged for inspection of contract files, but one (1) business days’ notice to the RFA Coordinator is required. All requests for information should be directed to the RFA Coordinator. The submission of any public records request to HCA pertaining in any way to this RFA will not affect the procurement schedule, as outlined in Section 2.2, unless HCA, in its sole discretion, determines that altering the schedule would be in HCA’s best interests. Washington State Health Care Authority Page 22 of 38 RFA #3953 REVISIONS TO THE RFA If HCA determines in its sole discretion that it is necessary to revise any part of this RFA, then HCA will provide addenda via e-mail to all individuals who have made the RFA Coordinator aware of their interest. Addenda will also be published on Washington’s Electronic Bid System (WEBS), at https://fortress.wa.gov/ga/webs/. For this purpose, the published questions and answers and any other pertinent information will be provided as an addendum to the RFA and will be placed on the website. HCA also reserves the right to cancel or to reissue the RFA in whole or in part, prior to execution of a contract. ACCEPTANCE PERIOD Applications must provide one-hundred twenty (120) calendar days for acceptance by HCA from the due date for receipt of Applications. NOTIFICATION TO APPLICANTS HCA will notify the ASAs of their selection in writing upon completion of the evaluation process. Applicants whose proposals were not selected for further negotiation or award will be notified separately by e-mail. COMPLAINT PROCESS Vendors may submit a complaint to HCA based on any of the following:  The RFA unnecessarily restricts competition;  The RFA evaluation or scoring process is unfair or unclear; or  The RFA requirements are inadequate or insufficient to prepare a response. A complaint must be submitted to HCA prior to five (5) business days before the Application response deadline. The complaint must:  Be in writing;  Be sent to the RFA Coordinator in a timely manner;  Clearly articulate the basis for the complaint; and  Include a proposed remedy. The RFA Coordinator will respond to the complaint in writing. The response to the complaint and any changes to the RFA will be posted on WEBS. The Director of HCA will be notified of all complaints and will be provided a copy of HCA’s response. An Applicant cannot raise during a bid protest any issue that the Applicant raised in a complaint. HCA’s action or inaction in response to a complaint will be final. There will be no appeal process. https://fortress.wa.gov/ga/webs/ Washington State Health Care Authority Page 23 of 38 RFA #3953 RESPONSIVENESS The RFA Coordinator will review all proposals to determine compliance with administrative requirements and instructions specified in this RFA. An Applicant’s failure to comply with any part of the RFA may result in rejection of the proposal as non-responsive. HCA also reserves the right at its sole discretion to waive administrative irregularities. CONTRACT AND GENERAL TERMS & CONDITIONS A Contract for the services provided under this RFA will be provided to those Applicants selected as ASAs. HCA and the ASAs will then negotiate the terms and conditions of the awarded services. If, after the announcement of the ASAs, and after a reasonable period of time, the ASA and HCA cannot reach agreement on acceptable terms for the Contract, the HCA may cancel the selection and Award the Contract to the next most qualified Applicant. COSTS TO APPLY HCA will not be liable for any costs incurred by the Applicant in preparation of An Application submitted in response to this RFA or any other activities related in any way to this RFA. RECEIPT OF INSUFFICIENT NUMBER OF APPLICATIONS If HCA receives only one responsive Application as a result of this RFA, HCA reserves the right to either: 1) directly negotiate and contract with the Applicant; or 2) not award any contract at all. HCA may continue to have the Applicant complete the entire RFA. HCA is under no obligation to tell the Applicant if it is the only Applicant. NO OBLIGATION TO CONTRACT This RFA does not obligate HCA to enter into any contract for services specified herein. REJECTION OF PROPOSALS HCA reserves the right, at its sole discretion, to reject any and all proposals received without penalty and not to issue any contract as a result of this RFA. COMMITMENT OF FUNDS The Director of HCA or his/her delegate is the only individual who may legally commit HCA to the expenditures of funds for a contract resulting from this RFA. No cost chargeable to the proposed contract may be incurred before receipt of a fully executed contract. Washington State Health Care Authority Page 24 of 38 RFA #3953 INSURANCE COVERAGE (ADD OTHER INSURANCE AS REQUIRED) A requirement of the resulting contract is the ASA is to furnish HCA with a Certificate(s) of Insurance executed by a duly authorized representative of each insurer, showing compliance with the insurance requirements set forth below. The