Wisconsin Department of Health Services
Wisconsin Perinatal Quality Collaborative
Request for Application G-0400 DPH-15
For more information, contact:
Katie Gillespie
Wisconsin Department of Health Services (DHS)
Division of Public Health
(608) 266-1538
kate.gillespie@wisconsin.gov
APPLICATIONS ARE DUE FRIDAY, February 20, 2015
NO LATER THAN 3:00 PM CST
Perinatal Quality Collaborative
TABLE OF CONTENTS
TABLE OF CONTENTS......................................................................................................................................... 2
1
GENERAL INFORMATION ......................................................................................................................... 4
1.1
1.2
1.3
1.4
1.5
1.6
1.7
2
KEY DATES ................................................................................................................................................. 10
2.1
2.2
2.3
2.4
2.5
2.6
2.7
3
CLARIFICATION AND/OR REVISIONS TO RFP SPECIFICATIONS AND REQUIREMENTS ...................................... 10
REASONABLE ACCOMMODATIONS ..................................................................................................... 11
CALENDAR OF EVENTS ..................................................................................................................... 11
CONTRACT TERM ........................................................................................................................... 12
NUMBER OF CONTRACTS ................................................................................................................. 12
RETENTION OF RIGHTS .................................................................................................................... 12
VENDORNET REGISTRATION ............................................................................................................. 13
PREPARING AND SUBMITTING PROPOSALS .................................................................................. 14
3.1
3.2
3.3
3.4
4
INTRODUCTION ................................................................................................................................ 4
PURPOSE ........................................................................................................................................ 5
BACKGROUND/HISTORY .................................................................................................................... 6
DEFINITIONS ................................................................................................................................... 8
WHO MAY SUBMIT AN APPLICATION ................................................................................................... 9
REQUIRED MEETINGS AND REPORTS .................................................................................................. 10
PROCURING AND CONTRACTING AGENCY ............................................................................................ 10
GENERAL INSTRUCTIONS .................................................................................................................. 14
INCURRING COSTS .......................................................................................................................... 14
SUBMITTING THE PROPOSAL ............................................................................................................. 14
APPLICATION ORGANIZATION AND FORMAT ........................................................................................ 15
APPLICANT REQUIREMENTS ............................................................................................................... 17
4.1
APPLICANT REQUIREMENTS .............................................................................................................. 17
5
WORK PLAN TEMPLATE ....................................................................................................................... 21
6
TRANSMITTAL LETTER ......................................................................................................................... 22
7
POST AWARD REQUIREMENTS .......................................................................................................... 23
7.1
7.2
7.3
7.4
7.5
AFFIRMATIVE ACTION ..................................................................................................................... 23
CIVIL RIGHTS COMPLIANCE .............................................................................................................. 23
TOBACCO SMOKE FREE ENVIRONMENT............................................................................................... 23
BUSINESS ASSOCIATE AGREEMENT .................................................................................................... 23
PRIME CONTRACTOR AND SUBCONTRACTORS ...................................................................................... 24
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7.6
STANDARD TERMS AND CONDITIONS.................................................................................................. 24
8
APPENDIX A............................................................................................................................................... 25
9
APPENDIX B............................................................................................................................................... 26
10
ATTACHMENT A .................................................................................................................................. 27
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1
1.1
GENERAL INFORMATION
Introduction
The Department of Health Services (DHS), Division of Public Health (DPH) is pleased to announce the
availability of $200,000 in Title V grant funds to pilot a statewide Perinatal Quality Collaborative
(PQC). A statewide Perinatal Quality Collaborative (PQC) would serve as a network of perinatal care
providers and public health professionals who work to improve pregnancy outcomes for women and
infants by advancing evidence-based practices and processes through continuous quality improvement.
This project will be conducted jointly with DPH, to improve the perinatal health outcomes for
vulnerable populations in Wisconsin. The purpose of these funds is to:
a) Create a statewide PQC to address risk appropriate regional care and;
b) Promote implementation of standardized maternal and infant protocols of care.
c) Recommend and assist with implementing a medical community and public health partnership
aimed at impacting a focused determinant of infant mortality.
This grant funding must be used to pilot a Wisconsin Perinatal Quality Collaborative. Wisconsin’s DPH
Bureau of Community Health Promotion (BCHP), along with the Office of Health Informatics (OHI)
and Division of Healthcare Access and Accountability (DHCAA) are seeking to establish a collaborative
system that will improve the health and safety of women and infants, promote health equity, and
strengthen maternal and child health in Wisconsin.
The Perinatal Quality Collaborative grant will be awarded over a two-year funding period. One award
will be issued in the total amount of $200,000 ($100,000 in year one and $100,000 in year two). Funding
period year one will be from April 06, 2015 through April 05, 2016. All Year one funds must be
expended by the end of year one. No carry over or extensions will be available. Year two funding will
be awarded based on successful completion of Year one deliverables and availability of funding.
The successful applicant must be able to provide a minimum of a 75% match (cash and/or in-kind
contributions) for the awarded funding. Indirect is limited to no more than 10% of salaries and wages.
Recipients should demonstrate their ability to work collaboratively with the DPH (BCHP and OHI),
DHCAA, and other partners to seek outside funding to sustain the program. (See Appendix B for more
information).
Year one activities will focus on convening stakeholders necessary to develop the infrastructure needed
to establish regional protocols of care and develop at least one Quality Improvement initiative. The QI
initiative must include a logic model for the initiative, and data measurement/benchmarks and evaluation
elements. Key activities anticipated in Year two include continued work on establishing a regional
approach to perinatal care, establishing at least one regional best-practice care protocol; carrying out the
QI initiative; and demonstrating sustainability.
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1.2
Purpose
Grant funds must be used to complete the predetermined steps required to pilot a sustainable Perinatal
Quality Collaborativei with DPH (BCHP and OHI) and DHCAA.
1.2.1 Establish the structure and processes for a Perinatal Quality Collaborative by :

