Overview Information
National Council on Disability
Notice of Funding Opportunity
The Current State of Health Care for Americans with Disabilities

April 23, 2007 - Initial Announcement of Funding Opportunity
Funding Opportunity for a Cooperative Agreement:  NCD-0701A
Authority: Section 400, Title IV of the Rehabilitation Act of 1973, as amended
Application materials are available at  www.ncd.gov/resources_researchopps.htm
You also can request applications by writing to:
Julie Carroll
National Council on Disability
1331 F St NW Ste 850
Washington, DC  20004
or by e-mail request to: jcarroll@ncd.gov
Applications will be due on June 4, 2007 by 5:00 PM EDT

Deliver all materials to:
National Council on Disability
1331 F Street NW Suite 850
Washington, DC  20004-1107
ATTN:  Julie Carroll
Maximum amount available for this project:  $250,000
All potential applicants are eligible to apply
Cost sharing is not required
The estimated period of performance is August 1, 2007 - August 1, 2008

Project Summary
The National Council on Disability (NCD) is an independent federal agency charged with making recommendations to Congress and the Administration on issues, policies, and laws affecting people with disabilities. It is NCD's mission to promote policies, programs, practices, and procedures that guarantee equal opportunity for all individuals with disabilities, regardless of the nature or severity of the disability, and to empower individuals with disabilities to achieve economic self-sufficiency, independent living, and inclusion and integration into all aspects of society. NCD is responsible for gathering information about the implementation, effectiveness, and impact of the Americans with Disabilities Act (ADA).

In the course of monitoring the impact of the ADA, NCD has learned that Americans with disabilities do not have equal access to quality health care and health promotion services, due in part to a lack of ADA implementation and enforcement in health care facilities, as well as to inadequate access to health insurance, deficiencies in health care coverage, and inadequate training of health care professionals.

The United States health care delivery system is touted by many to have outstanding providers, facilities, and technology. Many Americans enjoy easy access to care. However, not all Americans have full access to high quality health care, and too many Americans with disabilities have inadequate or no access to health care.

The lack of access to high quality health care can be particularly problematic for service members and veterans with disabilities, women with disabilities, and individuals with communication disabilities, such as people who are deaf or hard-of-hearing, people who are blind, people who have speech impairments, or people with intellectual disabilities. The consequences of these problems are often far-reaching, leading to unemployment, poverty, homelessness, the development of secondary health conditions, and a shortened life span.

NCD seeks to enter into a Cooperative Agreement with entities that have the knowledge and experience to conduct a study of the current state of health care for Americans with disabilities, with a particular focus on service members and veterans with disabilities, women with disabilities, and individuals with communication disabilities. Partnerships and collaborative efforts are encouraged to ensure that appropriate expertise is brought to bear on this complex project involving diverse stakeholders. Input must be gathered from individuals with disabilities, health care providers, and health insurers. An NCD report blending a similar mix of perspectives can be viewed in The Current State of Transportation for People with Disabilities in the United States (June 2005) at www.ncd.gov/newsroom/publications/2005/current_state.htm.

I.  Funding Opportunity Description
The National Council on Disability (NCD) is an independent federal agency charged with making recommendations to Congress and the Administration on issues, policies, and laws affecting people with disabilities. It is NCD's mission to promote policies, programs, practices, and procedures that guarantee equal opportunity for all individuals with disabilities, regardless of the nature or severity of the disability, and to empower individuals with disabilities to achieve economic self-sufficiency, independent living, and inclusion and integration into all aspects of society. NCD is responsible for gathering information about the implementation, effectiveness, and impact of the Americans with Disabilities Act (ADA).

In the course of monitoring the impact of the ADA, NCD has learned that Americans with disabilities do not have equal access to quality health care and health promotion services, due in part to a lack of ADA implementation and enforcement in health care facilities, as well as inadequate access to health insurance, deficiencies in health care coverage, and inadequate training of health care professionals.

The United States health care delivery system is touted by many to have outstanding providers, facilities, and technology. Many Americans enjoy easy access to care. However, not all Americans have full access to high quality health care, and too many Americans with disabilities have inadequate or no access to health care. The lack of access to high quality healthcare can be particularly problematic for service members and veterans with disabilities, women with disabilities, and individuals with communication disabilities, such as people who are deaf or hard-of-hearing, people who are blind, people who have speech impairments, or people with intellectual disabilities.

