office of rural health policy technical assistance workshop

Office of Rural Health Policy

Technical Assistance Workshop

U.S. Department of Health & Human Services Health Resources & Services Administration


Regional Extension Center, KY September 4, 2014

Natassja Manzanero, MS Katherine Lloyd, MPH

Presenter

Presentation Notes

Greeting

Presentation Overview Part I

Office of Rural Health Policy 101

• ORHP Overview • ORHP Programs and Activities

Part II

Applying for a HRSA Grant • General Grant Writing Tips

Presenter

Presentation Notes

Some of you may know us well, some may be aware and some may not know who we are or what we do or why So start there Today we’ll be talking about value … term we’re hearing more and more across HC system So we’ll talk about several notions of value in RH and weave into key issues such as collaboration, finance, quality, workforce, community health and how we’re trying to align our programs and resources to help rural communities with this transition. Trying a new approach with this update … less about ORHP HRSA and HHS structurally and more about where our programs and resources link to the issues you’re dealing with every day At end of slide deck that is online with NRHA, we’ve included number of slides with more specific information on our program funding, resources, partners and tools that we hope will be of use to you but that we won’t necessarily cover Also, at end, we’re going to bring Matt Heinz from the Office of Secretary up to talk about ACA.

Part I

Office of Rural Health Policy 101

Office of Rural Health Policy (ORHP)

• “Voice for Rural” within HHS

• Rural-Focused Review of HHS Regulations

• Research & Policy Development

• Rural-Specific Grant Programs

• Technical Assistance

Overview


Presenter

Presentation Notes

Key Points to Make: ORHP plays a unique role, serving as the Department of Health and Human Services but residing in HRSA given its focus on vulnerable populations and improving access to care. For our policy role, we review all the key regulations that may affect rural providers with an eye toward making sure rural considerations are taken into account in the HHS policy process. We support rural health services research to help assist in those policy activities We also operate a number of grant programs that support rural communities We also provide a broad range of technical assistance. Note: For folks presenting who do not feel comfortable with policy or programs, it is okay to acknowledge it is not your area but tell the audience you can connect them with the right people.

Office of Rural Health Policy (ORHP) Rural Programs: Building a Rural Evidence Base

Policy Research Team

Community Based Programs

Hospital State Programs

Telehealth Programs

Presenter

Presentation Notes

Key Points to Make: In terms of building an evidence base, we’re making a renewed effort to build evaluation into our programs and finding out what approaches work in our programs and making sure we build on those promising practices. We’re working to make sure that in our community-based approaches we’re learning from past investments and using that to help current and future grantees. In our Hospital-State programs, we want to make sure that as we work with CAHs we use strategies for performance and quality improvement that have a proven track record for working. Similarly, we want to make sure that our telehealth programs build on more than 15 years of strong experience to use the strongest approaches to harnessing this technology to improve access to care over a distance.

How ORHP Programs Support Rural Health Finance &

Quality

Research and Policy

Technical Assistance

Community Health

Flex SHIP Small Health Care

Provider QI

State Office of Rural Health

Technical Assistance & Services Center

Rural Assistance Center

Regulation Review Flex Monitoring

Team National Advisory

Committee on Rural Health & Human Services

Policy Briefs

Outreach Network Network Planning Telehealth Networks Workforce

Presenter

Presentation Notes

Finally, a summary of our activities in support of rural health. This view emphasizes how our Office functions have produced components of value – that Community Health activities have impacted rural health by Network planning and development, and that tech assistance works through SORHs and RAC, and that Research and Policy outcomes include NAC and Policy Briefs.

“Within the total amount requested for Rural Health Activities, the Budget includes $77 million to continue the President’s initiative to improve rural health. The goal of this initiative is to improve the access to and quality of health care in rural areas.”

Improving Rural Health Initiative

Presenter

Presentation Notes

Key Points to Make: The President’s budget does include funding for the Improving Rural Health Care Initiative for the third straight year. This initiative focuses primarily on three key budget lines: Outreach, Telehealth and the State Offices of Rural Health.

Improve Rural Health Initiative: Key Elements

• Building a Programmatic “Evidence Base”

• Health Workforce Recruitment & Retention

• Telehealth/ HIT Coordination

• Cross Governmental Collaboration

Presenter

Presentation Notes

Key Points to Make: The Improving Rural Health Care Initiative includes four key elements: Moving our grant programs to use more of an evidence base. Helping rural communities recruit and retain health care providers Improving coordination between the rural grant programs and the telehealth programs while also focusing on the health information technology issues facing rural communities. And the final part of the Initiative pushes us to engage our partners in HRSA, HHS and across the government. This is something we have already done and we have particularly strong collaborative relationships with … Bureau of Primary Health Care Centers for Medicare and Medicaid Services The National Health Service Corps The Administration for Aging The Department of Agriculture The Department of Veteran Affairs The Office of the National Coordinator for HIT The Federal Communications Commission

