Technical Assistance Session:

1. Technical Assistance Session: Rural Health Grants Office of Rural Health Policy Updated June 21, 2002

2. Introduction • Overview of ORHP, HRSA, HHS • Targeted technical assistance for ORHP grants • General tips on grants RURAL HEALTH GRANTS

3. The Office of Rural Health Policy • Established in 1987 as a voice for rural health within HHS • Policy role • Grant programs RURAL HEALTH GRANTS

4. HRSA: The Access Agency RURAL HEALTH GRANTS

5. RURAL HEALTH GRANTS

6. ORHP Programs • Outreach • Network Development • Small Hospital Improvement Program • Rural Automated External Defibrillators • Medicare Rural Hospital Flexibility Grant Program • Rural Health Research • State Offices of Rural Health RURAL HEALTH GRANTS

7. To Apply You Must Contact the HRSA Grant Application Center HRSA Grants Application CenterAttn: Grants Management Officer901 Russell Avenue, Suite 450Gaithersburg, MD 20879 hrsagac@hrsa.gov 1-877-477-2123 RURAL HEALTH GRANTS

8. Outreach or Network Grant? • Outreach grant program is focused on improving service delivery • Network grant program is focused on creating a better system of care OUTREACH & NETWORK

9. Rural Health Outreach Grants RURAL HEALTH GRANTS

10. Program Purpose To expand access, to coordinate and improve the quality of essential health care services, including preventive and emergency services. OUTREACH

11. Important Dates • Application available: June 17, 2002 • Applications due: September 13, 2002 • Grant funding starts: May 1, 2003 • Number of grants funded this year: 39 new starts and 92 continuing ($23.1 million) OUTREACH

12. Applicant Eligibility Criteria • Rural headquarters • Rural county, eligible rural zip codes in an urban county • Public or non-profit designation (state or Federal) • Three separately owned organizations = network OUTREACH

13. Applicant Information • Non-profit designation • Loose networks • $200,000 maximum per year for three years • No capital purchases • No construction/renovations • Preferences and priority • Current or previous grantees cannot apply OUTREACH

14. Pre-Application Homework • Identify needs • Needs assessment • Back it up with data (local, state and national sources) • Enlist network members • Identify roles and responsibilities • Gain “real” commitment • Build on past experiences OUTREACH

15. Pre-Application Homework • Develop strategies • Involve the community • Town meetings • Health status questionnaires • Surveys OUTREACH

16. Individual Review Criteria • Need for the Proposed Project and the Network(25 points) • Description of the Program to Meet the Need (25 points) • Project Management and Network and Community Involvement (20 points) • Budget (10 points) • Personnel (5 points) • Evaluation and Dissemination (10 points) • Sustainability (5 points) OUTREACH

17. Need (25 points) • Description of Need • Unmet health needs of the target population • Access barriers to needed services • Description of the service area and a map to illustrate it • Relevant services available in or near the service area OUTREACH

18. Need (continued) • Description of Network Capability • Applicant management information • Management review form • Identification and credentials of network members • History of network development and collaborative activities • Letters of commitment from network members OUTREACH

19. Description of the Program to Meet the Needs (25 points) • Description of the planning process • Role of the network in planning • Role of the community in planning • Models that work • Project Plan • Goals, strategies, activities, responsible agents, completion milestones OUTREACH

20. Project Management, Network and Community Involvement (20 points) • Responsibilities of applicant and network members • Plans for governance • Plans for coordination • Plans for organization • Lines of authority OUTREACH

21. Project Management (continued) • Community support and involvement • Explanation of community involvement • Letters of support OUTREACH

22. Budget (10 Points) • Budget justification narrative • Identify which component is funded • Explain contractual arrangements • What is being purchased? • Who provides the service? • How will the contract be managed? OUTREACH

23. Budget (continued) • Budget should delineate extent of cost participation • Cash or in-kind contributions • Justify the need for the requested funds • Explain the purchases, personnel and any contractual arrangements OUTREACH

24. Personnel (5 points) • Biographical and position information should be included • Identify the key personnel • Include position descriptions of jobs to be filled in the course of the grant with the level of expertise needed OUTREACH

25. Evaluation and Dissemination (10 points) • Evaluation • Find ways to measure your progress and chart your results • Show how you will utilize those results OUTREACH

26. Sustainability (5 points) • Sustainability • Identify viable strategies (e.g., program income through Medicaid, SCHIP, etc.) • Community support • Other government or foundation support OUTREACH

27. About Goals, Objectives and Strategies • Problem(High Infant Mortality) Solution (Project) • Goal 1: 50% Fewer infants deaths within 2 years • Goal 2: 75% Fewer teen pregnancies within 3 years OUTREACH

28. Goals, Objectives (continued) • Goal 1: 50% Fewer Infants Deaths Within 2 Years • ObjectiveA: By end of year 1, enroll 20% more high-risk pregnant women. • Strategy 1: Educate community health aides and social service workers in identification and referral of high-risk pregnant women OUTREACH

29. Rural Health Development Network Grants RURAL HEALTH GRANTS

30. Key Points • Funding • 3-year grants at up to $200K/year • Important Dates • Available: June 17, 2002 • Due: September 20, 2002 • Start Date: May 1, 2003 • Number of Grants Funded This Year: • 10 new starts and 22 continuing ($5.8 million) NETWORK