A substantially lower percentage of people with disabilities than those without disabilities report their health to be excellent or very good (28.4% versus 61.4%) (Centers for Disease Control and Prevention, 2004). According to the N.O.D./Surveys of Americans with Disabilities, Americans with disabilities are more than twice as likely as those without disabilities to postpone needed health care because they cannot afford it (28% versus 12%). In the 2000 N.O.D. Harris Survey, 28 percent of insured people with disabilities reported having special needs that insurance does not cover, such as particular therapies, equipment, and medications, compared with 7 percent of people without disabilities. And, even among people who are working, people with disabilities are less likely to have health insurance than people without disabilities.

In 2004, the Rehabilitation Institute of Chicago released It Takes More than Ramps to Solve the Crisis of Healthcare for People with Disabilities, which explores the extent to which people with disabilities experience problems and barriers receiving health care services and offers analyses of their root causes. The report highlights three conclusions:

1. People with disabilities use healthcare services at a significantly higher rate than people without disabilities, yet they commonly express dissatisfaction with their healthcare services, are particularly susceptible to disparities in healthcare, and experience widespread lack of appropriate accommodations.
2. The roots of these quality-of-care and safety shortfalls include inadequate training of clinicians and other healthcare professionals, poor executive oversight to enforce the Americans with Disabilities Act (ADA), limited funds and few financial incentives for upgrading equipment and hiring and training support staff members to assist patients, and misperceptions and stereotypes about disability.
3. Healthcare institutions have the moral as well as the legal responsibility to take actions to improve the healthcare delivery system for people with disabilities in a way that is safe, patient-centered, and culturally competent.

Compounding the quality of care disparities for people with disabilities is the fact that people with disabilities often are overlooked when it comes to wellness and prevention services. In 2005, the U.S. Surgeon General, Richard H. Carmona, MD, issued a "Call to Action to Improve the Health and Wellness of Persons with Disabilities,” saying, "People with disabilities are still not getting the healthcare that is available to others."  Existing health care and wellness systems are not sufficiently responsive to the needs of persons with disabilities. As a result, access to education, prevention, screening, diagnosis, treatment, and wellness services can be limited, incomplete, or misdirected.  (U.S. Department of Health and Human Services, Access to Quality Health Services And Disability - A Companion To Chapter 1 Of Healthy People 2010). One reason for the lack of attention to people with disabilities in health, wellness and prevention programs is due, in part, to a focus on preventing disability, as opposed to preventing secondary conditions for people with disabilities. While there has been a recent paradigm shift among federal health policymakers to include people with disabilities in wellness and prevention programs, this shift has not led to change at the health professional and delivery system level.  When encountering a person with a disability, many health professionals still focus on the disability, rather than the whole person, and do not focus on the potential for preventing secondary conditions. 

Despite the emphasis in recent years on physical fitness through exercise and nutrition, The Washington Post reports that 56 percent of Americans with disabilities say they get no physical activity whatsoever. Health and fitness centers are often not accessible to people with disabilities, either because of structural barriers, such as inaccessible restrooms and shower facilities, inadequate clear floor space in the equipment area, and inaccessible operating mechanisms and displays on exercise equipment, or because of the attitudes of fitness professionals toward people with disabilities. Fitness professionals are not trained to assist people with disabilities.

In the 2004 National Healthcare Disparities Report (NHDR), a comprehensive national overview of disparities in health care among racial, ethnic, and socioeconomic groups in the U.S., three key themes are highlighted for policymakers, clinicians, health system administrators, and community leaders who seek to use this information to improve health care services for all Americans: (a) Disparities are pervasive; (b) Improvement is possible; and (c) Gaps in information exist, especially for specific conditions and populations. Other than its focus on children with special health care needs, however, little information is provided about health disparities and Americans with disabilities.

