13054-CONTRACT - CPLC.PDF

CONTRACT PURSUANT TO RFP
SERIAL 13054 -RFP
This Contract is entered into this 26th day of February, 2014 by and between Maricopa County (“County”), a
political subdivision of the State of Arizona, and Chicanos Por La Causa (CPLC), an Arizona corporation
(“Contractor”) for the purchase of Medical and Non-Medical Case Management Services.
1.0 CONTRACT TERM:
1.1 This Contract is for a term of five (5) years, beginning on the 1st day of March, 2014 and ending
the 28th day of February, 2019.
1.2 The County may, at its option and with the agreement of the Contractor, renew the term of this
Contract for additional terms up to a maximum of five (5) one-year renewal terms, (or at the
County’s sole discretion, extend the contract on a month-to-month bases for a maximum of six (6)
months after expiration). The County shall notify the Contractor in writing of its intent to extend
the Contract term at least thirty (30) calendar days prior to the expiration of the original contract
term, or any additional term thereafter.
2.0 PAYMENTS:
2.1 As consideration for performance of the duties described herein, County shall pay Contractor the
sum(s) stated in Exhibit “B”.
2.2 Payment shall be made upon the County’s receipt of a properly completed invoice. Invoices shall
contain the following information: Contract number, purchase order number, item numbers,
description of supplies and/or services, sizes, quantities, unit prices, extended totals and any
applicable sales/use tax.
2.3 INVOICES:
2.3.1 The Contractor shall submit electronically to the Administrative Agent one (1) legible
copy of their detailed monthly invoice before payment(s) can be made.
2.3.2 Contractor will submit the invoice packet for services performed on or before the fifteen
(15th) calendar day following the month in which services were performed.
2.3.3 The invoice must include the requirements as outlined in the Ryan White Part A’s current
policies and procedures manual.
2.3.4 Contractors providing medical services are required to utilize the Health Care Form 1500
(HCF-1500), Uniform Billing 92 (UB-92) or other standardized medical claim forms as
agreed to with the Administrative Agent, and to submit these to the Ryan White Part A
Program in addition to the other required invoice reports and forms.
2.3.5 Problems regarding billing or invoicing shall be directed to the County as listed on the
Purchase Order.
2.3.6 Payment shall be made to the Contractor by Accounts Payable through the Maricopa
County Vendor Express Payment Program. This is an Electronic Funds Transfer (EFT)
process. After Contract Award the Contractor shall complete the Vendor Registration

SERIAL 13054-RFP
Form located on the County Department of Finance Vendor Registration Web Site
(www.maricopa.gov/finance/vendors).
2.3.7 EFT payments to the routing and account numbers designated by the Contractor will
include the details on the specific invoices that the payment covers. The Contractor is
required to discuss remittance delivery capabilities with their designated financial
institution for access to those details.
3.0 DUTIES:
3.1 The Contractor shall perform all duties stated in Exhibits “B & C” and the budget’s schedule of
deliverables for that grant year and/or as directed by the current Ryan White Part A policies and
procedures manual or as otherwise directed in writing by the Procurement Officer.
3.2 The Contractor shall perform services at the location(s) and time(s) stated in this application, the
current approved work plan or as otherwise directed in writing, via contract amendment and/or
task order from the Administrative Agent.
3.3 During the Contract term, County shall provide Contractor’s personnel with adequate workspace
for consultants and such other related facilities as may be required by Contractor to carry out its
contractual obligations.
4.0 TERMS and CONDITIONS:
4.1 PRICE ADJUSTMENTS:
4.1.1 Any request for a fee adjustment must be submitted sixty (60) days prior to the current
Contract anniversary date. Requests for adjustment in cost of labor and/or materials must
be supported by appropriate documentation. If County agrees to the adjusted fee, County
shall issue written approval of the change. The reasonableness of the request will be
determined by comparing the request with the AHCCCS fee schedule or by performing a
market survey.
4.2 INDEMNIFICATION:
4.2.1 To the fullest extent permitted by law, Contractor shall defend, indemnify, and hold
harmless County, its agents, representatives, officers, directors, officials, employees and
volunteers from and against all claims, damages, losses and expenses, including, but not
limited to, attorney fees, court costs, expert witness fees, and the cost of appellate
proceedings, relating to, arising out of, or alleged to have resulted from the negligent acts,
errors, omissions, mistakes or malfeasance relating to the performance of this Contract.
Contractor’s duty to defend, indemnify and hold harmless County, its agents,
representatives, officers, directors, officials, employees and volunteers shall arise in
connection with any claim, damage, loss or expense that is caused by any negligent acts,
errors, omissions or mistakes in the performance of this Contract by the Contractor, as
well as any person or entity for whose acts, errors, omissions, mistakes or malfeasance
Contractor may be legally liable.
4.2.2 The amount and type of insurance coverage requirements set forth herein will in no way
be construed as limiting the scope of the indemnity in this paragraph.
4.2.3 The scope of this indemnification does not extend to the sole negligence of County.
4.3 INSURANCE REQUIREMENTS:
4.3.1 The Contractor shall have in effect at all times during the term of this Contract insurance
which is adequate to protect Maricopa County, its officers and employees, participants
and equipment funded under the Contract against such losses as are set forth below. The
Contractor shall provide County with current documentation of insurance coverage by

SERIAL 13054-RFP
furnishing a Certificate of Insurance or a certified copy of the insurance policy naming
Maricopa County as an additional insured.
4.3.2 The following types and amounts of insurance are required as minimums:
4.3.2.1 Worker's Compensation as required by Arizona law; and employer’s liability
insurance with $1,000,000 per accident, $1,000,000 per disease and $1,000,000
per limit disease.
4.3.2.2 Unemployment Insurance as required by Arizona law.
4.3.2.3 Commercial general liability insurance the limits of the policies shall not be less
than $2,000,000 per occurrence, $4,000,000 general aggregate, $2,000,000
products completed operations aggregate.
4.3.3 Automobile and Truck Liability, Bodily Injury and Property Damages:
4.3.3.1 Combined single limit; $1,000,000.
4.3.4 Standard minimum deductible amounts are allowable. Any losses applied against
insurance deductibles are the sole responsibility of the Contractor.
4.3.5 Professional Liability Insurance; $2,000,000 per occurrence or claim and $4,000,000
aggregate.
4.3.6 The Contractor will immediately inform the Director of any cancellation of its insurance
or any decrease in its lines of coverage at least thirty (30) days before such action takes
place.
4.3.7 Certificates of Insurance.
4.3.7.1 Prior to commencing work or services under this Contract, Contractor shall have
insurance in effect as required by the Contract in the form provided by the
County, issued by Contractor’s insurer(s), as evidence that policies providing the
required coverage, conditions and limits required by this Contract are in full
force and effect. Such certificates shall be made available to the County upon
ten (10) business days. BY SIGNING THE AGREEMENT PAGE THE
CONTRACTOR AGREES TO THIS REQUIREMENT AND FAILURE
TO MEET THIS REQUIREMENT WILL RESULT IN CANCELLATION
OF CONTRACT.
4.3.7.1.1In the event any insurance policy (ies) required by this Contract is (are)
written on a “claims made” basis, coverage shall extend for two (2)
years past completion and acceptance of Contractor’s work or services
and as evidenced by annual Certificates of Insurance.
4.3.7.1.2If a policy does expire during the life of the Contract, a renewal
certificate must be sent to County fifteen (15) days prior to the
expiration date.
4.3.8 Cancellation and Expiration Notice.
Insurance required herein shall not be permitted to expire, be canceled, or materially
changed without thirty (30) days prior written notice to the County.
4.4 NOTICES:
All notices given pursuant to the terms of this Contract shall be addressed to:
For County:
Maricopa County

SERIAL 13054-RFP
Office of Procurement Services
ATTN: Contract Administration
320 West Lincoln Street
Phoenix, Arizona 85003-2494
For Contractor:
Chicanos Por La Causa
ATTN: Dottie O’Connell
1402 S. Central Avenue
Phoenix, AZ85004
4.5 REQUIREMENTS CONTRACT:
4.5.1 Contractor signifies its understanding and agreement by signing this document that this
Contract is a requirements contract. This Contract does not guarantee any purchases will
be made (minimum or maximum). Orders will only be placed when County identifies a
need and issues a purchase order or a written notice to proceed.
4.5.2 County reserves the right to cancel purchase orders or notice to proceed within a
reasonable period of time after issuance. Should a purchase order or notice to proceed be
canceled, the County agrees to reimburse the Contractor for actual and documented costs
incurred by the Contractor. The County will not reimburse the Contractor for any
avoidable costs incurred after receipt of cancellation, or for lost profits, or shipment of
product or performance of services prior to issuance of a purchase order or notice to
proceed.
4.5.3 Contractor agrees to accept written cancellation of purchase orders.
4.6 TERMINATION:
4.6.1 Either party may terminate this Contract at any time with thirty (30) days prior written
notice to the other party. Such notice shall be given by personal delivery or by
Registered or Certified Mail.
4.6.2 This Contract may be terminated by mutual written agreement of the parties specifying
the termination date therein.
4.6.3 County may terminate this Contract upon twenty-four (24) hours notice when County
deems the health or welfare of a patient is endangered or Contractor non-compliance
jeopardizes funding source financial participation. If not terminated by one of the above
methods, this Contract will terminate upon the expiration date of this Contract as stated
on the Cover Page.
4.7 TERMINATION FOR DEFAULT:
County may suspend, modify or terminate this Contract immediately upon written notice to
Contractor in the event of a non-performance of stated objectives or other material breach of
contractual obligations; or upon the happening of any event, which would jeopardize the ability of
the Contractor to perform any of its contractual obligations.
4.8 TERMINATION BY THE COUNTY:
If the Contractor should be adjudged bankrupt or should make a general assignment for the benefit
of its creditors, or if a receiver should be appointed on account of its insolvency, the County may
terminate the Contract. If the Contractor should persistently or repeatedly refuse or should fail,
except in cases for which extension of time is provided, to provide enough properly skilled
workers or proper materials, or persistently disregard laws and ordinances, or not proceed with
work or otherwise be guilty of a substantial violation of any provision of this Contract, then the
County may terminate the Contract. Prior to termination of the Contract, the County shall give the

SERIAL 13054-RFP
Contractor fifteen- (15) calendar day’s written notice. Upon receipt of such termination notice, the
Contractor shall be allowed fifteen (15) calendar days to cure such deficiencies.
4.9 STATUTORY RIGHT OF CANCELLATION FOR CONFLICT OF INTEREST:
Notice is given that pursuant to A.R.S. §38-511 the County may cancel this Contract without
penalty or further obligation within three years after execution of the contract, if any person
significantly involved in initiating, negotiating, securing, drafting or creating the contract on
behalf of the County is at any time while the Contract or any extension of the Contract is in effect,
an employee or agent of any other party to the Contract in any capacity or consultant to any other
party of the Contract with respect to the subject matter of the Contract. Additionally, pursuant to
A.R.S §38-511 the County may recoup any fee or commission paid or due to any person
significantly involved in initiating, negotiating, securing, drafting or creating the contract on
behalf of the County from any other party to the contract arising as the result of the Contract.
4.10 OFFSET FOR DAMAGES;
In addition to all other remedies at law or equity, the County may offset from any money due to
the Contractor any amounts Contractor owes to the County for damages resulting from breach or
deficiencies in performance under this contract.
4.11 ADDITIONS/DELETIONS OF SERVICE:
4.11.1 The County reserves the right to add and/or delete materials to a Contract. If a service
requirement is deleted, payment to the Contractor will be reduced proportionately, to the
amount of service reduced in accordance with the bid price. If additional materials are
required from a Contract, prices for such additions will be negotiated between the
Contractor and the County.
4.11.2 The County reserves the right of final approval on proposed staff for all Task Orders.
Also, upon request by the County, the Contractor will be required to remove any
employees working on County projects and substitute personnel based on the discretion
of the County within two business days, unless previously approved by the County.
4.12 RELATIONSHIPS:
In the performance of the services described herein, the Contractor shall act solely as an
independent contractor, and nothing herein or implied herein shall at any time be construed as to
create the relationship of employer and employee, partnership, principal and agent, or joint venture
between the District and the Contractor.
4.13 USE OF SUBCONTRACTORS:
4.13.1 The use of subcontractors and/or consultants shall be pre-approved by the County. If the
use of subcontractors is approved by County, the Contractor agrees to use written
subcontract/consultant agreements which conform to Federal and State laws, regulations
and requirements of this Contract appropriate to the service or activity covered by the
subcontract. These provisions apply with equal force to the subcontract as if the
subcontractor were the Contractor referenced herein. The Contractor is responsible for
Contract performance whether or not subcontractors are used. The Contractor shall
submit a copy of each executed subcontract to County within fifteen (15) days of its
effective date.
4.13.2 All subcontract agreements must provide a detailed scope of work, indicating the
provisions of service to be provided by both the Contractor and Subcontractor.
4.13.2.1 All subcontract agreements must include a detailed budget, identifying all
administrative and direct service costs as defined in the Budget, Revenues and
Expenditures section.

SERIAL 13054-RFP
4.13.2.2 All subcontract agreements must document the qualifications and ability to
provide services by the subcontracting agency.
4.13.2.2.1 The Contractor agrees to include in any subcontracts a provision to
the effect that the subcontractor agrees that County shall have access
to the subcontractor’s facilities and the right to examine any books,
documents and records of the subcontractor, involving transactions
related to the subcontract and that such books, documents and
records shall not be disposed of except as provided herein.
4.13.2.2.2 The Contractor shall not enter into a subcontract for any of the work
contemplated under this Agreement except in writing and with prior
written approval of the County. Such approval shall include the
review and acceptance by the County of the proposed sub-contractual
arrangement between the Contractor and the subcontractor.
4.14 AMENDMENTS:
All amendments to this Contract shall be in writing and approved/signed by both parties. Maricopa
County Office of Procurement Services shall be responsible for approving all amendments for
Maricopa County.
4.15 ACCESS TO AND RETENTION OF RECORDS FOR THE PURPOSE OF AUDIT AND/OR
OTHER REVIEW:
4.15.1 In accordance with section MCI 367 of the Maricopa County Procurement Code the
Contractor agrees to retain all books, records, accounts, statements, reports, files, and
other records and back-up documentation relevant to this Contract for six (6) years after
final payment or until after the resolution of any audit questions which could be more
than six (6) years, whichever is latest. The County, Federal or State auditors and any
other persons duly authorized by the Department shall have full access to, and the right to
examine, copy and make use of, any and all said materials.
4.15.2 If the Contractor’s books, records , accounts, statements, reports, files, and other records
and back-up documentation relevant to this Contract are not sufficient to support and
document that requested services were provided, the Contractor shall reimburse Maricopa
County for the services not so adequately supported and documented.
4.16 AUDIT DISALLOWANCES:
4.16.1 The Contractor shall, upon written demand, reimburse Maricopa County for any
payments made under this Contract, which are disallowed, by a Federal, State or
Maricopa County audit in the amount of the disallowance, as well as court costs and
attorney fees which Maricopa County incurs to pursue legal action relating to such a
disallowance.
4.16.2 If at any time it is determined by County that a cost for which payment has been made is
a disallowed cost, County shall notify the Contractor in writing of the disallowance and
the required course of action, which shall be at the option of County either to adjust any
future claim submitted by the Contractor by the amount of the disallowance or to require
repayment of the disallowed amount by the Contractor.
4.16.3 The Contractor shall be responsible for repayment of any and all applicable audit
exceptions, which may be identified by County, State and Federal auditors of their
designated representatives, and reviewed by the Contractor. The Contractor will be billed
by the County for the amount of said audit disallowance and shall promptly repay such
audit disallowance within 60 days of said billing.

SERIAL 13054-RFP
4.17 CONTRACT COMPLIANCE MONITORING:
4.17.1 County shall monitor the Contractor's compliance with, and performance under, the terms
and conditions of this Contract. On-site visits for Contract compliance monitoring may be
made by County and/or its grantor agencies at any time during the Contractor's normal
business hours, announced or unannounced. The Contractor shall make available for
inspection and/or copying by County, all records and accounts relating to the work
performed or the services provided under this Contract, or for similar work and/or service
provided under other grants and contracts.
4.17.2 The Contractor shall have policies and procedures in place that allow the County as the
funding agency prompt and full access to financial, program and management records
and documents as needed for program and fiscal monitoring and oversight.
4.17.3 Contractor shall follow and comply with all related corrective action plans and
requirements of site visits and subsequent audits conducted by County and its
representatives. When monetary penalties are imposed or unallowable costs determined,
the County will define how repayment will be made to the County. This may include
decreasing or withholding the Contractor’s monthly billing or requiring payment to the
County.
4.17.4 The Contractor shall submit reports to County as requested that detail performance and
allow review of budget, cost of services and unit cost methodology.
4.18 AVAILABILITY OF FUNDS:
4.18.1 The provisions of this Contract relating to payment for services shall become effective
when funds assigned for the purpose of compensating the Contractor as herein provided
are actually available to County for disbursement. The Director shall be the sole judge
and authority in determining the availability of funds under this Contract and County
shall keep the Contractor fully informed as to the availability of funds.
4.18.2 If any action is taken by any State Agency, Federal Department or any other agency or
instrumentality to suspend, decrease, or terminate its fiscal obligations under, or in
connection with, this Contract, County may amend, suspend, decrease, or terminate its
obligations under, or in connection with, this Contract. In the event of termination,
County shall be liable for payment only for services rendered prior to the effective date of
the termination, provided that such services are performed in accordance with the
provisions of this Contract. County shall give written notice of the effective date of any
suspension, amendment, or termination under this section, at least ten (10) days in
advance.
4.19 RESTRICTIONS ON USE OF FUNDS:
4.19.1 The Contractor shall not utilize funds made available under this Contract to make
payments for any item or service to the extent that payment has been made, or can
reasonably be expected to be made, with respect to that item or service:
4.19.1.1 Under any State compensation program, under any insurance policy, or under
any Federal, State, or county health benefits program; or
4.19.1.2 By an entity that provides health services on a prepaid basis.
4.19.2 Funds shall not be used to purchase or improve (other than minor remodeling) any
building or other facility, or to make cash payments to intended recipients of services as
referenced in the Arizona Revised Statutes (ARS) A.R.S. § 41-2591, R2-7-701 and Code
of Federal Regulations, Chapter 1, Subchapter e., Part 31, and Public Health Service
Grants Policy Statement.

SERIAL 13054-RFP
4.19.3 The federal Office of General Counsel and County emphasize that Ryan White Act funds
may only support HIV-related needs of eligible individuals. All activities and
expenditures must reflect an explicit connection between any service supported with
Ryan White Act funds and the intended recipient’s HIV status.
4.19.4 Contractor is not authorized to provide services anonymously, unless specifically
approved for the service category in which the Contractor is providing services. All
services must only be provided to documented eligible clients as defined in this contract.
4.19.5 Ryan White funds shall not be used to finance the services of lobbyists, fundraisers or
grant/proposal writers, nor to support lobbying, fundraising activities and/or the writing
of grant/contract proposals. The Contractor shall have personnel policies and an
employee orientation manual that include regulations that forbid using federal funds to
lobby Congress or other Federal personnel.
4.19.6 The Ryan White Act limits the administrative expenses to not more than 10% of the total
grant award. The Act defines allowable “administrative activities” to include:
4.19.6.1 Usual and recognized overhead, including established indirect rates for agencies;
4.19.6.2 Management and oversight of specific programs funded under this title; and
4.19.6.3 Other types of program support such as quality assurance, quality control, and
related activities.”
4.20 CONTINGENCY RELATING TO OTHER CONTRACTS AND GRANTS:
4.20.1 The Contractor shall, during the term of this Contract, immediately inform County in
writing of the award of any other contract or grant where the award of such contract or
grant may affect either the direct or indirect costs being paid/reimbursed under this
Contract. Failure by the Contractor to notify County of such award shall be considered a
material breach of the Contract and County shall have the right to terminate this Contract
without liability.
4.20.2 County may request, and the Contractor shall provide within a reasonable time, a copy of
any other contract or grant, when in the opinion of the Director, the award of the other
contract or grant may affect the costs being paid or reimbursed under this Contract.
4.20.3 If County determines that the award to the Contractor of such other Federal or State
contract or grant has affected the costs being paid or reimbursed under this Contract,
County shall prepare a Contract Amendment effecting a cost adjustment. If the
Contractor protests the proposed cost adjustment, the protest shall be construed as a
dispute within the meaning of the "Disputes" clause contained herein.
4.21 SEVERABILITY:
The invalidity, in whole or in part, of any provision of this Contract shall not void or affect the
validity of any other provision of this Contract.
4.22 ALTERNATIVE DISPUTE RESOLUTION:
4.22.1 After the exhaustion of the administrative remedies provided in the Maricopa County
Procurement Code, any contract dispute in this matter is subject to compulsory
arbitration. Provided the parties participate in the arbitration in good faith, such
arbitration is not binding and the parties are entitled to pursue the matter in state or
federal court sitting in Maricopa County for a de novo determination on the law and facts.
If the parties cannot agree on an arbitrator, each party will designate an arbitrator and
those two arbitrators will agree on a third arbitrator. The three arbitrators will then serve
as a panel to consider the arbitration. The parties will be equally responsible for the
compensation for the arbitrator(s). The hearing, evidence, and procedure will be in

SERIAL 13054-RFP
accordance with Rule 74 of the Arizona Rules of Civil Procedure. Within ten (10) days
of the completion of the hearing the arbitrator(s) shall:
4.22.1.1 Render a decision;
4.22.1.2 Notify the parties that the exhibits are available for retrieval; and
4.22.1.3 Notify the parties of the decision in writing (a letter to the parties or their
counsel shall suffice).
4.22.1.4 Within ten (10) days of the notice of decision, either party may submit to the
arbitrator(s) a proposed form of award or other final disposition, including any
form of award for attorneys’ fees and costs. Within five (5) days of receipt of
the foregoing, the opposing party may file objections. Within ten (10) days of
receipt of any objections, the arbitrator(s) shall pass upon the objections and
prepare a signed award or other final disposition and mail copies to all parties or
their counsel.
4.22.1.5 Any party which has appeared and participated in good faith in the arbitration
proceedings may appeal from the award or other final disposition by filing an
action in the state or federal court sitting in Maricopa County within twenty (20)
days after date of the award or other final disposition. Unless such action is
dismissed for failure to prosecute, such action will make the award or other final
disposition of the arbitrator(s) a nullity.
4.23 MEDIATION/ARBITRATION:
In the event that a dispute arises under the terms of this agreement, or where the dispute involves
the parties to the agreement, a recipient of services under the terms of this agreement, it is
understood that the parties to the dispute shall meet and confer in an effort to resolve the dispute.
In the event that such efforts to resolve the dispute are not successful, the parties to the dispute
will agree to submit the dispute to non-binding mediation before a mutually agreed upon and
acceptable person who will act as the mediator. In the event that such non-binding mediation
efforts are not able to resolve the dispute, the parties agree to submit the matter to binding
arbitration wherein each party selects their own arbitrator and the two selected arbitrators meet and
mutually agree upon the selection of a third arbitrator. Thereafter, the three arbitrators are to
proceed with arbitration in a manner that is consistent with the provision of A.R.S. 12-1518.
4.24 STRICT COMPLIANCE:
Acceptance by County of performance not in strict compliance with the terms hereof shall not be
deemed to waive the requirement of strict compliance for all future performance obligations. All
changes in performance obligations under this Contract must be in writing.
4.25 NON-LIABILITY:
Maricopa County and its officers and employees shall not be liable for any act or omission by the
Contractor or any subcontractor, employee, officer, agent, or representative of Contractor or
subcontractors occurring in the performance of this Contract, nor shall they be liable for purchases
or Contracts made by the Contractor in anticipation of funding hereunder.
4.26 RIGHT OF PARTIAL CANCELLATION:
If more than one service category is funded by this Contract, Maricopa County reserves the right
to terminate this Contract or any part thereof based upon the Contractor’s failure to perform any
part of this contract without impairing, invalidating or canceling the remaining service category
obligations as stated in the current schedule of deliverables.