2014 President’s Budget

Rural Health Policy Development $10M

Rural Health Care Services Outreach $56M

Medicare Rural Hospital Flexibility $26M

State Offices of Rural Health $10M

Telehealth $12M

Radiation Exposure Screening and Education $2M

Black Lung / Coal Miners Clinics $7M

Collaboration

HHS Partners

Federal Partners

External Partners

Presenter

Presentation Notes

One reality is that we have to collaborate … Happy to have the roughly $128 m budget we have … but to really do anything we have to do in partnership That starts within HHS … are there things we can do to help highlight rural issues for others in HRSA and HHS? I mentioned USDA earlier … While we do a lot with them, are we doing all we can? And then there’s the work with folks like NRHA and you all and handful of other stakeholder groups.

http://www.whitehouse.gov/administration/eop/rural-council





White House Rural Council

• NHSC Expansion to CAHs • Rural Philanthropy Partnership • Rural HIT Training Networks • Regulatory Burden Reduction for Rural Providers

Federal Partners

• Working with USDA to Expand Access to HIT Capital • Health Information Exchange for Rural Veterans • Rural Policy Collaboration with CMS

External Partners

• NRHA • State Offices of Rural Health • American Hospital Association • National Association of Rural Health Clinics • Rural Health Resource Center • Rural Assistance Center

Knowledge Check #1

• Name 2 external partners of ORHP.

• What is the name of the national council

that supports some of ORHP’s activities?

ORHP Programs and Activities

Policy and Research Team

Policy and Research Team

• Responsible for analyzing possible policy effects on rural communities

• Translating the larger policy context • Conducting research that informs and is

driven by policy • Engaging with rural health stakeholders • Ensuring a voice for Rural • Reviewing the annual payment updates • Informing policy

Presenter

Presentation Notes

Under our Section 711 authority, ORHP has the department-wide responsibility of analyzing the possible effects of policy on residents of rural communities. This includes critically examining the effects of current policies and proposed statutory, regulatory, administrative, and budgetary changes. Because many of the policy levers at the Federal level are related to the Medicare program, review and analysis of prospective changes to Medicare comprise much of the ORHP’s policy work ORHP is also responsible for funding rural health research. Through our rural health research center cooperative agreement program we fund 7 research centers across the united states. The research portfolios of these grantees are developed in conjunction with ORHP staff and are designed to inform our policy work. Recently released research covers a broad range of topics, including: Effects of Medicare Payment Policy Changes on Rural Primary Care Practice Revenue, Home Health Care Agency Availability in rural counties, Independently owned pharmacy closures and Support for rural recruitment and practice among U.S. NP education Programs.

Policy and Research Resources

http://www.ruralhealthresearch.org/

Presenter

Presentation Notes

Renewing efforts to focus on key issues you are facing & that are being debated All work by K, G and other Ctrs on Research Gateway Also staff NACRHHS Advise HHS Sec. … took on CAH mileage a year ago Looking at premium pricing; network adequacy now Briefs all on line Always a need for objective policy & research analysis with appropriate rural context … these sites have it

Policy and Research Resources

http://www.hrsa.gov/advisorycommittees/rural/publications/index.html

The National Advisory Committee on Rural Health & Human Services

• Policy Briefs and Recommendations Available online

Presenter

Presentation Notes

Renewing efforts to focus on key issues you are facing & that are being debated All work by K, G and other Ctrs on Research Gateway Also staff NACRHHS Advise HHS Sec. … took on CAH mileage a year ago Looking at premium pricing; network adequacy now Briefs all on line Always a need for objective policy & research analysis with appropriate rural context … these sites have it

A New Resource …

http://cph.uiowa.edu/ruralhealthvalue/

Policy Briefs Available

Policy Brief: Rural Residency Training for Family Medicine Physicians: Graduate Early-Career Outcomes, 2008-2012. Patterson DG, Longenecker R, Schmitz D, Phillips Jr RL, Skillman SM, Doescher MP. Seattle, WA: WWAMI Rural Health Research Center, University of Washington; 2013. http://www.raconline.org/rtt/policy.php

Presenter

Presentation Notes

Check for more information: http://www.raconline.org/rtt/ http://www.traindocsrural.org/?q=profiles http://traindocsrural.wordpress.com/

Affordable Care Act Office Hours “ORHP, ACA and You”

• Rural outreach and enrollment office hours hosted by the Office of Rural Health Policy.

• E-mail [email protected] with your name and organization to be added to the office hour listserv.

• Office hours are held every 2 weeks and currently scheduled for every other Wednesdays from 3-4pm EST.