31. Program Purpose To support and strengthen rural health care providers and rural health care systems by funding integration of activities across clinical, financial, technological, and administrative functions of network members. NETWORK

32. Anticipated Outcomes of Grants • Achieving economies of scale and cost efficiencies of certain administrative functions like billing, collections, claims processing, purchasing • Ensuring continuous quality improvement of care provided by network members • Enhancing ability of members to respond positively to changes in the health care marketplace like the Health Insurance Portability and Accountability Act requirements or prospective payment systems NETWORK

33. Outcomes (continued) • Enhancing the continuum of care in an area • Enhancing workforce recruitment and retention efforts • Sharing staff and expertise across the network • Improving access to capital and new technologies for network members • Increasing the financial viability of network members NETWORK

34. Definition of a Network “an Integrated Rural Health Network is a formal organizational arrangement among at least three separately owned health care providers or other entities that provide or support the delivery of health care services.” NETWORK

35. A Network Defined: • May be horizontal or vertical • May include for profit entities but they may not be the grantee • May include urban organizations • May include entities that support delivery of health care services, e.g., faith-based organizations, social service agencies, local government, employers, educational institutions NETWORK

36. Applicant Eligibility Criteria • Rural Headquarters • Rural county, eligible rural zip codes in an urban county • Public or Non-Profit Designation (state or Federal) • Three separately owned organizations = Network NETWORK

37. Program Requirements • Network organizational relationship is formal, e.g., Memorandum of Agreement or other formal collaborative agreement • Network consists of at least three separately owned organizations • Network identifies its developmental stage: formative, evolving, mature • Members show strong commitment to network and a history of collaboration and accomplishment commensurate with developmental stage NETWORK

38. Program Requirements (continued) • Network should have strategic plan or include creating a strategic plan in the application • Strategic plan needs to include sustainability strategy • The network entity and/or its members contribute 20% of total funds requested from ORHP, cash or in-kind • Network has a governing body with representation from all network members – this body should drive network decision making rather than an individual network member NETWORK

39. Evaluation Criteria: • Statement of Need (15 points) • Prior Collaboration (20 points) • Statement of Project and Budget (35 points) • Sustainability (20 points) • Evaluation (10 points) NETWORK

40. Statement of Need (15 points) • Describe network members and why chosen, why not others • Describe the environment in which the network has developed • Discuss data sources used in need analysis • Why is Federal funding necessary and appropriate now? • Discuss how the network will provide value to its members • How will this network provide value to the community? • <> • <> • <> NETWORK

41. Prior Collaboration and Readiness for Funding (20 points) • Describe prior collaborative history among network members including accomplishments • Provide evidence of Memorandum of Agreement or other formal agreement. • Describe level of commitment among network members including allocation of time, personnel, cash and other in-kind contributions • Have a network leader in place • Or an interim director with a permanent director position to be filled within 6 months of receiving grant NETWORK

42. Statement of Project & Budget (35 points) • Describe a workplan aligned with the program intent • Provide a matrix of project goals, objectives, activities, outputs/outcomes and how they will be measured, timeline, and responsible person for each activity • Provide a narrative that describes how the project furthers the network’s strategic plan • Networks that haven’t created a strategic plan must include creation of a strategic plan in the project workplan NETWORK

43. Project & Budget (continued) • Describe how application relates to other grant programs • Provide budget forms, spreadsheet, and budget narrative • Network member contributions constitute at least 20 % of total funds requested; network entity and/or members contribute in-kind or cash each year NETWORK

44. Project & Budget (continued) • Federal funds may not be used to pay for direct provision of health care services • No more than 20% of the total Federal payment may be spent on equipment • Federal funds may not be used to purchase, construct or renovate facilities • Federal funds may not be used to purchase vehicles NETWORK

45. Sustainability (20 points) • Describe the network’s sustainability strategy • This strategy should identify • Mechanism for ongoing planning and assessment of member and community needs • How the network plans to meet long-range leadership and staffing needs • Alternative sources of network revenue including approach for diversifying sources of network revenue • Plans for building financial reserves NETWORK

46. Sustainability (continued) • Plans for measuring and communicating the network’s value to its members • Approach for sustained financial commitment from network members • Formative networks should include development of a network sustainability strategy in the application workplan NETWORK

47. Evaluation (10 points) • Describe appropriateness of output and outcome measures for the project goals, objectives, and activities • Explain any assumptions used in developing project workplan • Describe process by which data will be collected and analyzed • Describe approach for continuous self-evaluation of network’s progress in relation to proposed outputs/outcomes to monitor and improve execution of project goals NETWORK

48. Common Problems • Network Concept & Members • Network members not involved early = weak plan • Network relationships not well defined • No formalized network relationships • Form letters, roles not specific, investment not defined NETWORK

49. Outreach and Network Application Details

50. Funding Preferences and Priorities • Funding priority gives an application additional points during the scoring process of approved applications. • Funding preference moves those approved, scored applicants who request preference to the top of the funding list, regardless of their score. • Both must be specifically requested and documented OUTREACH & NETWORK