SERIAL 13054-RFP
4.27 RIGHTS IN DATA:
The County shall own have the use of all data and reports resulting from this Contract without
additional cost or other restriction except as provided by law. Each party shall supply to the other
party, upon request, any available information that is relevant to this Contract and to the
performance hereunder.
4.28 INTEGRATION:
This Contract represents the entire and integrated agreement between the parties and supersedes
all prior negotiations, proposals, communications, understandings, representations, or agreements,
whether oral or written, express or implied.
4.29 VERIFICATION REGARDING COMPLIANCE WITH ARIZONA REVISED STATUTES §41-
4401 AND FEDERAL IMMIGRATION LAWS AND REGULATIONS:
4.29.1 By entering into the Contract, the Contractor warrants compliance with the Immigration
and Nationality Act (INA using e-verify) and all other federal immigration laws and
regulations related to the immigration status of its employees and A.R.S. §23-214(A). The
contractor shall obtain statements from its subcontractors certifying compliance and shall
furnish the statements to the Procurement Officer upon request. These warranties shall
remain in effect through the term of the Contract. The Contractor and its subcontractors
shall also maintain Employment Eligibility Verification forms (I-9) as required by the
Immigration Reform and Control Act of 1986, as amended from time to time, for all
employees performing work under the Contract and verify employee compliance using the
E-verify system and shall keep a record of the verification for the duration of the
employee’s employment or at least three years, whichever is longer. I-9 forms are available
for download at USCIS.GOV.
4.29.2 The County retains the legal right to inspect contractor and subcontractor employee
documents performing work under this Contract to verify compliance with paragraph
4.20.1 of this Section. Contractor and subcontractor shall be given reasonable notice of the
County’s intent to inspect and shall make the documents available at the time and date
specified. Should the County suspect or find that the Contractor or any of its subcontractors
are not in compliance, the County will consider this a material breach of the contract and
may pursue any and all remedies allowed by law, including, but not limited to: suspension
of work, termination of the Contract for default, and suspension and/or debarment of the
Contractor. All costs necessary to verify compliance are the responsibility of the
Contractor.
4.30 CONTRACTOR LICENSE REQUIREMENT:
4.30.1 The Respondent shall procure all permits, insurance, licenses and pay the charges and
fees necessary and incidental to the lawful conduct of his/her business, and as necessary
complete any required certification requirements, required by any and all governmental
or non-governmental entities as mandated to maintain compliance with and in good
standing for all permits and/or licenses. The Respondent shall keep fully informed of
existing and future trade or industry requirements, Federal, State and Local laws,
ordinances, and regulations which in any manner affect the fulfillment of a Contract and
shall comply with the same. Contractor shall immediately notify both Office of
Procurement Services and the using agency of any and all changes concerning permits,
insurance or licenses.
4.30.2 Respondents furnishing finished products, materials or articles of merchandise that will
require installation or attachment as part of the Contract, shall possess any licenses
required. A Respondent is not relieved of its obligation to posses the required licenses by
subcontracting of the labor portion of the Contract. Respondents are advised to contact
the Arizona Registrar of Contractors, Chief of Licensing, at (602) 542-1525 to ascertain

SERIAL 13054-RFP
licensing requirements for a particular contract. Respondents shall identify which
license(s), if any, the Registrar of Contractors requires for performance of the Contract.
4.31 CERTIFICATION REGARDING DEBARMENT AND SUSPENSION
4.31.1 The undersigned (authorized official signing for the Contractor) certifies to the best of his
or her knowledge and belief, that the Contractor, defined as the primary participant in
accordance with 45 CFR Part 76, and its principals:
4.3.1.1 are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by any Federal
Department or agency;
4.3.1.2 have not within 3-year period preceding this Contract been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a
public (Federal, State or local) transaction or contract under a public transaction;
violation of Federal or State antitrust statues or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
4.3.1.3 are not presently indicted or otherwise criminally or civilly charged by a
government entity (Federal, State or local) with commission of any of the
offenses enumerated in paragraph (2) of this certification; and
4.3.1.4 have not within a 3-year period preceding this Contract had one or more public
transaction (Federal, State or local) terminated for cause of default.
4.3.1.5 Should the Contractor not be able to provide this certification, an explanation as
to why should be attached to the Contract.
4.3.1.6 The Contractor agrees to include, without modification, this clause in all lower
tier covered transactions (i.e. transactions with subcontractors) and in all
solicitations for lower tier covered transactions related to this Contract.
4.32 INFLUENCE
As prescribed in MC1-1202 of the Maricopa County Procurement Code, any effort to influence an
employee or agent to breach the Maricopa County Ethical Code of Conduct or any ethical conduct,
may be grounds for Disbarment or Suspension under MC1-902.
An attempt to influence includes, but is not limited to:
4.32.1 A Person offering or providing a gratuity, gift, tip, present, donation, money,
entertainment or educational passes or tickets, or any type valuable contribution or
subsidy;
4.32.2 That is offered or given with the intent to influence a decision, obtain a contract, garner
favorable treatment, or gain favorable consideration of any kind.
If a Person attempts to influence any employee or agent of Maricopa County, the Chief
Procurement Officer, or his designee, reserves the right to seek any remedy provided by the
Maricopa County Procurement Code, any remedy in equity or in the law, or any remedy provided
by this contract.
4.33 GOVERNING LAW:
This Contract shall be governed by the laws of the state of Arizona. Venue for any actions or
lawsuits involving this Contract will be in Maricopa County Superior Court or in the United States
District Court for the District of Arizona, sitting in Phoenix, Arizona

SERIAL 13054-RFP
4.34 LAWS, RULES AND REGULATIONS:
The Contractor understands and agrees that this Contract is subject to all State and Federal laws,
rules and regulations that pertain hereto.
4.35 ANTI-KICKBACK REGULATIONS:
4.35.1 If the Contractor is a Medicare/Medicaid provider, it shall maintain a Corporate
Compliance Plan.
4.35.2 The Contractor shall maintain Personnel Policies, Code of Ethics or Standards of
Conduct, Bylaws and Board policies that include ethics standards or business conduct
practices.
4.35.3 The Contractor shall maintain documentation of any employee or Board member
violations of Code of Ethics/Standards of Conduct, and complaints of violations and
resolution.
4.35.4 The Contractor’s Code of Ethics/Standards of Conduct shall include:
• Conflict of interest
• Prohibition on use of provider property, information or position without approval or
advance personal interest
• Fair dealing: Contractor engages in fair and open competition
• Confidentiality
• Protection and use of company assets
• Compliance with laws, rules, regulations
• Timely and truthful disclosure of significant accounting deficiencies and non-
compliance
4.35.5 The Contractor shall have adequate policies and procedures to discourage soliciting cash
or in-kind payments for:
• Awarding contracts
• Referring clients
• Purchasing goods of services
• Submitting fraudulent billings
4.35.6 The Contractor shall have employee policies that discourage:
• Hiring persons with a criminal record
• Hiring persons being investigated by Medicare/Medicaid
• Large signing bonuses
4.36 ORDER OF PRECEDENCE:
In the event of a conflict in the provisions of this Contract and Contractor’s license agreement, if
applicable, the terms of this Contract shall prevail.
4.37 PUBLIC RECORDS:
All Offers submitted and opened are public records and must be retained by the Records Manager
at the Office of Procurement Services. Offers shall be open to public inspection after Contract
award and execution, except for such Offers deemed to be confidential by the Office of
Procurement Services. If an Offeror believes that information in its Offer should remain
confidential, it shall indicate as confidential, the specific information and submit a statement with
its offer detailing the reasons that the information should not be disclosed. Such reasons shall

SERIAL 13054-RFP
include the specific harm or prejudice which may arise. The Records Manager of the Office of
Procurement Services shall determine whether the identified information is confidential pursuant
to the Maricopa County Procurement Code.
4.38 INCORPORATION OF DOCUMENTS:
The following are to be attached to and made part of this Contract:
4.38.1 Exhibit A, Service Provider Application;
4.38.2 Exhibit B, Pricing/RWPA Budget Form including the schedule of deliverables;
4.38.3 Exhibit C, Scope of Work.


SERIAL 13054-RFP
EXHIBIT A
SERVICE PROVIDER APPLICATION

SERIAL 13054-RFP

SERIAL 13054-RFP
EXHIBIT B-1
PRICING & BUDGET FORM
MEDICAL CASE MANAGEMENT
NOTE: The following budget is for fiscal year 2013/2014 the 2014/2015 budgets will be developed
upon issuance of a Task Order, Condition of Award and the new budget pending grant award and
funding allocations.
DATE PREPARED 8/8/13
PREPARED BY: Maclovia Morales
NAME OF ORGANIZATION: Chicanos Por La Causa Inc.
Fed. Employee ID # (FEIN) 86-0027210
DUNS # 136249609
ADDRESS: 1402 S. Central Avenue
Phoenix, AZ 85004
AUTHORIZED CONTACT Dottie O' Connell
TELEPHONE 602-257-0700 FAX 602-258-1206
E-MAIL Dottie.Oconnell@cplc.org
PRIMARY CONTACT
Maclovia Morales
TELEPHONE 602-253-4247 FAX 602-258-1206
EMAIL Maclovia Morales
CONTRACT NUMBER M-2013-MCM-002
SERVICE CATEGORY Medical Case Management
BUDGET PERIOD: 3/1/2013 2/28/2014
Start Date End Date
CONTRACT AMOUNT $128,000.00
By submission of this budget, the Provider certifies that they have read the List of Unallowable Costs under
the Ryan White Part A Program and agree to follow the HRSA specific standards related to Unallowable Costs.
In addition, the following documents must be submitted with your budget proposal (Check the appropriate boxes)
If applicable, Negotiated Indirect Cost Agreement is attached Cost Allocation Policy is attached (required)

SERIAL 13054-RFP
Date Prepared: 8/8/2013
(Section I)
Organization Chicanos Por La Causa Inc.
Service Category Medical Case Management
Budget Period 3/1/2013 Through 2/28/2014
(Section II) Contract Amount $128,000.00
Administrative Total Budget
Operating Expenses Budget Direct Service Budget
FTES 0.00 1.74 1.74
Personnel: Salaries $ - $ 87,659.10 $ 87,659.10
Personnel: Fringe/Benefits - 20,871.63 20,871.63
Subtotal: Personnel/Fringe Benefits - 108,530.74 108,530.74
Other Operating Expenses
Travel - 2,117.88 2,117.88
Supplies - 3,365.02 3,365.02
Equipment - - -
Contractual - - -
Program Support - 2,350.00 2,350.00
Other Professional Services - - -
Subtotal: Other Operating Expenses - 7,832.90 7,832.90
Total Operating Expenses - 116,363.64 116,363.64
(Personnel and Other Direct Costs)
Indirect Costs 11,636.36 11,636.36
Enter Indirect Cost Rate 10.00% Providers claiming an indirect cost must submit their most current negotiated indirect
(may not exceed 10% of Direct Costs) costs rate agreement issued by the cognizant federal agency with their budget.
Total Costs of Contract 11,636.36 116,363.64 128,000.00
(Admin-Percent of Direct Costs) 10.00%
Administration may not exceed 10% of Direct Costs
CONTRACT BALANCE (Contract Revenue less Total Costs of Contract) $ (0.00)
*The Contract Balance should equal zero.

SERIAL 13054-RFP
Budget Summary B05-SU-1
This form summarizes all of the line items in the submitted budget packet for the award listed in the Cover Page.
If completing this form electronically, the information will automatically populate as the budget packet
is completed:
Section I Summarizes the organizational information provided in the Cover Page.
The information will automatically populate when the Cover Page is completed
Section II This section summarizes the budget information calculated in the submitted budget packet for this grant.
This form is required for all Ryan White Part A awards issued by Maricopa County Ryan White Part A Program
This form reports the summary line item amounts allocated as Administrative Costs, Direct Service Cost, and
total budget for the budget packet for this service award.
1 Direct Services allocations are for service that directly benefits Ryan White HIV clients such as staff, medicine
and drugs clinical supplies, etc.
2 Administrative costs relate to oversight and management of CARE Act funds: The Administrative Costs
Column, including indirect cost, cannot exceed 10% of Direct Costs.
Administrative Costs, defined in Section 2604(f)(3) defines allowable "subcontractor administrative activities to include:
a. Usual and recognized overhead, including establishing indirect rates for agencies. (HRSA has determined
that rent, utilities and facility costs must be categorized as administrative expenses.)
b. Management and oversight of specific programs funded under this title (including program coordination,
clerical, financial and management staff not directly related to patient care; program evaluation; liability insurance;
audits; computer hardware/software not directly related to patient care.)
c. Other types of program support such as quality assurance, quality control, and related activities."
Other Examples include: salaries and expenses of executive officers, personnel administration, contracting, accounting, data recording,
the costs of operating and maintaining facilities, and depreciation or use allowances on building and equipment.
Indirect Costs- Enter the indirect rate you are claiming (not to exceed 10% of direct costs).
** Indirect Cost - Providers claiming an indirect cost must submit their most current negotiated indirect
Cost agreement with their budget. The indirect costs claimed from the Ryan White Part A Program may
not exceed 10% of direct costs nor the amount that would be claimed using their agency's federally
negotiated indirect cost rate and base, whichever is lower. Note: Only United States Health and Human Services (HHS)
negotiated indirect rates will be accepted unless an exception is approved by the HHS.
3 Contract Balance - This cell calculates the amount of the contract less the projected costs. This number should equal 0.
The final determination for cost allocations between Administrative Costs and Direct Service Costs
resides with Maricopa County Ryan White Part A Program

SERIAL 13054-RFP
Personnel All staff paid in full or part from this Ryan White Part A grant are to be listed in the following chart. Date Prepared: 8/8/2013
1 Staffing Provider Entry Auto Calculation Fringe Benefit Rate 23.81%
Staffing Chicanos Por La Causa Inc. Medical Case Management
Benefits
Annual Hourly Salary Applied to Applied to grant Job Status % Applied as Gross Admin Gross Admin Direct Service Direct Service
Position Title Last Name Hours % RWPA FTE Rate grant per FTE per FTE A, D or A/D Administrative Salary Benefits Salary Benefits
1 Program Director Morales 2080 10.00% 0.1000 $28.78 $ 5,986.24 $ 1,425.32 D 0% - - $ 5,986.24 $ 1,425.32
Ms. Morales will provide MCM services that will inlcude linkage to PMC, medicationand treatment adherence. Conduct case staffings complete risk assessments and needs assessments. Administrative time spent on this contract will
be tracked by timesheets and will be funded by a different funding source identified as "Contributions."
List Benefit Categories and %;
( this table w ill not print)
Lead Case
2 Manager Ornelas 2080 88.00% 0.8800 $33.17 $ 60,714.37 $ 14,456.09 D 0% - - $ 60,714.37 $ 14,456.09 (R) Benefits
This person will provide MCM services that will inlcude linkage to PMC, medication and treatment adherence, Conduct case staffings, complete risk assessments, and needs assessments.
Benefits Name Percent
FICA 6.20%
3 Case Aide Bailon 2080 70.00% 0.7000 $13.00 $ 18,928.00 $ 4,506.76 D 0% - - $ 18,928.00 $ 4,506.76 Medicare 1.45%
This person will provide MCM services that will inlcude linkage to PMC, medication and treatment adherence, Conduct case staffings, complete risk assessments, and needs assessments.
Workers Comp 0.93%
Unemployment 0.94%
4 Case Manager Madero 2080 3.00% 0.0300 $16.94 $ 1,057.06 $ 251.69 D 0% - - $ 1,057.06 $ 251.69 Disability 0.29%
This person will provide MCM services that will inlcude linkage to PMC, medication and treatment adherence, Conduct case staffings, complete risk assessments, and needs assessments.
Med. Insurance 6.00%
Dental 1.00%
5 Case Manager Diaz 2080 3.00% 0.0300 $15.60 $ 973.44 $ 231.78 - - $ 973.44 $ 231.78 Retirement 7.00%
This person will provide MCM services that will inlcude linkage to PMC, medication and treatment adherence, Conduct case staffings, complete risk assessments, and needs assessments.
TOTAL 23.81%
6 0.0000 $ - $ - - - $ - $ -
Description
7 0.0000 $ - $ - - - $ - $ -
Description
8 0.0000 $ - $ - - - $ - $ -
Description
Subtotal Personnel 1.74 $ 87,659.10 $ 20,871.63 $ - $ - $ 87,659.10 $ 20,871.63
Subtotal from Personnel Continuation Sheet 0.00 $ - $ - $ - $ - $ - $ -
TOTAL Personnel 1.74 $ 87,659.10 $ 20,871.63 $ - $ - $ 87,659.10 $ 20,871.63
(Admin) 0.00 FTE Percent Admin 0%
(Direct Service) 1.74 FTE Percent Direct 100%
Total 1.74 FTE 100%

SERIAL 13054-RFP
Personnel Instructions B05-PE-1 ( These instructions will not print)
Use this form to list ALL persons being paid a salary from the Ryan White Part A grant in this budget packet.
This form calculates the applied annual salary and applied annual benefits per individual position.
The Provider must determine if the position(s) listed are Administrative, Direct Service, or Both
* for Both, the Provider must indicate how much of the time spent on Ryan White Part A activities
are considered administrative.
For example - a Case Management Supervisor may continue with a case load of their own, in this
case, it must be determined how much of their time should be allocated to Administrative duties
and Direct Service support.
If at the time of submission of a service budget one or more of the personnel positions are vacant, contractors must indicat
and provide a date when the positions will be filled, and prorate/apportion personnel and other associated costs to reflect
service. Alternatively, contractors may note the vacancy, with no associated cost, and develop the contract to reflect actual
staffing at the time of budget preparations, amending the budget to reflect ongoing personnel changes as they occur.
The Cells referenced in the form requiring entry are:
Position Title Enter the position title
Last Name Enter the last name of the employee who occupies the position or enter "Vacant"
If you have more than 8 employees/positions who will be paid on this grant, use the
Personnel Continuation Tab in this budget template to list the remaining employees.
The subtotal from the Personnel Continuation will roll over to the main Personnel Page.
Annual Hours Enter Number of Budgeted Hours for this position/employee. Typically, annual hours for full time
staff are 2,080 hours. Adjust hours if position will not be filled for an entire year or if the person
works part time and explain under "Description"
% RWPA Enter the % of time this employee/position is budgeted on the Part A grant
(i.e., A person who spends 1/2 of their work hours on this grant would be 50% )
FTE FTE = Full Time Equivalent. This is a calculated field. ( Annual Hours/2080* % RWPA)
Hourly Rate Enter the employee/budgeted position's hourly rate
Job Status Determine whether an employee's primary responsibilities on this grant will be for Direct Service
activities or Administrative activities by entering A or D.
* For a staff member who has both responsibilities, enter A and D
Percent applied Enter how much of the employee's time is spent on Administrative duties.
as Admin. (i.e., a staff member can spend 90% of their time doing administrative duties and 10% performing
Direct Services.)
Description Provide the Position Number and a Description of Duties. If the employee will not be in the
position for the entire year, enter the start and end dates.
Benefit Table Enter a brief name of each benefit included for staff and the percentage of gross salary
associated with that benefit. (i.e., Social Security- (FICA), Health Insurance, Retirement, etc.)
This data will calculate the total Benefit Rate that will be applied to your budget.
( Note: to maximize space, the benefit table will not print on the printed copy of this page )

SERIAL 13054-RFP
2 Staffing Continuation Sheet ( Page 2 of 2) Provider Entry Auto Calculation Date Prepared: 8/8/2013
Staffing Continuation Sheet ( Page 2 of 2) Chicanos Por La Causa Inc. Medical Case Management
Annual Hourly Salary Applied Benefits Applied to Job Status % Applied as Gross Admin Gross Admin Direct Service Direct Service
Position Title Last Name Hours % RWPA FTE Rate to grant per FTE grant per FTE A, D or A/D Administrative Salary Benefits Salary Benefits
9 0.0000 $ - $ - - - $ - $ -
Description
10 0.0000 $ - $ - - - $ - $ -
Description
11 0.0000 $ - $ - - - $ - $ -
Description
12 0.0000 $ - $ - - - $ - $ -
Description
13 0.0000 $ - $ - - - $ - $ -
Description
14 0.0000 $ - $ - - - $ - $ -
Description
15 0.0000 $ - $ - - - $ - $ -
Description
16 0.0000 $ - $ - - - $ - $ -
Description
17 0.0000 $ - $ - - - $ - $ -
Description
Subtotal to Page 1 0.00 $ - $ - - - $ - $ -

SERIAL 13054-RFP
TRAVEL Provider Entry Auto Calculation Date Prepared: 8/8/2013
Travel can be budgeted for the cost of staff mileage and other travel associated with Ryan White Part A.
1 Mileage Mileage will be budgeted utilizing the standard calculation of # of monthly miles for a full time staff person x12 months x the rate per mile
used by your organization x the number of FTE(s) budgeted who will travel to provide services under this grant.
Enter only the FTEs that will travel and provide a Narrative Justification including who will travel and why.
Mileage Chicanos Por La Causa Inc. Medical Case Management
Mileage Rate
$0.555
FTE Monthly Miles Annual Miles Total
Budgeted (Per 1 Admin Direct Svc Narrative Justification
FTE)* Applied to Grant Budget
1 Admin 0.00 0 0 $ - $ - $ -
Direct Svc Miles will be used to conduct home/offsite visits. An average of 200 miles will be traveled per
month per FTE. Cost is based from miles traveled in 2011-2012 FY and factoring additional
2 1.59 200 3816 $ 2,117.88 $ 2,117.88 clients.
TOTAL 200 3816 $ 2,117.88 $ - $ 2,117.88 $ 2,117.88
(Total Miles applied to this grant)
*Note - Budget monthly mileage for 1 FTE. This is a revision to prior year budget templates.
2 Other Allowable Travel ( car rental, parking, fees, etc.)
Ryan White Part A has determined that costs included in this section are Administrative Costs.
Other Allowable Travel Chicanos Por La Causa Inc. Medical Case Management
Dates Total Admin Direct Svc Narrative Justification
of Travel Budget
1 Cost $ - $ - 0
Line Item 0
2 Cost $ - $ - 0
Line Item 0
3 Cost $ - $ - 0
Line Item 0
$ - $ - - $ -
Admin Direct Service Total
SUMMARY (Travel) $ - $ 2,117.88 $ 2,117.88

SERIAL 13054-RFP
Travel Budget Instructions B05-TV-1 ( These instructions will not print)
Use this form to budget any travel expenses associated with the services of the Ryan White Part A Grant.
This form consists of two (2) sections - Mileage and Other Allowable Travel
The Travel budget form requires the following entries:
Mileage This section establishes a budget amount, both Administrative and Direct Service, for
mileage reimbursement in conjunction with providing services to the grant.
Maricopa County Ryan White Part A Program has adapted a standard formula to apply all
mileage reimbursements budgets.
Mileage Rate: Enter the current rate used by your organization to reimburse mileage requests
FTE: Enter the number of FTE who will travel, both Administrative and Direct Service, in the corresponding row.
Monthly Miles Enter the monthly miles that are budgeted for one (1) FTE staff person.
Narrative/ Provide a detailed justification for the travel budget requested, including who will travel and why.
Justification:
Other
Allowable
Travel In some cases, other travel may be allowed under the Ryan White Part A Grant.
Each item listed in this section must have a detailed and accurate budget justification attached.
Dates of Travel: Enter the dates that the other travel is expected.
Cost and Enter the estimated cost and name of the expense
Line Item: *this can include car rental, parking fees, etc.
Narrative/ Provide a detailed description and justification of the expense in relation to Ryan White Part A services
Justification: as awarded in this grant.

SERIAL 13054-RFP
SUPPLIES Provider Entry Auto Calculation Date Prepared: 8/8/2013
The supplies line item is used to budget funds for supplies used in the operations of the Grant.
This category can include general office supplies and program/medical supplies
1 General Office Supplies: (Apply an FTE Ratio from the Budgeted Personnel Page)
Pens, paper, toner and general supplies that are used to run an office.
General Office Supplies Chicanos Por La Causa Inc. Medical Case Management
Annual % Admin % Direct Total
Narrative Description/Cost Allocation Methodology
Item Budget 0% 100% 100%
1 Paper, pens $ 2,200.00 $ - $ 2,200.00 $ 2,200.00 For the documentation of direct services. Cost base on units provider per client
2 $ - $ - $ -
3 $ - $ - $ -
4 $ - $ - $ -
5 $ - $ - $ -
$ - $ - $ -
TOTAL $ - $ 2,200.00 TOTAL $ 2,200.00
2 Program Supplies
Program/Medical Supplies are budgeted as Direct Service.
Program Supplies Chicanos Por La Causa Inc. Medical Case Management
Annual
Item Admin Direct Narrative Description/Cost Allocation Methodology
Budget
For the rerpoduction of direct service documentation, to be used directly w ith clients during individual
sessions, for the storage of clinical documentation for clients. Cost based on units provider per client.
Water justification:Some people may be more vulnerable to contaminants in drinking w ater than the
general population.
People w ith severely compromised immune systems, such as people w ith cancer undergoing
chemotherapy,
people w ho have undergone organ transplants, people w ith HIV/AIDS or other immune system
Toner, w ater, disorders,
1 files, storage $ 1,165.02 $ - $ 1,165.02 some elderly, and infants can be particularly at risk from infections.
2 $ -
3 $ -
4 $ -
5 $ -
$ -
TOTAL $ - $ 1,165.02 TOTAL $ 1,165.02
Admin Direct Total
SUMMARY ( Supplies) $ - $ 3,365.02 $ 3,365.02

SERIAL 13054-RFP
Supplies Budget Instructions B05-SP-1 (These instructions will not print)
Use this form to create the general office and program supply budgets for the Ryan White Part A grant.
Section I General Office Supplies
General office supplies include pens, paper, toner and general supplies that are used to run an office.
Maricopa County Ryan White Part A Program has initiated a standard allocation model for general office supplies
to determine the appropriate budget for Administrative and Direct Services.
(Administrative Allocation = Total Budget x Percent of administrative FTE to total FTE)
In the Narrative, describe how the supplies will be used and also the methodology used to determine the Annual Budget Amount.
Note: The cost allocation methodology should be based on your organization's cost allocation policy.
Section II Program Supplies
This chart can be used to identify and budget for program supplies used in providing services.
Program Supplies include supplies that are specifically related to performance of the direct services; i.e. medical supplies, folders for client files, etc.
Program Supplies have been determined to be Direct Service Costs, however final determination resides with Maricopa County
Ryan White Part A Program, therefore it is important to provide an adequate justification.
In the Narrative, describe how the supplies will be used and also the methodology used to determine the Annual Budget Amount.
Note: The cost allocation methodology should be based on your organization's cost allocation policy.