ASA must, at its own expense, obtain and keep in force the minimum required insurance coverage based on entity which will be maintained in full force and effect during the term of the contract. The ASA must furnish evidence in the form of a Certificate of Insurance that insurance will be provided, and a copy must be forwarded to HCA within 15 days of the contract effective date. WOKERS’ COMPENSATION COVERAGE The ASA will at all times comply with all applicable workers’ compensation, occupational disease, and occupational health and safety laws, statutes, and regulations to the full extent applicable. The state will not be held responsive in any way for claims filed by the ASA or their employees for services performed under the terms of this contract. DEBRIEFING OF UNSUCCESSFUL APPLICANTS Any Applicant who has submitted an Applications and been notified it was not selected for contract award may request a debriefing. The request for a debriefing conference must be received by the RFA Coordinator no later than 2:00 p.m. Pacific Time within three (3) business days after the Unsuccessful Applicant Notification is e-mailed to the Applicant. The debriefing will be held within three (3) business days of the request, or as schedules allow. Discussion at the debriefing conference will be limited to the following:  Evaluation and scoring of the Application;  Critique of the Application based on the evaluation; and  Review of the Applicant’s final score in comparison with other final scores without identifying the other Applicants. Topics an Applicant could have been raised as part of the complaint process (Section 4.7) cannot be discussed as part of the debriefing conference, even if the Applicant did not submit a complaint. Comparisons between proposals, or evaluations of the other proposals will not be allowed. Debriefing conferences may be conducted in person or on the telephone and will be scheduled for a maximum of thirty (30) minutes. PROTEST PROCEDURE Washington State Health Care Authority Page 25 of 38 RFA #3953 A bid protest may be made only by Applicants who submitted a response to this RFA and who have participated in a debriefing conference. Upon completing the debriefing conference, the Applicant is allowed five business days to file a protest with the RFA Coordinator. Protests must be received by the RFA Coordinator no later than 2:00 p.m. Pacific Time on the fifth business day following the debriefing. Protests may be submitted by e-mail or by mail. Applicants protesting this RFA must follow the procedures described below. Protests that do not follow these procedures will not be considered. This protest procedure constitutes the sole administrative remedy available to Applicants under this RFA. All protests must be in writing, addressed to the RFA Coordinator, and signed by the protesting party or an authorized agent. The protest must state (1) the RFA number, (2) the grounds for the protest with specific facts, (3) complete statements of the action(s) being protested, and (4) the relief or corrective action being requested. Only protests alleging an issue of fact concerning the following subjects will be considered:  A matter of bias, discrimination, or conflict of interest on the part of an evaluator;  Errors in computing the score; or  Non-compliance with procedures described in the RFA or HCA requirements. Protests based on anything other than those items listed above will not be considered. Protests will be rejected as without merit to the extent they address issues such as: 1) an evaluator’s professional judgment on the quality of a Proposal; or 2) HCA’s assessment of its own needs or requirements. Topics an Applicant could have been or were raised as part of the complaint process (Section 4.718) can’t be included as part of the protest process. Upon receipt of a protest, HCA will undertake a protest review. The HCA Director, or an HCA employee delegated by the HCA Director who was not involved in the RFA, will consider the record and all available facts. If the HCA Director delegates the protest review to an HCA employee, the Director nonetheless reserves the right to make the final agency decision on the protest. The HCA Director or his or her designee will have the right to seek additional information from sources he or she deems appropriate in order to fully consider the protest. If HCA determines in its sole discretion that a protest from one Applicant may affect the interests of another Applicant, then HCA may invite such Applicant to submit its views and any relevant information on the protest to the RFA Coordinator. In such a situation, the protest materials submitted by each Applicant will be made available to all other Applicants upon request. The final determination of the protest will:  Find the protest lacking in merit and uphold HCA’s action; or  Find only technical or harmless errors in HCA’s acquisition process and determine HCA to be in substantial compliance and reject