• ACA topics for discussion will vary session to session.

mailto:[email protected]

Hospital State Division

Hospital State Division Grants • Medicare Rural Hospital Flexibility (FLEX)

Program • Small Rural Hospital Improvement Program • State Offices of Rural Health Program

Initiatives • Flex Medicare Beneficiary Quality Improvement

Project (MBQIP) • Delta Rural Hospital Performance Improvement

Project (RHPI) • Rural Health Clinic Quality Measure Set Pilot • Medicare QIO Special Project

Presenter

Presentation Notes

The Hospital State Division works to improve and maintain access to high quality health care in rural areas through strategic partnerships. HSD manages grants, cooperative agreements and contracts to strengthen the role of state offices of rural health and their support to rural communities, particularly with rural hospitals. ORHP administers three grant programs within the Hospital State Division (HSD). The grant programs are; 1) Rural Hospital Flexibility (Flex) Program; 2) Small Rural Hospital Improvement Program (SHIP); 3) the State Offices of Rural Health (SORH) Grant Program. I won’t go into too much detail about the Hospital-State grants because as I’ve mentioned before they are specifically for critical access hospitals and State Offices of Rural Health So, I would just like to mention that 3 main programs in that Division. If you are interested in finding out more about this, let me know during the break and I’ll be happy to talk about it with you

Hospital State Division FY2015 Competitive Grant

Programs

• The Rural Hospital Flexibility Grant Program • $25 million to 45 States with CAHs

• The Small Hospital Improvement Grant Program

• $15 million to More Than 1,500 Small Rural Hospitals

Presenter

Presentation Notes

Ongoing Rural Hospital Grant Funding

National Organization of State Offices of Rural Health

http://www.nosorh.org

National Rural Health Resource Center &

Technical Assistance and Services Center

http://www.ruralcenter.org

Office for the Advancement of Telehealth

Office for the Advancement of Telehealth

Programs

• Telehealth Network Grants • Telehealth Resource Centers • Evidence-Based Telehealth Network

Program • Licensure and Portability • Rural Veterans Health Access Program • Evidence-Based Tele-Emergency

Network Program

Presenter

Presentation Notes

Licensure Portability is a competitive grant program that provides support for State professional licensing boards to carry out programs under which licensing boards of various States cooperate to develop and implement State policies that will reduce statutory and regulatory barriers to telemedicine. Licensure Portability grantees with active projects Next Competitive Cycle/ FOA Release: # of awards: Amounts: Telehealth Network is a competitive grant program that funds projects that demonstrate the use of telehealth networks to improve healthcare services for medically underserved populations in urban, rural, and frontier communities. Telehealth Network grantees with active projects So. Now, I’d like to talk a little bit about the Telehealth Network Grant Program It is a 3-year program that mainly supports established telehealth networks (not startups) that are looking to use the funding to expand their existing clinical services and/or existing “rural” spoke sites, to which those clinical services are being provided. If a Telehealth network has maximized its level of expansion, then funding may also be used to, perhaps, enhance existing evaluation plan/performance metrics. Eligibility The applicant can be either a rural or urban nonprofit entity that will provide services through a telehealth network (TNGP-TH) or a telehomecare network (TNGP-THC). Each entity participating in the networks may be a nonprofit or for-profit entity. Faith-based and community based organizations are eligible to apply. Tribal organizations are eligible to apply for these grants. the Telehealth Networks use electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health, and health administration. Whereas, Telehomecare Networks provides telehealth services to individuals in their place of residence through a healthcare provider using telecommunications technologies to exchange healthcare information over a distance. A “place of residence” is broadly defined to include assisted living facilities and other congregate arrangements where people live. A network should have at least one hub site and one spoke site. For this grant opportunity, however, we’re looking for seasoned networks who’ve been doing telehealth for some time. Basically, a start-up project would not really qualify because we’ve had our share of start-up projects failing to produce performance outcomes in past cohorts and therefore, we prefer experienced telehealth network organizations. --The next competitive cycle for TNGP Next Competitive Cycle/ FOA Release: # of awards: Amounts: Telehealth Resource Center is a competitive grant program that provides support for the establishment and development of Telehealth Resource Centers (TRCs). These centers are to assist health care organizations, health care networks, and health care providers in the implementation of cost-effective telehealth programs to serve rural and medically underserved areas and populations. Telehealth Resource Center grantees with active projects The TRCGP is designed to create centers of excellence that expedite and customize the provision of telehealth technical assistance across the country, while at the same time working together to make available a wide range of expertise that might not be available in any one region. The TRCs provide technical assistance to health care organizations, health care networks, and health care providers in the implementation of cost-effective telehealth programs to serve rural and medically underserved areas and populations. Next Competitive Cycle/ FOA Release: # of awards: Amounts:

http://www.telehealthresourcecenter.org

Health Information Technology and Telehealth

• Leveraging Telehealth Technology

• Grants as a Test Bed • A New Focus on the Evidence-Base • A Special Focus on Veterans • Connecting Communities with National Experts • Identifying Ongoing and Emerging Policy

Challenges

Telehealth, Health Information Exchange & Broadband

• Provides Support for Improving Access to Affordable Broadband Services

• USDA • Annual Program

• FCC • New Program

Two Key Federal Programs • FCC’s Healthcare Connect • http://www.fcc.gov/encyclopedia/rural-health-care

• USDA Broadband • http://www.rurdev.usda.gov/RUSTelecomPrograms.html

Community Based Division

Community Health

• Developing a Rural Evidence Base • Changing Nature of the Outreach

Authority Programs • The Rural Community Health

Gateway • New and Continuing Partnerships

Community-Based Division Programs

• Rural Health Care Services Outreach • Rural Health Network Development • Rural Health Network Planning • Small Health Care Provider Quality