Convening stakeholders - multidisciplinary team members must include both health care
providers and payers, such as: Health plans, Medicaid, hospitals, content experts, physicians,
nurses, nutritionists, social workers, psychologists, and others including but not limited to:
tobacco prevention providers, lactation providers, sexual assault and domestic violence
providers, and community-based agencies and community members. (See Appendix A.)

Establishing priorities – must work with content advisors to set data driven priorities around
issues affecting perinatal health outcomes. Content advisors, including but not limited to: DPH
(BCHP and OHI), DHCAA, academic partners from the University of Wisconsin systems and
Medical College of Wisconsin, professional organizations, and clinicians and hospitals providing
obstetric, neonatal, and pediatric services

Risk management - Develop risk appropriate regional care and transfer protocols for the
management of high-risk maternal and neonatal care. Recommendations to include but not
limited to: care protocols establishing risk and systems that allow for a site of care change to a
higher level, establish associated quality measures, reporting system, policy incentives for
practice.

Infant mortality determinant - Identify clinical and public health issues to be addressed by the
collaborative. Include an analysis of how the determinant impacts infant mortality.

Data analysis - Use data and risk models such as Perinatal Periods of Risk Models to prioritize
action items. Examples of action items: hard stop early gestational age elective delivery policies ,
hypertension in pregnancy treatment, safe sleep hospital protocols, increased breastfeeding rates,
obesity reduction, tobacco cessation, educational readiness, maternal mental health, etc.
1.2.2 Design and implement a quality improvement initiative

Year one: Select a topic for an initial quality improvement initiative for the Perinatal Quality
Collaborative, informed by the information and partners identified in Section 4. Design a quality
improvement initiative for this topic, including a logic model, timeline, key stakeholders,
i Griffith, K., Moore, E., Berger, C., Kennedy, H., Martinez-Vidal, E., Neese-Todd, S., Finnerty, M. (2014, October). Implementing a State-Level Quality
Improvement Collaborative: A Resource Guide From the Medicaid Network for Evidence-based Treatment (MEDNET). Agency for Healthcare Research and
Quality. Retrieved from www.ahrq.gov
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measures (see 1.2.3), targets, and a plan for ongoing monitoring and reporting. It is expected that
the Collaborative will aim for a project that is broad enough in scope to allow for addressing the
problem from many angles, in multiple venues, and with roles for a variety of partners. For
example, an effort to improve breastfeeding initiation and duration might address prenatal
education and support (clinics, providers, and prenatal care coordinators), institutional practices
(hospitals), and postpartum lactation support (payers, home visitors, pediatricians).

Year two: Implement the identified quality improvement initiative in collaboration with key
partners and target sites.
1.2.3 Identify Measures

Must work with DPH (BCHP and OHI) and DHCAA, hospitals, clinics, providers, other
partners, and EHR systems where feasible to establish appropriate measurable benchmarks for
reporting, to include process and outcome measures.

Work with the partners listed above to establish a process for reporting benchmarks.

Establish or identify a website for public reporting of initiatives and outcomes
1.2.4 Evaluation and Sustainability
1.3

In collaboration with DPH (BCHP and OHI) and DHCAA identify external funding to sustain
the program beyond this grant period and submit at least one jointly written proposal.

Work with collaborative partners to conduct a rapid cycle (PDSA) evaluation of at least one
jointly agreed-upon quality improvement initiative.