SERIAL 13054-RFP
EQUIPMENT Provider Entry Auto Calculation Date Prepared: 8/8/2013
The equipment line item is budgeted for equipment purchased or leased in conjunction with operations of the grant
Refer to your contract terms and conditions for requirements related to equipment purchases
Equipment less than $5,000
Equipment less than $5,000 - includes computers, fax machines, shredders, and other
equipment less than $5,000 to be used in the operations of this grant.
Equipment less than $5,000 Chicanos Por La Causa Inc. Medical Case Management
Item Admin Direct Total Narrative Description/Cost Allocation Methodology
Budgeted Service
1 $ -
2 $ -
3 $ -
4 $ -
5 $ -
$ -
TOTAL $ - $ - TOTAL $ -
Equipment $5,000 or greater
Equipment $5,000 or greater Chicanos Por La Causa Inc. Medical Case Management
Item Admin Direct Total Narrative Description/Cost Allocation Methodology
Budgeted Amount Amount
1 $ -
2 $ -
3 $ -
4 $ -
TOTAL $ - $ - TOTAL $ -
Admin Direct Total
SUMMARY (Equipment) $ - $ - $ -
Equipment Budget Instructions B05-EQ-1
Use this form to budget for equipment needed to support services under this Part A grant.
The Equipment budget form requires the following entries:
Item Budgeted: Enter the name of the equipment to be purchased or leased
Admin and Direct Amt: Enter the total budgeted amount for Admin and Direct Services.
Narrative/ In the Narrative, describe how the equipment will be used and also the methodology used
Cost Allocation to allocate the total or a portion of the cost to the Ryan White Program. Also
Methodology: describe the methodology used to allocate the cost to Admin and/or Direct Service.
Refer to your contract terms and conditions for requirements related to equipment purchases
The final determination for cost allocations between Administrative Costs and Direct Service Costs
resides with Maricopa County Ryan White Part A Program

SERIAL 13054-RFP
Contractual Provider Entry Auto Calculation Date Prepared: 8/8/2013
Use this form to budget for consulting and contract labor (Section 1) and subcontracts ( Section 2) in conjunction with operating this Part A grant.
A copy of the fully executed contract covering the dates of service is required for each subcontract listed in this section.
1. Consulting/Professional Contract Labor/Clerical Support
This budget category includes payments to outside consultants, temporary services, professional contract labor and clerical support.
Indicate the name, licenses/qualifications, hours budgeted, quoted rate, dates of service, and a detailed Narrative/Justification
of activities to be provided.
1. Consulting/Professional Contract Labor/Clerical Support Chicanos Por La Causa Inc. Medical Case Management
Dates of Service
Consultant Annual Quoted Total Admin Admin Direct Service
Name Budgeted Hours Rate Budget Budget % Budget Budget
1 $ - $ - $ -
Licenses /
qualifications
Narrative/
Justification
2 $ - $ - $ - $ -
Licenses /
qualifications
Narrative/
Justification
3 $ - $ - $ - $ -
Licenses /
qualifications
Narrative/
Justification
4 $ - $ - $ - $ -
Licenses /
qualifications
Narrative/
Justification
5 $ - $ - $ - $ -
Licenses /
qualifications
Narrative
6 $ - $ - $ - $ -
Licenses /
qualifications
Narrative/
Justification
Consulting/ Prof./ Clerical Sup. Page 1 SUBTOTAL $ - $ - $ -
Consulting/ Prof./ Clerical Sup. From Contractual Continuation Page SUBTOTAL $ - $ - $ -
TOTAL $ - $ - $ -

SERIAL 13054-RFP
2. Subcontracts
Include any payments through subcontracts to provide services under this grant.
Each Subcontractor listed in this section who is a sub recipient (not a vendor) must complete a Budget using the RWPA budget template.
Maricopa County RWPA will enforce the 10% administrative Cost Cap established by HRSA for first-line and second line sub recipient entities receiving Ryan White Part A Funds.
2. Subcontracts Chicanos Por La Causa Inc. Medical Case Management
Subcontractor Sub recipient Admin Direct Service Total Admin Dates of Service
Name or Vendor Budget Budget Budget % of Direct
1 $ - #DIV/0!
Service(s)
Provided
Narrative/
Justification
2 $ - #DIV/0!
Service(s)
Provided
Narrative/
Justification
3 $ - #DIV/0!
Service(s)
Provided
Narrative/
Justification
TOTAL - - -
Admin Direct Total
SUMMARY Contractual $ - $ - $ -
Contractual B05-CT-1 ( These instructions will not print)
Consulting/Professional Contract Labor/Clerical Support
Enter the Consultant/Contractor Name, Annual Budgeted Hours, Quoted Rate, the percent of time that will be spent on Administrative Activities,
Dates of Service, Licenses, Qualifications and Description /Justification of Services to be provided.
If there are more than 9 entries, continue on the Contractual Continuation Tab of this budget template. The subtotals from the Contractual
Continuation Page will be carried over to the main Contractual budget page.
Subcontracts
Enter the Subcontractor Name and indicate if the subcontractor is a Vendor or a Subrecipient.
(b) A Subrecipient:
(1) Determines who is eligible to receive what Federal financial assistance;
(2) Has its performance measured against whether the objectives of the Federal program are met;
(3) Has responsibility for programmatic decision making;
(4) Has responsibility for adherence to applicable Federal program compliance requirements; and
(5) Uses the Federal funds to carry out a program of the organization as compared to providing goods or services for a program
of the pass-through entity.
(c) A Vendor:
(1) Provides the goods and services within normal business operations;
(2) Provides similar goods or services to many different purchasers;
(3) Operates in a competitive environment;
(4) Provides goods or services that are ancillary to the operation of the Federal program; and
(5) Is not subject to compliance requirements of the Federal program.
Enter the Admin and Direct Service Subcontract Amounts. These amounts will calculate the Total Budget.
The Administrative percentage ratio will also calculate automatically.
List the services and provide a narrative justification of the services to be provided.
Note: Subcontractors who are sub recipients must also prepare a detailed budget using the RWPA budget template.
Submit the subcontractor budget with your budget submission.

SERIAL 13054-RFP
Contractual- Continuation Page Date Prepared: 8/8/2013
The Contractual line item is used for consulting and contracting to be utilized in conjunction with operations of the grant.
Use this page to list Consultant/Contract Labor and Clerical Support if there is insufficient space on the Contractual Page.
Consulting/Professional Contract Labor/Clerical Support
Consulting/Professional Contract Labor/Clerical Support Chicanos Por La Causa Inc. Medical Case Management
Dates of Service
Consultant Hours Quoted Total Admin Admin Direct Service
Budgeted Rate Budget Budget % Budget
6 $ - $ - $ -
Licenses /
qualifications
Narrative
7 0 $ - $ - $ -
Licenses /
qualifications
Narrative
8 0 $ - $ - $ -
Licenses /
qualifications
Narrative
9 0 $ - $ - $ -
Licenses /
qualifications
Narrative
10 0 $ - $ - $ -
Licenses /
qualifications
Narrative
11 0 $ - $ - $ -
Licenses /
qualifications
Narrative
12 0 $ - $ - $ -
Licenses /
qualifications
Narrative
13 $ - $ - $ - $ - $ -
Licenses /
qualifications
Narrative
14 0 $ - $ - $ -
Licenses /
qualifications
Narrative
15 0 $ - $ - $ -
Licenses /
qualifications
Narrative
16 0 $ - $ - $ -
Licenses /
qualifications
Narrative
Consulting/ Prof./ Clerical Sup. Subtotal to Page 1 TOTAL - - $ -
Consulting/Professional/Clerical Support-
Enter the Consultant/Contractor Name, Annual Budgeted Hours, Quoted Rate, the percent of time that will be spent on Administrative Act
Dates of Service, Licenses, Qualifications and Description /Justification of Services to be provided
If there are more than 9 entries, continue on the Contractual Continuation Tab of this budget template. The subtotals from the Contractual
Continuation Page will be carried over to the main Contractual budget page.

SERIAL 13054-RFP
Other Program Support Provider Entry Auto Calculation Date Prepared: 8/8/2013
Use this form to budget for other support necessary to provide services under this grant. In the Narrative Justification
describe how the program support will be used and also the methodology used to allocate the total or a portion of the total cost
to the grant.
1 Communications/Telephone/Internet
Communications/Telephone/Internet Chicanos Por La Causa Inc. Medical Case Management
Item Total Narrative/Cost Allocation Methodology
Amount Admin Direct
Budgeted 0% 100%
For saftey purposes w hen traveling to and from offisite visits
and answ ering crisis/after hour calls. Cost based on units
Cell Phone $ 2,000.00 $ - $ 2,000.00 $ 2,000.00 provided per client.
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
TOTAL $ - $ 2,000.00 TOTAL $ 2,000.00
2 Copy/Duplicating
Copy/Duplicating Chicanos Por La Causa Inc. Medical Case Management
Item Amount Admin Direct Total Narrative/Cost Allocation Methodology
Budgeted 0% 100%
1 Program Brochures
$ - $ -
2 Other Copying/Duplicating
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
TOTAL $ - $ - TOTAL $ -
3 Postage
Postage Chicanos Por La Causa Inc. Medical Case Management
Item Amount Admin Direct Total Narrative/Cost Allocation Methodology
Budgeted 0% 100%
To communicate w ith clients w ho are not able to be contacted
Postage $ 350.00 $ - $ 350.00 $ 350.00 via hone. Cost based on units provided per client.
$ - $ - $ -
TOTAL $ - $ 350.00 TOTAL $ 350.00
4 Utilities
Utilities are 100% administrative. (Ruling 6.6.B05)
Utilities Chicanos Por La Causa Inc. Medical Case Management
Item Amount Admin Direct Total Narrative/Cost Allocation Methodology
Budgeted
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
TOTAL - - TOTAL $ -
4 Other Program Support
Other Program Support Chicanos Por La Causa Inc. Medical Case Management
Item Admin Direct Total Narrative/Cost Allocation Methodology
$ 500.00 $ - $ - $ -
$ - $ - $ - $ -
$ - $ - $ - $ -
$ - $ - $ - $ -
$ - $ - $ - $ -
TOTAL $ - $ - TOTAL $ -
Admin Direct Total
SUMMARY Program Support $ - $ 2,350.00 $ 2,350.00
Other Program Support B05-SP-1 ( These instructions will not print)
Section 1-3. These sections apply the FTE ratio for the expenditures including: telephone, postage, copying, and utilities.
Section 4 - Other Program Support allows you to use your own calculation method to allocate costs between Admin and Direct.
Enter the Admin Amount and Direct Amount to calculate the Total Budget and provide adequate justification of the methodology used
to allocate the costs; the methodology must be in line with your agency's cost allocation policy. Final determination resides with the
Maricopa County Ryan White Part A Program.

SERIAL 13054-RFP
Other Professional Service Provider Entry Auto Calculation Date Prepared:
Use this form to budget for other professional services; audit/accounting, insurance, rent/space, or other professional services.
1 Audit/Accounting/Finance
Audit/Accounting/Finance Chicanos Por La Causa Inc. Medical Case Management
Vendor Hours Quoted Total Dates Admin Direct Service Description of Service
Name Budgeted Price* Price of Service
a $ - $ -
Cost Method
Used
Budget
Justification
b $ - $ -
Cost Method
Used
Budget
Justification
c $ - $ -
Cost Method
Used
Budget
Justification
TOTAL - $ -
2 Insurance
Insurance Chicanos Por La Causa Inc. Medical Case Management
Vendor Annual Percent Total Dates Admin Direct Service Description of Service
Name Premium To grant Grant of Service
a $ - $ - $ -
Cost Method
Used
Budget
Justification
b $ - $ - $ -
Cost Method
Used
Budget
Justification
c $ - $ - $ -
Cost Method
Used
Budget
Justification
TOTAL $ - $ -
3 Rent/Space
Rent is considered 100% administrative
Rent/Space Chicanos Por La Causa Inc. Medical Case Management
Vendor Annual Percent Total Dates Admin Direct Service Description of Service
Name Rent to Grant Grant of Service
$ -
a $ - $ -
Cost Method
Used
Budget
Justification
TOTAL $ - $ -
4 Other Professional Service
Other Professional Service Chicanos Por La Causa Inc. Medical Case Management
Vendor Hours Quoted Total Admin Admin Direct Service Description of Service
Name Budgeted Price* Price Budget %
a $ - $ - $ -
Cost Method
Used
Budget
Justification
b $ - $ - $ -
Cost Method
Used
Budget
Justification
c $ - $ - $ -
Cost Method
Used
Budget
Justification
$ - TOTAL $ - $ - $ -
Admin Direct Total
SUMMARY Other Prof. Svc $ - $ - $ -
Other Professional B05-PF-1 ( These instructions will not print)
For each section, indicated the provider of service(s), the rate, a detailed description of the services provided, the method of calculating the
budget for this Part A grant and a narrative justification describing why is service is needed.
Section 1-3. Auditing, Insurance and Rent have been determined by the Maricopa County Ryan White Program to be Administrative Services.
Section 4 allows providers to indicate the percentage requested as administrative and direct service. Adequate explanation of the methodology
used to allocate costs is required; final determination resides with the Maricopa County Ryan White Part A Program.
If a vendor is not paid based on an hourly rate, enter a 1 for Hours Budgeted and the total cost of the service under Quoted Price.

SERIAL 13054-RFP
Schedule of Deliverables Provider Entry Auto Calculation Date Prepared: 8/8/2013
Organization Name: Chicanos Por La Causa Inc. Performance Measures:
Service Category Medical Case Management Number of New Clients 15
Number of Returning Clients 65
Total # of Unduplicated Clients 80
Fee for Service Only
Schedule of Deliverables ( Not Applicable to Cost Reimbursement Contracts)
Service Unit
CAREWare Fee Source (ie
Definition Number of Proposed Fee Total Payment Per
Service Unit Service Description Mar Apr May June July Aug Sep Oct Nov Dec Jan Feb AHCCCS, I H S,
1 unit = Units Per Product/ Objective/Activity
Name/Code Negotiated Rate, etc.)
(i.e. 15 minutes) Proposed Deliverable
FMCMAssessmen face to face MCM
1 t assessment 1 unit=15 min 300 25 25 25 25 25 25 25 25 25 25 25 25 $ -
2 FMCM face to face MCM 1 unit=15 min 1,943 162 162 162 162 161.83 161.83 161.83 161.83 161.83 161.83 161.83 161.83 $ -
3 OMCM non-face to face MCM 1 unit=15 min 4,746 395.5 395.5 395.5 395.5 395.5 395.5 395.5 395.5 395.5 395.5 395.5 395.5 $ -
4 - $ -
5 - $ -
6 - $ -
7 - $ -
8 - $ -
9 - $ -
10 - $ -
11 - $ -
12 - $ -
13 - $ -
14 - $ -
15 - $ -
TOTAL 6,989 583 583 583 583 582 582 582 582 582 582 582 582 $ -
Total Budget $ 128,000.00
Over/(Under Budget) $ (128,000.00)
Balance should equal zero
Instructions for Schedule of Deliverables ( These instructions will not print)
Fee for Service Only
Example ( Not Applicable to Cost Reimbursement Contracts)
CAREWare Service Unit Number
Service Unit Service Description Definition 1 of Units Mar Apr May June July Aug Sep Oct Nov Dec Jan Feb Proposed Fee Per Total Payment Per Fee Source (ie AHCCCS, I H
Name/Code unit = (i.e. Proposed Product/ Objective/Activity S, Negotiated Rate, etc.)
Face to face medical 15 minutes) Deliverable
FMCM case management
Assessment assessment. 1 unit = 15 minutes 1,128 94 94 94 94 94 94 94 94 94 94 94 94 $ - $ -
Food boxes Food box 1 unit = 1 food box 3,396 283 283 283 283 283 283 283 283 283 283 283 283 $ - $ -
H0004 Ind Individual counseling
Counseling session 1 unit = 15 minutes 6,900 600 600 600 600 500 600 600 600 600 400 600 600 $ 16.76 $ 115,644.00 AHCCCS Rate
1 Enter the CAREWare Service Name and or/Code; i.e. HCPCS or CPT Codes
2 Service Name Description- Use this cell to provide the full service name or describe the service
3 Service Unit Definition- Enter the DEFINITION of 1 unit. i.e. 15 minutes
The Unit definitions for each service category can be found in the RWPA P&P Manual
4 The TOTAL NUMBER OF UNITS PROPOSED calculates automatically, based on the total number of units
entered in the Schedule of Deliverables.
5 SCHEDULE OF DELIVERABLES: Enter the # of units BY MONTH proposed in the corresponding column and row.
Complete the information in the final 3 columns for Fee for Service Contracts Only
6 Enter the proposed fee for the corresponding activity/unit.
7 The Total Payment for each Activity/Unit calculates based on proposed # of units x proposed fee.
8 The TOTAL PAYMENT for all activity/units must equal the Total Budget from the Budget Summary.
9 In the final column, enter the source of the fee, i.e. AHCCCS, I H S, Negotiated Rate

SERIAL 13054-RFP
EXHIBIT B-2
PRICING & BUDGET FORM
NON- MEDICAL CASE MANAGEMENT
NOTE: The following budget is for fiscal year 2013/2014 the 2014/2015 budgets will be
developed upon issuance of a Task Order, Condition of Award and the new budget pending
grant award and funding allocations.
DATE PREPARED 9/18/13
PREPARED BY: Maclovia Morales
NAME OF ORGANIZATION: Chicanos Por La Causa Inc.
Fed. Employee ID # (FEIN) 86-0027210
DUNS # 136249609
ADDRESS: 1402 S. Central Avenue
Phoenix, AZ 85004
AUTHORIZED CONTACT Dottie O' Connell
TELEPHONE 602-257-0700 FAX 602-258-1206
E-MAIL Dottie.Oconnell@cplc.org
PRIMARY CONTACT
Maclovia Morales
TELEPHONE 602-253-4247 FAX 602-258-1206
EMAIL Maclovia Morales
CONTRACT NUMBER M-2013-SCM-CPL-002
SERVICE CATEGORY Non Medical Case Management
BUDGET PERIOD: 3/1/2013 2/28/2014
Start Date End Date
CONTRACT AMOUNT $120,219.00
By submission of this budget, the Provider certifies that they have read the List of Unallowable Costs under
the Ryan White Part A Program and agree to follow the HRSA specific standards related to Unallowable Costs.
In addition, the following documents must be submitted with your budget proposal (Check the appropriate boxes)
If applicable, Negotiated Indirect Cost Agreement is attached Cost Allocation Policy is attached (required)

SERIAL 13054-RFP
Date Prepared: 9/18/2013
(Section I)
Organization Chicanos Por La Causa Inc.
Service Category Non Medical Case Management
Budget Period 3/1/2013 Through 2/28/2014
(Section II) Contract Amount $120,219.00
Administrative Total Budget
Operating Expenses Budget Direct Service Budget
FTES 0.00 2.06 2.06
Personnel: Salaries $ - $ 73,384.06 $ 73,384.06
Personnel: Fringe/Benefits - 17,472.75 17,472.75
Subtotal: Personnel/Fringe Benefits - 90,856.81 90,856.81
Other Operating Expenses
Travel - 9,603.72 9,603.72
Supplies - 5,979.47 5,979.47
Equipment - - -
Contractual - - -
Program Support - 2,850.00 2,850.00
Other Professional Services - - -
Subtotal: Other Operating Expenses - 18,433.19 18,433.19
Total Operating Expenses - 109,290.00 109,290.00
(Personnel and Other Direct Costs)
Indirect Costs 10,929.00 10,929.00
Enter Indirect Cost Rate 10.00% Providers claiming an indirect cost must submit their most current negotiated indirect
(may not exceed 10% of Direct Costs) costs rate agreement issued by the cognizant federal agency with their budget.
Total Costs of Contract 10,929.00 109,290.00 120,219.00
(Admin-Percent of Direct Costs) 10.00%
Administration may not exceed 10% of Direct Costs
CONTRACT BALANCE (Contract Revenue less Total Costs of Contract) $ 0.00
*The Contract Balance should equal zero.

SERIAL 13054-RFP
Budget Summary B05-SU-1
This form summarizes all of the line items in the submitted budget packet for the award listed in the Cover Page.
If completing this form electronically, the information will automatically populate as the budget packet
is completed:
Section I Summarizes the organizational information provided in the Cover Page.
The information will automatically populate when the Cover Page is completed
Section II This section summarizes the budget information calculated in the submitted budget packet for this grant.
This form is required for all Ryan White Part A awards issued by Maricopa County Ryan White Part A Program
This form reports the summary line item amounts allocated as Administrative Costs, Direct Service Cost, and
total budget for the budget packet for this service award.
1 Direct Services allocations are for service that directly benefits Ryan White HIV clients such as staff, medicine
and drugs clinical supplies, etc.
2 Administrative costs relate to oversight and management of CARE Act funds: The Administrative Costs
Column, including indirect cost, cannot exceed 10% of Direct Costs.
Administrative Costs, defined in Section 2604(f)(3) defines allowable "subcontractor administrative activities to include:
a. Usual and recognized overhead, including establishing indirect rates for agencies. (HRSA has determined
that rent, utilities and facility costs must be categorized as administrative expenses.)
b. Management and oversight of specific programs funded under this title (including program coordination,
clerical, financial and management staff not directly related to patient care; program evaluation; liability insurance;
audits; computer hardware/software not directly related to patient care.)
c. Other types of program support such as quality assurance, quality control, and related activities."
Other Examples include: salaries and expenses of executive officers, personnel administration, contracting, accounting, data recording,
the costs of operating and maintaining facilities, and depreciation or use allowances on building and equipment.
Indirect Costs- Enter the indirect rate you are claiming (not to exceed 10% of direct costs).
** Indirect Cost - Providers claiming an indirect cost must submit their most current negotiated indirect
Cost agreement with their budget. The indirect costs claimed from the Ryan White Part A Program may
not exceed 10% of direct costs nor the amount that would be claimed using their agency's federally
negotiated indirect cost rate and base, whichever is lower. Note: Only United States Health and Human Services (HHS)
negotiated indirect rates will be accepted unless an exception is approved by the HHS.
3 Contract Balance - This cell calculates the amount of the contract less the projected costs. This number should equal 0.
The final determination for cost allocations between Administrative Costs and Direct Service Costs
resides with Maricopa County Ryan White Part A Program

SERIAL 13054-RFP
Personnel All staff paid in full or part from this Ryan White Part A grant are to be listed in the following chart. Date Prepared: 9/18/2013
1 Staffing Provider Entry Auto Calculation Fringe Benefit Rate 23.81%
Staffing Chicanos Por La Causa Inc. Non Medical Case Management
Benefits
Annual Hourly Salary Applied to Applied to grant Job Status % Applied as Gross Admin Gross Admin Direct Service Direct Service
Position Title Last Name Hours % RWPA FTE Rate grant per FTE per FTE A, D or A/D Administrative Salary Benefits Salary Benefits
1 Program Director Morales 2080 6.00% 0.0600 $28.78 $ 3,591.74 $ 855.19 D 0% - - $ 3,591.74 $ 855.19
Ms. Morales will provide SCM services that will inlcude linkage to PMC, medicationand treatment adherence. Conduct case staffings complete risk assessments and needs assessments. Administrative time spent on this contract will be
tracked on timesheet and paid from another funding source identified as "Contributions".
List Benefit Categories and %;
( this table w ill not print)
Lead Case
2 Manager Ornelas 2080 6.00% 0.0600 $33.17 $ 4,139.62 $ 985.64 D 0% - - $ 4,139.62 $ 985.64 (R) Benefits
This person will provide SCM services that will inlcude linkage to PMC, medication and treatment adherence, Conduct case staffings, complete risk assessments, and needs assessments.
Benefits Name Percent
FICA 6.20%
3 0.0000 $ - $ - D 0% - - $ - $ - Medicare 1.45%
Workers Comp 0.93%
Unemployment 0.94%
4 Case Manager Madero 2080 97.00% 0.9700 $16.94 $ 34,178.14 $ 8,137.82 D 0% - - $ 34,178.14 $ 8,137.82 Disability 0.29%
This person will provide SCM services that will inlcude linkage to PMC, medication and treatment adherence, Conduct case staffings, complete risk assessments, and needs assessments.
Med. Insurance 6.00%
Dental 1.00%
5 Case Manager Diaz 2080 97.00% 0.9700 $15.60 $ 31,474.56 $ 7,494.09 - - $ 31,474.56 $ 7,494.09 Retirement 7.00%
This person will provide SCM services that will inlcude linkage to PMC, medication and treatment adherence, Conduct case staffings, complete risk assessments, and needs assessments.
TOTAL 23.81%
6 0.0000 $ - $ - - - $ - $ -
Description
7 0.0000 $ - $ - - - $ - $ -
Description
8 0.0000 $ - $ - - - $ - $ -
Description
Subtotal Personnel 2.06 $ 73,384.06 $ 17,472.75 $ - $ - $ 73,384.06 $ 17,472.75
Subtotal from Personnel Continuation Sheet 0.00 $ - $ - $ - $ - $ - $ -
TOTAL Personnel 2.06 $ 73,384.06 $ 17,472.75 $ - $ - $ 73,384.06 $ 17,472.75
(Admin) 0.00 FTE Percent Admin 0%
(Direct Service) 2.06 FTE Percent Direct 100%
Total 2.06 FTE 100%