Improvement • Rural Health IT Workforce

• Rural Health IT Network Development • Delta States Rural Development Network

Program • Black Lung/Coal Miner Clinics • Radiation Exposure Screening and

Education Program • Public Access Defibrillation

Demonstration Projects

• Rural Access to Emergency Devices Grant Program

Community Need

Outreach Funding

Outreach Tools Performance Data/Outcomes

Build the Rural Evidence Base

Presenter

Presentation Notes

As an office, not done a good job collecting data and w/out it, we can’t show the value and worth of our programs PIMS was first step in our office for all programs to develop performance measures (clinical and process measures) ECI: track how your dollars flow in the community, identify wages earned, # of jobs created- generalizable formula to help you do that and help sustain BP: NORC- evaluate and monitor all our 330a programs to help us identify BP, lessons learned, challenges faced- help to produce documents which we can disseminate to rural communities so that they don’t have to recreate the wheel. Excited about the things going on CBD and hope that they will help you all as grantees. 2015 Focus Identify best practice models Sustainability Measure Performance Providing Evidence Based Tools

Rural Health Services Outreach

Activities • Direct Health Care Services • Health Fairs and Screenings • Patient Education • Provider Education

• 3 Year Program • Up To $300,000 • Competitive FY 2017

Rural Health Network Development

Activities • Integrate Behavioral Health in

Primary Care Settings • Improve Coordination of

Services • Provide Interactive Telehealth

Services

3 Year Program Up To $300,000 Competitive FY 2017 Contact: Jayne Berube [email protected]

3 Year Program Up To $200,000 Competitive FY 2015 Contact: Linda Kwon [email protected]



Rural Health Network Development Planning

Activities • Develop a business, strategic

and/or operational plan • Conduct a Community Needs

Assessment • Perform a Network Self-

Assessment

Small Health Care Provider Quality Improvement

Activities • Develop QI Strategies to

Improve Patient Care/Chronic Disease Outcomes

• Improve health indicators and decrease ER visits/admissions to hospital

• ACA Outreach and Enrollment 3 Year Program

Up To $150,000 Competitive FY 2016 Contact: Ann Ferrero [email protected]

1 Year Program Up To $100,000 Competitive FY 2015 Contact: Amber Berrian [email protected]

Presenter

Presentation Notes

The purpose of the Small Health Care Provider Quality Improvement Grant (Rural Quality) Program is to provide support to rural primary care providers for implementation of quality improvement activities. Organizations participating in the program are required to utilize an evidence-based quality improvement model, perform tests of change focused on improvement, and use health information technology (HIT) to collect and report data



Rural Health IT Workforce

Activities • Develop rural-focused health

IT curriculum • Provide health IT students

training opportunities • Retain health IT specialists in

rural areas

Rural Health IT Network Development

Activities • Improve health care and support

the adoption of health information technology (HIT) in rural America

• Facilitation of infrastructure for successful implementation of HIT and Electronic Health Records

• Targeted HIT support to existing health care networks

3 Year Pilot Program Up To $300,000 2011-2014 Funding Cycle Contact: Marcia Green [email protected]

3 Year Pilot Program Up To $300,000 2013-2016 Funding Cycle Contact: Natassja Manzanero [email protected]



Black Lung/Coal Miner Clinic Grant Program (BLCGP) and

Black Lung Center of Excellence (BLCE)

Activities • BLCGP--Screening, diagnosis, and

treatment for active, inactive, disabled, and retired coal miners

• BLCE--Technical support, training, collaboration with regional and national entities, and promotion of practices and outreach which enhance understanding of miner health and safety

Rural Access to Emergency Devices and Public Access to Defibrillation Demonstration

Projects Activities

• Develop community partnerships to purchase automated external defibrillators (AEDs)

• Provide defibrillator and basic life support training

• Place the AEDs in rural communities with local organizations

3 Year Program $150,000 (RAED and PADD)

Competitive FY 2017 Contact: Michelle Pray [email protected]

3 Year Program

$900,000 (BLCE) or $150,000 (BLCGP) Competitive FY 2017

Contact: Nadia Ibrahim [email protected]

Presenter

Presentation Notes

The purpose of the Delta States Rural Development Network Grant Program (Delta) is to fund organizations located in the eight Delta States to address unmet local health care needs and prevalent health disparities in rural Delta communities. In practice, the Delta Program provides resources to help rural communities develop partnerships to jointly address health problems that could not be solved by single entities working alone. A priority of the Office of Rural Health Policy is to fund evidence-based programs which demonstrate improved health outcomes. Applicants are required to propose multi-county/multi-parish projects that address delivery of preventive or clinical health services for individuals with, or at risk of developing chronic health diseases which disproportionately affect rural Delta communities. Due to the high disparities in the region[3] applicants are required to propose a program based on one of the following focus areas: 1) diabetes; 2) cardiovascular disease; or 3) obesity. The purpose of this program is to reduce the morbidity and mortality associated with occupationally-related coal mine dust lung disease through the provision of screening, diagnosis, and treatment services. Only the organizations located in the high-impact States cited in the Radiation Exposure Compensation A develop education programs; disseminate information on radiogenic diseases and the importance of early detection; screen eligible individuals for cancer and other radiogenic diseases; provide appropriate referrals for medical treatment; and facilitate documentation of Radiation Exposure Compensation Act (RECA) claims. The purpose of this grant program is to: (1) purchase AEDs that have been approved, or cleared for marketing by the Food and Drug Administration; (2) provide basic life training in automated external defibrillator usage through nationally recognized courses; (3) provide information to community members about the public access defibrillation demonstration project to be funded with the grant; (4) provide information to the local emergency medical services (EMS) system regarding the placement of AEDs in the unique settings; and (5) further develop strategies to improve access to AEDs in public places. RAED The purpose of the RAED Grant Program is to develop community partnershps to purchase automated external defibrillators (AEDs), provide defibrillator and basic life support training, and place the AEDs in rural communities with local organizations.