Participate in the development of, and coordinate planning with the emerging statewide Maternal
and Child Health Quality Collaborative Network
Background/History
Maternal health is closely tied to the health of infants, children, and families and is a strong measure of
overall societal health. In 2012, 7.2% of all infants born in Wisconsin were of low birth weight and
10.2% were born prematurelyii. Some groups in Wisconsin have experienced disproportionately poor
outcomes, including African American, infants and mothers. From 2010 to 2012, the disparity ratio
between African American infant deaths and white infant deaths was 2.7.iii The rate of maternal
mortality in the United States is increasing. In 1990 the rate of U.S. maternal deaths was 12 per 100,000
ii Wisconsin Birth Statistics. (n.d.). Retrieved June 5, 2014, from http://www.dhs.wisconsin.gov/births/index.htm
iii Wisconsin Birth Statistics. (n.d.). Retrieved June 5, 2014, from http://www.dhs.wisconsin.gov/births/index.htm
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births; while in 2013 the rate was 28 per 100,000 birthsiv, without access to healthcare prior to
pregnancy, delayed entry into prenatal care during pregnancy, and poor follow up between pregnancies
or interconception care, opportunities to screen for and address health conditions are lost. According to
the Wisconsin Pregnancy Risk Assessment Monitoring System (PRAMS)v fewer poor women receive
prenatal care during their first trimester compared to all women in the state. Some of the barriers to early
entry into prenatal care were identified as the following:

Unaware of pregnancy

Unable to get an appointment

Insurance not active

Could not pay for appointment

Unable to get time off work and too busy

No transportation
Adequacy of prenatal care can be measured using the Kotelchuck Adequacy of Prenatal Care
Utilization, the APNCU Index, which looks at the initiation of prenatal care and the total number of
prenatal care visits from initiation until delivery. Overall 83% of Wisconsin women receive adequate
prenatal care, but only 70% of African American mothers and 49% of uninsured mothers reported
receiving adequate prenatal care.vi
This RFA defines the term perinatal as including the preconception (three months prior to pregnancy),
prenatal, intrapartum, neonatal, and infant (up to one year of life) periods. Perinatal morbidity and
mortality are linked to maternal health, quality and access to medical care, public health practices, and
socioeconomic conditions. For every maternal, fetal or infant death there are many times greater
numbers of complications that relate back to pregnancy. Among the factors that contribute to these
complications are decisions made in healthcare delivery systems that are linked to relationships between
organizations and providers. The Wisconsin Healthiest Women Initiative identified opportunities for
improving women’s health and birth outcomes through improved health care and other conditions in the
areas of (1) Build and strengthen community capacity; (2) Expand access to and affordability of high
quality services; and (3) Improve accountability by identifying and monitoring relevant information. A
statewide Perinatal Quality Collaborative (PQC) would serve as a network of perinatal care providers
and public health professionals who work to improve pregnancy outcomes for women and infants by
advancing evidence-based practices and processes through continuous quality improvement.
iv Kaiser Family Foundation - Health Policy Research, Analysis, Polling, Facts, Data and Journalism. (n.d.). Retrieved June 5, 2014, from http://kff.org/
v Wisconsin PRAMS Data Book 2009-2011-Division of Public Health, Department of Health Services. (n.d.). Retrieved from
http://www.dhs.wisconsin.gov/publications/P0/p00740.pdf
vi Wisconsin PRAMS Data Book 2009-2011-Division of Public Health, Department of Health Services. (n.d.). Retrieved from
http://www.dhs.wisconsin.gov/publications/P0/p00740.pdf
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Wisconsin does not currently have a formalized structure for perinatal regionalization. A process for
voluntary self-identification of the perinatal level of practice exists, but policy and practices can
interfere with appropriate and timely transfer of care. The Wisconsin Maternal Mortality Review
(MMR) team has identified that early and accurate diagnosis, followed by appropriate planning for
delivery, is very important to reducing severe morbidities related to complications such as maternal
hemorrhage as well as to improving infant outcomes. Currently in Wisconsin there are certain aspects of
a PQC in place:

The Wisconsin Association for Perinatal Care (WAPC) is a membership organization that
supports perinatal care providers with education and resources to deliver evidence-based, quality
perinatal care. They have also implemented a perinatal regionalization process that includes
guidance for hospitals’ self- assessment.

The Wisconsin Neonatal Perinatal Quality Collaborative is an informal network that collectively
addresses Neonatal Intensive Care Unit (NICU) processes and tracks outcomes with the Vermont
Oxford database.

The Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality is
intended to further Wisconsin’s efforts as part of this national quality improvement effort.
What is needed is the structure to effectively bring these resources and partners together in an ongoing
and sustainable fashion. This Perinatal Quality Collaborative pilot is a key component in the planned
development of a statewide Maternal and Child Health Quality Collaborative Network. It is expected
that the Perinatal Quality Collaborative will participate in the development of this statewide network
throughout the grant period and coordinate with this emerging Network structure to address
sustainability of the PQC.
1.4
Definitions
The following definitions are used through the RFP:
Agency, Department, or DHS means the Wisconsin Department of Health Services.
Agreement and Contract (used interchangeably) means the final written contract negotiated between
DHS and the contractor.
BCHP means Bureau of Community Health Promotion
CDC means Centers for Disease Control and Prevention
CoIIN means Collaborative Improvement and Innovation Network
Contractor means proposer or vendor awarded final contract.
Division/DPH: the Division of Public Health
DHCAA means the Division of Health Care Access and Accountability
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DOA means the Wisconsin Department of Administration
HIPAA refers to the Health Insurance Portability and Accountability Act of 1996
MCH means Maternal and Child Health
OHI means the Office of Health Informatics
RFA is defined as a Grant Request for Application
Subcontractor a third party who contracts with the awarded contractor for the provision of services,
which the contractor has contracted with the Department to perform.
Technical Proposal means the vendor’s proposal not including the Cost Proposal.
Proposer/Vendor means a firm submitting a proposal in response to this RFP.
State means the State of Wisconsin.
1.5
Who May Submit an Application
DPH will consider responses from Wisconsin legally incorporated agencies and organizations such as
academic institutions, community-based organizations, or hospitals. Responders must have:

Knowledge in perinatal health and healthcare

Knowledge about the major risk factors driving disparities in maternal and infant mortality and
morbidity

Experience in continuous quality improvement processes

Agreement to participate in the CoIIN to Reduce Infant Mortality

Experience in development and training of providers of perinatal care on evidence-based
practices

Experience in coalition/team building

Experience in coordinating and planning statewide education and trainings

Experience in providing training on data collection and reporting
The applying agency must have the capacity to recruit statewide organizational partners to develop a
Wisconsin Perinatal Quality Collaborative, coordinate the process for selection, oversight and
monitoring of quality improvement initiatives, and provide education, training and ongoing technical
assistance to participating health care and public health systems and providers. Please refer to the
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Sections 1, 3 and 4 of this RFA to ensure that you include all stated requirements when preparing your
grant proposal. Section 4 also provides point distribution for scoring the RFA
1.6
Required Meetings and Reports
The successful applicant will meet regularly with the DPH (BCHP and OHI) and DHCAA to discuss the
work plan, timeline, logic model and next steps, including a “kick-off” meeting at the beginning of each
year.
Quarterly progress reports, including evaluation measures will be reviewed and discussed at scheduled
face-to-face meetings with DPH (BCHP and OHI) and DHCAA
End of project report, including sustainability plan will be due approximately 90 days after the contract
period is completed.
Monitoring progress and technical assistance will be provided by DPH (BCHP and OHI) and DHCAA.
1.7
Procuring and Contracting Agency
This RFP is issued by the Wisconsin Department of Health Services, which is the sole point of contact
for the State of Wisconsin during the selection process. The person responsible for managing the
procurement process, referred to hereafter as the Procurement Manager, is Katie Gillespie.
2
2.1
KEY DATES
Clarification and/or Revisions to RFP Specifications and Requirements
Any questions concerning this RFP must be submitted in writing to Katie Gillespie at
kate.gillespie@wisconsin.gov.
Written questions must be submitted before 02/06/2015. All questions are to be submitted in nonprotected Microsoft Word format with the following subject line listed below:
Subject Line: Question G-0400 DPH-15 – Proposer Name
Telephone questions will not be accepted. Any oral responses, information, dates, and/or technical
assistance received by a prospective Proposer from the Department or Department staff shall not, in any
manner whatsoever and whether before or after the release of this RFP, be binding on the State of
Wisconsin, unless followed-up and explicitly confirmed and stated in writing by the State. Proposers
are cautioned that only formal addenda issued via VendorNet are binding.
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Vendors are expected to raise any questions, exceptions, or additions they have concerning the RFP
document at this point in the RFP process. If a vendor discovers any significant ambiguity, error,
conflict, discrepancy, omission, or other deficiency in this RFP, the vendor should notify immediately
the above named individual of such error and request modification or clarification of the RFP.
In the event that it becomes necessary to provide additional clarifying data or information, or to revise
any part of this RFP, revisions/amendments and/or supplements will be provided through the State
VendorNet system. Each proposal shall stipulate that it is predicated upon the requirements, terms, and
conditions of this RFP and any supplements or revisions thereof.
From the date of release of this RFP, until a Letter of Intent is issued, all contacts with the Department
of Health Services regarding this RFP shall be made through Katie Gillespie unless otherwise noted in
the RFP. Phone calls to state staff regarding this procurement are not permitted during the
procurement process. Violation of these conditions may be considered sufficient cause for
automatic rejection of a Proposal.
2.2
Reasonable Accommodations
The Department will provide reasonable accommodations, including the provision of informational
material in an alternative format for qualified individuals with disabilities upon request. If a vendor
needs accommodations at the outset of this RFP process, please contact the Procurement Manager (See
Section 1.7).
2.3
Calendar of Events
Listed below are specific and estimated dates and times of actions related to this Request for Proposal
(RFP). The actions with specific dates must be completed as indicated unless otherwise changed by the
State. In the event that the State finds it necessary to change any of the specific dates and times in the
calendar of events listed below, it will do so by issuing an amendment to this RFP. There may or may
not be a formal notification issued for changes in the estimated dates and times.
Date
Event
Use the “find and replace
function” to update the items
below.
Delete or add events as needed.
01/30/2015
Date of issue of the RFP (Posted to VendorNet)
02/06/2015
Written Inquiries Due: deadline for submitting written inquires,
questions, and requests for clarification
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Date
Event
Use the “find and replace
function” to update the items
below.
Delete or add events as needed.
02/11/2015 (Estimated)
Questions and Answers Posted
02/20/2015 3:00PM CST
Proposals Due: late proposals will not be accepted
03/20/2015 (Estimated)
Notification of intent to award
04/06/2015 (Estimated)
Contract Start Date
2.4
Contract Term
The contract shall be effective on the date indicated on the purchase order or the contract execution date
and shall run for one year from that date, with an option by mutual agreement of the agency and
contractor to renew for one year.
Subcontracting may be part of the response to this RFA in order to meet the criteria for the provision of
services. Proposed subcontracted entity or entities (if applicable) must be identified and included on the
RFA Response Cover Sheet.
Any Contract resulting from this RFP shall not be, in whole or in part, subcontracted, assigned, or
otherwise transferred to any other Contractor without prior written approval from the Department.
2.5
Number of Contracts
It is the intention of the State to award a single contract for the services required in this RFA. However,
the contractor shall not have exclusive rights to provide all services covered under the contract during