SERIAL 13054-RFP
Personnel Instructions B05-PE-1 ( These instructions will not print)
Use this form to list ALL persons being paid a salary from the Ryan White Part A grant in this budget packet.
This form calculates the applied annual salary and applied annual benefits per individual position.
The Provider must determine if the position(s) listed are Administrative, Direct Service, or Both
* for Both, the Provider must indicate how much of the time spent on Ryan White Part A activities
are considered administrative.
For example - a Case Management Supervisor may continue with a case load of their own, in this
case, it must be determined how much of their time should be allocated to Administrative duties
and Direct Service support.
If at the time of submission of a service budget one or more of the personnel positions are vacant, contractors must indicat
and provide a date when the positions will be filled, and prorate/apportion personnel and other associated costs to reflect
service. Alternatively, contractors may note the vacancy, with no associated cost, and develop the contract to reflect actual
staffing at the time of budget preparations, amending the budget to reflect ongoing personnel changes as they occur.
The Cells referenced in the form requiring entry are:
Position Title Enter the position title
Last Name Enter the last name of the employee who occupies the position or enter "Vacant"
If you have more than 8 employees/positions who will be paid on this grant, use the
Personnel Continuation Tab in this budget template to list the remaining employees.
The subtotal from the Personnel Continuation will roll over to the main Personnel Page.
Annual Hours Enter Number of Budgeted Hours for this position/employee. Typically, annual hours for full time
staff are 2,080 hours. Adjust hours if position will not be filled for an entire year or if the person
works part time and explain under "Description"
% RWPA Enter the % of time this employee/position is budgeted on the Part A grant
(i.e., A person who spends 1/2 of their work hours on this grant would be 50% )
FTE FTE = Full Time Equivalent. This is a calculated field. ( Annual Hours/2080* % RWPA)
Hourly Rate Enter the employee/budgeted position's hourly rate
Job Status Determine whether an employee's primary responsibilities on this grant will be for Direct Service
activities or Administrative activities by entering A or D.
* For a staff member who has both responsibilities, enter A and D
Percent applied Enter how much of the employee's time is spent on Administrative duties.
as Admin. (i.e., a staff member can spend 90% of their time doing administrative duties and 10% performing
Direct Services.)
Description Provide the Position Number and a Description of Duties. If the employee will not be in the
position for the entire year, enter the start and end dates.
Benefit Table Enter a brief name of each benefit included for staff and the percentage of gross salary
associated with that benefit. (i.e., Social Security- (FICA), Health Insurance, Retirement, etc.)
This data will calculate the total Benefit Rate that will be applied to your budget.
( Note: to maximize space, the benefit table will not print on the printed copy of this page )

SERIAL 13054-RFP
2 Staffing Continuation Sheet ( Page 2 of 2) Provider Entry Auto Calculation Date Prepared: 9/18/2013
Staffing Continuation Sheet ( Page 2 of 2) Chicanos Por La Causa Inc. Non Medical Case Management
Annual Hourly Salary Applied Benefits Applied to Job Status % Applied as Gross Admin Gross Admin Direct Service Direct Service
Position Title Last Name Hours % RWPA FTE Rate to grant per FTE grant per FTE A, D or A/D Administrative Salary Benefits Salary Benefits
9 0.0000 $ - $ - - - $ - $ -
Description
10 0.0000 $ - $ - - - $ - $ -
Description
11 0.0000 $ - $ - - - $ - $ -
Description
12 0.0000 $ - $ - - - $ - $ -
Description
13 0.0000 $ - $ - - - $ - $ -
Description
14 0.0000 $ - $ - - - $ - $ -
Description
15 0.0000 $ - $ - - - $ - $ -
Description
16 0.0000 $ - $ - - - $ - $ -
Description
17 0.0000 $ - $ - - - $ - $ -
Description
Subtotal to Page 1 0.00 $ - $ - - - $ - $ -

SERIAL 13054-RFP
TRAVEL Provider Entry Auto Calculation Date Prepared:
Travel can be budgeted for the cost of staff mileage and other travel associated with Ryan White Part A.
1 Mileage Mileage will be budgeted utilizing the standard calculation of # of monthly miles for a full time staff person x12 months x the rate per mile
used by your organization x the number of FTE(s) budgeted who will travel to provide services under this grant.
Enter only the FTEs that will travel and provide a Narrative Justification including who will travel and why.
Mileage Chicanos Por La Causa Inc. Non Medical Case Management
Mileage Rate
$0.555
FTE Monthly Miles Annual Miles Total
Budgeted (Per 1 Admin Direct Svc Narrative Justification
FTE)* Applied to Grant Budget
1 Admin 0.00 0 0 $ - $ - $ -
Direct Svc Miles will be used to conduct home/offsite visits. An average of 700 miles will be traveled per
2 2.06 700 17304 $ 9,603.72 $ 9,603.72 month. Cost is based from miles traveled in 2013-14 FY and factoring additional clients.
TOTAL 700 17304 $ 9,603.72 $ - $ 9,603.72 $ 9,603.72
(Total Miles applied to this grant)
*Note - Budget monthly mileage for 1 FTE. This is a revision to prior year budget templates.
2 Other Allowable Travel ( car rental, parking, fees, etc.)
Ryan White Part A has determined that costs included in this section are Administrative Costs.
Other Allowable Travel Chicanos Por La Causa Inc. Non Medical Case Management
Dates Total Admin Direct Svc Narrative Justification
of Travel Budget
1 Cost $ - $ - 0
Line Item 0
2 Cost $ - $ - 0
Line Item 0
3 Cost $ - $ - 0
Line Item 0
$ - $ - - $ -
Admin Direct Service Total
SUMMARY (Travel) $ - $ 9,603.72 $ 9,603.72

SERIAL 13054-RFP
Travel Budget Instructions B05-TV-1 ( These instructions will not print)
Use this form to budget any travel expenses associated with the services of the Ryan White Part A Grant.
This form consists of two (2) sections - Mileage and Other Allowable Travel
The Travel budget form requires the following entries:
Mileage This section establishes a budget amount, both Administrative and Direct Service, for
mileage reimbursement in conjunction with providing services to the grant.
Maricopa County Ryan White Part A Program has adapted a standard formula to apply all
mileage reimbursements budgets.
Mileage Rate: Enter the current rate used by your organization to reimburse mileage requests
FTE: Enter the number of FTE who will travel, both Administrative and Direct Service, in the corresponding row.
Monthly Miles Enter the monthly miles that are budgeted for one (1) FTE staff person.
Narrative/ Provide a detailed justification for the travel budget requested, including who will travel and why.
Justification:
Other
Allowable
Travel In some cases, other travel may be allowed under the Ryan White Part A Grant.
Each item listed in this section must have a detailed and accurate budget justification attached.
Dates of Travel: Enter the dates that the other travel is expected.
Cost and Enter the estimated cost and name of the expense
Line Item: *this can include car rental, parking fees, etc.
Narrative/ Provide a detailed description and justification of the expense in relation to Ryan White Part A services
Justification: as awarded in this grant.

SERIAL 13054-RFP
SUPPLIES Provider Entry Auto Calculation Date Prepared:
The supplies line item is used to budget funds for supplies used in the operations of the Grant.
This category can include general office supplies and program/medical supplies
1 General Office Supplies: (Apply an FTE Ratio from the Budgeted Personnel Page)
Pens, paper, toner and general supplies that are used to run an office.
General Office Supplies Chicanos Por La Causa Inc. Non Medical Case Management
Annual % Admin % Direct Total
Narrative Description/Cost Allocation Methodology
Item Budget 0% 100% 100%
1 Paper, pens $ 4,000.00 $ - $ 4,000.00 $ 4,000.00 For the documentation of direct services. Cost base on units provider per client
2 $ - $ - $ -
3 $ - $ - $ -
4 $ - $ - $ -
5 $ - $ - $ -
$ - $ - $ -
TOTAL $ - $ 4,000.00 TOTAL $ 4,000.00
2 Program Supplies
Program/Medical Supplies are budgeted as Direct Service.
Program Supplies Chicanos Por La Causa Inc. Non Medical Case Management
Annual
Item Admin Direct Narrative Description/Cost Allocation Methodology
Budget
For the rerpoduction of direct service documentation, to be used directly w ith clients during individual
sessions, for the storage of clinical documentation for clients. Cost based on units provider per client.
Water justification:Some people may be more vulnerable to contaminants in drinking w ater than the
general population.
People w ith severely compromised immune systems, such as people w ith cancer undergoing
chemotherapy,
people w ho have undergone organ transplants, people w ith HIV/AIDS or other immune system
Toner, w ater, disorders,
1 files, storage $ 1,979.47 $ - $ 1,979.47 some elderly, and infants can be particularly at risk from infections.
2 $ -
3 $ -
4 $ -
5 $ -
$ -
TOTAL $ - $ 1,979.47 TOTAL $ 1,979.47
Admin Direct Total
SUMMARY ( Supplies) $ - $ 5,979.47 $ 5,979.47

SERIAL 13054-RFP
Supplies Budget Instructions B05-SP-1 (These instructions will not print)
Use this form to create the general office and program supply budgets for the Ryan White Part A grant.
Section I General Office Supplies
General office supplies include pens, paper, toner and general supplies that are used to run an office.
Maricopa County Ryan White Part A Program has initiated a standard allocation model for general office supplies
to determine the appropriate budget for Administrative and Direct Services.
(Administrative Allocation = Total Budget x Percent of administrative FTE to total FTE)
In the Narrative, describe how the supplies will be used and also the methodology used to determine the Annual Budget Amount.
Note: The cost allocation methodology should be based on your organization's cost allocation policy.
Section II Program Supplies
This chart can be used to identify and budget for program supplies used in providing services.
Program Supplies include supplies that are specifically related to performance of the direct services; i.e. medical supplies, folders for client files, etc.
Program Supplies have been determined to be Direct Service Costs, however final determination resides with Maricopa County
Ryan White Part A Program, therefore it is important to provide an adequate justification.
In the Narrative, describe how the supplies will be used and also the methodology used to determine the Annual Budget Amount.
Note: The cost allocation methodology should be based on your organization's cost allocation policy.

SERIAL 13054-RFP
EQUIPMENT Provider Entry Auto Calculation Date Prepared: 9/18/2013
The equipment line item is budgeted for equipment purchased or leased in conjunction with operations of the grant
Refer to your contract terms and conditions for requirements related to equipment purchases
Equipment less than $5,000
Equipment less than $5,000 - includes computers, fax machines, shredders, and other
equipment less than $5,000 to be used in the operations of this grant.
Equipment less than $5,000 Chicanos Por La Causa Inc. Non Medical Case Management
Item Admin Direct Total Narrative Description/Cost Allocation Methodology
Budgeted Service
1 $ -
2 $ -
3 $ -
4 $ -
5 $ -
$ -
TOTAL $ - $ - TOTAL $ -
Equipment $5,000 or greater
Equipment $5,000 or greater Chicanos Por La Causa Inc. Non Medical Case Management
Item Admin Direct Total Narrative Description/Cost Allocation Methodology
Budgeted Amount Amount
1 $ -
2 $ -
3 $ -
4 $ -
TOTAL $ - $ - TOTAL $ -
Admin Direct Total
SUMMARY (Equipment) $ - $ - $ -
Equipment Budget Instructions B05-EQ-1
Use this form to budget for equipment needed to support services under this Part A grant.
The Equipment budget form requires the following entries:
Item Budgeted: Enter the name of the equipment to be purchased or leased
Admin and Direct Amt: Enter the total budgeted amount for Admin and Direct Services.
Narrative/ In the Narrative, describe how the equipment will be used and also the methodology used
Cost Allocation to allocate the total or a portion of the cost to the Ryan White Program. Also
Methodology: describe the methodology used to allocate the cost to Admin and/or Direct Service.
Refer to your contract terms and conditions for requirements related to equipment purchases
The final determination for cost allocations between Administrative Costs and Direct Service Costs
resides with Maricopa County Ryan White Part A Program

SERIAL 13054-RFP
Contractual Provider Entry Auto Calculation Date Prepared: 9/18/2013
Use this form to budget for consulting and contract labor (Section 1) and subcontracts ( Section 2) in conjunction with operating this Part A grant.
A copy of the fully executed contract covering the dates of service is required for each subcontract listed in this section.
1. Consulting/Professional Contract Labor/Clerical Support
This budget category includes payments to outside consultants, temporary services, professional contract labor and clerical support.
Indicate the name, licenses/qualifications, hours budgeted, quoted rate, dates of service, and a detailed Narrative/Justification
of activities to be provided.
1. Consulting/Professional Contract Labor/Clerical Support Chicanos Por La Causa Inc. Non Medical Case Management
Dates of Service
Consultant Annual Quoted Total Admin Admin Direct Service
Name Budgeted Hours Rate Budget Budget % Budget Budget
1 $ - $ - $ -
Licenses /
qualifications
Narrative/
Justification
2 $ - $ - $ - $ -
Licenses /
qualifications
Narrative/
Justification
3 $ - $ - $ - $ -
Licenses /
qualifications
Narrative/
Justification
4 $ - $ - $ - $ -
Licenses /
qualifications
Narrative/
Justification
5 $ - $ - $ - $ -
Licenses /
qualifications
Narrative
6 $ - $ - $ - $ -
Licenses /
qualifications
Narrative/
Justification
Consulting/ Prof./ Clerical Sup. Page 1 SUBTOTAL $ - $ - $ -
Consulting/ Prof./ Clerical Sup. From Contractual Continuation Page SUBTOTAL $ - $ - $ -
TOTAL $ - $ - $ -

SERIAL 13054-RFP
2. Subcontracts
Include any payments through subcontracts to provide services under this grant.
Each Subcontractor listed in this section who is a sub recipient (not a vendor) must complete a Budget using the RWPA budget template.
Maricopa County RWPA will enforce the 10% administrative Cost Cap established by HRSA for first-line and second line sub recipient entities receiving Ryan White Part A Funds.
2. Subcontracts Chicanos Por La Causa Inc. Non Medical Case Management
Subcontractor Sub recipient Admin Direct Service Total Admin Dates of Service
Name or Vendor Budget Budget Budget % of Direct
1 $ - #DIV/0!
Service(s)
Provided
Narrative/
Justification
2 $ - #DIV/0!
Service(s)
Provided
Narrative/
Justification
3 $ - #DIV/0!
Service(s)
Provided
Narrative/
Justification
TOTAL - - -
Admin Direct Total
SUMMARY Contractual $ - $ - $ -
Contractual B05-CT-1 ( These instructions will not print)
Consulting/Professional Contract Labor/Clerical Support
Enter the Consultant/Contractor Name, Annual Budgeted Hours, Quoted Rate, the percent of time that will be spent on Administrative Activities,
Dates of Service, Licenses, Qualifications and Description /Justification of Services to be provided.
If there are more than 9 entries, continue on the Contractual Continuation Tab of this budget template. The subtotals from the Contractual
Continuation Page will be carried over to the main Contractual budget page.
Subcontracts
Enter the Subcontractor Name and indicate if the subcontractor is a Vendor or a Subrecipient.
(b) A Subrecipient:
(1) Determines who is eligible to receive what Federal financial assistance;
(2) Has its performance measured against whether the objectives of the Federal program are met;
(3) Has responsibility for programmatic decision making;
(4) Has responsibility for adherence to applicable Federal program compliance requirements; and
(5) Uses the Federal funds to carry out a program of the organization as compared to providing goods or services for a program
of the pass-through entity.
(c) A Vendor:
(1) Provides the goods and services within normal business operations;
(2) Provides similar goods or services to many different purchasers;
(3) Operates in a competitive environment;
(4) Provides goods or services that are ancillary to the operation of the Federal program; and
(5) Is not subject to compliance requirements of the Federal program.
Enter the Admin and Direct Service Subcontract Amounts. These amounts will calculate the Total Budget.
The Administrative percentage ratio will also calculate automatically.
List the services and provide a narrative justification of the services to be provided.
Note: Subcontractors who are sub recipients must also prepare a detailed budget using the RWPA budget template.
Submit the subcontractor budget with your budget submission.

SERIAL 13054-RFP
Contractual- Continuation Page Date Prepared: 9/18/2013
The Contractual line item is used for consulting and contracting to be utilized in conjunction with operations of the grant.
Use this page to list Consultant/Contract Labor and Clerical Support if there is insufficient space on the Contractual Page.
Consulting/Professional Contract Labor/Clerical Support
Consulting/Professional Contract Labor/Clerical Support Chicanos Por La Causa Inc. Non Medical Case Management
Dates of Service
Consultant Hours Quoted Total Admin Admin Direct Service
Budgeted Rate Budget Budget % Budget
6 $ - $ - $ -
Licenses /
qualifications
Narrative
7 0 $ - $ - $ -
Licenses /
qualifications
Narrative
8 0 $ - $ - $ -
Licenses /
qualifications
Narrative
9 0 $ - $ - $ -
Licenses /
qualifications
Narrative
10 0 $ - $ - $ -
Licenses /
qualifications
Narrative
11 0 $ - $ - $ -
Licenses /
qualifications
Narrative
12 0 $ - $ - $ -
Licenses /
qualifications
Narrative
13 $ - $ - $ - $ - $ -
Licenses /
qualifications
Narrative
14 0 $ - $ - $ -
Licenses /
qualifications
Narrative
15 0 $ - $ - $ -
Licenses /
qualifications
Narrative
16 0 $ - $ - $ -
Licenses /
qualifications
Narrative
Consulting/ Prof./ Clerical Sup. Subtotal to Page 1 TOTAL - - $ -
Consulting/Professional/Clerical Support-
Enter the Consultant/Contractor Name, Annual Budgeted Hours, Quoted Rate, the percent of time that will be spent on Administrative Act
Dates of Service, Licenses, Qualifications and Description /Justification of Services to be provided
If there are more than 9 entries, continue on the Contractual Continuation Tab of this budget template. The subtotals from the Contractual
Continuation Page will be carried over to the main Contractual budget page.

SERIAL 13054-RFP
Other Program Support Provider Entry Auto Calculation Date Prepared: 9/18/2013
Use this form to budget for other support necessary to provide services under this grant. In the Narrative Justification
describe how the program support will be used and also the methodology used to allocate the total or a portion of the total cost
to the grant.
1 Communications/Telephone/Internet
Communications/Telephone/Internet Chicanos Por La Causa Inc. Non Medical Case Management
Item Total Narrative/Cost Allocation Methodology
Amount Admin Direct
Budgeted 0% 100%
For saftey purposes w hen traveling to and from offisite visits
and answ ering crisis/after hour calls. Cost based on units
Cell Phone $ 2,500.00 $ - $ 2,500.00 $ 2,500.00 provided per client.
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
TOTAL $ - $ 2,500.00 TOTAL $ 2,500.00
2 Copy/Duplicating
Copy/Duplicating Chicanos Por La Causa Inc. Non Medical Case Management
Item Amount Admin Direct Total Narrative/Cost Allocation Methodology
Budgeted 0% 100%
1 Program Brochures
$ - $ -
2 Other Copying/Duplicating
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
TOTAL $ - $ - TOTAL $ -
3 Postage
Postage Chicanos Por La Causa Inc. Non Medical Case Management
Item Amount Admin Direct Total Narrative/Cost Allocation Methodology
Budgeted 0% 100%
To communicate w ith clients w ho are not able to be contacted
Postage $ 350.00 $ - $ 350.00 $ 350.00 via hone. Cost based on units provided per client.
$ - $ - $ -
TOTAL $ - $ 350.00 TOTAL $ 350.00
4 Utilities
Utilities are 100% administrative. (Ruling 6.6.B05)
Utilities Chicanos Por La Causa Inc. Non Medical Case Management
Item Amount Admin Direct Total Narrative/Cost Allocation Methodology
Budgeted
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
TOTAL - - TOTAL $ -
4 Other Program Support
Other Program Support Chicanos Por La Causa Inc. Non Medical Case Management
Item Admin Direct Total Narrative/Cost Allocation Methodology
$ 500.00 $ - $ - $ -
$ - $ - $ - $ -
$ - $ - $ - $ -
$ - $ - $ - $ -
$ - $ - $ - $ -
TOTAL $ - $ - TOTAL $ -
Admin Direct Total
SUMMARY Program Support $ - $ 2,850.00 $ 2,850.00
Other Program Support B05-SP-1 ( These instructions will not print)
Section 1-3. These sections apply the FTE ratio for the expenditures including: telephone, postage, copying, and utilities.
Section 4 - Other Program Support allows you to use your own calculation method to allocate costs between Admin and Direct.
Enter the Admin Amount and Direct Amount to calculate the Total Budget and provide adequate justification of the methodology used
to allocate the costs; the methodology must be in line with your agency's cost allocation policy. Final determination resides with the
Maricopa County Ryan White Part A Program.

SERIAL 13054-RFP
Other Professional Service Provider Entry Auto Calculation Date Prepared:
Use this form to budget for other professional services; audit/accounting, insurance, rent/space, or other professional services.
1 Audit/Accounting/Finance
Audit/Accounting/Finance Chicanos Por La Causa Inc. Non Medical Case Management
Vendor Hours Quoted Total Dates Admin Direct Service Description of Service
Name Budgeted Price* Price of Service
a $ - $ -
Cost Method
Used
Budget
Justification
b $ - $ -
Cost Method
Used
Budget
Justification
c $ - $ -
Cost Method
Used
Budget
Justification
TOTAL - $ -
2 Insurance
Insurance Chicanos Por La Causa Inc. Non Medical Case Management
Vendor Annual Percent Total Dates Admin Direct Service Description of Service
Name Premium To grant Grant of Service
a $ - $ - $ -
Cost Method
Used
Budget
Justification
b $ - $ - $ -
Cost Method
Used
Budget
Justification
c $ - $ - $ -
Cost Method
Used
Budget
Justification
TOTAL $ - $ -
3 Rent/Space
Rent is considered 100% administrative
Rent/Space Chicanos Por La Causa Inc. Non Medical Case Management
Vendor Annual Percent Total Dates Admin Direct Service Description of Service
Name Rent to Grant Grant of Service
$ -
a $ - $ -
Cost Method
Used
Budget
Justification
TOTAL $ - $ -
4 Other Professional Service
Other Professional Service Chicanos Por La Causa Inc. Non Medical Case Management
Vendor Hours Quoted Total Admin Admin Direct Service Description of Service
Name Budgeted Price* Price Budget %
a $ - $ - $ -
Cost Method
Used
Budget
Justification
b $ - $ - $ -
Cost Method
Used
Budget
Justification
c $ - $ - $ -
Cost Method
Used
Budget
Justification
$ - TOTAL $ - $ - $ -
Admin Direct Total
SUMMARY Other Prof. Svc $ - $ - $ -
Other Professional B05-PF-1 ( These instructions will not print)
For each section, indicated the provider of service(s), the rate, a detailed description of the services provided, the method of calculating the
budget for this Part A grant and a narrative justification describing why is service is needed.
Section 1-3. Auditing, Insurance and Rent have been determined by the Maricopa County Ryan White Program to be Administrative Services.
Section 4 allows providers to indicate the percentage requested as administrative and direct service. Adequate explanation of the methodology
used to allocate costs is required; final determination resides with the Maricopa County Ryan White Part A Program.
If a vendor is not paid based on an hourly rate, enter a 1 for Hours Budgeted and the total cost of the service under Quoted Price.