Radiation Exposure Screening and Education (RESEP)

Program Activities

• Outreach to inform public of services available through the program

• Education programs on detection, prevention, and treatment of radiogenic cancers and diseases

• Medical screening for patients at risk of developing specific radiogenic cancers and diseases

Activities

• Development/implementation of multi-county/parish projects to address delivery of preventive or clinical health services

• Provision of outcome oriented health care services for diabetes, cardiovascular disease, or obesity

• Services for other identified areas such as pharmacy assistance, oral health, women’s health etc.

3 Year Program

$325,000-$525,000

Competitive FY 2017

Contact: Valerie Darden [email protected]

3 Year Program

Up To $300,000

Competitive FY 2017

Contact: Katy Lloyd [email protected]

Delta States Rural Development Network Program (Delta)

Presenter

Presentation Notes

The purpose of the Delta States Rural Development Network Grant Program (Delta) is to fund organizations located in the eight Delta States to address unmet local health care needs and prevalent health disparities in rural Delta communities. In practice, the Delta Program that could not be solved by single entities working alone. A priority of the Office of Rural Health Policy is to fund evidence-based programs which demonstrate improved health outcomes. Applicants are required to propose multi-county/multi-parish projects that address delivery of preventive or clinical health services for individuals with, or at risk of developing chronic health diseases which disproportionately affect rural Delta communities. Due to the high disparities in the region[3] applicants are required to propose a program based on one of the following focus areas: 1) diabetes; 2) cardiovascular disease; or 3) obesity. The purpose of this program is to reduce the morbidity and mortality associated with occupationally-related coal mine dust lung disease through the provision of screening, diagnosis, and treatment services. Only the organizations located in the high-impact States cited in the Radiation Exposure Compensation A develop education programs; disseminate information on radiogenic diseases and the importance of early detection; screen eligible individuals for cancer and other radiogenic diseases; provide appropriate referrals for medical treatment; and facilitate documentation of Radiation Exposure Compensation Act (RECA) claims. The purpose of this grant program is to: (1) purchase AEDs that have been approved, or cleared for marketing by the Food and Drug Administration; (2) provide basic life training in automated external defibrillator usage through nationally recognized courses; (3) provide information to community members about the public access defibrillation demonstration project to be funded with the grant; (4) provide information to the local emergency medical services (EMS) system regarding the placement of AEDs in the unique settings; and (5) further develop strategies to improve access to AEDs in public places. RAED The purpose of the RAED Grant Program is to develop community partnershps to purchase automated external defibrillators (AEDs), provide defibrillator and basic life support training, and place the AEDs in rural communities with local organizations.



FY 2015 Competitive Grant Programs

Rural Health Care Services Outreach Program

• Length of award: 3 years • Award amount: $200,000 per year • Purpose: To deliver health care services in

rural communities – Evidence-based – Outcomes oriented

• Eligibility: rural, non-profit or public entity, partner with 2 other entities

• FOA available September 2014 • Start date: May 2015 • Contact: Linda Kwon, [email protected],

301-594-4205

Rural Health Network Development Planning Program

• Length of award: 1 year • Award amount: $100,000 • Purpose: To promote the planning and

development of healthcare networks • Eligibility: rural, non-profit or public entity,

network composed of at least 3 health care providers

• FOA available November 2014 • Start date: June 2015 • Contact: Amber Berrian,

[email protected], 301-443-0845

Rural Assistance Center

Community Health Gateway Toolkits • Resources and best practices to help you identify and

implement public health programs Rural Health Models and Innovations Hub • Find examples of approaches you can adapt for your program,

including models shown to be effective, as well as new and emerging ideas.

Sustainability Tools • The tools provided here are intended to help you consider the

sustainability of programs that address community needs and to engage your partners and stakeholders in this planning process.

Economic Impact Tool

• Show how your program’s grant funding affects your community’s economic well-being

http://www.raconline.org/communityhealth/

Presenter

Presentation Notes

One stop shopping for rural news – funding information, resource guides, best practices. Customized assistance – 800-270-1898 Electronic updates – subscribe on the website.