To ensure that Americans with disabilities are included in this critical research effort and related federal policymaking efforts, the National Council on Disability is interested in conducting research to:

• Review the literature and history of federal efforts in health care as it relates to Americans with disabilities, including wellness and prevention services;
• Evaluate the availability and accuracy of health data regarding Americans with disabilities, including access to wellness and prevention services and their relative long-term costs and benefits;
• Identify access barriers to health care, including barriers to wellness and prevention services, for people with disabilities, including any unique barriers for service members and veterans with disabilities, women with disabilities, and individuals with communication disabilities;
• Analyze efforts towards access to coverage and care through the public and private sector, avoiding duplication of existing research dealing with Medicare and Medicaid, and focusing instead on identification of promising or best practices;
• Evaluate the state of federal efforts at health promotion and disease prevention (public health) as it affects Americans with disabilities, particularly service members and veterans with disabilities, women with disabilities, and individuals with communication disabilities;
• Evaluate disparities in third-party coverage of the types of programs and services most needed by Americans with disabilities, particularly service members and veterans with disabilities, women with disabilities, and individuals with communication disabilities, and document the long-term costs and benefits of making those programs and services available;
• Make recommendations for practical solutions to improve access to healthcare, including wellness and prevention programs and services, for people with disabilities, including the three targeted subgroups discussed more fully below.

Health access barriers encountered by people with disabilities can be even more severe for service members and veterans with disabilities, women with disabilities, and individuals with communication disabilities. Additionally, the consequences of these barriers are often far-reaching, leading to unemployment, poverty, homelessness, the development of secondary health conditions, and a shortened life span.

Service Members and Veterans with Disabilities
NCD hosted a veterans program at its quarterly meeting held in San Diego, January 29 - 31, 2007. The purpose of the program was for Council members to learn from veterans with disabilities, particularly service members returning from the current conflict, about the programs available to assist them as they transition to life with a disability, and whether those programs are meeting their needs. Veterans with disabilities returning from the current conflict differ from those in prior wars in that many are electing to remain in the military after rehabilitation. This is possible now due, in part, to advances in assistive technology that make it possible for people with disabilities to perform a wide range of jobs, and, in part, because attitudes towards disability have progressed. Assistive technology is typically readily available to service members with disabilities while they are enlisted, but can be difficult or impossible to obtain once they leave the military. The same is true for quality health care. For service members with disabilities who do not elect to, or are not able to, remain in the service after rehabilitation, transition services and health care services are often inadequate, unavailable, or difficult to learn about and access.

Facts have come to light recently about the state of health care for service members returning from the current conflicts, revealing systemic failures of crisis proportion. Widespread reports of neglect and delays in the provision of basic health services, rehabilitation services, specialized care, and the processing of disability claims, have shocked America. With both the military and the Department of Veterans Affairs admittedly unprepared for the number of service men and women returning with severe and multiple disabilities, there is an urgent need for stop-gap measures that can meet the immediate needs of these soldiers, as well as the need for long-term system reforms.

Although the current spotlight on deficiencies has sparked widespread system reviews and reform in the military health care delivery system, historically, mental health issues do not receive equal attention. For this reason, NCD intends to focus on presenting recommendations to ensure that systems are in place for readily diagnosing and treating mental illnesses and traumatic brain injuries of service members and veterans with disabilities, as well as to ensure appropriate services that will encourage a fulfilling and purposeful life upon their return.

A high proportion of veterans returning from Iraq and Afghanistan have experienced traumatic brain injuries, and a high proportion experience symptoms of post-traumatic stress disorder (PTSD).  Evidence suggests that the appropriate screening and treatment for both conditions are inadequate, even within the military, and are especially limited in the general health care system.  Chronic, untreated mental illness is associated with higher rates of poverty, homelessness, and unemployment for people with disabilities, especially for veterans with mental illness.

Early in the Iraq War, the Army surveyed 3,671 returning veterans and found that up to 17 percent of the soldiers were suffering from depression, anxiety and symptoms of PTSD. Other studies have indicated that protracted warfare in Iraq—with its intense urban street fighting, civilian combatants and terrorism—could drive PTSD rates even higher. According to the 2004 Report of the Special Committee on Post-Traumatic Stress Disorder, established by Congress in 1984 to monitor this problem, forty percent of casualties returning from Iraq and Afghanistan to Walter Reed Army Medical Center reported symptoms consistent with PTSD.

It is well documented that screening and prompt intervention can result in shorter, less severe effects from PTSD. However, there are numerous longstanding systemic barriers to prompt screening, such as failure to report symptoms for fear of discharge or stigma, unavailability of trained professionals to detect and treat PTSD, and, commonly for service members transitioning out of active service, a delay in manifestation of symptoms beyond expiration of their military benefits.

Recent articles in The Washington Post reveal that DOD is not prepared to meet this challenge.  Given the inadequacy of the U.S. health care system as it pertains to mental health services, and the likelihood that veterans with mental or emotional disabilities will not receive prompt or adequate treatment from the military health care system, NCD seeks to explore ways to ensure that service members and veterans with disabilities will be readily diagnosed and provided immediate treatment to encourage a fulfilling and purposeful life upon their return.