SERIAL 13054-RFP
Schedule of Deliverables Provider Entry Auto Calculation Date Prepared: 9/18/2013
Organization Name: Chicanos Por La Causa Inc. Performance Measures:
Service Category Non Medical Case Management Number of New Clients 15
Number of Returning Clients 65
Total # of Unduplicated Clients 80
Fee for Service Only
Schedule of Deliverables ( Not Applicable to Cost Reimbursement Contracts)
Service Unit
CAREWare Fee Source (ie
Definition Number of Proposed Fee Total Payment Per
Service Unit Service Description Mar Apr May June July Aug Sep Oct Nov Dec Jan Feb AHCCCS, I H S,
1 unit = Units Per Product/ Objective/Activity
Name/Code Negotiated Rate, etc.)
(i.e. 15 minutes) Proposed Deliverable
FMCMAssessmen face to face MCM
1 t assessment 1 unit=15 min 300 25 25 25 25 25 25 25 25 25 25 25 25 $ -
2 FMCM face to face MCM 1 unit=15 min 3,000 250 250 250 250 250 250 250 250 250 250 250 250 $ -
3 OMCM non-face to face MCM 1 unit=15 min 5,270 436.16 436.16 438 440 440 440 440 440 440 440 440 440 $ -
4 - $ -
5 - $ -
6 - $ -
7 - $ -
8 - $ -
9 - $ -
10 - $ -
11 - $ -
12 - $ -
13 - $ -
14 - $ -
15 - $ -
TOTAL 8,570 711 711 713 715 715 715 715 715 715 715 715 715 $ -
Total Budget $ 120,219.00
Over/(Under Budget) $ (120,219.00)
Balance should equal zero
Instructions for Schedule of Deliverables ( These instructions will not print)
Fee for Service Only
Example ( Not Applicable to Cost Reimbursement Contracts)
CAREWare Service Unit Number
Service Unit Service Description Definition 1 of Units Mar Apr May June July Aug Sep Oct Nov Dec Jan Feb Proposed Fee Per Total Payment Per Fee Source (ie AHCCCS, I H
Name/Code unit = (i.e. Proposed Product/ Objective/Activity S, Negotiated Rate, etc.)
Face to face medical 15 minutes) Deliverable
FMCM case management
Assessment assessment. 1 unit = 15 minutes 1,128 94 94 94 94 94 94 94 94 94 94 94 94 $ - $ -
Food boxes Food box 1 unit = 1 food box 3,396 283 283 283 283 283 283 283 283 283 283 283 283 $ - $ -
H0004 Ind Individual counseling
Counseling session 1 unit = 15 minutes 6,900 600 600 600 600 500 600 600 600 600 400 600 600 $ 16.76 $ 115,644.00 AHCCCS Rate
1 Enter the CAREWare Service Name and or/Code; i.e. HCPCS or CPT Codes
2 Service Name Description- Use this cell to provide the full service name or describe the service
3 Service Unit Definition- Enter the DEFINITION of 1 unit. i.e. 15 minutes
The Unit definitions for each service category can be found in the RWPA P&P Manual
4 The TOTAL NUMBER OF UNITS PROPOSED calculates automatically, based on the total number of units
entered in the Schedule of Deliverables.
5 SCHEDULE OF DELIVERABLES: Enter the # of units BY MONTH proposed in the corresponding column and row.
Complete the information in the final 3 columns for Fee for Service Contracts Only
6 Enter the proposed fee for the corresponding activity/unit.
7 The Total Payment for each Activity/Unit calculates based on proposed # of units x proposed fee.
8 The TOTAL PAYMENT for all activity/units must equal the Total Budget from the Budget Summary.
9 In the final column, enter the source of the fee, i.e. AHCCCS, I H S, Negotiated Rate

SERIAL 13054-RFP
EXHIBIT C
SCOPE OF WORK
1.0 SCOPE OF WORK:
1.1 PURPOSE OF THE PROGRAM, AUTHORITY AND BACKGROUND:
The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act was first enacted in
1990 and amended in 1996, 2000, 2006 and 2009. Currently, the Act was reauthorized in 2009
and is called the Ryan White HIV/AIDS Treatment Extension Act of 2009. The authority for this
grant program is the Public Health Service Act Section 2603, 42 USC 300ff-13. The U.S.
Department of Health and Human Services (DHHS) administers the Part A program through the
Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB), Division of
Service System (DSS). The entire CARE Act may be accessed at
http://hab.hrsa.gov/abouthab/legislation.html.
Part A funds provide direct financial assistance to Eligible Metropolitan Area (EMAs) that have
been the most severely affected by the HIV epidemic. Formula and supplemental funding
components of the grant assist EMAs in developing or enhancing access to a comprehensive
continuum of high quality, community-based care for low-income individuals and families with
HIV disease. A comprehensive continuum of care includes primary medical care, HIV-related
medications, mental health treatment, substance abuse treatment, oral health and case management
services that assist PLWH/A (People Living with HIV/AIDS) in accessing treatment of HIV
infection that is consistent with Public Health Service (PHS) Treatment Guidelines (current
treatment guidelines are available at www.AIDS info.nih.gov). Comprehensive HIV/AIDS care
beyond these core services also includes access to other health services (e.g. home health care,
nutritional, and rehabilitation service). In addition, this continuum of care may include supportive
services that enable individuals to access and remain in primary medical care (e.g. outreach,
transportation, and food services).
Part A supplemental funds have been awarded since fiscal year (FY) 1999 under the Minority
AIDS Initiative (MAI) to improve the quality of care and health outcomes in communities of color
disproportionately impacted by the HIV epidemic. Funds are to initiate, modify, or expand
culturally and linguistically appropriate HIV care services for disproportionately impacted
communities of color. Following Congressional intent, MAI funds must be used to expand or
support new initiatives consistent with these goals.
MAI funds are subject to special conditions of award, and providers of services funded with MAI
funds must document their use separately from other Part A funds. Progress reports must be
provided in a beginning of year, Mid-Year Progress Report, and end-of-fiscal year Final Progress
Report. This information reported is used to monitor:
1. Compliance with the MAI Condition of Award and related requirements;
2. Progress in meeting planned objectives;
3. Potential grantee technical assistance needs;
4. Type and quantity of services delivered and demographics of clients served, and;
5. Improvements in access and health outcomes being achieved through these services.
In preparing all responses to this Request for Proposal (RFP), applicant should consider how
efforts at the local level are consistent with the Ryan White HIV/AIDS Treatment Extension Act
of 2009 which emphasizes the use of funds to address the service needs of “individuals who know
their HIV status and are not receiving primary medical care services and for informing individuals
of and enabling the individuals to utilize the services, giving particular attention to eliminating
disparities in access and services among affected subpopulations and historically underserved
communities” Section 2602 (b)(4)(D)(i).

SERIAL 13054-RFP
Additionally, applicants should consider the impact of the epidemic within the Phoenix EMA,
which consists of Maricopa and Pinal counties. Several studies are available for applicants to
review including:
1. 2006 Hispanic PLWH/A Needs Assessment
2. 2006 African American PLWH/A Needs Assessment
3. 2006 PLWH/A Out of Care Needs Assessment
4. 2006 Pinal County Needs Assessment
5. Phoenix EMA 2006-2009 Comprehensive Plan
All reports can be viewed at the Phoenix EMA Ryan White Planning Council's website at:
http://www.ryanwhiteparta.com
Moreover, in developing your application you should consider the HIV/AIDS Bureau (HAB)
Guiding Principles indicated below that have significant implications for HIV/AIDS care services
planning.
1. The HIV/AIDS epidemic is growing among traditionally underserved and hard-to-
reach populations;
1. The quality of emerging HIV/AIDS therapies can make a difference in the lives of
people living with HIV disease;
2. Changes in the economics of health care are affecting HIV/AIDS care network; and
3. Outcomes are a critical component of program performance.
All CARE Act funded projects in any service category must participate in the existing community-
based continuum of care. This concept requires that services in a community must be organized to
respond to the individual’s or family’s changing needs, in order to reduce fragmentation of care.
For the Phoenix EMA to achieve this intent as required by HRSA guidance funded providers will
be required to attend meetings sponsored by the Phoenix EMA Ryan White Planning Council and
other management and technical assistance meetings deemed mandatory by Maricopa County
Ryan White Part A Program.
Lastly, Part A funds must be used in a manner consistent with current and future HRSA policies as
developed by the Division of Services Systems, HIV/AIDS Bureau. These policies can be
reviewed on the HAB website at http://hab.hrsa.gov.
1.2 THE PHOENIX EMA RYAN WHITE PLANNING COUNCIL:
The Phoenix EMA Ryan White Planning Council (PC) is a planning body required under the Part
A authorization. The Maricopa County Board of Supervisors serves as the Chief Elected Official
for the Planning Council. Membership of the PC must be reflective of the epidemic within the
Phoenix EMA and includes representatives from a variety of specific groups such as providers of
housing and homeless shelters, HIV prevention services, representatives of individuals who were
formerly Federal, State or local prisoners released from the custody of the penal system and had
HIV disease on the date released, other mandated entities and interested advocates. The PC
establishes service priorities, allocates Part A funds, develops a comprehensive plan, and
addresses the efficiency of the grantee’s administrative mechanism for rapidly contracting out
funds to service providers.
The PC establishes Directives for service categories that are additional requirements that must be
incorporated into the program plan along with applicable Standards of Care. These Directives are
discussed under the service category description and should also guide prospective applicants in
the development of goals objectives and a work plan.
1.3 ADMINISTRATIVE AGENT AND QUALITY MANAGEMENT:
Part A funds are awarded to the chief elected official (CEO). The CEO retains ultimate
responsibility for submitting grant applications, ensuring that funds awarded are used
appropriately, and complying with reporting or other requirements. Most CEOs delegate day-to-

SERIAL 13054-RFP
day responsibility for administering their Part A award to a health related department within the
jurisdiction.
For the purposes of this section, the CEO of the EMA has delegated this responsibility to the Ryan
White Part A Program within Maricopa County Department.
Administrative activities under the authority of the Administrative Agent include:
Routine grant administration and monitoring activities, including the development of
applications for funds, the receipt, monitoring and disbursal of program funds, the
development and establishment of reimbursement and accounting systems, the
preparation of routine programmatic and financial reports, compliance with grant
conditions and audit requirements/promulgation of policies and procedures and
continuous quality improvement initiatives.
All activities associated with the grantee’s contract award procedures, including the
development of requests for proposals, contract proposal review activities, negotiation
and awarding of contracts, monitoring of contracts through telephone consultation,
written documentation or onsite visits, reporting on contracts, and funding reallocation
activities.
The administrative agent will conduct site visits with service providers to monitor
program and fiscal compliance with contracts, and to ensure adherence to the EMA’s
Standards of Care as developed by the PC.
The lead agency (Contractor) agrees to include in any subcontracts a provision to the
effect that the subcontractor agrees that Maricopa County Ryan White Part A Program
shall have access to the subcontractor’s facilities and the right to examine any books,
documents, and records of the subcontractor, involving transactions related to the
subcontract. Additionally, client charts, care/treatment plans, eligibility requirements, etc
shall be available for inspection.
The Administrative Agent will also provide technical assistance and training that
providers may be required to attend.
The CARE Act requires the establishment of quality management program and quality
service indicators for all Part A programs to ensure that persons living with HIV disease
receive those services and that the quality of those services meet certain criteria,
specifically Standards of Care and the Public Health Services treatment guidelines.
The Maricopa County Ryan White Part A Program has established a Quality Management
Program to assess all services funded under Ryan White Part A Program and to achieve the goals
set forth in the CARE Act. All funded programs are subject to quality management reviews and
technical assistance. All agencies must be able to demonstrate that health and support services
supported by Part A funds are consistent with PHS treatment guidelines and the Standards of Care
as established by the Planning Council.
All funded providers will be asked to submit quality management plans to reflect how providers
are ensuring quality services.
1.4 CONTRACTOR ELIGIBILITY:
Eligible contractor for awards include public or non-profit health and social services providers,
and other non-profit community organizations, medical care providers, community-based
organizations, HIV/AIDS service organizations, academic entities, and city, county, state, federal
governmental units. The CARE Act Amendments of 1996 provide for contracting with for-profit
entities under certain limited circumstances. Specifically, the amendments allow Part A funds to
be used to provide direct financial assistance through contracts with private for-profit entities if
such entities are the only available provider of quality HIV care in the area (Sec 2604(b) (2) (A);

SERIAL 13054-RFP
Section 2631(a) (1). Contractors are prohibited from serving as conduits to pass on their awards to
for-profit entities. To better serve Persons Living with HIV/AIDS (PLWHA) within the EMA,
the Maricopa County Ryan White Part A Program reserves the right, at its discretion, to
issue multiple contracts within a service category pursuant to this Request for Proposal.
All services must be directed to enhance the delivery of services to persons living with HIV, and,
in limited, restricted instances, their families. These funds may not be used for prevention
services.
Joint proposals from coalitions of agencies and organizations are allowable. However, if a lead
agency (prime contractor) is proposing to sub-contract with another agency to perform more than
50% of the deliverables, the proposal must provide sufficient information regarding the
qualifications of the sub-contracting agency.
In all cases, a lead agency (as prime contractor) must be identified. All proposals in response to
this RFP which include the use of subcontractors must be submitted by a lead agency, with the
approach to use the subcontractor(s) clearly outlined in their proposal.
All providers must have documented evidence to substantiate referral relationships on an ongoing
basis. All officers must submit any written agreements with other organizations/entities that serve
the community of persons living with HIV and are 1) service providers and/or 2) points of entry or
access to HIV services. All officers’ are strongly encouraged to include copies of such
agreements, detailing each agencies/organization’s roles and responsibilities, with each
application.
The use of subcontractors and/or consultants must be pre-approved by the Maricopa County Ryan
White Part A Program. If approved, the Contractor agrees to use written agreements which
conform to Federal and State laws, regulations and requirements of this proposal appropriate to the
service or activity defined by this RFP. These provisions apply with equal force to the subcontract
as if the subcontractor were the contractor referenced herein. The Contractor is responsible for the
performance of this contract regardless of whether or not a subcontract is used. The lead agency
(Contractor) will submit a copy of each executed subcontract to the RWPA within fifteen (15)
days of its effective date.
All proposals in response to this RFP which include the use of subcontractors must clearly state
and document the details of the subcontract agreement. This will include a scope/intent of work
for both the lead agency and all subcontracts proposed. The scope of the proposal must clearly
identify the services to be provided by all parties for the proposal. Additionally, all subcontract
agreements proposed must include a detailed budget and narrative, identifying all administrative
costs, as defined in the “Administrative Costs” section of this RFP. Subcontracts will be restricted
to no more than ten percent of the budget proposed.
1.5 COMPENSATION:
1.5.1 The County reserves the right to reallocate funding during the contract period so that the
services provided and corresponding contract amount may be decreased or increased, via
contract amendment or Task Order, at the discretion of the County.
1.5.2 County will pay the Contractor on a monthly basis for approved services and expenses
and in accordance with the reimbursement methodology determined by the County’s
Administrative Agent; either fee-for service or cost. The total funds paid to the
Contractor will be dependent upon the approved invoice according to the Administrative
Agent. County does not guarantee a minimum payment to the Contractor. County will
not reimburse for fee-for-service activities when an appointment is canceled either by the
client or Contractor.
1.5.3 The Contractor understands and agrees to notify the County of any deviations or changes
to any budget line of the current budget in place for this contract within 30 days of such
change.

SERIAL 13054-RFP
1.5.4 The Contractor shall be compensated for services provided only by the staff
classifications/positions included/referenced in the current approved budget.
1.5.5 Unless specifically allowed and referenced elsewhere in this contract, all services are to
be provided at approved Contractor sites and/or venues. Services provided at non-
authorized locations or venues will not be reimbursed by the County.
1.5.6 The Contractor shall provide monthly financial and corresponding programmatic reports
per the reporting schedule to the County. If the Contractor is not in compliance due to
non-performance, submission of reports after deadlines, insufficient back-up statements
or improperly completed forms, the Contractor may not be reimbursed or reimbursement
may be delayed until program compliance issues and any other related financial
consequences are resolved. Furthermore, instances of non-compliance with billing and
reporting requirements may result in the County reducing the Contractor’s reimbursement
by up to 10% of the corresponding month’s billing. Billing forms and instructions are
included in the current Ryan White Part A Program Policies and Procedures Manual refer
to http://www.ryanwhiteparta.com
1.5.7 The actual amount of consideration to be paid to the Contractor depends upon the actual
hours worked, services provided and related expenses as stated in the current approved
budget or as modified by contract amendment or appropriately executed task order. Any
un-obligated balance of funds at the end of this Agreement period will be returned to the
County in accordance with instruction provided.
1.6 INVOICES AND PAYMENTS:
1.6.1 The Contractor shall submit electronically to the Administrative Agent one (1) legible
copy of their detailed monthly invoice before payment(s) can be made.
1.6.2 Contractor shall submit the invoice packet for services performed on or before the
fifteenth (15th) calendar day following the month in which services were performed.
1.6.3 The invoice shall include the requirements as outlined in the Ryan White Part A’s current
policies and procedures manual.
1.6.4 Contractors providing medical services are required to utilize the Health Care Form
(HCF-1500) Uniform Billing (UB-92) or other standardized medical claim forms as
agreed to with the Administrative Agent, and to submit these to the Ryan White Part A
Program in addition to the other required invoice reports and forms.
1.7 METHOD OF PAYMENT:
1.7.1 Subject to the availability of funds, County will, within sixty (60) business days from the
date of receipt of the documents enumerated herein, process and remit to the Contractor a
warrant for payment up to the maximum total allowable for services provided or work
performed during the previous month. Payment may be delayed or reduced if invoices
are in non-compliance due to late submission, improperly completed or missing
documentation/information or for other contract non-compliance occurring in the related
grant year. Other non-compliance issues that may delay or reduce payments can be
related to any contractual issue, and may not necessarily be related to the bill itself.
Should County make a disallowance in the claim, the claim shall be processed for the
reduced amount. If the Contractor protests the amount or the reason for a disallowance,
the protest shall be construed as a dispute concerning a question of fact within the
meaning of the "Disputes" clause of the Special Provisions of this Contract.
1.7.1.1 The Contractor understands and agrees that County will not honor any claim for
payment submitted 60 calendar days after date of service. The Contractor
understands and agrees that County will not process any claim for payment for
services rendered prior to the end of the contract period which are submitted
sixty (60) calendar days after the end of the contract period without approval of

SERIAL 13054-RFP
County. For claims that are subject to AHCCCS Regulation R9-22703.B1,
County will not honor any claim for payment submitted nine months after date
of service. Claims submitted 45 calendar days from the last day of the grant year
will not be honored or reimbursed.
1.7.1.2 Payments made by County to the Contractor are conditioned upon the timely
receipt of applicable, accurate and complete invoice reports and forms submitted
by the Contractor. All monthly invoices must be supported by auditable
documentation, which is determined to be sufficient, competent evidential
matter defined by the County.
1.7.1.3 The Contractor understands and agrees that Ryan White Part A Program is the
payer of last resort, and shall maximize and monitor all other revenue streams
including self-pay and all sources of third party reimbursements. The
Contractor understands and agrees that all self-pay and third party payments
must be exhausted to offset program costs before Ryan White funds are used.
The Contractor must have policies and procedures documented and in place to
determine and bill these other potential payment sources. These third party
payers include but are not limited to Regional Behavioral Health Authority
(RBHA), Medicaid (Arizona Health Care Cost Containment
Services/AHCCCS), Arizona Long Term Care System (ALTCS), TRICARE,
Medicare and private/commercial or other insurance. The Contractor will
determine eligibility of clients and assist with client enrollment whenever
feasible. Payments collected by the Contractor for Ryan White services must be
recorded as Program Income in the Contractor’s financial management system
and deducted from bills issued to the County. Program income records must be
made available to the County for assurance that such revenues are used to
support related services. The Contractor shall have policies and procedures for
handling Ryan White revenue including program income.
1.7.1.4 The Contractor shall have policies and staff training on the payer of last resort
requirement and how it meets that requirement.
1.7.1.5 Payment shall be made to the Contractor by Accounts Payable through the
Maricopa County Vendor Express Payment Program. This is an Electronic
Funds Transfer (EFT) process. After Contract Award the Contractor shall
complete the Vendor Registration Form located on the County Department of
Finance Vendor Registration Web Site
(http://www.maricopa.gov/Finance/Vendors.aspx).
1.7.1.6 EFT payments to the routing and account numbers designated by the Contractor
will include the details on the specific invoices that the payment covers. The
Contractor is required to discuss remittance delivery capabilities with their
designated financial institution for access to those details.
1.8 BUDGET, REVENUES AND EXPENDITURES:
1.8.1 The Contractor shall have written fiscal and general policies and procedures that include
compliance with federal and Ryan White programmatic requirements.
1.8.2 The Contractor shall prepare and submit to County a budget using the current Ryan
White Part A Program-approved formats at the beginning of each grant year in
accordance with the stated funds allocated on the most recently issued task order. If the
task order is increased or decreased at any time throughout the duration of the grant year,
a revised budget may be required. Failure to provide a required budget or schedule of
deliverables within the designated timeframe may result in termination of the contract.
1.8.2.1 The total administrative costs budgeted; including any federally approved
indirect rate (inclusive of contractor and subcontractor(s)) cannot exceed 10% of

SERIAL 13054-RFP
the amount of the current grant award. Any amount of administrative
expenditures in excess of 10% will not be reimbursed.
1.8.2.2 Contractor agrees that all expenditures are in accordance with the current
approved budget. Any expenditure deemed unallowable by the Administrative
Agent is subject to the Contractor submitting a full reimbursement to the
County.
1.8.2.3 Contractor agrees to establish and maintain a “Financial Management System”
that is in accordance with the standards required by Federal OMB Circular A-
110, Subpart C. Such system must also account for both direct and indirect cost
transactions, reports on the results of those transactions, are in compliance with
the requirements of OMB Circular A-21 and generally accepted accounting
principles.
1.8.2.4 All expenditures and encumbered funds shall be final and reconciled no later
than 45 days after the close of the grant year.
1.8.2.5 Funds collected by the Contractor in the form of fees, charges, and/or donations
for the delivery of the services provided for herein shall be accounted for
separately. Such fees, charges and/or donations must be used for providing
additional services or to defray the costs of providing these services consistent
with the Schedule of Deliverables of this Contract. As applicable, the
Contractor agrees to include, in the underlying budget, the amount of projected
revenue from client fees. The amount of funds collected from client fees shall
be reported by Contractor in the Monthly invoice by discrete service. For audit
purposes, the Contractor is responsible for maintaining necessary documentation
to support provision of services.
1.9 AMENDMENTS:
All amendments to this Contract must be in writing and signed by both parties. All amendments
shall clearly state the effective date of the action.
1.10 TASK ORDERS:
Contractor shall not perform a task other than those found/defined in the contract award document.
Task Orders may be issued by the Administrator of this contract. Task Orders will be
communicated via written document and shall include, but is not limited to: budget amount,
reference to special conditions of award, and any special service and reporting requirements.
Amended Task Orders can be issued at any time during the grant year. Both parties shall sign a
new or amended Task Order.
1.11 CHANGES:
1.11.1 The Maricopa County Ryan White Part A Program, with cause, by written order, may
make changes within the general scope of this Contract in any one or more of the
following areas (Also see AMENDMENTS & TASK ORDER SECTIONS):
1.11.1.1 Schedule of deliverables activities reflecting changes in the scope of services,
funding source or County regulations,
1.11.1.2 Administrative requirements such as changes in reporting periods, frequency of
reports, or report formats required by funding source or County regulations,
policies or requirements, and/or,
1.11.1.3 Contractor fee schedules, reimbursement methodologies and/or schedules and/or
program budgets.

SERIAL 13054-RFP
Examples of cause would include, but are not limited to: non-compliance, under
performance, service definition changes, reallocations or other directives
approved by the Planning Council, or any other reason deemed necessary by the
Administrative Agent.
1.11.2 Such order will not serve to increase or decrease the maximum reimbursable amount to
be paid to the Contractor. Additionally, such order will not direct substantive changes in
services to be rendered by the Contractor.
1.11.3 Any dispute or disagreement caused by such written order shall constitute a "Dispute"
within the meaning of the Disputes Clause found within this Contract and shall be
administered accordingly.
1.12 AUDIT REQUIREMENTS:
1.12.1 If the Contractor expends $500,000 or more from all contracts administered and/or
funded via County, and/or receives $500,000 or more per year from any federal funding
sources, the Contractor will be subject to Federal audit requirements per P.L. 98-502
"The Single Audit Act." The Contractor shall comply with OMB Circulars A-128, A-
110, and A-133 as applicable. The audit report shall be submitted to the Maricopa
County Internal Audit Department of Public Health for review within the twelve months
following the close of the fiscal year. The Contractor shall take any necessary corrective
action to remedy any material weaknesses identified in the audit report within six months
after the release date of the report or by a date defined by the Internal Audit Department.
Maricopa County may consider sanctions as described in OMB Circular A-128 for
contractors not in compliance with the audit requirements. All books and records shall be
maintained in accordance with Generally Accepted Accounting Principles (GAAP).
1.12.2 The Contractor shall schedule an annual financial audit to be submitted to County for
review within twelve months following the close of the program’s fiscal year. Contractor
understands that failure to meet this requirement may result in loss of current funding and
disqualification from consideration for future County-administered funding.
1.12.3 The Contractor shall have and make available to County financial policies and procedures
that guide selection of an auditor, based on an Audit Committee for Board of Directors (if
Contractor is a non-profit entity).
1.12.4 The Contractor shall also comply with the following OMB Circulars as applicable to its
organizations business status:
1.12.4.1 A-102 Uniform Administrative Requirements for Grants to State and Local
Government.
1.12.4.2 A-110 Uniform Administrative Requirements for Grants and Agreement with
Institutions of Higher Education, Hospitals and other non-profit organizations.
1.12.4.3 A-122 Cost Principles for Non-Profit Organizations.
1.12.4.4 A-87 Cost Principles for State and Local Governments.
1.12.4.5 A-21 Cost principles for Education Institutions.
1.13 SPECIAL REQUIREMENTS:
1.13.1 The Contractor shall adhere to all applicable requirements of the Ryan White HIV/AIDS
Treatment Extension Act of 2009 and/or current authorized or reauthorized Ryan White
HIV/AIDS Act.
1.13.2 The Contractor shall participate in provider technical assistance meetings and/or
teleconference calls that will be scheduled by the Administrative Agent throughout the
year.
1.13.3 The Contractor shall retain the necessary administrative, professional and technical

SERIAL 13054-RFP
personnel for operation of the program.
1.13.4 The Contractor agrees to maintain adequate programmatic and fiscal records and files
including source documentation to support program activities and all expenditures made
under terms of this agreement as required.
1.13.5 Contractor agrees to install and utilize the CAREWare client level reporting software
system as described in the current Ryan White Part A Program Policies and Procedures
Manual. There are no licensing costs associated with the use of CAREWare, however,
the provider is required to pay for the cost related to installing and configuring internal
firewall devices to gain access to the CAREWare database. These expenses can be
reimbursed by Ryan White if included in the current approved budget.
1.14 RELEASE OF INFORMATION:
1.14.1 The Contractor agrees to secure from all clients provided services under this contract any
and all releases of information or other authorization requested by County. Each client
file documenting the provision of Part A services must contain a current Administrative
Agent authorized release form signed and dated by the client or client’s legal
representative. Failure to secure such releases from clients may result in disallowance of
all claims to County for covered services provided to eligible individuals. If service to
anonymous clients is specifically allowed and approved by the County according to the
current Ryan White Part A policies and procedures manual or otherwise stated in writing
by the Administrative Agent, this provision does not apply.
1.14.2 The Contractor agrees to comply with ARS §36-662, access to records. In conducting an
investigation of a reportable communicable disease the department of health services and
local health departments may inspect and copy medical or laboratory records in the
possession of or maintained by a health care provider or health care facility which are
related to the diagnosis, treatment and control of the specific communicable disease case
reported. Requests for records shall be made in writing by the appropriate officer of the
department of health services or local health department and shall specify the
communicable disease case and the patient under investigation.
1.15 CERTIFICATION OF CLIENT ELIGIBILITY:
1.15.1 The Contractor agrees to determine and certify eligibility all clients seeking services
supported by Ryan White funds, according to the requirements detailed in of the
Eligibility section of the current Ryan White Part A Program Policies and Procedures
Manual.
1.15.2 The Contractor agrees to have billing, collection, co-pay and sliding fee policies and
procedures that do not deny clients services for non-payment, inability to produce income
documentation, or require full payment prior to service, or include any other barriers to
service based on ability to pay.
1.15.3 If the Contractor charges clients for services, the Contractor agrees to charge and
document client fees collected in accordance with their sliding fee schedule. This fee
schedule shall be consistent with current federal guidelines. This fee schedule must be
published and made available to the public. If charging fees, the Contractor must have a
fee discount policy, sliding fee schedule, and sliding fee eligibility applications. The
Contractor must track fees charged and paid by clients. The Contractor must have a fee
discount policy that includes client fee caps, including:
1.15.3.1 Clear responsibility for annually evaluating clients to establish individual fees
and caps.
1.15.3.2 Tracking of Part A charges or medical expenses inclusive of enrollment fees,
deductibles, and co-payments.