Georgia Health Policy Center • Technical Assistance contractor for the Rural Health Care

Services Outreach Program, Delta State Rural Development Network Grant Program, Rural Health Network Development Program, and Rural Health Information Technology (HIT) Workforce Program grantees

• Technical Assistance supports grantees with strategic planning, evaluation, consortium and network development, program implementation, and sustainability

• Focus on peer-to-peer connections and learning

• Technical assistance delivered through monthly contacts, site visits, e-learning, and webinars

• Tools, resources, and e-learning modules available at www.ruralhealthlink.org

Knowledge Check #2

Fill in the blank: The Policy Research Team in ORHP ensures the voice for ___________. What is the name of the resource that provides various toolkits related to public health?

APPLYING FOR A HRSA GRANT

PART II

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

1) Register and Get Ready

• Register with DUNS • Register with SAM • Register with Grants.gov

Register with DUNS

• Go to D&B DUNS Numbers for U.S. Government Contractors and

Grantees. http://fedgov.dnb.com/webform/pages/CCRSearch.jsp

• Select the country or territory where your organization is physically located. Complete and submit the form which includes: • Your organization’s physical and mailing addresses, • Name and title of the chief executive • Primary Standard Industrial Code (SIC) • Whether or not the organization is minority-, woman- or

veteran-owned, number of employees, and annual revenue. • Your DUNS number will be e-mailed to you the same day.

http://fedgov.dnb.com/webform/pages/CCRSearch.jsp

https://www.osha.gov/pls/imis/sic_manual.html

Register with System for Award Management (SAM)

• Go to the SAM and select Create User Account or Register/Update Entity and

complete the form, which will take about an hour. • Be prepared with your organization’s:

• DUNS number , • Tax ID number (NOTE: If you do not have an EIN, Apply for an Employer

Identification Number (EIN) Online) organization’s • Business start date, • Congressional district • Physical mailing addresses, • E-Business Point of Contact (E-Biz POC) and a Marketing Partner

Identification Number (MPIN).

• After you submit your SAM registration , you will receive an email from SAM.gov letting you know your registration is active. To keep your SAM registration active, be sure to renew at least once each year which takes about 5 days to process. If your registration expires, you cannot submit a grant application until it is renewed.

https://www.sam.gov/portal/public/SAM/

http://www.irs.gov/Businesses/Small-Businesses-&-Self-Employed/Apply-for-an-Employer-Identification-Number-(EIN)-Online



Register with Grants.gov

• Allow 2 to 3 weeks to register with Grants.gov after DUNS and SAM registration

• Go to Get Registered with Grants.gov.

• Know your organization's DUNS number from step 1

• After each Authorized Organization Representative (AOR) registrant submits a registration form to Grants.gov, the E-BIZ POC will receive an e-mail, prompting her or him to log into Grants.gov and approve the AOR. The E-BIZ POC will need organization's MPIN acquired in Step Two to approve AOR registrations

• When the registration is approved, the submitting AOR will receive a confirmation e-mail and will be able to submit applications.

http://www.grants.gov/web/grants/register.html

How long will the registration process take?

DUNS SAM GRANTS.GOV

Up to 4 weeks

2) Find & Submit

• Find open funding opportunities in Grants.gov

• Download the instructions and application

• Complete the application • Save and Submit • Watch your E-mail

Look for funding opportunities

Download Application Package

For HRSA funding opportunity announcements (FOAs)….

Remember to download: FOA Instructions

• Provides programmatic requirements

HRSA SF-424 Application Guide

• Companion guide to the FOA

• Referenced throughout the FOA

For ORHP funding opportunity announcements

http://datawarehouse.hrsa.gov/RuralAdvisor/RuralHealthAdvisor.aspx

Apply for funding opportunities

3) Write a Strong Application

• Have I read the funding opportunity announcement?

• Is my organization eligible to apply? • Does my organization have the technical

expertise, the personnel, and the financial capacity?

• Are all stakeholders in my organization supportive?

• Is my organization prepared to do what it takes?

4) Understand the Review Process

• Standard review criteria, common among almost all opportunities, are as follows: • Needs assessment; • Response; • Evaluative measures; • Impact; • Resources/capabilities; and • Support requested

• Most funding opportunity announcements include more

specific criteria for each category and many list additional review criteria, such as cultural competence

Understand the Review Process

• Division of Independent Review (DIR) • Panel of reviewers • Review Criterion • Objective Review Committee (ORC)

Process • Rank Order Listing

Presenter

Presentation Notes

So, once you’ve submitted your application, an objective review committee reviews your application The ORC is a panel of reviewers and they go by a set of criteria. Then your application goes through a rigorous review process and then scored Applications are ranked based on the score, so there’s really no cut-off score. So, if we are only able to fund 80 application that year, we’ll make awards to the top 80 applicants So, it is important that you write a really good application because you never know what “good enough” really is Once the awardees are identified, we notify your Congressional Liaison office and send letters to all applicants indicating whether they are funded or not. Awardees also receive a notice of grant award. The person that receives the NGA is whoever is listed on the application when it was submitted