the term of the contract or any extension thereof. Grant awards are tentatively scheduled to be
announced on or before March 20, 2015.
2.6
Retention of Rights
The State of Wisconsin retains the right to accept or reject any or all proposals if it is deemed to be in
the best interest of the State of Wisconsin.
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2.7
VendorNet Registration
The State of Wisconsin’s purchasing information and vendor notification service is available to all
businesses and organizations that want to sell and/or provide payable services to the State. Anyone may
access VendorNet on the Internet at http://vendornet.state.wi.us to receive information on State
purchasing practices and policies, goods, and services that the state buys, and tips on selling to the State.
Vendors may use the same website address for inclusion on the bidders list for goods and services that
the organization wants to sell to the State. A subscription with notification guarantees the organization
will receive an e-mail message each time a state agency, including any campus of the University of
Wisconsin System, posts a request for bid or a request for proposal in their designated
commodity/service area(s) with an estimated value exceeding $50,000. Organizations without Internet
access receive paper copies in the mail. Increasingly, state agencies also are using VendorNet to post
simplified bids valued at $50,000 or less. Vendors also may receive e-mail notices of these simplified
bid opportunities as they are registered with the VendorNet system.
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3
3.1
PREPARING AND SUBMITTING PROPOSALS
General Instructions
The selection of a contractor will be based on the information submitted in the vendor's proposal and
may include references and any required on-site visits or oral interviews. Failure to respond to each of
the requirements in the RFP may be the basis for rejecting a response.
Elaborate proposals (e.g., expensive artwork, illustrations, advanced modeling techniques, etc.) beyond
what is sufficient to present a complete and effective vendor proposal are not necessary or desired.
3.2
Incurring Costs
The State of Wisconsin is not liable for any cost incurred by proposers in replying to this RFP.
3.3
Submitting the Proposal
Proposers must submit Proposals in strict accordance with the requirements set forth in this section. The
original application plus 4 paper copies must be submitted to:
COMMON CARRIER ADDRESS:
USPS ADDRESS:
Department of Health Services
Department of Health Services
Attn: Katie Gillespie, Procurement Manager
Attn: Katie Gillespie, Procurement Manager
Division of Public Health
Division of Public Health
Bureau of Community Health Promotion
Bureau of Community Health Promotion
1 West Wilson Street, Room 233
1 West Wilson Street, Room 233
Madison, WI 53701-2659
PO Box 2659
Madison, WI 53701-2659
All materials must be received in the prescribed formats by 02/20/2015 3:00PM CST.
Applications must be received in the Division of Public Health, Bureau of Community Health
Promotion to be time-stamped upon receipt. Applications not so stamped by the stated due date and
time will be considered late and will not be accepted. Receipt of an application by the State mail system
does not constitute receipt of an application by the Wisconsin Department of Health Services, for
purposes of this request.
To ensure confidentiality of the document, all proposals must be packaged, sealed and show the
following information on the outside of the package:
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—Proposer's name and address
—RFA Title, number and due date
Additionally, please also email one copy of your application to kate.gillespie@wisconsin.gov on or
before 3:00 PM CST Monday, February 20, 2015, the mailed copies must still meet the application
deadline. The emailed copy is for convenience only.
3.4
Application Organization and Format
The application must be organized into clearly delineated sections, as shown below. Each heading and
subheading should be separated by tabs or otherwise clearly marked. The State reserves the right to
exclude any responses from consideration that do not follow the required format as instructed below.
The grant application narrative should be 12 point font, single spaced with one-inch margins. Please
limit to 10 total pages and comply with the section limitations as described in Section 7. The 10 pages
do not include the budget worksheets, work plan or logic model. Please refer to the Proposal Checklist
(Section 6) for the required materials and in the order in which they should be addressed. Include footer
on all pages of the grant application, including the title of the program and page number.
The applicant must respond to the requested information in each of the following sections and
subsections, and responses should be clearly labeled with the following bolded headings and
subheadings and be presented in the following order:
PROPOSAL CHECKLIST
Table of Contents
Grant Proposal Form
Narrative in the following order, using these headings:
Executive Summary
Agency Capacity
Agency Experience
Work Plan Description
Evaluation and Sustainability
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Budget Narrative
Attachment A: Budget Worksheet
Work Plan (as shown in Section 4)
Transmittal Letter (Section 6)
APPENDICES
Key staff bio-sketches
Letters of endorsement or support (optional)
Relevant and appropriate materials, forms, etc. (optional)
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4
APPLICANT REQUIREMENTS
4.1
Applicant Requirements
Responses to this section must clearly demonstrate the Proposer’s capacity to meet the requirements
stated in this RFP in addition to the Proposer’s current workload. The State reserves the right to request
supplementary information deemed pertinent to assure Proposers competence, business organization,
and financial resources are adequate to perform successfully. This determination is at the sole discretion
of the Department and by submitting a proposal for this RFP the proposer agrees to these terms.
Requirements that include the word "must" or "shall” describe a mandatory requirement. Failure to meet
a mandatory requirement may disqualify your proposal. The awarded proposer must perform the
required work in accordance with all federal, state, and local rules and regulations.
To complete Section 4 of the proposal response Proposer must:
1) describe how the specifications will be met and/or provide additional information where
requested;
2) complete any required form(s) and;
3) provide a complete and detailed response to any requirement that can be fulfilled.
4.1.1 Required Sections and Scoring for Grant Applications
Executive Summary - limit 1 page