the protest; or Washington State Health Care Authority Page 26 of 38 RFA #3953  Find merit in the protest and provide options to the HCA Director, which may include:  Correct the errors and re-evaluate all Proposals; or  Issue a new solicitation document and begin a new process; or  Make other findings and determine other courses of action as appropriate. If the protest is not successful, HCA will enter into a contract with the ASA(s), assuming the parties reach agreement on the contract’s terms. Washington State Health Care Authority Page 27 of 38 RFA #3953 EXHIBIT A Letter of Submittal  The Letter of Submittal must be signed and dated by a person authorized to legally bind the Applicant to a contractual relationship, e.g., the President or Executive Director if a corporation, the managing partner if a partnership, or the proprietor if a sole proprietorship. Along with introductory remarks, the Letter of Submittal is to include by attachment the following information about the Applicant and any proposed subcontractors:  Name, address, principal place of business, telephone number, and fax number/e-mail address of legal entity or individual with whom contract would be written.  Name, address, and telephone number of each principal officer (President, Vice President, Treasurer, Chairperson of the Board of Directors, etc.).  Legal status of the Applicant (sole proprietorship, partnership, corporation, etc.) and the year the entity was organized to do business as the entity now substantially exists.  Federal Employer Tax Identification number or Social Security number and the Washington Uniform Business Identification (UBI) number issued by the state of Washington Department of Revenue. If the Applicant does not have a UBI number, the Applicant must state that it will become licensed in Washington within 30 calendar days of being selected as the Apparently Successful Applicant.  Location of the facility from which the Applicant would operate.  Identify any state employees or former state employees employed or on the firm’s governing board as of the date of the Application. Include their position and responsibilities within the Applicant’s organization. If following a review of this information, it is determined by HCA that a conflict of interest exists, the Applicant may be disqualified from further consideration for the award of a contract.  Any information in the Application that the Applicant desires to claim as proprietary and exempt from disclosure under the provisions of RCW 42.56 must be clearly designated. The page must be identified and the particular exemption from disclosure upon which the Applicant is making the claim must be listed. Each page claimed to be exempt from disclosure must be clearly identified by the word “Proprietary” printed on the lower right hand corner of the page. In your Letter of Submittal, please list which pages and sections that have been marked “Proprietary” and the particular exemption from disclosure upon which the Applicant is making the claim. Washington State Health Care Authority Page 28 of 38 RFA #3953 EXHIBIT B Project Narrative Please provide complete information to the following questions. The weight for each question as well as the maximum total points are reflected next to each question. The Project Narrative will be scored according to how well the applicant answers each question and Section 3 of the RFA. If an applicant cannot answer a specific question, then the reason for this must be explained within the answer to the question. Responses to the questions in this Exhibit B, Project Narrative should be no longer than 10 pages total. Be sure to include page numbers, RFA short-title, RFA number, and the name of the applicant community on the footer of each page. Questions Weight Maximum Points 1. Provide a list of the grants the Applicant has applied for, as well as the list of all the grants/contracts the Applicant has been awarded in the last five (5) years. The list should include: the amount received, the purpose, description of the successes and challenges of each. 3 12 2. Provide the Applicant’s mission/vision statements, policies and procedures and previous contract requirements and anything else the Applicant feels is relevant to youth engagement and leadership that is on record within the Applicant organization. Include origination dates of the policies and procedures and well as a description of the evolution of these policies and procedures. 3 12 3. Describe the Applicant’s knowledge of the function of Regional FYSPRT’s and the various roles of those involved with the FYSPRT’s. 7 28 4. Describe the Applicant’s understanding of System Of Care (SOC) Values and Guiding Principles and how the Applicant’s organization has incorporated and modeled these values in daily work. Include experience you have had related to SOC. 7 28 5. Describe how the Applicant has engaged youth and youth leaders from diverse backgrounds, including but not limited to LGBTQ, youth of color, gender, and economical suppressed areas. Please include lessons learned and describe how you might engage youth differently for this project. 