SERIAL 13054-RFP
1.15.3.3 A process for alerting the billing system that client has reached cap and no
further charges will be charged for the remainder of the year.
1.15.3.4 Documentation of policies, fees, and implementation, including evidence that
staff understand those policies and procedures.
1.15.3.5 Contractor must have a process for charging, obtaining, and documenting client
charges through a medical practice information system, manual or
electronically.
The chart below must be followed when developing the fee schedule.
Fees For Service
Client Income
Less than or equal to 100% of the No fees or charges to be imposed
official poverty line
Greater than 100%, but not exceeding Fees and charges for any calendar year may not
200%, of the official poverty line exceed 5% of the client’s annual gross income
Greater than 200%, but not exceeding Fees and charges for any calendar year may not
300%, of the official poverty line exceed 7% of client’s annual gross income
Greater than 300% of the official Fees and charges for any calendar year may not
poverty line exceed 10% of client’s annual gross income
1.16 QUALITY MANAGEMENT:
1.16.1 The Contractor will participate in the Quality Management program as detailed in the
current Ryan White Part A Program Policies and Procedures Manual.
(http://www.maricopa.gov/publichealth/Services/RyanWhite/publications.aspx) (See
Ryan White Part A Program Policies and Procedures).
1.16.2 The Contractor will utilize and adhere to the most current Standards of Care as developed
by the Phoenix Eligible Metropolitan Area Planning Council.
1.16.3 The Contractor will develop and implement an agency-specific quality management plan
for Ryan White Part A-funded services. The Contractor will conduct Quality
Improvement projects at the agency level utilizing the Plan-Do-Check-Act (PDCA)
model.
1.16.4 The Contractor will participate in cross-cutting Quality Improvement projects and report
data per the timeline established with the County. Additionally, the Contractor will
report quality outcome measures established by the County per the reporting schedule.
1.16.5 The Contractor will participate in the Quality Management activities of the Clinical
Quality Management Committee as requested by the County.
1.16.6 The Contractor will conduct and provide documentation of quality assurance and
improvement activities, including maintenance of client satisfaction surveys and other
mechanisms as designated by the County.
1.16.7 The Contractor will maintain a comprehensive unduplicated client level database of all
eligible clients served as well as demographic and service measures required and submit
this information in the format and frequency as requested by the County. The County
will make available to the Contractor software for the collection of this information
(CAREWare).
1.16.8 The Contractor will maintain consent to serve forms signed by the clients to gain
permission to report their data to County, State and Federal authorized entities and to
view their records as a part of site visits and quality management review activities.

SERIAL 13054-RFP
1.16.9 The Contractor will participate in Quality Management trainings sponsored by the
County which are deemed mandatory. The Contractor understands that non-participation
in these types of activities may result in non-compliance with the Standards of Care as
mandated by the Ryan White Act. Further, such non-participation in Quality
Management trainings could result in prompting a performance monitoring site visit.
1.17 REPORTING REQUIRMENTS:
1.17.1 The Contractor agrees to submit monthly invoices as defined in the Invoice and Payments
section.
1.17.2 The Contractor agrees to submit any administrative, programmatic, quality and/or fiscal
reports requested and at the due date defined by the Administrative Agent.
1.17.3 The Contractor agrees to comply with and submit annual and semi-annual client-level
and provider-level data as required by HRSA by the due date(s) defined by the
Administrative Agent.
1.17.4 The Contractor agrees to comply with ARS § 36-621, reporting contagious diseases. Any
employee, subcontractor or representative of the Contractor providing services under this
contract shall follow the requirements of this law. Specifically, a person who learns that a
contagious, epidemic or infectious disease exists shall immediately make a written report
of the particulars to the appropriate board of health or health department. The report shall
include names and residences of persons afflicted with the disease. If the person reporting
is the attending physician he shall report on the condition of the person afflicted and the
status of the disease at least twice each week.
1.18 PROGRAM MARKETING INITIATIVES:
1.18.1 When issuing statements, press releases and/or Internet-based or printed documents
describing projects, programs and/or services funded in whole or in part with Ryan White
Part A funds, the Contractor shall clearly reference the funding source as the federal
Department of Health and Human Services, Health Resources and Services
Administration, the Ryan White HIV/AIDS Treatment Extension Act of 2009 (or current
authorized or reauthorized name of Act), and Maricopa County Ryan White Part A
Program. Such references to funding source must be of sufficient size to be clear and
legible.
1.18.2 Contractor is responsible for advertising Ryan White Part A-funded services. Such
advertisement is to promote/incorporate the following components: Services available,
venues/locations, and hours of operation. The content of any and all advertising for these
services must be in a format allowed by Local, State and Federal regulations and shall
contain the funding language referenced in this contract section.
1.18.3 Contractor is responsible to ensure that all appropriate program descriptions, including
hours and locations, and any changes related to these services are disseminated to the
community and other Ryan White providers to ensure that clients have access to care.
The Contractor shall be able to document and explain this communication process to the
Administrative Agent upon request.
1.19 OTHER REQUIREMENTS:
1.19.1 Contractor shall comply with all policies and procedures as defined in the current Ryan
White Part A Policies and Procedures Manual.
1.19.2 Contractor will maintain discrete client files for all individuals served and will secure the
necessary releases of information to allow for review of all pertinent client information
by employees of County and/or their designated representatives.

SERIAL 13054-RFP
1.19.3 Contractor shall respond to all requests for information and documentation solicited by
County when they are submitted in writing no later than 72 hours of receipt of request.
1.19.4 Contractor shall participate with a standardized anonymous Consumer Satisfaction
Survey issued to all program participants, at least once during the contract year. The
survey and procedure is included in the Ryan White Part A Program Policies and
Procedures Manual. Refer to
http://www.maricopa.gov/publichealth/Services/RyanWhite/providers.aspx
1.19.5 Contractor’s service locations shall be accessible by public transportation. If service
locations are not accessible by public transportation, the Contractor shall have policies
and procedures in place that describe how it will provide transportation assistance to
clients.
1.19.6 Contractors providing Medicaid eligible services shall be certified to receive Medicaid
payments, or receive a waiver from the U.S. Secretary of Health and Human Services.
The Contractor shall document efforts to receive certification or waiver, and when
certified, maintain proof of certification and file of contracts with Medicaid insurance
companies.
1.20 SAFEGUARDING OF CLIENT INFORMATION:
The use or disclosure by any party of any information concerning an eligible individual served
under this Contract is directly limited to the performance of this Contract.
1.21 NON-DISCRIMINATION:
The Contractor, in connection with any service or other activity under this Contract, shall not in
any way discriminate against any patient on the grounds of race, color, religion, sex, national
origin, age, or handicap. The Contractor shall include a clause to this effect in all Subcontracts
inuring to the benefit of the Contractor or County.
1.22 EQUAL EMPLOYMENT OPPORTUNITY:
1.22.1 The Contractor will not discriminate against any employee or applicant for employment
because of race, age, handicap, color, religion, sex, or national origin. The Contractor
will take affirmative action to insure that applicants are employed and that employees are
treated during employment without regard to their race, age, handicap, color, religion,
sex, or national origin. Such action shall include, but not be limited to the following:
employment, upgrading, demotion or transfer, recruitment or recruitment advertising,
lay-off or termination, rates of pay or other forms of compensation, and selection for
training, including apprenticeship. The Contractor shall to the extent such provisions
apply, comply with Title VI and VII of the Federal Civil Rights Act; the Federal
Rehabilitation Act; the Age Discrimination in Employment Act; the Immigration Reform
and Control Act of 1986 (IRCA) and Arizona Executive Order 99.-4 which mandates that
all persons shall have equal access to employment opportunities. The Contractor shall
also comply with all applicable provisions of the Americans with Disabilities Act of
1990.
1.22.2 The Contractor will operate under this agreement so that no person otherwise qualified is
denied employment or other benefits on the grounds of race, color, sex, religion, national
origin, ancestry, age physical or mental disability or sexual orientation except where a
particular occupation or position reasonably requires consideration of these attributes as
an essential qualification for the position.
1.23 CULTURAL COMPETENCY:

SERIAL 13054-RFP
1.23.1 The Contractor shall meet and comply with applicable standards of the federal Culturally
and Linguistically Appropriate Services (CLAS) standards The Contractor shall develop
and implement organizational policies that comply with these standards.
1.23.2 The Contractor shall recognize linguistic subgroups and provide assistance in overcoming
language barriers by the appropriate inclusion of American Sign Language and languages
of clients accessing care.
1.24 RYAN WHITE CAREWARE DATA BASE:
1.24.1 RWPA requires the installation and utilization of HRSA-supplied Ryan White
CAREWare software. CAREWare is used for client level data reporting and monthly
billing reports, demographic reports, and various custom reporting. The Contractor
agrees to install, collect, and report all data requested by the RWPA via RYAN WHITE
CAREWare within 60 days of request by the RWPA. The Contractor agrees to
participate in technical assistance training and/or informational presentations for
CAREWare at various times scheduled during the contract year.
1.24.2 The Contractor is responsible for coordinating the installation of the CAREWare
software with their internal information technology staff. CAREWare software is
developed by HRSA and requires no licensing fees. The Contractor will be responsible
for the cost of Virtual Provider Network (VPN) cards for each user within their
organization.
1.24.3 The Ryan White Part A office will provide technical assistance to eligible applicants for
the implementation, configuration and end user support for the CAREWare database. In
addition, technical assistance is made available to eligible applicants to integrate
CAREWare with proprietary in-house billing systems on an as needed basis to minimize
data entry efforts needed to report client level demographic and service related data.
1.25 IMPROPRIETIES AND FRAUD:
1.25.1 The contractor shall notify the Ryan White Part A Program in writing of any actual or
suspected incidences of improprieties involving the expenditure of CARE Act funds or
delivery of services. This will include when potential or current clients receive services,
or attempt to receive services, for which they are ineligible. Notification is also required
whenever acts of indiscretion are committed by employees that may be unlawful or in
violation of this contract. Notification to the Ryan White Part A Program shall occur in
writing within 24 hours of detection.
1.25.2 The Federal Department of HHS Inspector General maintains a toll-free hotline for
receiving information concerning fraud, waste, or abuse under grants and cooperative
agreements. Such reports are kept confidential and callers may decline to give their
names if they choose to remain anonymous.
Office of Inspector General
TIPS HOTLINE
P. O. Box 23489
Washington, D. C. 20026
Telephone: 1-800-447-8477 (1-880-HHS-TIPS)
1.25.3 The Contractor shall be responsible for any loss of funds due to mismanagement, misuse,
and/or theft of such funds by agents, servants and/or employees of the Contractor.
1.26 ADHERENCE TO RYAN WHITE PART A POLICIES:
1.26.1 Contractor shall adhere to all Ryan White Part A Program Policies. Such policies are
referenced in the Ryan White Part A Program Policies and Procedures Manual (See
http://www.maricopa.gov/publichealth/Services/RyanWhite/providers.aspx

SERIAL 13054-RFP
1.27 REFERRAL RELATIONSHIPS:
1.27.1 Contractors must have documented evidence to substantiate referral relationships on an
ongoing basis consistent with HRSA guidance regarding “Maintaining Appropriate
Referral Relationships” available from the RWPA upon request.
1.27.2 The Contractor shall have letters of agreement and Memorandums of Understanding
(MOUs) to document referral relationships with key points of entry. Key points of entry
include:
• Emergency rooms
• Substance abuse and mental health treatment programs
• Detox(ification) centers
• Detention facilities
• Sexually Transmitted Disease (STD) Clinics
• Homeless shelters
• HIV counseling and testing sites
Additional points of entry:
• Public health departments
• Health care points of entry specified by eligible areas
• Federally Qualified Healthcare Centers (FQHCs)
• Entities such as Ryan White Part C and D grantees
1.28 POLICY ON CONFIDENTIALITY:
1.28.1 The Contractor understands and agrees that this Contract is subject to all State and
Federal laws protecting client confidentiality of medical, behavioral health and drug
treatment information.
1.28.2 The Contractor shall establish and maintain written procedures and controls that ensure
the confidentiality of client medical information and records.
1.28.3 The Contractor shall maintain and document employee and direct service provider
training on their organization’s policies and procedures related to client confidentiality.
1.28.4 In accordance with Section 318 (e)(5) of the Public Health Service Act [42 U.S.C.
247c(e)(5)], no information obtained in connection with the examination, care or services
provided to any individual under any program which is being carried out with Federal
monies shall, without such individual’s consent, be disclosed except as may be necessary
to provide services to such individual or as may be required by laws of the State of
Arizona or its political subdivisions. Information derived from any such program may be
disclosed (a) in summary, statistical, or other form, or (b) for clinical research purposes,
but only if the identity of the individuals diagnosed or provided care under such program
is not disclosed. The Contractor shall comply with the provisions of A.R.S. § 36-663
concerning HIV-related testing; restrictions; exceptions and A.R.S. § 36-664 concerning
confidentiality; exceptions, in providing services under this Contract.
1.28.5 Confidential communicable disease related information may only be disclosed as
permitted by law, and only consistent with the current Ryan White Part A Program
Policies and Procedures Manual (See http://www.ryanwhiteparta.com
1.29 EQUIPMENT:
1.29.1 All equipment and products purchased with grant funds should be American-made.
1.29.2 The title to any and all equipment acquired through the expenditure of funds received
from County shall remain that of the Department of Health and Human Services, Health

SERIAL 13054-RFP
Resources and Services Administration. County must specifically authorize the
acquisition of any such equipment in advance. Upon termination of this Contract,
County may determine the disposition of all such equipment.
1.29.3 The Contractor agrees to exercise reasonable control over all equipment purchased with
capital outlay expense Contract funds. All equipment lost, stolen, rendered un-usable, or
no longer required for program operation must be reported immediately to County for
disposition instructions. The Contractor shall report the physical inventory of all
equipment purchased with contract funds within sixty (60) days of receipt of such
equipment.

SERIAL 13054-RFP
NARRATIVE
Chicanos Por La Causa, Inc. (CPLC) proposes to provide Medical Case Management (MCM) and Non-Medical
Case Management Services (NMCM) services to people living with HIV/AIDS (PLWHA) eligible for Ryan White
Part A services in the Phoenix Eligible Metropolitan Area (EMA). CPLC is proposing to deliver MCM and NMCM
services as outlined in this grant application based on the needs identified for (PLWHA) in the Phoenix EMA
service area and in accordance with Ryan White Part A requirements and standards of care.
CPLC also intends to serve as a Minority AIDS Initiative (MAI) Contractor for Medical Case Management and
Non-Medical Case Management services should supplemental funding for MAI become available. CPLC will utilize
MAI funding to serve HIV/AIDS positive minorities as defined by the current MAI implementation plan.
II. NEED:
More than 20 years after Maricopa and Pinal counties qualified as an Eligible Metropolitan Area (EMA) to receive
Ryan White funding, there continues to be disproportionate representation of racial/ethnic minority populations in
the region’s HIV and AIDS epidemic. While Hispanics account for 29% of the EMA’s population, nearly 35% of
emergent HIV/AIDS cases are among this population. The same holds true for African-Americans who account for
5% of the EMA’s population yet represent 12% of emergent HIV/AIDS cases.1
HIV/AIDS cases among minority populations in the Phoenix EMA increased by 30% during the period 2007 to
2009. In 2006, close to 50% of newly reported HIV cases were among Hispanic persons.2 The Phoenix EMA has a
combined HIV/AIDS prevalence of 10,492 persons. Of prevalent cases, 87% are among men, 13% are among
women, 57% are White; 12% are African-American, 26% are Hispanic, 3% are American Indian and 1% Asian. 3
Men who have sex with men (MSM) remain the predominant reported HIV transmission risk in Arizona for all
racial/ethnic groups. These data are consistent with national HIV/AIDS trends that illustrate Hispanic, African-
Americans and young MSM as special populations that need urgent attention.4
Nationally, the Centers for Disease Control and Prevention (CDC) estimates that young MSM, especially those of
minority races and ethnicities, are at increased risk for HIV infection. In 2009, young MSM accounted for 27% of
new HIV infections in the United States and 69% of new HIV infections among persons aged 13–29.5 According to
the most recent data available through the Arizona Department of Health Services (ADHS), the peak among
prevalent cases of HIV/AIDS in the EMA occurs in the age range of 35-59 years.6
The Ryan White Planning Council designates newly diagnosed individuals with HIV, MSM, Hispanics, African
Americans, American Indians as well as those who are Incarcerated/Recently Released, as Severe Needs Groups
(SNG) in the EMA. Further, the Phoenix EMA’s Strategy for Early Identification of Individuals with HIV/AIDS
(EIIHA) focuses primarily on addressing the disparities that exist in these traditionally underserved populations. As
highlighted in the findings of recent surveys conducted by the Ryan White Part A program, SNGs who are “In Care”
and “Out of Care” identify with unique barriers and challenges to accessing services and tend to experience unmet
needs at higher levels compared to their relative proportions in the EMA.
A majority of the Phoenix EMA out of care population includes Hispanic and White Males, whose risks include
MSM and/or IDU. Approximately 31% of out of care People Living With HIV/AIDS (PLWHA) in the EMA are
Hispanic.
Additionally, MSM account for 55% of those who are out of care with unmet service needs.7 The out of care
PLWHA population also consists of a high percentage of African Americans. PLWHA living in the more rural
areas of the EMA face additional challenges to accessing services including fear of discrimination/stigma, lack of
confidentiality and very limited availability of infectious disease or HIV qualified medical providers.
Collaborative Research, Inc. surveyed 496 persons living with HIV/AIDS for the 2010 EMA wide Triennial Needs
1 3-Year Comprehensive HIV Services Plan of the Phoenix EMA Ryan White Planning Council, May, 2012
2 2006 Hispanic Needs Assessment
3 2010 Phoenix EMA Triennial Need Assessment Report
4 Arizona Department of Health Services, Annual Report, 2011
5 HIV Among Youth, Centers for Disease Control and Prevention Fact Sheet, 2011
6 HIV/AIDS Data ADHS EPIDEMIOLOGIC PROFILE, 2010
7 EMA-Wide Comprehensive “Out of Care” PLWHA Needs Assessment in Maricopa and Pinal Counties, Arizona.

SERIAL 13054-RFP
Assessment, to ascertain the top Needs, Uses, Gaps and Barriers as expressed by consumers of HIV related services
in both Maricopa and Pinal Counties. Severe Needs Groups reporting the greatest number of service barriers include
MSM, Hispanics, African-Americans and those recently released from incarceration. Findings of the Needs
Assessment also point to issues that are specific to each Severe Needs Group. For example, Hispanic persons with
HIV in the EMA experience issues related to poverty, immigration status and high-uninsured status, which may
contribute to this population having to rely on Ryan White Programs as the only option for accessing HIV primary
care. 8 These barriers also create challenges in successfully facilitating the entry into and retention in HIV primary
medical care for the growing numbers of Hispanic persons living with HIV/AIDS in the Phoenix EMA. Survey
respondents cited the following as some of the reasons that they identified certain HIV related services as difficult to
access:
 Red tape
 Illegal status
 Budget cuts
 Lack of income/inability to afford
 Lack of information regarding location of services and how to access them
 Not having a Case Manager
 Unable to qualify for services
 Lack of insurance
 Transportation too hard/far away
 Too few providers/services
 Wait list
Results of the 2010 Out of Care survey as well as findings of the 2010 EMA Wide Triennial Needs Assessment
guide the Ryan White Planning Council’s processes for developing a three-year comprehensive plan for the EMA,
establishing service priorities, documenting the need for specific services and determining barriers to accessing
care. The goals and objectives outlined in the Three-Year Comprehensive HIV Services Plan for the Phoenix EMA
approved in 2012, address identified needs of PLWHA including issues unique to Severe Needs Groups (i.e., Newly
Diagnosed, MSM, Hispanics, African-Americans, American Indians and Incarcerated/Recently Released).
The Three-Year Plan focuses on ensuring that individuals who are aware or unaware of their HIV status and not
receiving primary medical care have access to support service that facilitate their entry into care. Additionally,
strategies for achieving the Plan's proposed goals and objectives will promote coordination of care and build on
current efforts for eliminating barriers and strengthening retention in services.
The Ryan White Planning Council prioritizes and allocates funding to service categories for establishing a
comprehensive continuum of care that supports goals and objectives to improve health outcomes of PLWHA.
The ideal continuum of care as proposed in the Three Year Plan for the Phoenix EMA focuses on primary medical
care coordinated with services that improve medical outcomes. Additionally, supportive programs that promote
access to primary medical care to help improve retention in services complete the continuum. The Plan identifies
Medical Case Management as a key component of this proposed continuum.9 Case Management is one of the most
critical points of contact for clients within the Phoenix EMA. This includes Medical and Non-Medical Case
Management services that target minority communities to increase treatment adherence as well as awareness of
resources available to PLWHA.
III. ORGANIZATIONAL BACKGROUND AND EXPERIENCE
Chicanos Por La Causa (CPLC) is currently one of the major providers of Ryan White Part A comprehensive
Medical and Non-Medical Case Management services in the Phoenix EMA. The Organization serves a
predominantly Hispanic population and is uniquely qualified to address the cultural and linguistic needs of this
Severe Needs Group. CPLC provides a broad range of services that focus on a holistic approach to meeting the
numerous identified needs of PLWHA clients served. The Organization has a long-standing history as a service
provider with a strong reputation and national recognition as the fourth largest Hispanic Community Development
Corporation in the United States.10 Further, CPLC is the only community development corporation in Arizona that
offers extensive services in both urban and rural areas by maintaining a physical presence in 14 of the 15 counties in
the State. The Organization has more than 40 years of experience operating programs and services that promote
positive change and self-sufficiency to enhance the quality of life for the benefit of clients served. CPLC serves
more than 100,000 individuals annually, targeting its services primarily to disadvantaged and vulnerable populations
8 HIV/AIDS Statewide Coordinated Statement of Need
9 3-Year Comprehensive HIV Services Plan of the Phoenix EMA Ryan White Planning Council
10 Hispanic Business Magazine 2012