Women with Disabilities
According to the CDC, inadequate access to preventive health care services among people with disabilities, particularly women, is a serious public health concern. Low rates of health care usage among women with disabilities can lead to decreased health status, including the delayed treatment of chronic illness and failure to prevent secondary conditions.

The CDC reports that health care providers sometimes only concentrate on health issues related to a woman’s disability, thereby neglecting to screen and counsel for other health conditions. Failure to provide comprehensive preventive services for women with disabilities can have significant implications on their health. Data reported by the Baylor College of Medicine suggest that, as compared to women without disabilities, women with disabilities have much higher rates of obesity, receive mammogram screenings less frequently, are less likely to have had a Pap screening in the past three years, are less likely to be screened for STDs, and are less likely to receive healthy pregnancy counseling. Reasons cited for these disparities include lack of health insurance, lack of transportation, lack of personal care assistance, inaccessible exam rooms, and restricted access to providers due to a lack of health insurance.

NCD seeks to advance the state of health care for women with disabilities by further identifying barriers to care, identifying successful models of comprehensive care, including wellness and prevention services, and developing recommendations for implementation across health care settings.

Individuals with Communication Disabilities
Obtaining quality health care can be especially problematic for people with communication disabilities, such as people who are deaf or hard-of-hearing, people who are blind, people who have speech disabilities, and people who have intellectual disabilities. Iezzoni and O'Day documented many situations in which people who are deaf or hard-of-hearing failed to be provided necessary information, due either to failure to provide a sign language interpreter, or failure to speak directly to the patient who may be lip-reading. (More than Ramps: A Guide to Improving Health Care Quality and Access for People with Disabilities, 2006). The result can be an improper diagnosis, if, for example, the patient misunderstands the question being asked and provides an answer different than he would if he understood the question, failure to follow instructions that are not provided in writing, and inability to get the patient's questions answered because the clinician does not know how to communicate with the patient. One deaf woman in an emergency room was denied access to the restroom. There was no interpreter present, and when she tried to ask for directions to the restroom using gestures, the nurses thought she was becoming agitated because of waiting so long to be seen by a doctor. One can imagine the medical mistakes that have occurred solely due to such communication barriers. This can lead to additional stress for the person in need of medical attention. According to the U.S. Department of Justice, "Hospitals should have arrangements in place to ensure that qualified interpreters are readily available on a scheduled basis and on an unscheduled basis with minimal delay, including on-call arrangements for after-hours emergencies. Larger facilities may choose to have interpreters on staff."

Private health care providers, such as physician practices and laboratories, also are required by the ADA to provide effective communications for patients with communication disabilities, yet people who are blind occasionally encounter office staff in medical facilities who expect them to bring someone with them to appointments to fill out their paperwork. When a patient who is blind is not accompanied by someone who assists in filling out the forms, the office staff will sometimes do so, but then might ask personal questions aloud in the waiting room. Obtaining medical information in an accessible format, such as in an electronic file, Braille, or tapes, is extremely rare. This can be particularly problematic if the person who is blind is the care-giver for someone who is very ill. One blind woman was never able to obtain accessible nutrition instructions from the hospital where her husband had a transplant, even though the instructions were very detailed and failure to follow them was potentially life-threatening.

People who have intellectual disabilities report difficulties obtaining quality health care and are not able to access fitness, wellness, and prevention programs. For people with developmental disabilities, the nature of the impact of the aging process and the role of leisure in maintaining well-being are relatively uncharted (Hawkins, 1997). What is known is that these individuals tend to participate in sedentary leisure, watching television or listening to the radio with family and friends (Boyd, 1997; Modell & Megginson, 2001; Wilhite & Keller, 1996). The sedentary lifestyle of people with intellectual disabilities is associated with low levels of physical fitness, obesity, and cardiovascular disorders (Balic, Mateos, Blasco, & Fernhall, 2000; Chanias, Reid, & Hoover, 1998). This is exacerbated by limited access to fitness opportunities, to trained practitioners, and to coordinated community preventive health care, which helps to explain why people with intellectual disabilities have higher than normal incidents of high blood pressure and cholesterol, heart disease, diabetes, obesity, chronic skin problems, and hygiene-related issues. (Cluphf, O'Connor, & Vanin, 2001; Connolly, 1998).