10 40 6. Describe how the Applicant has engaged in work relating to implicit biases and micro-aggressions as it relates to youth culture and to the workforce for 10 40 Washington State Health Care Authority Page 29 of 38 RFA #3953 Behavioral health. Please include lesson learned and describe how you might engage youth differently for this project. 7. Describe how the Applicant has collaborated with youth serving systems (i.e. County level Juvenile Justice, State Juvenile Rehabilitation, Foster Care, Homelessness, and Substance Use Treatment). Please include lesson learned and describe how you might engage youth differently for this project. 10 40 Total 200 Washington State Health Care Authority Page 30 of 38 RFA #3953 EXHIBIT C Budget Sample Budget and Deliverables Table Activities from November 16th, 2019 to June 30, 2020 Deliverable Anticipated Due Date Payment Submit the name of Interim .5 FTE. December 15, 2019 15,000 Submit selection process, including chaperone information with timeline for 3 individuals to attend a youth related conference or event. December 15 , 2019 8,000 Submit a job description and hiring selection process for .50 permanent FTE. Please articulate your plan to have individuals with lived experience as a youth, participate in the hiring process. January 10, 2020 5,000 Submit final sign in sheet/roster electronic template to be used to collect names, contacts, and demographics of participants for network meetings and other events. January 10, 2020 4,200 Submit evaluation templates (paper and electronic) to be utilized for quality improvement purposes for network meetings and events. January 10, 2020 4,200 Submit process for compensation for the Statewide FYSPRT Youth Tri-Lead. January 10, 2020 2,000 Show evidence of compensation to Statewide FYSPRT Youth Tri-lead. April 10, 2020 June 30, 2020 Up to 1000 Submit sign in sheet/roster for network meeting webinar 1 April 10, 2020 2,100 Submit sign in sheet roster for network meeting webinar 2 April 10, 2020 2,100 Submit all participant support for travel and other expenses for January 10, 2020 up to 4,500 Washington State Health Care Authority Page 31 of 38 RFA #3953 participation, and as requested by DBHR on the Participant Support Reimbursement Form. (contract start date – December 31, 2019) April 10, 2020 (January 1 – March 31, 2020) June 30, 2020 (April 1 – June 30, 2020) Submit names and qualifications of the final candidate for a minimum .5 FTE to DBHR for approval, prior to an offer of employment. Complete all hiring steps for the .5 FTE. Submit a report that includes all candidates’ that applied and their resumes. Submit the name of candidate selected for the position and all other applicants and their resumes. April 10, 2020 15,000 Submit proof of Survey distributions for this project June 30, 2020 6,000 Submit draft policy and procedure to DBHR for approval that guides payment of Steering Committee members June 30, 2020 3,000 Host a face to face event that includes a training component relevant to the youth movement and includes training related to infrastructure/organizational development. This training event shall also include activities to collect and assess needs that are identified by the Youth Network. Submit final agenda and sign in sheet. June 30, 2020 15,000 Submit a final report that includes outcomes of all activities and includes the components categorized. Submit roster/electronic table (word or excel) of names, contacts and demographics of participants for network meetings and other events. June 30, 2020 2,000 Washington State Health Care Authority Page 32 of 38 RFA #3953 Submit the names of 3 participants who attended the youth related conference or event. June 30, 2020 2,000 Submit the youth driven selection process used to select members of the Steering Committee. Submit the names and roles of steering committee members with a description of each role to DBHR for approval. June 30, 2020 2,000 Submit a report of discussion and outcomes from webinar with Family Network. June 30, 2020 2,000 Washington State Health Care Authority Page 33 of 38 RFA #3953 EXHIBIT D References of Similar Work and Letters of Support Applicants are required to provide three (3) Work References demonstrating effective youth engagement and SOC values implementation. Submit one (1) page per Work Reference. Applicants are required to provide three (3) Letters of Support from a Coalition or Community representatives demonstrating their support for the Applicant’s project proposal. Submit one (1) page per Letter of Support It is acceptable for a Work Reference and Letter of Support to be within one document per reference/supporter, as long the file is appropriately labeled and it meets the content requirements described above within Exhibit D. Washington State Health Care Authority Page 34 of 38 RFA #3953 EXHIBIT E Certifications and Assurances I/we make the following certifications and assurances as a required element of the Application to which it is attached, understanding that the truthfulness of the facts affirmed here and the continuing compliance with these requirements are conditions precedent to the award or continuation of the related contract: 1. I/we declare that all answers and statements made in the Application are true and correct. 