How to be a Grant Reviewer • ORHP has multiple grant program

reviews each year • We need reviewers with rural

experience to be a part of our Objective Review Committee panels

• You must register to be a

reviewer: http://www.hrsa.gov/grants/reviewers/ • Indicate “rural health” as one of

your specialties in the background information

http://www.hrsa.gov/grants/reviewers/

http://www.hrsa.gov/grants/reviewers/

In FY12, Outreach received/funded…. State

# of applications received in 2012

# of applications funded in 2012 State

# of applications received in 2012

# of applications funded in 2012

AK 2 1 MT 11 4 AL 6 0 NC 5 1 AR 7 1 ND 9 0 AZ 3 2 NE 5 2 CA 10 3 NH 4 3 CO 7 1 NM 5 2 DE 1 1 NV 2 0 FL 9 2 NY 6 2 GA 7 3 OH 6 2 HI 4 0 OK 3 0 IA 1 0 OR 8 2 ID 1 1 PA 12 2 IL 11 0 SC 6 1 IN 5 1 SD 7 3 KS 5 1 TN 5 1 KY 17 7 TX 6 1 LA 6 3 UT 2 0 MD 8 1 VA 7 1 ME 7 1 VI 1 0 MI 8 4 VT 2 2 MN 10 2 WA 5 0 MO 13 4 WI 8 1 MS 8 1 WV 5 1

WY 1 0

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Presentation Notes

Highlight Kentucky’s results for Region 4

FY2013 Rural Health Network Development Planning Applications Received and Awards by HRSA Region

• REGION I

• 8 Applications • 0 Awards

• REGION II • 6 Applications • 1 Award

• REGION III • 5 Applications • 1 Award

• REGION IV • 21 Applications • 4 Awards

• REGION V • 12 Applications • 2 Awards

• REGION VI • 8 Applications • 1 Award

• REGION VII • 12 Applications • 2 Awards

• REGION VIII • 8 Applications • 2 Awards

• REGION IX • 11 Applications • 3 Awards

• REGION X • 12 Applications • 4 Awards

103 Applications Received

20 Awards Made

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Presentation Notes

Breakdown by state will be available

Grant Resources

• Registration checklist: http://www.grants.gov/documents/19/18243/OrganizationRegChecklist.pdf/fc7e7c18-2497-4b08-8d9b-bfac399947a3

http://www.grants.gov/documents/19/18243/OrganizationRegChecklist.pdf/fc7e7c18-2497-4b08-8d9b-bfac399947a3




Knowledge Check #3

• How many different systems must you register with before submitting your grant application?

• How long will the registration process take?

GENERAL GRANT WRITING TIPS

Explore Options Start early

Become an expert on the

grant program that you want to apply for.

Research the types of projects that have been awarded under the program.

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Presentation Notes

Transition: so some key things to consider when applying for a grant 1st bullet: you want to start early. It takes a long time to acquire all the numbers you need to writing it and submitting your application 2nd bullet: when you’re knowledgeable with what you’re proposing, it shows in the quality of your application 3rd bullet: even before you start writing the application and coordinating partners, you want to know the projects that have been funded before and what their outcomes were. For example, for the Outreach program, every 3 years we publish a document called Outreach Sourcebook. This sourcebook describes each grantee’s project, outcomes and contact information

Application Planning Read and re-read Funding

Opportunity Announcement (FOA) Have one or two other staff read all

the program information (guidance, forms, etc.)

• You should agree on what needs to be in the application and how to proceed

Make certain you understand exactly what, how, when, etc. is required for the application

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Presentation Notes

When you first look at an RFP or guidance, it can be very daunting and overwhelming. But in reality, it is fairly easy to follow. However, you want to be able to follow the instructions correctly because the “devil is in the details” So make sure you read and re-read and have a few other people read it and if you are confused please call the program coordinator

Create a Team to Work

on the Project Name the lead person (Someone

that has the authority to get things done)

Set meeting times

Identify Consortium/Network Members & Obtain Commitment early (if applicable) Determine the roles and level of

participation of each member

Application Planning

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Presentation Notes

Most of our community-based grants require that you partner up with other organizations or form a consortium So, you want to build a team to write this grant. This way everyone has a sense of ownership and buy-in of your project And because there are a few people involved in writing this grant, you want to be able to name a lead person or at least someone who can coordinate the project ---tell story

Application Planning Call the program

contact person with any questions This is very important They are there to help

Paint the Right Picture

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Presentation Notes

When writing a grant, there is a bit of creative writing that goes into play (but just a little) You want to be able to paint the picture for the reviewers. The reviewers will read many applications and you want yours to stand out

Story Telling Tell the story of your community and its needs Make sure it aligns with the purpose of the grant

program

Find someone who is organized, writes well and is good at following directions to help with writing the grant

After the grant narrative is completed, give it to someone not involved in the project to read If they understand what the needs are, why there

are needs, who will be served and how the project will address the needs, the narrative is probably clear

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Presentation Notes

With that, you want to be able to tell the story of your community and how unique you’re community is and what impact this grant will do for your community Again, the reviewers will review tons of applications and you want yours to stand out

Getting Started Make your proposal clear,

simple, easy and enjoyable to read

Stay focused on the project activities

Avoid jargon and acronyms

Present gaps in current services

Don’t assume reviewers know your topic or geographical area (background)