In a recent publication by the Journal of the American Board of Family Practice, entitled Elderly Deaf Patients' Health Care Experiences, the following are some of the barriers reported:

• inability to communicate with office staff to make appointments or obtain lab results because their doctor's office does not have TTYs;
• losing appointment times because of receptionists failing to notify them when they were being called from the waiting room, even after the patient explains the deafness when checking in;
• not requesting a sign language interpreter, presuming the doctor will refuse or no longer treat them,
• doctors who make it clear they are uncomfortable treating them, and
• being afraid the doctor's instructions are not being fully or correctly communicated to them.

In April 2006, sixteen years after passage of the ADA, a deaf advocacy group in Ohio staged a four-hour sit-in to demand accessibility at Premier Physicians Centers, the largest independent physicians practice in Northeast Ohio with 60+ doctors located at 40 sites throughout the area.  An agreement was reached to provide the communication method of choice to deaf and deaf/blind patients, and for the entire physician's group to undergo training. But, patients should not have to go to such extreme measures to receive fundamental access to health care. NCD seeks to advance the state of health care for people who have communication disabilities by identifying and analyzing successful approaches to providing effective communication with patients, and making recommendations for practical solutions that can be applied in all health care settings.

Conclusion
NCD seeks to enter into a Cooperative Agreement with entities with the knowledge and experience to conduct a study of the current state of health care for Americans with disabilities, with particular attention to service members and veterans with disabilities, women with disabilities, and individuals with communication disabilities. Partnerships and collaborative efforts are encouraged to ensure that appropriate expertise is brought to bear on this complex project affecting diverse stakeholders. Input must be gathered from individuals with disabilities, healthcare providers, and health insurers. An NCD report blending a similar mix of perspectives can be viewed in The Current State of Transportation for People with Disabilities in the U.S. (June 2005) at www.ncd.gov/newsroom/publications/2005/current_state.htm

The final deliverables for this project will include:

1.  Three issue papers, one for each targeted subgroup, that describe the findings and draft recommendations;
2.  The convening of a national summit of experts, people with disabilities, policy makers, and health care providers to discuss and further develop recommendations for meeting the health care needs of people with disabilities, particularly service members and veterans with disabilities, women with disabilities, and individuals with communication disabilities;
3.  A detailed summary of the national summit proceedings; and
4.  A final report documenting the methodology, research findings, and recommendations for improving access to health care, including access to wellness and prevention services, for service members and veterans with disabilities, women with disabilities, and individuals with communication disabilities.

Any methodology used to obtain stakeholder input must allow for open-ended discussions between stakeholders, as opposed to soliciting answers to specific, predetermined questions. The use of surveys is strongly discouraged. The inclusion of people with disabilities must be integral to the planning, development, and execution of this project.

II. Award Information
NCD will make one award, not to exceed $250,000 in the form of a cooperative agreement. NCD will have substantial involvement in the administration of this project.
The projected start date for this project is August 15, 2007. The expected period of performance is 12 months.

III. Eligibility Information

1.  All potential applicants are eligible to apply.
2.  Cost-sharing is not required.
3.  Other Eligibility Criteria
Proposals that merely offer to conduct a project in accordance with the requirements of the Government’s scope of work will not be eligible for award.

IV. Application and Submission Information

1. Address to Request Application Package
Application materials are available at www.ncd.gov
You also can request applications by writing to:
Julie Carroll
National Council on Disability
1331 F St NW Ste 850
Washington, DC  20004
or by e-mail request to: jcarroll@ncd.gov

2. Content and Form of Application Submission
A.  General Requirements
The proposal must be prepared in two parts: A “Technical Proposal” and a “Business Proposal.”  Each of the parts shall be separate and complete in itself so that evaluation of one may be accomplished independently of evaluation of the other. The technical proposal must not contain reference to cost; however, resource information, such as data concerning labor hours and categories, materials, subcontracts, etc., must be contained in the technical proposal so that your understanding of the scope of the work may be evaluated. It must disclose your technical approach in sufficient detail to provide a clear and concise presentation that includes, but is not limited to, the requirements of the technical proposal instructions.

The proposal must be signed by an official authorized to bind the organization.

B.  Technical Proposal
A detailed work plan must be submitted indicating how each aspect of the statement of work is to be accomplished. The technical approach should be in as much detail as is necessary to fully explain the proposed technical approach or method. The technical proposal should reflect a clear understanding of the nature of the work being undertaken.