SERIAL 13054-RFP
including individuals and families with low to moderate incomes, regardless of ethnic origin, ethnicity, gender, age,
or creed.
In 1969, CPLC received non-profit status as a 501 (c) 3 with a mission to build stronger, healthier communities as a
lead advocate, coalition builder and direct service provider. CPLC’s original Founders came together as a group of
community and student activists of Mexican descent, to address problems of the barrios in South Central Phoenix,
Arizona. While CPLC is continually evolving and expanding services to keep pace with growth and change within
the communities it serves throughout Arizona, the Organization has not veered away from its initial focus on
creating opportunities that strengthen individuals and communities. Presently, CPLC functions as a multifaceted
corporation offering a wide array of programs and services in two states, Arizona and Nevada with plans to expand
services to New Mexico in the coming months. The Organization conducts needs assessments as part of the planning
process, prior to implementing service expansion projects or development of new programs, to ensure proposed
initiatives align with the needs and expectations of constituents and community partners.
A volunteer governing Board of Directors consisting of 23 members is responsible for providing oversight and
guidance, setting policy and providing strategic direction for the Organization. CPLC’s Senior Management Team
has an average tenure of twelve years and includes the President and CEO, Chief Operations Officer, Chief
Financial Officer and Chief Economic Development Officer. The President and CEO began serving in this position
in 2008 and previously served as the Organization’s Chief Operations Officer for nine years.
In 2011, CPLC achieved an important milestone with the Commission on Accreditation of Rehabilitation Facilities
(CARF) awarding the Organization a three-year accreditation, the highest level in the field, for the quality of its
behavioral health services programs. CPLC implements two behavioral health programs that address the unique
needs of a culturally diverse community, Corazón (a substance abuse residential treatment facility located in
Phoenix) and Centro De La Familia.
Ryan White Part A is currently the only source of funding that supports CPLC’s Medical and Non-Medical Case
Management Program and is the payer of last resort for these services. The Organization receives grants from local,
state and federal government sources as well as private foundations to support other CPLC programs and services.
CPLC is a direct grantee or serves as a sub-recipient for federal grant funding received through Department of
Agriculture, U.S. Department of Education, Federal Emergency Management Agency, Department of Health and
Human Services, Department of Housing and Urban Development, Department of Justice, Department of Labor, and
Small Business Administration.
Grant funding as well as other revenue streams support CPLC services provided in the areas of Education,
Economic Development, Housing and Health and Human Services as described below:
 Education: This service component includes programs such as Head Start, charter schools, prevention,
leadership workshops and academic enrichment programs.
 Economic Development: CPLC’s economic development division provides business lending, commercial
development, neighborhood revitalization, and financial empowerment.
 Community Development (Housing): The housing component encompasses all types of housing
development, property management, client counseling, and other pertinent services.
 Health and Human Services: Programs in this division include behavioral health, domestic violence shelter
and prevention, emergency assistance, elder services, legal immigration counseling, HIV, individual and family
counseling, women’s health, employment training and drug and alcohol rehabilitation and prevention.
CPLC has the appropriate operations and financial infrastructure for managing multiple grant funding and revenue
streams. The Organization has well established financial systems, processes and policies in place that enable the
effective implementation and operations of all above listed programs. CPLC uses Blackbaud, (Accounting for Non-
profits), which is a Windows-based SQL computerized accounting software for financial tracking and reporting. The
software includes a general ledger that interfaces with Accounts Payable, Receivables, Bank Reconciliation, Payroll
and Fixed Asset modules. The Organization hires certified accountants as financial analysts assigned to provide
guidance and support to each Department and sub-program. CPLC has systems in place to provide continuous
monitoring of all programs for compliance with applicable regulations as well as with performance measures that
are in place through internal guidelines and imposed by external public and private funding agencies. CPLC also

SERIAL 13054-RFP
complies with all requirements of its federal grant programs based on the results of the Organization’s Fiscal Year
2012 Financial Audit Report.
CPLC’s Research and Evaluation Department (R &E) serves as a valuable resource to the Organization. The
Research and Evaluation Department oversees data collection and is responsible for reporting activities associated
with grant-funded projects. R&E also works with program staff to collect, analyze and report process and outcome
data as appropriate and required for funded projects. R &E Program staff includes two Ph.D. level Social Scientists
as well as a Master’s Level Professional with expertise in Marketing Research.
Organization’s Experience Delivering HIV/AIDS Related Services:
As shown in the Organizational Chart included with this submission, CPLC designates Vice Presidents to lead each
sub-department and program falling under the areas of Education, Economic Development, Housing and Health and
Human Services. Ryan White Part A Medical and Non-Medical Case Management services fall under CPLC’s
Health and Human Services area in the Recovery & Resiliency Services Department as part of the comprehensive
HIV related services provided through the Centro De La Familia Project.
CPLC’s flagship HIV Program, L.U.C.E.S. (Latinos Unidos Contra El Sida or Latinos United Against AIDS), is one
of five Centro De La Familia initiatives. The L.U.C.E.S. Program came into fruition in 2001, in response to the
significant need for culturally sensitive street based, community based outreach services targeting Hispanic
HIV/AIDS infected persons in Maricopa and Pinal Counties. The need for this type of grassroots service delivery
model was evident based on 2001 HIV incident data that showed significant increases in the rate of infection among
the Hispanic population in both counties of the Phoenix EMA.
The L.U.C.E.S. Program initially focused primarily on marketing campaigns that promoted awareness of HIV/AIDS
services as well as the provision of linkage and referral services to Primary Medical Care and other social services.
Program services expanded over time to include a broader range of services such as client advocacy, behavioral
health services, case management and surveillance. L.U.C.E.S. is a peer driven program, with the main goal to
target, identify and provide HIV supportive services to any Latino newly diagnosed with HIV or not receiving
Primary Medical Care. L.U.C.E.S consists of five key elements intended to ensure continuum of care with Medical
Case Management and Non-Medical Case Management as vital components of the service delivery model. Clients
receiving Medical and Non-Medical Case Management Services through the L.U.C.E.S. Program also have access
to the numerous support programs offered by CPLC including behavioral health, housing and substance abuse
programs. Additionally, HIV testing services provided by CPLC through other sources of funding, complement the
Organization’s efforts towards early identification of HIV infected individuals and linking them into care using Case
Management services as a point of entry. CPLC delivers all services in clients’ native tongue in a culturally
appropriate manner that is sensitive to the specific needs of each client.
CPLC has extensive experience in developing programs for and delivering services to Hispanic persons infected
with HIV/AIDS in Maricopa and Pinal Counties. The Program Director of L.U.C.E.S. has 14 years of experience in
HIV service delivery including nine years of experience working with CPLC and served as a Member of the
Phoenix EMA Ryan White Title I Planning Council as well as the Arizona Prevention Central Region for
Community Planning Group.
CPLC has served as a Ryan White Provider in the Phoenix EMA for nearly 20 years and is requesting funding to
continue implementation of proven service delivery models for providing Medical and Non-Medical Case
Management Services to PLWHA. Over 200 PLWHA receive Medical Case Management services through the
L.U.C.E.S. Program annually. The Program is exceeding performance measure goals for facilitating clients’ entry
into and retention in Primary Care services (target goal = 80%) and providing counseling to improve treatment
adherence (target goal = 90%). As of the report period ending in February 2013, CPLC is attaining these goals at
95% and 100% respectively.
Non-Medical Case Management services provided through the L.U.C.E.S. Program focus on ensuring clients have
their basic needs met for other services that support their retention in care and adherence to treatment. As of the last
reporting period, 83% of HIV clients completed the BEHKA (Brief Estimate of Health Knowledge and Assessment)
HIV self-evaluation tool once within the measured period to identify additional needs for treatment adherence,
mental health services, or additional patient education ( target goal = 80%). Additionally, the Program ensured
that 96% of clients receiving Non-Medical case management who were enrolled in Part B ADAP services had a
minimum of one laboratory testing visit per 6-month period (target goal = 80%).

SERIAL 13054-RFP
IV. PROPOSED STAFFING PLAN
CPLC employs highly qualified staff that represents the cultural and linguistic characteristics of the population
served. This factor is especially crucial for the supportive case management service component, which utilizes a
peer-based model. The Lead Case Manager for the Medical Case Management is a licensed Registered Nurse with
the skills to address medical as well as social concerns of HIV patients. All CPLC staff receive mandatory cultural
competency training upon their hire that emphasize the importance of delivering services that are culturally,
linguistically and age appropriate and responsive to the individual needs of clients.
The proposed staffing plan for the L.U.C.E.S. Case Management Program includes the following positions that
provide oversight and management of the Program and support delivery of comprehensive Medical Case
Management (MCM) and Non-Medical Case Management (NMCM) service components:
Staffing shall be provided in accordance with the approved allocation of time and budget and may consist of the
following personnel.
 Maclovia Morales - Program Director:
Ms. Morales manages all HIV services provided through the L.U.C.E.S. program including HIV prevention services
not funded by Ryan White Part A. She spends 40% of her time managing L.U.C.E.S. Case Management services
and has over 14 years of experience in HIV Programs including nine years of experience at CPLC. Ms. Morales is
responsible for monitoring all contractual deliverables for Ryan White Part A funding and provides supervision of
MCM and NMCM program staff. Ms. Morales has extensive experience in developing programs that address the
needs of Severe Needs Groups in the Phoenix EMA including Hispanic persons infected with HIV/AIDS. She is a
strong advocate for and proponent of programs that specifically target hard to reach populations infected with
HIV/AIDS and linking them into care using evidence based and culturally effective approaches. She played an
instrumental role in helping to build CPLC’s collaboration with other AIDS Services Providers and Community
Based Organizations that serve similar populations.
Ms. Morales’ efforts to engage community health and human services providers in lobbying to maintain targeted
outreach funding for communities of color resulted in $320,000 being re-allocated to this service category. Ms.
Morales previously served as a Member of the Phoenix EMA Ryan White Title I Planning Council as well as the
Arizona Prevention Central Region for Community Planning Group. In 2003, Ms. Morales managed her own
campaign as a candidate for the Arizona State House of Representatives. She is also a Master Level Trainer for
National Culturally and Linguistically Appropriate Services (CLAS) Standards in Health and Health Care and fluent
in Spanish.
 Gerardo L. Angulo - Clinical Supervisor:
Mr. Angulo serves as the Clinical Supervisor for Outpatient Behavioral Health Services and responsible for
supervision of Case Management Program staff. Mr. Angulo dedicates 25% of his time performing activities related
to the L.U.C.E.S. Case Management Program. He joined CPLC in 2010 and has over 16 years of experience in the
Behavioral Health Field. He provides direct services and treatment to clients to include individual and group
counseling and participates in performance outcomes and evaluation activities. Mr. Angulo has worked with all age
groups, victims of domestic violence, mentally and physically handicapped children, youth at risk, substance abuse
and GLBT youth. He holds a Master of Education Degree in Counseling and Certified as a Professional Counselor
and Relationship Specialist and is a Licensed Substance Abuse Technician. Mr. Angulo is dedicated to the
Behavioral Health Field and has a natural ability to apply his educational background to real life situations where
guidance and counseling can make a difference in the lives of others. Mr. Angulo is also a Fellow Member of the
American Psychotherapy Association. He is fluent in Spanish.
 Edward Anthony Ornelas Lead Medical Case Manager:
Mr. Ornelas brings more than eight years of nursing experience to his position as the Lead Medical Case Manager of
the L.U.C.E.S. Program. The majority of Mr. Ornelas’ time is allocated to the Medical Case Management service
component where his primary responsibilities include delivering services that facilitate HIV patients’ entry into
primary care, assessing patients’ health status as well as developing and implementing appropriate treatment plans
for addressing patients’ health and social needs. Mr. Ornelas also provides counseling services regarding
medication and treatment adherence and educates patients about HIV disease. Additionally, Mr. Ornelas works with
HIV patients to ensure they have access to necessary supportive services that will stabilize the person’s life situation
(i.e., stable housing, food, transportation) with the goal of facilitating their entry into and retention in primary care
services. Mr. Ornelas monitors patients’ health status and program outcomes as a critical component of the services
he provides.

SERIAL 13054-RFP
Mr. Ornelas joined CPLC in 2010. He is a Licensed Registered Nurse with an Associate’s Degree in Nursing who is
in the process of completing a Bachelor’s of Science Degree in Nursing at the Arizona State University. He has
experience working in Correctional Health as well as Trauma, Critical Care and Emergency Nursing Observation
units. Mr. Ornelas has over a decade of experience in Outreach to the Hispanic community and is currently President
of the National Hispanic Nurses Association. He is Bilingual with fluency in both English and Spanish.
 Case Managers:
The primary responsibilities of L.U.C.E.S. Program Case Managers for MCM and NMCM services entail assisting
HIV clients with obtaining community resources (i.e., housing, food boxes, insurance and appropriate referrals) with
the overarching goal of stabilizing clients so that they are able to receive and remain in primary care services to
improve their health outcomes. The proposed staffing plan consists of three full time equivalents (FTE) Case
Manager positions including one new currently vacant position. CPLC anticipates hiring this staff within 30 days of
receipt of the Ryan White Part A Award Notice.
Ana Diaz – Case Manager: Ms. Diaz joined CPLC as a Case Aide in March 2009 and transitioned to the Case
Manager position as a promotion in March 2013. Ms. Diaz spends the majority of her time providing Non-Medical
Case Management services and supports the Medical Case Management services component by assisting HIV
patients in completing applications for medical services as well as the ADAP (AIDS Drug Assistance Program) and
dental assistance programs. Ms. Diaz is a Certified Medical Case Manager with training as a Substance Abuse
Specialist. She holds a Bachelor of Arts Degree in Graphic Design and Communication and she has completed
multiple training hours on topics related to HIV, Substance Abuse, STDs, Hepatitis C and Cultural Competency.
Francisca Y. Madero – Case Manager:
Ms. Madero has six years of experience in her current role as Case Manager with the CPLC L.U.C.E.S. Program.
Ms. Madero coordinates HIV patient referrals for support services, medical services and the ADAP and dental
assistance programs. She spends most of her time providing Non-Medical Case Management Services. Ms. Diaz
holds an Associate’s Degree in Sociology and has close to 20 years of work experience related to providing
eligibility screening services and assisting clients with applications for enrollment in benefits and programs. She is
Fluent in Spanish.
TBD – Case Manager: This position will divide their time providing services to HIV patients participating in the
MCM and NMCM service components. CPLC will ensure the individual hired to fill this position meets the
minimum qualifications and has skills, knowledge and competencies that align with the job responsibilities outlined
in the Case Manager/Outreach Specialist Position Description provided with this grant proposal submission.
 Enrique Bailon - Case Aide:
Mr. Bailon provides peer support services and guidance that facilitate newly identified HIV infected individuals
entry into care following their diagnosis. Mr. Bailon is also responsible for coordinating appointment schedules for
the MCM and NMCM programs and providing individual and group peer counseling services. He was previously a
volunteer with CPLC and appeared in the Public Service Announcement for the L.U.C.E.S. Program. Mr. Bailon is
currently pursuing a degree in Business Administration at the Arizona State University. He is Bilingual with
fluency in both English and Spanish.
V. PROPOSED SERVICES
CPLC’s L.U.C.E.S. Program delivers Medical Case Management and Non-Medical Case Management services that
incorporate activities outlined in the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau
(HAB) definitions for these services as well additional components that enhance the service delivery model. As
described in the previous section, the L.U.C.E.S. staff has the necessary qualifications, experience and credentials to
administer the Program and provide high quality comprehensive services.
According to the Phoenix EMA’s 2010 Out of Care Needs Assessment, 20% of PLWHA reported delaying entry
into care by longer than one year. CPLC provides a range of client-centered Case Management services that link
clients with primary HIV medical care, access to life sustaining medications, mental health, substance abuse,
psychosocial, and other supportive services. These services ensure timely, coordinated access to medically-
appropriate levels of health and support services, continuity of care, ongoing assessment of the client’s and other
family members’ needs and personal support systems, and a linkage that expedites discharge, as medically
appropriate, from inpatient facilities. Proposed Medical Case Management and Non-Medical Case Management
services will include the following activities:

SERIAL 13054-RFP
Medical Case Management Services:
 Initial comprehensive assessment of client’s needs and personal support systems
 Development of a comprehensive, individualized care plan
 Coordination of services required to implement the plan
 Continuous client monitoring to assess the efficacy of the plan
 Periodic re-evaluation and revision of the individualized care plan every six months and as necessary.
 Provision of client specific advocacy as needed
 Comprehensive Nursing Assessment - CPLC added the nursing assessment as part of the Medical Case
Management services provided to clients, which includes a detailed evaluation of clients’ medical needs
related to nutrition, mental health, gynecological and oral health.
 Coordination of referrals for medical, and mental health services
 Conducting routine follow-up to inquire about and encourage entry/re-entry into primary medical care
 Coordination of regular case conferencing of HIV patients receiving Medical Case Management Services
with Primary Medical Care Providers
Non-Medical Case Management Services:
 Benefits/entitlement counseling
 Peer support and guidance
 Assistance with applications for public and private programs for which HIV patients may be eligible
including ADAP, Health Insurance and Dental Assistance Programs
 Case management encounters and communications (face-to-face, telephone contact, other)
 Coordination of referrals for community, legal, financial, benefits counseling and assistance, and other
needed services
 Monitoring of laboratory testing
 Risk Acuity Assessment
HIV patients receiving Medical Case Management and Non-Medical Case Management services through the
L.U.C.E.S. Program at CPLC will also have access to a wide array of services that help ease the burden in dealing
with HIV disease and fill identified service gaps in the continuum of care. The following services are co-located and
offered at the same facility as the Medical Case Management and Non-Medical Case Management Program.
 Behavioral Health - PLWHA surveyed for the Out Of Care Needs Assessment identified “depression” as
the primary reason that they delayed entry into care. CPLC provides Psychological and psychiatric
treatment and counseling services, including individual and group counseling, provided by a mental-health
professional who is licensed or authorized within the State, including psychiatrists, psychologists, clinical-
nurse specialists, social workers, and counselors.
 Substance Abuse Services – Results of recent needs assessment for the Phoenix EMA show high levels of
substance abuse treatment needs among PLWHA. CPLC provides treatment and/or counseling to address
substance abuse issues (including alcohol, legal and illegal drugs), provided in an outpatient or residential
health service setting. Behavioral health and substance abuse services offered by CPLC strengthen access
and linkage to these programs for HIV patients and ensure ongoing on-site support for PLWHA with
mental health and substance abuse co-morbidities.
CPLC will address the following HIV/AIDS Bureau (HAB) Guiding Principles through the proposed service
delivery model for Medical Case Management and Non- Medical Case Management services
• The HIV/AIDS epidemic is growing among traditionally underserved and hard-to-reach populations
CPLC serves a predominantly Hispanic population that faces additionally barriers to accessing health care services
in the Phoenix EMA including language barriers, fear of deportation due to legislative reforms and lack of health
insurance. Results of recent needs assessments and surveys conducted of HIV infected individuals who are “in care”
or “out of care” in the Phoenix EMA, demonstrate the increasing need for case management services that
incorporate strategies for eliminating disparities among minority and underserved populations. CPLC receives
supplemental Minority AIDS Initiative (MAI) funding to support Non-Medical Case Management Services in
accordance with the MAI Implementation Plan. CPLC’s proposed service delivery model for Medical and
Supportive case management components is a proven culturally appropriate approach for successfully engaging
traditionally underserved populations in HIV/AIDS care.
• The quality of emerging HIV/AIDS therapies can make a difference in the lives of people living with
HIV disease

SERIAL 13054-RFP
CPLC will deliver high quality Medical Case Management Services provided by a Licensed Registered Nurse that
emphasize the importance of treatment adherence and reinforces the proper way to take prescribed HIV/AIDS
therapies through counseling and education. Additionally, Non-Medical Case Management services will assist HIV
patients with eligibility screening for and enrollment in ADAP and other medical assistance programs including the
Pre-existing Condition Insurance Plan (PCIP). These services help improve health outcomes among patients
receiving Medical Case Management services provided through the L.U.C.E.S. Program.
• Changes in the economics of health care are affecting HIV/AIDS care network
CPLC works collaboratively with other Ryan White Providers and other community based organizations including
federally qualified community health centers to leverage resources available to HIV patients and program staff.
Collaborations and coordination with other providers also help to reduce fragmentation of care for HIV patients
participating in the L.U.C.E.S. program. CPLC staff attends meetings sponsored by the Ryan White Planning
Council to increase opportunities to network with other HIV/AIDS providers. Program staff participates in trainings
to learn about how impending changes to the health insurance marketplace through implementation of the
Affordable Care Act in 2014, will affect HIV patients and Ryan White Part A providers.
• Outcomes are a critical component of program performance
CPLC is currently exceeding target goals for Medical Case Management and Non-Medical Case Management
performance measures. The Organization’s Research and Evaluation Department will work closely with Program
Staff to conduct other types of evaluation activities that measure the effectiveness and outcomes of services
provided including plans for a longitudinal study that will follow up with patients over time to determine the long-
term effects of the care they received. Results of performance measures and other evaluation studies will help CPLC
improve quality of care and services.
Proposed Service Delivery Model
The proposed service delivery model involves provision of the Medical Case Management and Non-Medical Case
Management services described below in clients’ homes or other offsite venues identified as convenient by the
client. Office appointments will occur at the CPLC Facility located at 1402 S. Central Avenue, Phoenix Arizona,
85004.
Medical Case Management
• Referral and Intake:
The Ryan White Part A Central Eligibility Office initiates the referral process of HIV patients who choose to
participate in the CPLC L.U.C.E.S. Case Management Programs. CPLC outreach services, word of mouth as well as
a PSA launched in 2012, serve as marketing tools to promote the services provided through the L.U.C.E.S. HIV
program. This helps ensure that HIV infected individuals are aware of the broad range of services available through
CPLC.
During patients’ intake appointment with the CPLC L.U.C.E.S. Program, the Medical Case Manager conducts an
initial assessment to obtain a social history and general demographic information. This initial assessment provides
staff with preliminary medical information to determine patients’ immediate needs for medical and social services
and current health status. The Medical Case Manager coordinates referrals to other programs and services based on
patients’ identified needs. Linkage to services may include a program within CPLC or community partner agency.
Patients also receive referrals for and assistance with determining their eligibility for ADAP, dental and medical
assistance programs as appropriate. The Medical Case Manager reviews patients’ financial status and information
including proof of income to determine and establish their eligibility for Ryan White Part A funded services.
Program Eligibility includes all HIV infected patients that are at or below 300% of the FPL.
• Comprehensive Nursing Assessment
The Medical Case Manager conducts a comprehensive nursing assessment of patients during the follow up
encounter. This hour-long assessment includes evaluation of clients’ medical history, presenting medical complaints,
adherence to HIV meds and knowledge of HIV 101 basics including CD4 count and viral load (for those who are
not newly diagnosed).
During this session, the Medical Case Manager conducts an evaluation of clients’ general functionality and ability to
perform activities of daily living as well as a detailed assessment of medical needs related to co-infections, liver
functioning, nutrition, sexually transmitted disease (STD) history, mental health, gynecological and oral health. The
Medical Case Manager will also obtain information about patients’ medical provider in order to establish contact for

SERIAL 13054-RFP
coordination of patients’ care. Patients sign a consent for disclosure to allow release of their medical information
including lab values and current prescriptions.
Education is a key component of the nursing assessment and entails a thorough discussion regarding STD/STI,
Condoms, importance of medication adherence, including how/when to take current HIV medications and
medication resistance education. Additionally, clients’ complete an MDI ICD 10 screening for depression and
evaluation for any previous mental health problems and substance use/abuse.
• Linkage to Primary Care Services and other services
Based on the information obtained through the initial and comprehensive nurse assessments the Medical Case
Manager develops an individualized care plan in consultation with the patient that includes goals for addressing
identified needs for social, mental health, support services and medical services. Patients receive referrals and
assistance with linkage to primary care services and other services as appropriate through CPLC or community
partner agencies. Medical Case Management services include continuous client monitoring to assess the efficacy of
implementation of the care plan. The Medical Case Manager or Case Aide accompanies patients to the initial
primary care services appointment to further support patients’ entry into care. Efforts to ensure that patients remain
in care and receive continued support include coordination of regular case conferencing between patients’ primary
care provider and the Medical Case Manager.
• Follow Up Services
The Medical Case Manager or Case Aide will follow up with clients periodically to ensure they have received and
started their medication and remain adherent to treatment. Clients receive education regarding medication within 90
days after starting their HIV regimen.
• Re-evaluation
Clients complete renewal of their eligibility for Ryan White Part A (RWPA) services and the ADAP program every
six months. During the RWPA renewal process, clients complete an Acuity/Risk Assessment to see if their needs
have decreased from the initial intake. The Medical Case Manager uses this Assessment Tool to ascertain clients’
appropriateness to transition to a different level of monitoring/assistance with Non-Medical Case Management.
Non-Medical Case Management clients with elevated needs, including non-adherence to HIV regimen, as well as
additional health problems will be transitioned back to Medical Case Management if indicated by the Acuity/Risk
Assessment.
Non-Medical Case Management Services:
Non-Medical Case Management is an important component in assisting clients with renewal of ADAP and Ryan
White programs on a timely basis. This service also plays a vital role in assisting clients with their treatment plan
goals for securing referrals for and linkage to services. Monthly contact is mandatory for clients who remain with
Non-Medical Case Management services. This service component includes the following:
• Benefits/entitlement counseling - Case Managers assist patients with eligibility screening and enrolment in
specific programs including ADAP assist for help with high insurance copays.
• Peer support and guidance – Case Managers establish monthly contact with patients to determine their
level of need for additional services based on issues identified in the individualized care plan and results of
the Acuity/Risk Assessment self-evaluation. Patients complete the Acuity/Risk Assessment tool
periodically to help Case Managers evaluate their need for treatment adherence, mental health services, or
additional patient education. The Case Manager may refer patients back to Medical Case Management
services based on the Assessment results. The L.U.C.E.S. Program also uses the BEHKA HIV self-
evaluation tool to test patients’ knowledge and understanding regarding HIV treatment.
• Case management encounters and communications (face-to-face, telephone contact) – Case Managers
communicate with patients by phone or face-to-face contact on a monthly basis or more often as required
for follow up services and to provide any needed support services.
• Coordination of referrals for community – Non Medical Case Managers support implementation of
patients’ individualized care plan through referral services for legal, financial, benefits counseling as well
as other needed services identified by client.

