FY 2013 New Access Point

Funding Opportunity Announcement HRSA-13-228

Health Resources and Services Administration

Department of Health and Human Services

NAP TA Website: http://www.hrsa.gov/grants/apply/assistance/nap

Agenda

• Overview• Eligibility and Funding• Submission Process• Project Narrative and Review Criteria• Budget Presentation• Attachments• Program Specific Forms• Program Specific Information• Funding Priorities• Important Reminders• Technical Assistance Resources• Questions & Answers

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Overview

NAP is a competitive funding opportunity for operational support for NEW primary care service delivery site(s) under the Health Center Program.

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OverviewThe Health Center Program

The Health Center Program provides grant support to public or private non-profit organizations that serve designated medically underserved areas/populations or special populations comprised of migratory and seasonal agricultural workers, homeless individuals and families, or residents of public housing. 

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OverviewThe Health Center Program

• HRSA currently provides grant support to 1,200 health centers operating more than 8,500 sites across the United States and its territories, serving more than 20 million patients.

• Health Center Program grantees target unserved and underserved individuals and families with the goals of ensuring access to all and reducing health disparities.  

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OverviewThe Health Center Program

• Health Center Program grantees must provide primary care services to all, regardless of their ability to pay.

• Health Center Program grantees are expected to comply with the 19 program requirements included as Appendix F in the NAP funding opportunity announcement (FOA).

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OverviewNAP Highlights

• Approximately $19 million for approximately 25 NAP grant awards.

• Authorized by Section 330 of the Public Health Service Act.

• Supported by the Affordable Care Act.

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OverviewNAP Highlights

• Open to current Health Center Program grantees and new applicants.

• Applications Due in Grants.gov:

February 27, 2013, 11:59 PM ET

• Applications Due in HRSA EHB:

April 3, 2013, 8:00 PM ET

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OverviewNAP Highlights

What is a New Access Point?

• A new service delivery site for the provision of comprehensive primary and preventive medical health care services.

Two types of New Access Point applicants:

• New Starts - Organizations that do not currently receive funding under section 330.

• Satellites - Organizations that currently receive funding under section 330 that are proposing to establish NEW delivery site(s).

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OverviewTypes of Health Centers

Applicants may request funding to serve any combination of populations based on the proposed service area’s needs

•Community Health Centers (CHC, section 330(e)) serve the general underserved population.

•Migrant Health Centers (MHC, section 330(g)) serve migratory and seasonal agricultural workers and their families.

•Healthcare for the Homeless (HCH, section 330(h)) serve homeless individuals and families.

•Public Housing Primary Care (PHPC, section 330(i)) serve residents of public housing.

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OverviewSpecial Populations

• Applicants proposing to serve special population(s) must address additional, specific program requirements.

• NEW for 2013: There is no funding priority for applicants requesting funding to serve special population(s).

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Eligibility

• Public or private, nonprofit entity, including tribal, faith based, and community based organizations.

• At least one proposed NAP site must be a full-time permanent site operating at least 40 hours per week.

• Comprehensive primary medical care must be the main purpose of the NAP application.

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Eligibility

• Ensure access to services for all service area populations. Proposed site(s) may not focus on a single age-group (e.g., children), lifecycle (e.g., geriatric), or health issue (e.g., HIV/AIDS).

• Provide comprehensive primary health care services without regard for ability to pay.

• Budget request may not exceed $650,000 in either Year 1 or Year 2.

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Eligibility

• No proposed NAP site can be in any Health Center Program grantee’s scope of project, including sites pending verification at the time of NAP application.

• Application must not exceed the 200-page limit when printed by HRSA.

• New Starts applying for Community Health Center (CHC) funding must propose a service area that is designated, in whole or in part, as an MUA and/or contains an MUP

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Funding Cap

• Year One: Up to $650,000 of which $150,000 may be used for one-time minor capital costs for equipment and/or minor alterations/renovations.

• Year Two: Up to $650,000 for operational support only.