Application Content Needs Response Evaluation Impact Resources &

Capabilities Support Requested

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Presentation Notes

Transition: In writing your application, you want to be able to address each of these criteria because these are the criteria that your application will be based on So, let me just break this down: Needs—you would need to illustrate a great health need in your community, your target population, anticipated barriers and strategies to overcome those barriers Response—this is where you propose your project and explain the extent to which the proposedproject responds to the purpose of the program Evaluation—this is where you have to propose an evaluation plan or measures on how you can assess the progress an outcome of your project Impact—this is where you demonstrate and convince your reviewers that your project will make a long-lasting impact in your community Resources and capabilities—this is where you show that your organization is stable enough that it will be able to carry out the proposed project Support requested—mainly budget and budget justification which I will talk about later

Planning Strategies Host a meeting of interested parties

Initial reaction Review funding opportunity announcement Mission match/community impact

SWOT (Strengths, Weaknesses, Opportunities, Threats)

Needs Assessment Focus groups Survey Secondary data

How Do You Assess Needs?

Example: Focus Groups A specially selected group to

discuss an issue Open ended questions 7-10 people Contrasts with Key Informant

Key informant provides individual perspective

Focus group offers individual within the context of a group

Advantages/Disadvantages Advantage

Speed Low cost Flexibility Benefit of group dynamics

Disadvantage Less control than key informant Difficulty in assembling the

group Disadvantage of group

dynamics


Example: Survey Sample of population (entire

population) Typically a closed ended

instrument (sometimes open ended)

Mailed, telephone, personal interview

Measure attitude present services (awareness,

use, need) need for future services quality of services/care provider assessment

Advantage/Disadvantage Advantage

Most scientifically valid and reliable

Representative of population Commonly used and

accepted Amount of data gathered

Disadvantage Most expensive Less flexible


Example: Community Forum • Open public meeting with all

interested persons invited to participate

• Generally provides a means of soliciting a broad range of views and concerns

• Pose questions to the audience • What do you see as the most important

community or regional health problems?

• What areas should be addressed? • How do we address these issues?

Advantages/Disadvantages Advantage

• Speed and low cost • Flexibility • Most participatory • Educate public and form

of community development

Disadvantage

• Can be unrepresentative of population

• “Gripe” session • Challenge “expert”

perspective

Writing and Development Tips • Remember others

• Talk to others who have written grants

• Try to locate people who have been funded by organizations you plan to submit a proposal

• State Office of Rural Health • Associations and other regional or

state organizations • Rural Assistance Center (RAC)

Writing and Development Tips • Remember your audience: The panel of reviewers

• Reviewers typically do not know anything about

your situation, your community, or even your state • Explain basic facts:

• rural and frontier as a concept (distance, weather, roads); culture; and your unique circumstances

• Central goal = convince reviewer of the legitimacy

of your problem, your solution, your ability

Presenter

Presentation Notes

Again, you are trying to convince a panel of reviewers that your community needs this grant more than any other community so you really want your application to stand out

Writing and Development Tips Don’t deviate from the FOA The order of sections and the titles

are set The rules are set

Be detailed (even to the point of being

elementary) Be concise (less words the better)

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Presentation Notes

Transition: this is important—do not deviate from the guidance. If the guidance says include a map on this section, include a map on this section --these last two bullets are kind of tricky because we want you to be detailed but do it in less words…but it’s really about finding balance between being detailed and being concise…getting to the point

Writing and Development Tips

Put yourself in the funding source’s shoes -- ask yourself the same questions that a skeptical reader would ask: Why should anyone bother to read this? Why should they care? What difference is this going to make?

Present it in layperson’s words -- program officer and

reviewers may not be an expert in your field and they have to explain the proposal to others

Goal. Objective. Activity.

Goal: Complete a Needs Assessment Objective: Within 3

months, develop a needs assessment tool Activity: Distribute

Needs Assessment Document to all Health Fair Participants

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Presentation Notes

In your application, you will be asked to develop your goal and objectives and what are your activities to fullfill this objective

Budget Narrative • How many organizations are

contributing to the budget

• What percent of funds are being solicited from the funding source

• Are subcontracts involved

• Annual salary increases (multiple year projects) • Allow for cost of living

increases

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Presentation Notes

The guidance will also ask you to submit a budget narrative or budget justification---please address everything that is asked. For example, if they ask for FTE, salary for that FTE –include both of those information

Budget Categories

Calculate all relevant expenses • Salary • Benefits (social security, workman’s

compensation) • Printing and photocopying • Postage and shipping • Long distance and cellular telephone service • Materials and supplies • Mileage and travel • Outside services

Presenter

Presentation Notes

Here is just an example of budget categories that is typically on a guidance

Presentation Summary Part I

Office of Rural Health Policy 101 • ORHP Overview • ORHP Programs and Activities

Part II

Applying for a HRSA Grant • General Grant Writing Tips

Contact Information

Natassja Manzanero 301-443-2077

[email protected]

Katy Lloyd 301-443-2933

[email protected]

office of rural health policy technical assistance workshop

Documents