2. The prices and/or cost data have been determined independently, without consultation, communication, or agreement with others for the purpose of restricting competition. However, I/we may freely join with other persons or organizations for the purpose of presenting a single Application. 3. The attached Application is a firm offer for a period of 120 days following receipt, and it may be accepted by HCA without further negotiation (except where obviously required by lack of certainty in key terms) at any time within the 120-day period. 4. In preparing this Application, I/we have not been assisted by any current or former employee of the state of Washington whose duties relate (or did relate) to this Application or prospective contract, and who was assisting in other than his or her official, public capacity. If there are exceptions to these assurances, I/we have described them in full detail on a separate page attached to this document. 5. I/we understand that HCA will not reimburse me/us for any costs incurred in the preparation of this Application. All Applications become the property of HCA, and I/we claim no proprietary right to the ideas, writings, items, or samples, unless so stated in this Application. 6. Unless otherwise required by law, the prices and/or cost data which have been submitted have not been knowingly disclosed by the Applicant and will not knowingly be disclosed by him/her prior to opening, directly or indirectly, to any other Applicant or to any competitor. 7. I/we agree that submission of the attached Application constitutes acceptance of the solicitation contents and the attached sample contract and general terms and conditions. If there are any exceptions to these terms, I/we have described those exceptions in detail on a page attached to this document. 8. No attempt has been made or will be made by the Applicant to induce any other person or firm to submit or not to submit an Application for the purpose of restricting competition. 9. I/we grant HCA the right to contact references and other, who may have pertinent information regarding the ability of the Applicant and the lead staff person to perform the services contemplated by this RFA. 10. If any staff member(s) who will perform work on this contract has retired from the State of Washington under the provisions of the 2008 Early Retirement Factors legislation, his/her name(s) is noted on a separately attached page. We (circle one) are / are not submitting proposed Contract exceptions. (See Section 2.12, Contract and General Terms and Conditions.) If Contract exceptions are being submitted, I/we have attached them to this form. On behalf of the Applicant submitting this Application, my name below attests to the accuracy of the above statement. If electronic, also include: We are submitting a scanned signature of this form with our Application. Signature of Applicant Title Date Washington State Health Care Authority Page 35 of 38 RFA #3953 EXHIBIT F Diverse Business Inclusion Plan DIVERSE BUSINESS INCLUSION PLAN (MANDATORY) Do you anticipate using, or is your firm, a State Certified Minority Business? Y/N Do you anticipate using, or is your firm, a State Certified Women’s Business? Y/N Do you anticipate using, or is your firm, a State Certified Veteran Business? Y/N Do you anticipate using, or is your firm, a Washington State Small Business? Y/N If you answered No to all of the questions above, please explain: ____________________________________________________________________________ Please list the approximate percentage of work to be accomplished by each group: Minority __% Women __% Veteran __% Small Business __% Please identify the person in your organization to manage your Diverse Inclusion Plan responsibility. Name: __________________ Phone: __________________ E-Mail: __________________ Washington State Health Care Authority Page 36 of 38 RFA #3953 EXHIBIT G Federal Funding Accountability and Transparency Act Data Form This Contract is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act). The purpose of the Transparency Act is to make information available online so the public can see how federal funds are spent. To comply with the act and be eligible to enter into this contract, your organization must have a Data Universal Numbering System (DUNS®) number. A DUNS® number provides a method to verify data about your organization. If you do not already have one, you may receive a DUNS® number free of charge by contacting Dun and Bradstreet at