*Two year project period.

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Submission Process

• 2-step process: Grants.gov and Electronic Handbooks (EHB).

Applicants should register early!

• Register in the System for Award Management (SAM) and Data Universal Numbering System (DUNS) prior to registering in Grants.gov.

• Register in Grants.gov and EHB as soon as possible – Grants.gov registration process may take up to one month.

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Grants.gov: Required Documents

Applicants must submit the following documents in Grants.gov by 11:59 PM EST on February 27, 2013:

•SF-424: Application for Federal Assistance (upload Project Abstract in box 15)

•SF-424B: Assurances – Non-Construction Programs

•Project/Performance Site Location(s) Form

•Grants.gov Lobbying Form

•SF-LLL: Disclosure of Lobbying Form

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SF-424: Application for Federal Assistance

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Applications will be New (new start applicants):

Or Revision/Supplement (satellite applicants):

Grants.gov: Submission Validation

Phase 1: Grants.gov

• Receive a series of confirmation emails from Grants.gov following successful submission (check your inbox and spam folders).

• Receive a tracking number for accessing EHB via email approximately 7 business days after Grants.gov submission.

• For help with electronic submission in Grants.gov, call 1-800-518-4726.

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EHB: Required Documents

Applicants must submit the following documents in EHB by 8:00 PM EST on April 3, 2013:

•Project Narrative

•SF-424A: Budget information – Non-Construction Programs

•Budget Justification

•Attachments

•Program Specific Forms

•Program Specific Information (Performance Measures and One-Time Funding)

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EHB: Submission Validation

Phase 2: EHB

• Application can only be submitted by the Authorizing Official.

• Receive an “Application successfully transmitted to HRSA” message in EHB.

• For help with electronic submission in EHB, call 1-877-974-2742.

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Project Narrative / Review Criteria

• The Project Narrative details the information the applicant must include to provide a comprehensive description of the proposed NAP.

• The Review Criteria are used by grant reviewers to evaluate how well the applicant presented the information requested.

• Applicants should consider both sections when developing the application.

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Review Criteria

• NEW for 2013: Review Criteria reference Project Narrative items, forms, and attachments that must be considered collectively when scoring the application.

• It is important that information is presented consistently throughout the application.

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Review Criteria

• Need (30 points)

• Response (20 points)

• Collaboration (10 points)

• Evaluative Measures (5 points)

• Resources/Capabilities (15 points)

• Governance (10 points)

• Support Requested (10 points)

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Highlights: Need

Need (30 points)

•20 of the 30 points available for the Need Section are determined by the Need for Assistance Worksheet (NFA – Form 9) score.

•The narrative response (10 of the 30 points) should reference the data provided in the NFA Worksheet as needed.

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Highlights: Response

Response (20 points)

•The narrative and referenced forms and attachments must describe the proposed project and how it will comply with the Health Center Program requirements.

•NEW for 2013: Implementation Plan to demonstrate operational readiness in 120 days.

•NEW for 2013: Describe plans for outreach and enrollment for Medicaid expansion and Health Insurance Exchanges.

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Highlights: Collaboration

Collaboration (10 points)

•The narrative and attachments must demonstrate collaboration between service providers within the service area.

•Letters of support that are not submitted with the application will not be reviewed.

•NEW for 2013: Letters of support are required from major private provider groups serving the target population.

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Highlights: Evaluative Measures

Evaluative Measures (5 points)

•The narrative and performance measures forms must demonstrate realistic goals and evaluation planning.

•NEW for 2013: New clinical performance measures are required.

•NEW for 2013: Describe implementation of certified Electronic Health Records (EHR) for patient tracking and meaningful use.

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Highlights: Resources/Capabilities

Resources/Capabilities (15 points)

•The narrative and referenced forms and attachments must demonstrate the organizational capacity and experience to successfully operate the new access point(s).

•NEW for 2013: Describe your current or planned integration with the state health care delivery plan.

