CL-QI grant proposal

This component of the proposal should demonstrate the responder's understanding of the quality improvement initiatives requested in this RFP. For this requirement, the applicant should include a written statement (maximum 500 words), that provides the following:

• Project name
• Brief description of the proposed project, including goals, objectives, and products/services to be developed or enhanced
• Outline of the overall design of the project in response to achieving the purpose and deliverables as defined in this RFP

*Note: Executive Summary from each applicant awarded a grant may be posted on the DHS public web page.

For this requirement, the applicant should include a written statement (maximum 1,000 words) that provides the following:

• A brief history of your organization, geographic areas served, address of project site, and the number of people served
• If the project spans multiple sites within your organization, provide the address and the number of people served at each site
• Describe current programs and activities, staff experience, strengths, challenges and accomplishments
• Include reasons why your organization is capable to fulfill the deliverables outlined in the RFP
• Highlight the skills and experience of lead staff and designate a project manager
• Describe any lasting effects the project will produce
• Discuss relationships with other entities that will help maintain the project long-term, and describe the value of any coordination across service providers and any secondary benefits you anticipate.

*Note: In addition to the items above, the applicant may wish to review the Qualification as a Targeted Organization list and provide an explanation of how qualification uniquely improves its ability to provide services under the grant.

Download the eligible grantee statement worksheet (xlsx)

For this requirement, you should complete the worksheet provided above to report the number of waiver (BI, CADI, EW) participants served in your setting(s) and the proportion of waiver participants as a percentage of your overall census.

The State will use the Eligible Grantee Statement attached to this RFP in order to score this section:

• The Responder must be an enrolled provider with DHS to provide customized living services under BI, CADI or EW.
• At least 75 percent of the residents served by the provider must be waiver participants.
• For providers of customized living services under the BI or CADI waivers, the waiver participants must reside at multiple locations each with six or more residents.

The State will give preference to providers who serve a higher percentage of waiver participants.

Download the sample workplan worksheet (pdf)

For this requirement, you should complete the worksheet provided above (maximum four pages). The information you provide in this worksheet should cover the following:

• The goals and objectives of the project in relation to the targeted population of individuals receiving customized living services
• Propose and describe specific milestones and outcomes that will be used to demonstrate the program’s effectiveness and successes
• All proposals submitted under this RFP must address, in sufficient detail, how the applicant will fulfill the expected outcomes and features set forth above. Simply repeating the outcomes and features and asserting that they will be performed is not an acceptable response.
• This section should detail how the project will be carried out in an effective and thoughtful manner, including who will be involved (internal staff, stakeholders, community organizations, etc.), what resources are required, target dates for project activities and the timeframe for completion.

Download the sample evaluation plan worksheet (pdf)

For this requirement, you should complete the worksheet provided above (maximum two pages). The information you provide in this worksheet should cover the following:

• Describe what outcomes will result from the objectives and key activities/strategies laid out in the work plan.
• Describe how you will measure the results of one or more key activities/strategies and when in the course of the project you will collect data and review the results.

*Note: The measurement results will demonstrate whether the project goals and objectives have been achieved as the project is being carried out. Improvements can be measured through data you already collect or through new data collection strategies.

Download the budget template worksheet (xlsx)

Responders are encouraged to apply for only the amount needed for their proposed programs. For this requirement, you should complete the worksheet provided above to outline the projected budget for your proposed project. Information provided in the worksheet should include the following:

• Each component of your proposed project to be carried out for the remainder of FY 2023 and FY 2024 
• How much each component is projected to cost

*Note: If you will use any subcontractors, include their costs in the budget template.
*Note: The State will not necessarily divide the total available funds equally, nor guarantee that selected applicants will receive the entire amount requested. The review committee judges Budget proposals on efficient use of funds and overall cost-effectiveness.

Assuming successful Responders meet all requirements defined in the final negotiated contract, the State plans to take the following approach to payments: Quarterly cost reimbursement based on the previous quarter’s expenses, documented by invoices or otherwise specified.

In addition to completing the proposal requirements listed above, you will need to fill out and sign the following forms. All forms require a wet signature. 

Once signed, submit these forms via e-mail to dhs.aasd.hcbs@state.mn.us. These forms can be submitted in the same e-mail as your proposal requirements, or in a separate e-mail, if needed.

Form 1: Responder Information and Declarations (required)
Download the Responder Information and Declarations form (pdf) 

Form 2: Exceptions to Terms and Conditions (required)
Download the Exceptions to Terms and Conditions form (pdf) 

Form 3: Human Rights Compliance: Workforce Certificate Information (as needed)
Download the Responder Information and Declarations Form (pdf) 

• Responders must complete this form only if a resulting contract will be in excess of $100,000.
• As required by Minnesota Rules, part 5000.3600, Subp. 9, “[i]t is hereby agreed between the parties that Minn. Stat. § 363A.36 and Minnesota Rules, parts 5000.3400 - 5000.3600 are incorporated into any contract between these parties based upon this specification or any modification of it. A copy of Minn. Stat. § 363A.36 and Minnesota Rules, parts 5000.3400 - 5000.3600 are available upon request from the contracting agency.”

Form 4: Documentation to Establish Financial Stability (required)
Download the Documentation to Establish Financial Stability form (pdf)  

• It is the policy of the State of Minnesota to make grants to organizations that are sufficiently financially stable to carry out the purpose of the grant. The information collected under this section will be used in STATE’s determination of the award of the contract