5 points
Organizational structure and staffing plan including any subcontractors as well as an
organizational chart with the individuals who will implement this project and the contract
manager identified.
Agency Capacity - limit 2 pages
10 points
Proposers must describe their capacity to address the following:

Identify and recruit organizational representation.

Develop an infrastructure for the Perinatal Quality Collaborative.

Publicly report quality improvement efforts and results.

Develop a sustainability plan.
Agency Experience - limit 3 pages
25 points
Proposers must describe their experience with the following:
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
Building and sustaining health related coalitions.

Convening a broad group of stakeholders including healthcare providers and payers.

Quality improvement, including involvement with CoIIN.

Providing training and technical assistance to a variety of audiences involved in perinatal health.

Developing tools and resources for quality improvement efforts.

Developing and supporting evidence-based practice in perinatal health through quality
improvement processes, including selection, oversight and maintenance of initiatives.

Planning and coordinating local, regional and statewide educational meetings.

Collaborating with other community and statewide initiatives to eliminate disparities in maternal
and infant health.

Providing training and support to healthcare systems on data collection and reporting.

Developing and using Logic Models.
Work Plan (see sample template in section 4)
25 points
Proposers shall describe how they will meet project goals and identify objectives for the term of the
grant. Provide specific, measurable, achievable, realistic and time-phased (SMART) objectives to
support the project goal(s).
The plan must include the following activities:

Convening partners during the funding period, including a “kick-off” meeting in collaboration
with DPH (BCHP and OHI) and DHCAA. (Include healthcare payers and other organizations
from the list of recommended partners in appendix A).

Identifying content advisors

Establishing appropriate measurable benchmarks for reporting to include process and outcome
measures

Working with partners to establish a process for reporting benchmarks

Selection of quality improvement initiatives (include process to determine population at greatest
risk, see The National Partnership for Action to End Health Disparities,
http://minorityhealth.hhs.gov/npa/)

Oversight and monitoring of quality improvement initiatives
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
Providing education, training and ongoing technical assistance to participating health care and
public health systems

Developing tools and resources for quality improvement effort

Evaluating the implementation of evidence-based strategies

Public reporting of quality improvement efforts and results

Identifying how the activities will be responsive to the Statewide Framework for Improving
Women’s Health developed by the Wisconsin Healthiest Women Initiative.

Developing a Logic Model that illustrates the stakeholders and the Quality Improvement
initiative.
Evaluation and Sustainability – limit 3 pages
20 points
Applicants must demonstrate the implementation of at least one quality improvement initiative
during the two year contract period:

Describe the process to establish appropriate measurable benchmarks for reporting to include
interim process and outcome measures.

Describe the plan to conduct a rapid cycle (PDSA) evaluation of at least one jointly agreed-upon
quality improvement initiative.