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Highlights: Governance

Governance (10 points)

•The narrative and referenced forms and attachments must document how the organization and its board are compliant with the Health Center Program governance requirements.

•Governance requirements do not apply to health centers operated by Indian tribes, tribal groups, or Indian organizations.

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Highlights: Support Requested

Support Requested (10 points)

•The budget justification and referenced forms and attachments must document a consistent budget presentation appropriate for the proposed project.

•NEW for 2013: Provide the proposed total cost and federal cost per patient (by requested funding type) and explain how this is reasonable and appropriate.

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Budget Presentation

• The budget presentation must provide detailed information for each year of the 2-year project period.

• Required components:

– SF-424A: Budget Information – Non-Construction Programs

– Budget Justification

• The budget justification should include a line-item budget and narrative justification.

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Budget Presentation

• The budget must be consistent with:

– Form 1B: BPHC Funding Request Summary

– Form 2: Staffing Profile

– Form 3: Income Analysis Form

• If One-Time Funding is requested for A/R, a project budget must be provided.

• If One-Time Funding is requested for equipment, an equipment list must be provided.

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Attachments

• Attachment 1: Service Area Map and Table

• Attachment 2: Implementation Plan

• Attachment 3: Applicant Organizational Chart

• Attachment 4: Position Descriptions for Key Management Staff

• Attachment 5: Biographical Sketches for Key Management Staff

• Attachment 6: Co-Applicant Agreement

• Attachment 7: Summary of Contracts and Agreements

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Attachments

• Attachment 8: Independent Financial Audit

• Attachment 9: Articles of Incorporation

• Attachment 10: Letters of Support

• Attachment 11: Sliding Fee Discount Schedule(s)

• Attachment 12: Evidence of Nonprofit or Public Center Status

• Attachment 13: Floor Plans

• Attachment 14: Corporate Bylaws

• Attachment 15: Other Relevant Documents 35

Readiness and Full Operational Capacity

• NEW for 2013: An Implementation Plan has been added (Attachment 2), that details the steps necessary for an applicant to demonstrate that the new access point(s) will be operational (providing services to the target community/population) and compliant with Health Center Program requirements within 120 days of award.

• Full operational capacity must be achieved within 2 years of award (serving all projected patients).

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Program Specific Forms

• Form 1A: General Information Worksheet

• Form 1B: BPHC Funding Request Summary

• Form 1C: Documents on File

• Form 2: Staffing Profile

• Form 3: Income Analysis

• Form 4: Community Characteristics

• Form 5A: Services Provided

• Form 5B: Service Sites

• Form 5C: Other Activities/Locations

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Program Specific Forms

• Form 6A: Current Board Member Characteristics

• Form 6B: Request for Waiver of Governance Requirements

• Form 8: Health Center Agreements

• Form 9: Need for Assistance Worksheet

• Form 10: Annual Emergency Preparedness Report

• Form 12: Organization Contacts

• Summary Page38

Need for Assistance (NFA) Worksheet

The NFA Worksheet (Form 9) documents objective measures of need of the proposed service area and/or population to be served via health indicators•Use the Data Resource Guide available at http://www.hrsa.gov/grants/apply/assistance/nap to identify data sources for all indicators•Complete based on all proposed NAP sites•Maximum 100 points, converted to a 20-point scale •Review the total score and converted score in EHB prior to submission

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Summary Page

• NEW for 2013: Summary Page that presents important information from application forms

• Provides at-a-glance review of:

– proposed sites and service area zip codes

– health center type(s)

– funding requested, including one-time funding

– proposed number of patients to be served and federal cost per patient

– NFA score

• Applicants must verify accuracy of data

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Program Specific Information

• See Appendix B in the FOA:

– Clinical and Financial Performance Measures.

– Performance Measures should address only the service area and target population of the proposed new access point(s).

• See Appendix D in the FOA:

– One-Time Funding Project Information.

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Performance Measures

• Performance measures serve as ongoing monitoring and performance improvement tools.