www.dnb.com. Required Information about your organization and this contract will be made available on USASpending.gov by the Washington State Health Care Authority (HCA) as required by P.L. 109-282. As a tool to provide the information, HCA encourages registration with the Central Contractor Registry (CCR) because less data entry and re-entry is required by both HCA and your organization. You may register with CCR on-line at https://www.uscontractorregistration.com/. Contractor must complete this form and return it to the Health Care Authority (HCA). CONTRACTOR 1. Legal Name 2. DUNS Number 3. Principle Place of Performance 3a. Congressional District 3b. City 3c. State 3d. Zip+4 3e. Country 4. Are you registered in CCR (https://www.uscontractorregistration.com/)? YES (skip to page 2. Sign, date and return) NO 5. In the preceding fiscal year did your organization: a. Receive 80% or more of annual gross revenue from federal contracts, subcontracts, grants, loans, subgrants, and/or cooperative agreements; and b. $25,000,000 or more in annual gross revenues from federal contracts, subcontracts, grants, loans, subgrants, and/or cooperative agreements; and c. The public does not have access to information about the compensation of the executives through periodic reports filed with the IRS or the Security and Exchange Commission per 2 CFR Part 170.330 NO (skip the remainder of this section - Sign, date and return) YES (You must report the names and total compensation of the top 5 highly compensated officials of your organization). Name Of Official Total Compensation 1. 2. 3. Note: “Total compensation” means the cash and noncash dollar value earned by the executive during the sub- recipient’s past fiscal year of the following (for more information see 17 CFR 229.402 (c)(2)). By signing this document, the Contractor Authorized Representative attests to the information. http://www.dnb.com/ https://www.uscontractorregistration.com/ https://www.uscontractorregistration.com/ Washington State Health Care Authority Page 37 of 38 RFA #3953 Signature of Contractor Authorized Representative Date HCA will not endorse the Contractor’s subaward until this form is completed and returned. FOR HEALTH CARE AUTHORITY USE ONLY HCA Contract Number: _________ Sub-award Project Description (see instructions and examples below) Instructions for Sub-award Project Description: In the first line of the description provide a title for the sub-award that captures the main purpose of the subrecipients work. Then, indicate the name of the subrecipient and provide a brief description that captures the overall purpose of the sub-award, how the funds will be used, and what will be accomplished. Example of a Sub-award Project Description: Increase Healthy Behaviors: Educational Services District XYZ will provide training and technical assistance to chemical dependency centers to assist the centers to integrate tobacco use into their existing addiction treatment programs. Funds will also be used to assist centers in creating tobacco free treatment environments. Washington State Health Care Authority Page 38 of 38 RFA #3953 Exhibit H EXECUTIVE ORDER 18-03 – WORKER’S RIGHTS CONTRACTOR CERTIFICATION EXECUTIVE ORDER 18-03 – WORKERS’ RIGHTS WASHINGTON STATE GOODS & SERVICES CONTRACTS Pursuant to the Washington State Governor’s Executive Order 18-03 (dated June 12, 2018), the Washington State Health Care Authority is seeking to contract with qualified entities and business owners who certify that their employees are not, as a condition of employment, subject to mandatory individual arbitration clauses and class or collective action waivers. Solicitation No.: RFA 3953 I hereby certify, on behalf of the firm identified below, as follows (check one):  NO MANDATORY INDIVIDUAL ARBITRATION CLAUSES AND CLASS OR COLLECTIVE ACTION WAIVERS FOR EMPLOYEES. This firm does NOT require its employees, as a condition of employment, to sign or agree to mandatory individual arbitration clauses or class or collective action waivers. OR  MANDATORY INDIVIDUAL ARBITRATION CLAUSES AND CLASS OR COLLECTIVE ACTION WAIVERS FOR EMPLOYEES. This firm requires its employees, as a condition of employment, to sign or agree to mandatory individual arbitration clauses or class or collective action waivers. I hereby certify, under penalty of perjury under the laws of the State of Washington, that the certifications herein are true and correct and that I am authorized to make these certifications on behalf of the firm listed herein. FIRM NAME: _____________________________________________________ Name of Contractor/Bidder – Print full legal entity name of firm By: ______________________________ Signature of authorized person Title: ______________________________ Title of person signing certificate Date: ________________________________ ___________________________________ Print Name of person making certifications for firm Place: ________________________________ Print city and state where signed