The technical proposal must include information on how the project is to be organized, staffed, and managed. Information should be provided that will demonstrate how important events or tasks will be managed. The proposal must explain how the management and coordination of consultant and/or subcontractor efforts will be accomplished.

The technical proposal must include a list of names and proposed duties of the professional personnel, consultants, and key subcontractor employees assigned to the project. Their resumes or curriculum vitae should be included and should contain information on education, background, recent experience, and specific technical accomplishments. The approximate percentage of time each individual will be available for this project must be included. The proposed staff hours and tasks for each individual must be included on the chart/table identified under “Management Time and Schedule.”

The technical proposal must provide the general background, experience, and qualifications of the organization. Similar or related contracts, subcontracts, or grants should be included and contain the name of the customer, contract or grant number, dollar amount, time of performance, and the names and telephone numbers of the contracting officer’s technical representative or project officer and contracting/grants officer.

The technical proposal must be prepared and submitted in the following format:

1. Abstract (no more than 2 pages)

A two-page summary shall be provided abstracting the proposal contents, including objectives, activities, and expected outcomes, in language understandable to an informed layperson.

2. Table of Contents

3. Introduction (no more than 20 pages)

Offerors shall summarize, in their own words, the purposes and objectives of the project to demonstrate their complete understanding of NCD’s intent and requirements. This section also should contain a specific statement of any interpretations, questions, qualifications, limitations, deviations, or exceptions to the RFP scope of work and the extent to which the Offeror’s proposal can be expected to meet the requirements set forth in the scope of work.

4. Procedural Plan (no more than 40 pages)

This section shall fully describe the theoretical and technical approaches the Offeror will employ in complying with each task in the scope of work. While a general statement of strategy is appropriate, the proposal should be specific in describing the manner in which the overall project will be conducted, and the intended approach to the design.

5. Management Plan and Schedule (no more than 15 pages)

The management plan shall show the feasibility of implementing the Offeror’s resources. The Offeror shall present a time chart that specifies the amount of time (in person days) each staff member will commit to implementing each task. The plan shall present a clear description of the roles and work relationships among project personnel and project advisors. Finally, the plan shall contain a method for insuring the timely and successful completion of each work task, as a part of a projected schedule and target completion dates.

6. Personnel

Personnel with major responsibilities shall be listed by name, title, position, academic background, relevant experience, responsibilities with the project, and the extent to which this commitment is assured. This section should include specific time commitments of staff to other projects, both federal and non-federal. Consultants who have agreed to serve on the project should be similarly identified and assurances of their commitment included. The Project Director shall be committed for no less than approximately 60 percent of the contract. Vitae for all principal personnel, including consultants, should be appended to the proposal. Each vitae should be limited to not more than two (2) pages and should emphasize areas of experience directly relevant to this work statement.

7. Organization Experience

This section shall describe the Offeror’s pertinent experience and qualification in conducting work of a similar nature. Offerors shall offer evidence of not more than 5 previous related assignments, including the names and telephone numbers of client project offices able to comment on the Offeror’s performance of those assignments. Summaries (not to exceed one page) of related work shall be included. References to products resulting from these related activities also should be included.

8. Resources/Facilities/Equipment

This section shall identify those resources (other than personnel), facilities, and equipment (e.g., library holdings, computer hardware and software) available for use in conducting this project.

9. Current Contractual Obligations

Each Offeror will be required to outline both federal and non-federal contractual obligations existing during the course of this award for all projects involving personnel who will be assigned to this project. Such organizations/agencies must be identified by name and the percentage of work time allotted to these projects by personnel committed to the proposed project must be provided.

10. Issues and Associated Data Items

When responding to the tasks, when identifying what should receive emphasis, careful consideration should be given to the issues identified, their associated data items, and the desired contents of the Final Report.

Upon notification of intent to award, the Contractor will be expected to:

• Develop and submit a timeline and deliverables schedule that will be used to guide the conduct of the project and monitor the work;
• Develop and submit a payment schedule chart to be used for installment payments of the award;
• Meet with select NCD staff and board members.

3. Submission Dates and Times
Applications must be received by June 4, 2007 by 5:00 PM EDT. Late applications will not be considered.