Describe the plan to work with the DPH (BCHP and OHI) and DHCAA to obtain outside
funding to sustain the program
Budget Worksheet and Narrative – limit 3 pages for narrative
15 points
Based on available funding, the MCH Program has allocated $100,000 per year for the development
and conduct of a Wisconsin Perinatal Quality Collaborative for two years. Proposals with a budget
exceeding this amount will not be considered. Applicants must describe their ability to meet match
that is relevant to the project.
Proposed budgets should clearly describe and itemize how funds will be used to support the planned
activities identified in the work plan. Example of budget line items may include:
Salaries and Wages (include position title, salary and % time on project)
Fringe (for each position described above)
Equipment
Supplies
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Travel (In-state and out-of-state)
Indirect costs (not to exceed 10%)
Other
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5
WORK PLAN TEMPLATE
Work Plan
Objective
Personnel
Responsible
Expected
Completion
Date
Activities to Support Objectives /
Deliverable
1.
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enter text.
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enter text.
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2.
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enter text.
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enter text.
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3.
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enter text.
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enter text.
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4.
Click here to enter text.
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enter text.
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enter text.
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5.
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enter text.
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enter text.
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6
TRANSMITTAL LETTER
A Transmittal Letter must accompany the GRFP package. It must be on official business letterhead of
the proposer submitting the Proposal, and must be signed in ink by an individual authorized to legally
bind the vendor.
The Transmittal Letter must stipulate the following:

The Proposer is the primary Vendor and is a corporation or other legal organization;

Services that the Vendor intends to sub-contract to another entity;

No attempt has been made or will be made by the Vendor to induce any other person or firm to
submit or not to submit a Proposal;

The vendor certifies they have neither directly nor indirectly, entered into any agreement or
participated in any collusion or otherwise taken any action in restraint of free competition; that
this Proposal has been independently arrived at without collusion with any other Vendor,
competitor or potential competitor; that this proposal has not been knowingly disclosed prior to
the opening of proposals to any other vendor or competitor.

A Statement of Qualifications that the vendor is able to meet all the Mandatory Requirements
and Special Terms and Conditions in Sections 4.0.

The Proposal is valid for a minimum of 60 Days from the Proposal due date;

The person signing this letter and all GRFP documents is authorized to make decisions on behalf
of the Proposing organization and that the person has not participated, and will not participate, in
any action contrary to the this statement;

Assurance that the vendor will agree to execute and fulfill a contract according to the conditions
and terms specified in this GRFP;

That the Proposal is predicated upon the requirements, terms, and conditions of this GRFP, the
posted Questions and Answers, all its attachments, and any supplements or revisions thereof; and

That an individual authorized to bind legally the vendor has signed this Transmittal Letter
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7
7.1
POST AWARD REQUIREMENTS
Affirmative Action
As required by Wisconsin's Contract Compliance Law (s. 16.765, Wis. Stat.), every contractor
contracting with the state of Wisconsin must agree to equal employment and affirmative action policies
and practices in its employment programs. The Contractor must submit an Affirmative Action Plan to
the procuring agency in accordance with the Wisconsin Office of Contract Compliance instructions
posted on the following website: http://vendornet.state.wi.us/vendornet/contract/contcom.asp.
An affirmative action plan is required from a contractor who receives a state contract over $50,000 AND
who has a work force of 50 or more employees as of the award date, unless the contractor is exempt by
established criteria. The plan is due to the contracting agency within fifteen (15) working days of the
award date of the state contract. The plan must have been prepared or revised not more than one year
prior to the award date of the contract.
Universities, other states and local governments, except those of the State of Wisconsin who receive
state contracts of over $50,000, must submit affirmative action plans in the same manner as the
contractors.
7.2
Civil Rights Compliance
In agreements for the provision of services to clients, the Contractor must comply with all Federal Civil
Rights laws applicable to service delivery requirements. The Contractor agrees to meet state and federal
Civil Rights Compliance (CRC) laws, requirements, rules and regulations, as they pertain to the services
covered by this agreement. All Contractors must submit the appropriate CRC documentation within
fifteen (15) working days of the award date of the agreement or contract in accordance with the
procedures outlined on the following website:
http://dhs.wisconsin.gov/civilrights/CRC/requirements.htm.
7.3
Tobacco Smoke Free Environment
Public Law 103-227, also known as the Pro-Children Act of 2001, prohibits tobacco smoke in any
portion of a facility owned, leased, or contracted for by an entity that receives federal funds, either
directly or through the State, for the purpose of providing services to children under the age of 18.
7.4
Business Associate Agreement
The selected vendor will review and execute a Business Associate Agreement (BAA) with DHS as a
mandatory and critical exhibit to the Contract. A BAA must be executed before the selected vendor
performs any work of any kind for DHS as a result of this solicitation. The BAA that will be required
for this Contract will be included in contract negotiations.
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7.5
Prime Contractor and Subcontractors
The prime contractor will be responsible for contract performance when subcontractors are used.
However, when subcontractors are used, they must abide by all terms and conditions of the contract. If
subcontractors are to be used, the proposer must clearly explain their participation.
7.6
Standard Terms and Conditions
The State of Wisconsin Standard Terms and Conditions (DOA-3054) and Supplemental Standard Terms
and Conditions for Procurements for Services (DOA-3681) shall govern this solicitation and subsequent
award. In the event of a conflict between the Standard and Supplemental Standard Terms and
Conditions and this solicitation, the terms of RFA G-0400 DPH-15, including any amendments, shall
prevail.
Vendors must accept all terms and conditions or submit point-by-point exceptions along with proposed
alternative or additional language for each point, including any supplemental documents. Submission of
any standard vendor contracts as a substitute for language in the terms and conditions is not a sufficient
response to this requirement and may result in rejection of the vendor’s proposal.
Failure of the successful Proposer to accept these obligations in a contractual agreement may result in
cancellation of the award. The State reserves the right to negotiate contractual terms and conditions
other than those in the State of Wisconsin Contract when it is in the best interest of the State to do so.
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8
APPENDIX A
Recommended list of partners includes but is not limited to the following:

Division of Public Health, Bureau of Community Health Promotion (to include Chief Medical
Officer for Community Health Promotion, Maternal/Perinatal Nurse Consultant, and Senior
MCH Epidemiologist/CDC Assignee)

Division of Public Health, Office of Health Informatics

Division of Healthcare Access and Accountability, including Medicaid OB Medical Home
Providers

Healthcare payers (in addition to Medicaid)

Local health departments

Hospital and Health Systems

Medical College of Wisconsin

University of Wisconsin, Milwaukee Zilber School of Public Health

University of Wisconsin School of Medicine and Public Health

Wisconsin Association for Perinatal Care

Wisconsin Association of Family Practice Physicians

Wisconsin Chapter of American Academy of Family Medicine

Wisconsin Chapter of American Academy of Pediatrics

Wisconsin Chapter of American College of Nurse-Midwives

Wisconsin Chapter of American Congress of Obstetrics and Gynecology

Wisconsin Chapter of the Association of Women’s Health, Obstetric and Neonatal Nurses

Wisconsin Collaborative for Healthcare Quality

Wisconsin Hospital Association

Wisconsin March of Dimes

Wisconsin Medical Society

Wisconsin Neonatal Perinatal Quality Collaborative

Wisconsin Primary Healthcare Association

Other state and local partners, such as, tobacco prevention, chronic disease program, lactation
providers, sexual assault and domestic violence providers, mental health, and community-based
agencies.
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9
APPENDIX B
Local MCH/CYSHCN Match
Federal Maternal and Child Health regulations require the state to provide 75% match. Contracts must
include match as indicated below:




Local organizations are required to provide local match in an amount not less than 75% of the
requested grant funds. Tribal agencies, federally designated community health centers and
migrant health centers are exempt from this requirement.
Local match is the value of local agency efforts in furthering the objectives of the MCH
Program. Such efforts may be in the form of program costs incurred and not borne by the grant,
program income, or in-kind contributions. An organization may not claim as match any costs
used to match any other federal grant, award, or contract. No federal dollars may be used for
match of this grant except Title XIX and Title XX reimbursements received by the organization
for services when such are used to further the objectives of the MCH Program.
An organization may count as match any local expense which meets the qualifications outlined
above and which contributes to the project. For example, the local share of staff costs pertinent to
the project, and the value of supplies purchased with local funds and used in the project, may be
used as match.
An organization may also use as match any local share which meets the qualifications outlined
above and which consists of effort on the organization’s part to pursue the objectives of the
MCH Program. For example, if an organization receives funds for a child health program, it may
count as match not only the local effort which is directly pertinent to the child health program,
but local effort devoted to any other relevant maternal and child health activity.
Contractees will comply with year-end program reporting requirements set by the State of Wisconsin
MCH/CYSHCN Program including documentation of 75% local match ($0.75 local contribution for
every $1.00 federal), including program income, and report through the CARS system on the DHS/DES
F-80855 Expenditure Report form in the current net expense column using profile 193002. The original
DHS/DES F-80855 form goes to CARS with a copy to the State MCH/CYSHCN Contract
Administrator/Negotiator.
Reference: Public Health Service (PHS) Grants Policy Statement, U.S. DHHS, 4/1/94
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10 ATTACHMENT A
BUDGET
(NOTE: Applicants must prepare this budget and the following budget detail for year one for the time
period of April 6, 2015 to April 5, 2016)
i. Salaries
(a)
Title of Position
(b)
(c)
(d)
(e)
(f)
% of Hourly Rate or Hours per Number Personnel Cost
Time
Monthly
Week
of
Budgeted
Salary
Months
(g)
Salary
SubTotal
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BUDGET DETAIL
ITEM
DESCRIPTION/DETAILS
BUDGETED
AMOUNT
1. Total Salaries from A-1
2. Fringe Benefits
4. Travel for Staff
6. Equipment
7. Supplies and Operating Expenses
8. Contractual and Consultant Costs
9. Other Expenses including:
(i) Web development and maintenance
(ii) Local recruitment resources
(iii)Statewide recruitment campaign
(iv) Training expenses
(v) Additional expenses (list)
10. Total Agency Direct
Expenses (Total 1 – 9)
11. Total Agency Indirect Expenses (not to
exceed 10% of total)
12. Agency Match
(75 % of line 11)
13. Total Budget
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