SERIAL 13054-RFP
• Monitoring of laboratory testing - Non Medical Case Management Services clients enrolled in Part B
ADAP services complete a minimum of one laboratory testing visit per 6-month period to determine
improvement in their health status and CD4 and Viral Load count.
VI. PROPOSED SERVICE AREAS:
The proposed service delivery model involves provision of HIV services in clients’ homes or other offsite venues
identified as convenient by the client. Office appointments will occur at the CPLC Facility located at 1402 S.
Central Avenue, Phoenix Arizona, 85004.
CPLC will serve the following proposed service areas in Maricopa and Pinal Counties:
 Maricopa County:
PSA 1: Aguila, Anthem, Beardsly, Circle City, El Mirage, Gladden, Glendale, Moristown, New River,
Peoria, Surprise, Sun City, Tonopah, Wickenberg, Whittman, Youmgtown.
PSA 2: Arlington, Avondale, Bosque, Buckeye, Cashion, Estralla, Goodyear, Gila Bend, Litchfield Park,
Mobile, Palo /Verde, Rainbow Valley, Sentinel, Tolleson, Waddell, Wintersburg.
PSA 3: Camp Creek, Carefree, Cave Creek, Fort McDowell, Fountain Hills, Paradise Valley, Scottsdale,
Seven Springs, Tortilla Flats.
PSA 4: Chandler, Chandler Heights, Gilbert, Guadalupe, Mesa, Ocotillo, Queen Creek, Serape, Sun Lakes,
Tempe.
PSA 5: Laveen, Phoenix.
 Pinal County:
PSA 6: Apache Junction, Gold Canyon, Kearny, Maricopa, Oracle, Superior, Queen Valley.
PSA 7: Arizona City, Casa Grande, Coolidge, Eloy, Florence, Mammoth, Oracle, San Manual, Stanfield.
VII. SPECIAL POPULATIONS SERVED:
CPLC serves all HIV infected populations in the Phoenix EMA eligible for the Ryan White Part A Program
regardless of race/ethnicity, sexual orientation, religious creed, age or gender. The majority of patients receiving
Medical and Non-Medical Case Management services through the L.U.C.E.S. program are Hispanic. The
Organization also serves a high percentage of patients who identify as MSM. CPLC receives Minority AIDS
Initiative funding to increase the percentage of minority HIV patients that are aware of their HIV status and enrolled
in care.
VIII. CULTURALLY AND LINGUISTICALLY APPROPRIATE HIV/AIDS SERVICES:
CPLC is committed to delivering culturally, linguistically and age appropriate HIV/AIDS Services. The L.U.C.E.S.
Program Director is a Master Level Trainer for National Culturally and Linguistically Appropriate Services (CLAS)
Standards in Health and Health Care. Additionally, CPLC requires all staff to complete cultural competency
training when they are initially hired and on annual basis. L.U.C.E.S. Program Staff are bi-lingual and representative
of the client population served. All program forms and educational materials are available in both English and
Spanish and staff delivers services in patients’ native tongue. The Organization utilizes a Language Assistance Line
for Limited English Proficient patients that speak languages other than Spanish.
IX. SCOPE OF WORK:
Chicanos Por La Causa, Inc. (CPLC) proposes to provide Medical Case Management (MCM) and Non-Medical
Case Management Services (NMCM) services to people living with HIV/AIDS (PLWHA) eligible for Ryan White
Part A services in the Phoenix Eligible Metropolitan Area (EMA). CPLC is proposing to deliver MCM and NMCM
services as outlined in this grant application based on the needs identified for (PLWHA) in the Phoenix EMA
service area and in accordance with Ryan White Part A requirements and standards of care.
CPLC also intends to serve as a Minority AIDS Initiative (MAI) Contractor for Medical Case Management and
Non-Medical Case Management services should supplemental funding for MAI become available. CPLC will utilize
MAI funding to serve HIV/AIDS positive minorities as defined by the current MAI implementation plan. The
Organization will document use of these funds separately from Part A funds and will submit required Progress
reports that outline the status of activities related to improving the quality of care and health outcomes in

SERIAL 13054-RFP
communities of color disproportionately impacted by the HIV epidemic. MAI funding will enable CPLC to expand
current efforts that optimize linkage to, retention in, and re-engagement with care and prevention services for newly
diagnosed and previously diagnosed racial/ethnic minorities with HIV.
The Work Plan included with this grant application includes goals and objectives as well as activities CPLC will
perform related to the proposed Medical Case Management and Non-Medical Case Management services.
Applicant Eligibility: CPLC is a non-profit 501(c) 3 with long-term experience as a Ryan White Part A provider.
The Organization is currently in good standing with all current contracts funded through the Ryan White Part A
Program. CPLC is not proposing to utilize any subcontractors to administer the Medical Case Management and
Non-Medical Case Management services.
CPLC will utilize funding received to serve persons living with HIV by providing high quality Medical Case
Management and Non-Medical Case Management services. CPLC will not use this funding to provide prevention
services or to serve clients’ family members who are not infected with HIV.
CPLC is submitting documented evidence to substantiate referral relationships with other Ryan Part A providers as
signed written referral agreements with the following Organizations:
• HIV CARE Directions, Ryan White Part A, Central Eligibility Office
• Phoenix Shanti Group, Mental Health Provider
• TERROS, Substance Abuse Services
• Hispanic Nurse's Association- Phoenix Chapter
• Sun Life Family Health Center, Ryan White Part A Primary Medical Care Provider
CPLC proposes to deliver Medical Case Management Services to include the following:
Face-to-Face Medical Case Management Assessment
Face-to-Face Medical Case Management Services
Non Face-to-Face Medical Case Management Services
And
Non-Medical Case Management services to include the following:
Face-to-Face Non-Medical Case Management Assessment
Face-to-Face Non-Medical Case Management Services
Non Face-to-Face Non-Medical Case Management Services
Actual number of services and clients to be served shall be in accordance with the schedule of deliverables.
Additionally, CPLC also intends to serve as a Minority AIDS Initiative (MAI) Contractor for Medical Case
Management and Non-Medical Case Management services should supplemental funding for MAI become available.
CPLC will utilize MAI funding to implement these services in accordance with the MAI implementation plan.
The proposed service delivery model for Medical Case Management and Non-Medical Case Management services
involves provision of HIV services in clients’ homes or other offsite venues identified as convenient by the client.
Office appointments will occur at the CPLC Facility located at 1402 S. Central Avenue, Phoenix Arizona, 85004.
CPLC will submit monthly financial and corresponding programmatic reports per the reporting schedule to the
County as required.
Invoices And Payments: CPLC’s Finance Department will submit detailed monthly invoices to the Administrative
Agent in the required format outlined in the Ryan White Part A policies and procedures manual.
Method Of Payment: CPLC does not currently bill any third party payor for Medical Case Management and Non-
Medical Case Management Services provided. The Ryan White Part A Program is the only funding source that
supports these services and is the payer of last resort. Further, the majority of the patients receiving services through
the L.U.C.E.S. Case Management Program fall below the 400% Federal Poverty Guideline threshold for this service
category and will not pay any fees for the services received. CPLC has policies and procedures for handling Ryan
White revenue including program income, but does not anticipate that the proposed services will generate program
income.
All new Ryan White Part A Program (RWPA) staff receives training on the requirements of the RWPA as part of
their orientation when initially hired. The Orientation includes specific information on how the Organization

SERIAL 13054-RFP
utilizes RWPA funding as the payer of last resort.
Budget, Revenues And Expenditures: CPLC’s written policy and procedures are designed to include effective
checks and balances to safeguard the assets of the Organization. Those checks and balances are the systems,
procedures and activities used to detect or prevent errors and omissions in recording daily activities. Internal
controls come in the form of records and reports, authorizations and approvals before an action is taken, routine
supervision of critical activities, reports to a pre-determined list of employees and flow charts of responsibilities
ensure the proper segregation of duties. CPLC has systems in place to provide continuous monitoring of all
programs for compliance with applicable regulations as well as with performance measures that are in place through
internal guidelines and imposed by external public and private funding agencies.
CPLC proposed budgets includes administrative costs budgeted at 10% of the funding requested to support Medical
Case Management and Non-Medical Case Management services. A copy of the Organization’s federally approved
indirect rate is provided with this submission.
CPLC maintains a “Financial Management System” that is in accordance with the standards required by Federal
OMB Circular A-110, Subpart C. CPLC has strong internal controls, comprehensive asset and risk management
systems built into their accounting and financial management policies and procedures, and a strong computer and
management information system capable of managing the complexities of CPLC programs. CPLC uses
computerized accounting software for all of our financial tracking and reporting. The software is a Windows-based,
SQL product called Blackbaud, Accounting for Nonprofits. The software includes a general ledger that is integrated
with its Accounts Payable, Receivables, Bank Reconciliation, Payroll and Fixed Asset modules. All financial
transactions are coded following a structured chart of accounts that identifies the Project or Grant, Fund, Account
Number, Center and Report Code. The addition/deletion of an account requires management approvals.
CPLC is not projecting collection of any client fees for the proposed services. Any donations received for the
proposed services will be accounted for separately and used to defray the costs of providing these services outlined
in the proposed Schedule of Deliverables.
Audit Requirements: CPLC receives more than $500,000 in Federal funding per year and complies with audit
requirements per the “Single Audit Act”. The Organization’s Annual Financial Audit consists of OMB Circular A-
133 Supplementary Reports including a Schedule of Expenditures of Federal Awards. The Organization’s Fiscal
Year 2012 Audit report did not include any material weaknesses or major findings. CPLC utilizes an Independent
CPA firm to perform its annual audit. Procurement of this service is conducted in accordance with CPLC’s policies
and procedures for procurement of professional services. CPLC complies with OMB Circulars as A-122 Cost
Principles for Non-Profit Organizations.
Special Requirements:
 The Contractor shall adhere to all applicable requirements of the Ryan White HIV/AIDS Treatment
Extension Act of 2009 and/or current authorized or reauthorized Ryan White HIV/AIDS Act.
CPLC is currently a Ryan White Part A contractor and complies with all applicable requirements of the RWPA
Treatment Extension Act of 2009.
 The Contractor shall participate in provider technical assistance meetings and/or teleconference calls that
will be scheduled by the Administrative Agent throughout the year.
CPLC Program staff participates in provider technical assistance meetings as required by the Administrative Agent.
 The Contractor shall retain the necessary administrative, professional and technical personnel for operation
of the program.
CPLC’s proposed staffing plan for the Medical Case Management and Non-Medical Case Management Programs
include all personnel required to perform the administrative and direct service functions for delivery of the proposed
services. CPLC will fill the current vacant Case Manager position included in the proposed staffing plan within 30
days of receipt of the Ryan White Part A Award Notice.
CPLC currently maintains adequate programmatic and fiscal records and files including source documentation to
support program activities and all expenditures in accordance with the Organization’s fiscal policies and procedures
and in compliance with terms of current Ryan White Part A Contracts. Document retention policies and procedures
ensure the accurate storage and disposition of all project data as required by law and funding source. Standard
retention period is 7 years.

SERIAL 13054-RFP
CPLC is currently utilizing the CAREWare client level reporting software system as described in the current Ryan
White Part A Program Policies and Procedures Manual.
Release Of Information: CPLC has a detailed Confidentiality Policy that addresses safeguards for ensuring
confidentiality of client information including personal identifying information. The Organization requires all clients
receiving Ryan White Part A funded services to sign the Administrative Agent authorized release form. CPLC
maintains release forms as part of clients’ record.
Certification Of Client Eligibility: CPLC determines and certifies eligibility of all clients seeking services
supported by Ryan White funds, according to the requirements detailed in the Eligibility section of the current Ryan
White Part A Program Policies and Procedures Manual. The Organization requires that patients provide Financial
information including proof of income as part of the intake process. CPLC has billing, collection, co-pay and sliding
fee policies and procedures that do not deny clients services for non-payment, inability to produce income
documentation, or require full payment prior to service, or include any other barriers to service based on ability to
pay. The Organization will not deny services to clients due to inability to pay.
Case Management staff ensures that clients complete the renewal process to determine their continued eligibility for
Ryan White Part A services every six months. CPLC utilizes Claim Tracker practice information system.
Quality Management: CPLC participates in the Ryan White Part A Quality Management program and adheres to
the most current Standards of Care for delivering Medical Case Management and Non-Medical Case Management
Services as developed by the Phoenix EMA Planning Council.
CPLC implements an agency-specific quality management plan for Ryan White Part A-funded services that includes
tracking and collection of data related to required performance measures. The Organization currently exceeds target
goals for performance measures for the Medical Case Management and Non-Medical Case Management Program.
CPLC’s Research and Evaluation (R&E) Department is a valuable resource for the Organization. R&E evaluators
assist the L.U.C.E.S. Program in utilizing results of performance measures and other evaluation activities in making
data-driven decisions about management of staff and basic service deliverables (e.g., number of clients served,
timely completion of assessments, etc.). As preliminary findings emerge, evaluators will interpret them in
collaboration with program staff and service recipients to enhance the quality of the findings. CPLC agrees to share
the results of evaluation activities, performance measures and client satisfactions surveys with the Quality
Management Program and the Organization will participate in mandatory Quality Management trainings sponsored
by the County.
Reporting Requirements: CPLC complies with all Ryan White Part A reporting requirements as a current Medical
Case Management and Non-Medical Case Management Provider.
Program Marketing Initiatives: CPLC ensures that Internet-based or printed documents describing the Ryan
White Part A funded programs and/or services include reference and acknowledgment of the funding source. CPLC
outreach services, word of mouth as well as a PSA launched in 2012, serve as marketing tools to promote the
services provided through the L.U.C.E.S. HIV program. Information about the L.U.C.E.S. program is also included
on the CPLC website and in the Organization’s Annual Report.
Other Requirements: CPLC complies with all policies and procedures as defined in the current Ryan White Part A
Policies and Procedures Manual. The Organization maintains discrete client files for all individuals served and
secures the necessary releases of information to allow for review of all pertinent client information by employees of
County and/or their designated representatives.
CPLC agrees to participate with a standardized anonymous Consumer Satisfaction Survey issued to all Ryan White
Part A program participants.
CPLC’s main service delivery site in Maricopa County is located near a bus route. The Organization delivers
Medical Case Management and Non-Medical Case Management services in clients’ home or at other venues
identified as convenient for the client. Service sites located in rural areas of Pinal County are not accessible by
public transportation. Pinal County does not currently have public transportation services available to residents.
Safeguarding Of Client Information: CPLC complies with requirements of HIPAA for safeguarding of client
information.

SERIAL 13054-RFP
Non-Discrimination: CPLC has policies in place that ensures patients receiving or seeking services through any of
the Organization’s Programs will not be discriminated against on the grounds of race, color, religion, sex, national
origin, age, or handicap. Further, it is the policy of CPLC that a minimum of one staff person in each location
offering services to the public be bi-lingual in both English/ Spanish. Chicanos Por La Causa, Inc. maintains a
listing of “on call” employees who are proficient in the American Hand Signing Language for working with the
hearing impaired. The Organization’s facilities are regularly reviewed for handicap accessibility and no structural
changes are authorized which are not compatible with full accessibility.
Equal Employment Opportunity: CPLC is an Equal Opportunity Employer and does not discriminate against any
employee or applicant for employment because of race, age, handicap, color, religion, sex, or national origin. The
Organization’s recruitment and hiring practices comply with Title VI and VII of the Federal Civil Rights Act; the
Federal Rehabilitation Act; the Age Discrimination in Employment Act; the Immigration Reform and Control Act of
1986 (IRCA) and Arizona Executive Order 99.-4. CPLC also complies with all applicable provisions of the
Americans with Disabilities Act of 1990. The Organization’s facilities are wheel chair accessible and reasonable
accommodations are made for employees with disabilities.
Cultural Competency: CPLC complies with applicable standards of the federal culturally and Linguistically
Appropriate Services (CLAS) standards and ensures all newly hired receive training on these standards at orientation
and on an annually based. The Organization develops and implements services in a culturally and linguistically
appropriate manner. CPLC implements organizational policies that comply with these standards. CPLC uses staff as
interpreters, a Language Assistance Line and will include American Sign Language as appropriate to meet the needs
of Limited English Proficient clients as well as Deaf and Hard of Hearing populations accessing care. Chicanos Por
La Causa, Inc. maintains a listing of “on call” employees who are proficient in the American Hand Signing
Language for working with the hearing impaired

SERIAL 13054-RFP
WORK PLAN GOALS AND OBJECTIVES PROPOSED NUMBER OF CLIENTS AND SERVICES
SHALL BE IN ACCORDANCE WITH THE APPROVED BUDGET AND SCHEDULE OF
DELIVERABLES.
Need: A high percentage (86%)) of PLWH/A surveyed for the 2009 Phoenix EMA Newly-Diagnosed/New To Care PLWH/A Needs
Assessment, identified Case Management as a service they wanted to receive upon entry into care. PLWHA who are “in care” as well
as those who are “out of care” face many barriers in navigating the HIV/AIDS Care system. Populations identified as Severe Needs
Groups (Newly diagnosed, MSM, Hispanics, African-Americans, American Indians and those recently released from incarceration
experience unique challenges for entry into and remaining in care. Ryan White Part A funded Medical Case Management and Non-
Medical Case Management serve as critical programs designed to provide PLWHA with the supports needed to receive medical,
pharmaceutical and social services that will help to improve their health status and quality of life.
Goal 1: To implement a high quality client centered medical case management and non-medical case management service delivery
model that help increase timely and coordinated access to medically appropriate levels of health and support services and continuity of
care for PLWHA, especially populations identified as Severe Needs Groups.
Objectives: Activities Person(S) How Goals Will Be
Responsible Measured/Attained/
Evaluation Methods
Objective 1: Offer  Complete intake forms at initial appointment. Case Clients’ record includes:
comprehensive Medical  Determine clients’ eligibility for Ryan White Managers completed intake form, initial
Case Management Part A services. assessment and nursing
services that include  Conduct an initial comprehensive assessment Medical assessment.
initial and comprehensive of client’s needs and personal support systems. Case Clients’ proof of income and
assessments to determine Manager eligibility for Ryan White Part
patients’ level of need for  Conduct a comprehensive Nursing Assessment Registered A services.
education, primary care, to evaluate clients’ medical needs related to Nurse Results of BEHKA self-
mental health treatment nutrition, mental health, gynecological and evaluation
adherence, linkage and oral health. Case Aide Documentation of referrals
support services.  Refer patients for Non-Medical Case Documentation of services
Management services as appropriate. provided
Proposed Number of  Provide linkage into primary care services Documentation of contact
Unduplicated Patients:  Accompany patients to their first primary care made with patients’ primary
AND SERVICES appointment. care provider.
SHALL BE IN  Conduct routine follow-up Quality Management Reports
ACCORDANCE WITH Client Data Reports
THE APPROVED  Coordinate regular case conferencing of HIV
BUDGET AND patients receiving Medical Case Management
SCHEDULE OF Services with Primary Medical Care Providers
DELIVERFABLES  Administer BEHKA-HIV self- evaluation.
 Determine patients’ health literacy level
Proposed Units: SHALL regarding HIV/AIDS treatment.
CONSISIT OF THE  Provide client advocacy as appropriate.
FOLLOWING  Provide assistance with eligibility screening
FMCM Assessment for and enrollment in ADAP, ADAP Assist,
FMCM dental assistance services and the health
OMCM
insurance (Pre-existing Conditions Insurance
Program).
 Provide education and counseling on treatment
adherence, nutrition, HIV basics, STDS and
condom use.
 Provide mental health screening and mental
referral to mental health services as
appropriate.
Objective 2: Implement  Involve clients’ in development of their Medical Completed Individualized
a patient-centered system individualized treatment plan. Case Treatment Plan
of care that focuses on  Coordinate services required to implement the Manager Documentation in clients’
the individual needs of plan. record demonstrating re-
each patient.  Provide follow up services to monitor clients’ evaluation of the treatment plan
occurred every six months.

SERIAL 13054-RFP
progress in implementing the treatment plan.
 Work jointly with client in re-evaluating and
revising the treatment plan every six months
and as necessary.
Objective 3: Deliver  Recruit and hire one additional new Case Human Position advertisements and
Non-Medical Case Manager to deliver Non Case Management Resources Employee record.
Management Services and Medical Case Management Services Personnel Documentation of training
that help stabilize patients within 30 days of receiving Ryan White Part A VP of certificates, training log.
and support their Notice of Award. Recovery
participation and  Provide training to newly hired staff and Clients’ records include
retention in HIV/AIDS Resiliency documentation of:
Care including primary  Provide benefits/entitlement counseling and Services and Forms completed for assistance
care, pharmaceutical, education to increase clients’ awareness of LUCES programs.
mental health and other available services through the HIV/AIDS care Program Results of Acuity/Risk
services. system. Director Assessment and dates of
 Provide peer support and guidance through completion showing the
Unduplicated Patients: individual and group counseling. Case Assessment occurs once every
AND SERVICES  Assist patients with applications for public Managers six months.
SHALL BE IN and private programs for which HIV patients Documentation of case
ACCORDANCE WITH may be eligible including ADAP, Health Case Aide management encounters and
THE APPROVED Insurance and Dental Assistance Programs peer counseling services.
BUDGET AND Medical Results of lab work
SCHEDULE OF  Provide Case management encounters and Case
DELIVERABLES. communications (face-to-face, telephone Manager
contact, other), to follow up on patients;
FSCMAFSCMA progress in meeting goals for addressing
OSCM identified needs.
 Coordinate patient referrals for community,
legal, financial, benefits counseling and
assistance, and other needed services.
 Follow up with patients to ensure they are
completing laboratory tests on a routine basis
to monitor improvement or changes in their
health status.
 Administer Risk Acuity Assessment at least
once every six months or more often, to
monitor patients’ level of need for Case
Management services.
Goal 2 (Minority AIDS Initiative): Optimize linkage to, retention in, and re-engagement with care and prevention services for newly
diagnosed and previously diagnosed racial/ethnic minorities with HIV.
Objectives: Activities Person(S) How Goals Will Be
Responsible Measured/Attained/
Evaluation Methods
Objective 1  Assess clients’ eligibility for Ryan White Part Case MAI Progress Reports
Identify newly diagnosed A services. Managers
and previously diagnosed  Conduct outreach activities that focus on Client records include
racial/ethnic minorities identifying racial/ethnic minorities with HIV, Medical documentation of:
with HIV to engage them to link these individuals to primary care and Case
in the HIV/AIDS care supportive services. Manager Medical and Non-Medical Case
system, with case Management services received.
management services as  Provide enhanced Medical and Non-Medical Case Aide
the point of entry. Case Management services that specifically Results of Acuity/Risk
address the unique needs of newly diagnosed Assessment and dates of
and previously diagnosed racial/ethnic completion showing the
Unduplicated clients: minorities with HIV. Assessment occurs once every
Per Schedule of  Provide peer counseling and guidance to six months.
Deliverables. address barriers that prevent patients from
Documentation of monthly

SERIAL 13054-RFP
accessing and remaining in care Case Management contact with
 Provide benefits/entitlement counseling and patients.
education to increase clients’ awareness of
available services through the HIV/AIDS care Results of lab work.
system.
 Provide linkage to primary care services and
accompany patients to initial primary care
visit.
 Coordinate patient referrals for community,
legal, financial, benefits counseling and
assistance, and other needed services.
 Administer Risk Acuity Assessment at least
Administer Risk Acuity Assessment at least
once every six months or more often, to
monitor patients’ level of need for Case
Management services.
 Maintain monthly contact with patients by
phone to provide follow up services.
 Follow up with patients to ensure they are
completing laboratory tests on a routine basis
to monitor improvement or changes in their
health status.

SERIAL 13054-RFP
Chicanos Por La Causa Inc.
LUCES
Medical and Non-Medical Case Management Services
Ryan White Part A Sliding Fee Schedule
Family Size 100% FPG 200% FPG 300% FPG 400% FPG
Gross Income Monthly Yearly Monthly Yearly Monthly Yearly Monthly Yearly
Co-Payment $0.00 $0.00 $0.00 $0.00
1 $958 $11,490 $1,915 $22,980 $2,873 $34,470 $3,830 $45,960
2 $1,293 15,510 $2,585 $31,020 $3,878 $46,530 $5,170 $62,040
3 $1,628 19,530 $3,255 $39,060 $4,883 $58,590 $6,510 $78,120
4 $1,963 23,550 $3,925 $47,100 $5,888 $70,650 $7,850 $94,200
5 $2,298 27,570 $4,595 $55,140 $6,893 $82,710 $9,190 $110,280
6 $2,633 31,590 $5,265 $63,180 $7,898 $94,770 $10,530 $126,360
7 $2,968 35,610 $5,935 $71,220 $8,903 $106,830 $11,870 $142,440
8 $3,303 39,630 $6,605 $79,260 $9,908 $118,890 $13,210 $158,520

SERIAL 13054-RFP
STAFF RESUMES AND JOB DESCRIPTIONS

SERIAL 13054-RFP

SERIAL 13054-RFP

SERIAL 13054-RFP

SERIAL 13054-RFP

SERIAL 13054-RFP

SERIAL 13054-RFP

SERIAL 13054-RFP

SERIAL 13054-RFP

SERIAL 13054-RFP

SERIAL 13054-RFP

SERIAL 13054-RFP

SERIAL 13054-RFP

SERIAL 13054-RFP

SERIAL 13054-RFP

SERIAL 13054-RFP

SERIAL 13054-RFP

SERIAL 13054-RFP

SERIAL 13054-RFP