4. Intergovernmental Review
This opportunity does not require intergovernmental review.

5. Funding Restrictions
Awards will not allow reimbursement of pre‑award costs.

6. Other Submission Requirements
All application materials must be submitted in an accessible electronic format and must comply with NCD Document Requirements described in Section VI(2)(A). A hard copy submission also is required.

Applications must be submitted to:

Julie Carroll
National Council on Disability
1331 F Street NW Suite 850
Washington, DC  20004

Electronic applications can be submitted by e-mail to: jcarroll@ncd.gov, or by CD to the mailing address listed above.
 

V.  Application Review Information

1. Evaluation Criteria
NCD will evaluate proposals in accordance with the evaluation criteria set forth below. It is understood that your proposal will become part of the official contract file.

The RFP does not commit the Government to pay any cost for the preparation and submission of a proposal. In addition, the Contracting Officer is the only individual who can legally commit the Government to the expenditure of public funds in connection with this proposed acquisition.

Technical Evaluation Criteria
Evaluators will score proposals with a maximum of 100 points, divided as follows:

1. A clear understanding of the nature of the work (20 points)
                       
                  The proposal presents a clear understanding of the tasks required and the importance, quality and reliability of those tasks.

2. Procedural Plan (25 points)

The proposal contains evidence of a fully described technical approach to comply with each of the tasks in the scope of work. The proposal is consistent with the goals, objectives, and compliance requirements, and is practical in terms of producing needed information, analysis and recommendations.

3. Management Plan and Schedule (20 points)

The degree to which the project team, including any use of consultants, is organized and managed to accomplish effective and efficient implementation of all tasks to be completed. The proposal budget is appropriate to the administration of the project. The time frame is realistic. Plans and schedules to ensure smooth cooperation with the NCD staff involved are evident. The proposal clearly identifies who will be the project leader, and who will be key personnel, and includes a table showing the number of person-days by tasks for each of the key personnel. The management plan describes the extent and nature of involvement by individuals with disabilities in the design, operation, and deliverables of the project.

4. Personnel (20 points)

The proposal provides evidence of the specific qualifications and skills of staff and consultants to be assigned to this project, and their experience and familiarity with the topic, including relevant laws, regulations, and pertinent procedures and practices in the Federal Government. Skills in writing, and conducting research also should be clearly demonstrated.

5. Organizational Experience (15 points)

The degree to which the Offeror has prior experience and past performance in executing similar projects should be described. Evidence of related assignments should be detailed. Offeror shall present evidence of related assignments, including the names and telephone numbers of previous project officers who would be able to comment on the Offeror’s performance of those assignments.

2.  Review and Selection Process
The review and selection process consists of internal reviews, external peer reviews, and final review and selection by NCD's Health Care Team members. This process typically takes about five weeks.

VI. Award Administration Information

1.  Award Notices
NCD will notify the successful applicant by telephone and letter. This notification will begin negotiations for a Cooperative Agreement. The letter is not an authorization to begin performance.

2. Administrative and National Policy Requirements
A.  NCD Document Requirements
All written and electronic documents drafted for NCD must be submitted in an electronic Word format and in hard copy. If PDF is used, submissions to NCD must be created using the tools and guidance developed for creating accessible PDF.  See, http://www.design.ncsu.edu/cud/general_g/pdfcreate.htm.
 The document must be professionally edited. In addition, all documents must adhere to NCD's formatting and style standards, which follow the Government Printing Office Style Guide.

Formatting Requirements
Accessibility
First and foremost, NCD reports must be fully accessible to all people with disabilities. All graphs and charts must have full text descriptions. Shading is not permissible. Electronic copy must be Bobby 508 compliant.

Contrast
Text and covers should be printed with the highest contrast possible.

Fonts
Use Times New Roman, 12 point. Italics should be used sparingly, not for full sentences or paragraphs or recommendations. Do not use small caps.

Line Spacing
Set line spacing to 1.5. Reference, endnotes, appendices, etc. sections should be single spaced.

Paper Size
Set paper size to 8.5" x 11"

Margins
Set standard one inch (1") margins on all sides.

Paragraphs
Use block style. Begin paragraphs without tabbing in. Text should be in single column format. Use a double space between paragraphs.

Justification
Use left justified (ragged right).

Smart Quotes and Apostrophes
Use smart quotes and apostrophes.

Chapters
Chapters should start on odd-numbered pages, which fall on the right side.

Headers and Footers
Delete unnecessary headers and footers.

Widows and Orphans
Do not have widows or orphans.