– Clinical – 16 required measures

– Financial – 5 required measures

• BPHC will hold a separate call on January 30 to go over the performance measures in detail.

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Clinical Performance Measures

• Diabetes• Cardiovascular Disease• Cancer• Prenatal Health*• Perinatal Health*• Child Health• Behavioral Health• Oral Health

*may be marked “not applicable” if services are provided only via referral and not paid for by the applicant

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Clinical Performance Measures

• Weight Assessment and Counseling for Children and Adolescents

• Adult Weight Screening and Follow-Up• Tobacco Use Assessment• Tobacco Cessation Counseling• Asthma – Pharmacological Therapy• Coronary Artery Disease: Lipid Therapy• Ischemic Vascular Disease: Aspirin

Therapy• Colorectal Cancer Screening

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Financial Performance Measures

• Total Cost per Patient

• Medical Cost per Medical Visit

• Change in Net Assets to Expense Ratio*

• Working Capital to Monthly Expense Ratio*

• Long Term Debt to Equity Ratio*

*may be marked “not applicable” by tribal and public center applicants

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Performance Measures

• Applicants may create additional “Other” performance measures specific to their proposed projects.

• Applicants applying for special population funding must include additional clinical performance measures that address the health care needs of the special population(s).

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One-Time Funding

• Applicants requesting One-Time Funding for alteration and renovation must complete:– Equipment List (as applicable)– Alteration/Renovation Project Cover Page– Other Requirements for Sites– Environmental Information and

Documentation Checklist– Alteration/Renovation Budget Justification– Schematic Drawings– Landlord Letter of Consent (as applicable)

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Funding Priorities

A funding priority is the favorable adjustment of an application’s objective review score if specific criteria are met.

1.Unserved, High Poverty (up to 15 points)

2.Sparsely Populated (5 points)

NEW for 2013: All applications will automatically be assessed for these priorities.

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Funding Priorities

Unserved, High Poverty (up to 15 points)

• Goal: Prioritize new access point applications that propose to serve high need, unserved communities and populations

1. 75% or more of the proposed service area’s low-income population is NOT being served by the Health Center Program.

2. Unserved, low-income service area residents must be at least 1.5 times the number of proposed patients.

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Funding Priorities

Unserved, High Poverty (up to 15 points)

• For example, if you propose to serve 2,000 individuals, there must be at least 3,000 low-income residents in the proposed service area that are not being served by the Health Center Program AND only 25% or less of the low-income population in the service area is being served by the Health Center Program.

• See the table on page 50 of the FOA for a breakdown on points to be assigned.

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Funding Priorities

Sparsely Populated Area (5 points)

• 5 points will be awarded if the entire proposed service area (defined by the zip codes listed on Form 5B) has seven or fewer people per square mile.

• Only applicants that request all or partial CHC funding are eligible for this priority.

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Important Reminders

• Applications Due in Grants.gov:

February 27, 2013, 11:59 PM ET

• Applications Due in HRSA EHB:

April 3, 2013, 8:00 PM ET

• Applications may not exceed 200 pages

• Failure to follow the instructions and include all required documents may result in your application being considered non-responsive.

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Contact Information

Program related questions:

• Joanne Galindo: BPHCNAP@hrsa.gov or 301.594.4300

Budget related questions:

• Angela Wade: awade@hrsa.gov or 301.594.5296

EHB questions:

• BPHC Helpline: BPHCHelpline@hrsa.gov or 877.974.2742

Grants.gov related questions:

• support@grants.gov or 800.518.4726

NAP TA Website:• http://www.hrsa.gov/grants/apply/assistance/nap

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NAP TA Web Page Resources

Replays of TA Calls

Presentation Slides for TA Calls

Frequently Asked Questions

Data Resource Guide: NFA Worksheet

EHB NAP User Guide for Grant Applicants

Samples

Forms

Helpful Links

HRSA Contact Information

http://www.hrsa.gov/grants/apply/assistance/nap54

Questions

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