Web Addresses
Make all Web addresses hyperlinks.

Style Heads
Paragraph headers between major subject areas are encouraged. Headers should be bold, but not underlined. Headers should not be all caps nor small caps. Double space between headers and text.

Spacing After Periods
Use one space after a period at the end of a sentence. Use one space after colons, question marks, and endnote numbers.

Endnotes
All documents must use endnotes, not footnotes, and the endnotes should be in Times New Roman, 12 point, single spaced.

Page Numbering
Page numbering should be centered at the bottom of each page. Blank pages require page numbers.
Begin page numbering in roman numerals on Letter of Transmittal page (suppress page number of that page). Begin ordinal numbering on Executive Summary page.

Contents Page
All documents should include a complete table of contents page. This includes page numbers for chapters and major sections. The Table of Contents text should be in regular font. Do not bold the entire page.

Style Requirements

General:
Use active voice (within reason)
Serial comma
Numbers: one-nine, 10 and above

Use “people [[not “persons” or “individuals”]] with disabilities” and “people without disabilities,” not disabled, handicapped, or nondisabled

1990s (not 1990’s)

Use “people from diverse cultures,” “people from diverse racial background,” and so forth [not minorities]

Punctuation NEVER comes after a closing quotation mark.

Due to or Because of?
“Due to” modifies nouns and is generally used after some form of the verb to be (is, are, was, were, etc.). Jan's success is due to talent and spunk (due to modifies success). “Because of” should modify verbs. Ted resigned because of poor health (because of modifies resigned).

Generally, use between for two, and among for three or more.

Legal Cases/Bills/Laws, etc:
H.R. 2457
S. 1322
P.L. 106-515
Italicize names of court cases
Convert small caps used in notes

Word List:
ADA, not the ADA
Administration (presidential)
closed captioning
Congress, not the Congress
data indicates (treat data as singular)
decision making
Department (capped referring to a U.S. Department)
email
end-user
Executive Order
federal
Federal Government
governor
health care (n, um*)
home- and community-based (um)
interagency (closed up)
multi (close up)
nation
NCD, not the NCD
non (close up)
percent, not %, unless in tables or parentheses
Ph.D.
policymaker
the President
proactive
reauthorize
reenter
rulemaking
screen-reader
standalone
state (l.c.) upfront
Supreme Court, the Court
Web site, the Web
white
workforce
workplace

In titles, cap prepositions of 5 or more letters.

*um=unit modifier, meaning two words used as an adjective

NCD will be responsible for the final printing of the document and will coordinate printing of multiple copies with the Government Printing Office (GPO).

B.  Rights in Data, Copyright, and Disclosure

i. Data – The term “data” as used here includes written reports (progress, draft, and final), electronic format and work of any similar nature that is required under any resulting Cooperative Agreement to perform this project. It does not include the Contractor’s financial reports, or other information incidental to Contractor administration. Data submitted to and accepted by NCD under any Cooperative Agreement shall be the property of NCD, and NCD shall have full and unlimited rights to use such data for any purpose in whatever manner deemed desirable and appropriate, including making it available to the general public. Such use shall be without any additional payment to the Contractor. Data may be published as the property of NCD without giving authorship to the Contractor.

ii. Copyright – The Contractor relinquishes any and all copyrights and/or privileges developed under any Cooperative Agreement. The Contractor shall not include in the data any copyrightable matter without the written approval of NCD, unless the Contractor provides NCD with the written permission of the copyright owner for NCD to use the matter.

iii. Disclosure – The Contractor agrees not to divulge or release any information, reports or recommendations developed or obtained in connection with the performance of any Cooperative Agreement with NCD, and not otherwise available to the public, without the prior approval of NCD.

iv. Final Approval of Deliverables
All final deliverables are the product of NCD and require acceptance and approval by NCD. NCD reserves the right to make substantive edits to any final deliverables. 

3.  Reporting
Throughout the project, the Contractor and Contract Officer will conduct mutually agreed upon monthly teleconference calls and/or bi-weekly meetings, to include other project staff members and NCD staff members and, as appropriate, selected project advisors and NCD board members.
The Contractor also will provide monthly electronic progress reports to the Contract Officer.

VII. Agency Contact
If you have questions about this RFP, contact:
Julie Carroll
202-272-2019 (voice)
202-272-2074 (TTY)
jcarroll@ncd.gov

For more information about NCD, go to www.ncd.gov.