U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Bureau of Primary Health Care Health Center Program Service Area Competition Announcement Type: New, Competing Continuation, and Competing Supplement Funding Opportunity Number: HRSA-17-054 Catalog of Federal Domestic Assistance (CFDA) No. 93.224 FUNDING OPPORTUNITY ANNOUNCEMENT Fiscal Year 2017 Application Due Date in Grants.gov: November 7, 2016 Supplemental Information Due Date in HRSA EHB: November 29, 2016 Ensure SAM and Grants.gov registration and passwords are current immediately! Deadline extensions are not granted for lack of registration. Registration in all systems, including SAM.gov, Grants.gov, and EHB may take up to one month to complete. Issuance Date: September 7, 2016 Beth Hartmayer Bureau of Primary Health Care Office of Policy and Program Development E-mail: [email protected] Telephone: (301) 594-4300 SAC Technical Assistance Web site: http://bphc.hrsa.gov/programopportunities/fundingopportunities/SAC/index.html Authority: Public Health Service Act, Section 330, as amended (42 U.S.C. 254b) EXECUTIVE SUMMARY The Health Resources and Services Administration (HRSA), Bureau of Primary Health Care (BPHC) is accepting applications for the fiscal year (FY) 2017 Service Area Competition (SAC) under the Health Center Program. The purpose of this grant program is to improve the health of the Nation’s underserved communities and vulnerable populations by assuring continued access to comprehensive, culturally competent, quality primary health care services. Health Center Program funds support a variety of community-based and patient-directed public and private nonprofit organizations that provide primary and preventive health care services to the Nation’s underserved. Funding Opportunity Title: Service Area Competition (SAC) Funding Opportunity Number: HRSA-17-054 Due Date for Applications – Grants.gov: November 7, 2016 (11:59 p.m. ET) Due Date for Supplemental Information – November 29, 2016 (5:00 p.m. ET) EHB: Anticipated Total Annual Available Approximately $152.9 million Funding: Estimated Number and Type of Award(s): 69 grants Estimated Award Amount: Varies Cost Sharing/Match Required: No May 1, 2017 through Project Period: April 30, 2020 (up to three years) Eligible Applicants: Public or nonprofit private entity, including tribal, faith-based, or community-based organizations that propose to provide comprehensive primary health care services to a service area and its associated population(s) and patients identified in the Service Area Announcement Table (SAAT). [See Section III-1 of this funding opportunity announcement (FOA) for complete eligibility information.] Application Guide You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 Two-Tier Application Guide, except where instructed in this funding opportunity announcement to do otherwise. A short video is available explaining the new Application Guide. Technical Assistance Application resources, including a webinar recording, form samples, and a frequently asked questions document are available at the SAC Technical Assistance Web site. HRSA-17-054 i Refer to How to Apply for a Grant for general (i.e., not SAC-specific) videos and slides on a variety of application and submission components. The BPHC Primary Health Care Digest is a weekly email newsletter containing information and updates pertaining to the Health Center Program, including release of all competitive funding opportunities. Organizations interested in seeking funding under the Health Center Program are encouraged to subscribe several staff. Throughout the application development and preparation process, you are encouraged to work with the appropriate Primary Care Associations (PCAs), Primary Care Offices (PCOs), and/or National Cooperative Agreements (NCAs) to prepare a quality, competitive application. For a complete listing of HRSA-supported PCAs, PCOs, and NCAs, refer to Strategic Partnerships. Summary of Changes • Total Funding announced in the SAAT may be adjusted while this funding opportunity is open due to supplemental award(s) for the announced service area. The total request for federal funding on the SF-424A may not exceed the amount noted in the SAAT. • The instructions for the Application for Federal Assistance (SF-424) form (Section IV.2) provide information specific to this funding opportunity for select fields. • In the Collaboration section of the Project Narrative, you are asked to describe collaboration with veterans and veteran-serving organizations as applicable. • In the Evaluative Measures section of the Project Narrative, you are asked to describe the organization’s certified Electronic Health Record (EHR) system. • Ten Clinical Performance Measures have been revised. Details are provided in Appendix B and PAL 2016-02: Approved Uniform Data System Changes for Calendar Year 2016. • Prior to making awards, HRSA is required to review and consider information about each applicant in the Federal Awardee Performance and Integrity Information System (FAPIIS). Other Federal Benefits You are reminded that receipt of Health Center Program funds, while a basis for eligibility, does not, of itself, confer such federal benefits as Federal Tort Claims Act (FTCA) coverage or FQHC reimbursement, both of which depend upon compliance with applicable requirements in addition to the award of Health Center Program funding. For more information about the FTCA Health Center Program and its requirements, refer to the FTCA Health Center Program Policy Manual (as updated). HRSA-17-054 ii Table of Contents I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION ............................................................... 1 1. Purpose ........................................................................................................................................ 1 2. Background ................................................................................................................................. 1 II. AWARD INFORMATION .................................................................................................................... 4 1. Type of Application and Award .............................................................................................. 4 2. Summary of Funding................................................................................................................. 4 III. ELIGIBILITY INFORMATION ............................................................................................................ 6 1. Eligible Applicants ..................................................................................................................... 6 2. Cost Sharing/Matching ............................................................................................................. 7 3. Other .............................................................................................................................................. 8 IV. APPLICATION AND SUBMISSION INFORMATION ................................................................... 9 1. Address to Request Application Package ........................................................................... 9 2. Content and Form of Application Submission ................................................................... 9 i. Project Abstract (Submitted in Grants.gov) .............................................................................. 11 ii. Project Narrative (Submitted in EHB).......................................................................................... 12 iii. Budget (Submitted in EHB) ............................................................................................................ 26 iv. Budget Narrative (Submitted in EHB) ......................................................................................... 28 v. Program Specific Forms (Submitted in EHB) ........................................................................... 28 vi. Attachments (Submitted in EHB) ................................................................................................. 29 3. Dun and Bradstreet Universal Numbering System (DUNS) Number and System for Award Management ................................................................................................................. 32 4. Submission Dates and Times ............................................................................................... 33 5. Intergovernmental Review ..................................................................................................... 33 6. Funding Restrictions............................................................................................................... 34 V. APPLICATION REVIEW INFORMATION .................................................................................... 35 1. Review Criteria .......................................................................................................................... 35 2. Review and Selection Process ............................................................................................. 38 3. Assessment of Risk and Other Pre-Award Activities ..................................................... 40 4. Anticipated Announcement and Award Dates ................................................................. 41 VI. AWARD ADMINISTRATION INFORMATION ............................................................................. 41 1. Award Notices ........................................................................................................................... 41 2. Administrative and National Policy Requirements ......................................................... 41 3. Reporting .................................................................................................................................... 42 VII. AGENCY CONTACTS .................................................................................................................... 43 VIII. OTHER INFORMATION ................................................................................................................ 44 IX. TIPS FOR WRITING A STRONG APPLICATION ...................................................................... 45 APPENDIX A: PROGRAM SPECIFIC FORMS INSTRUCTIONS .................................................. 46 APPENDIX B: PERFORMANCE MEASURES INSTRUCTIONS ................................................... 62 APPENDIX C: IMPLEMENTATION PLAN ......................................................................................... 68 HRSA-17-054 iii I. Program Funding Opportunity Description 1. Purpose This announcement solicits applications for the Health Center Program’s Service Area Competition (SAC). The Health Center Program supports patient-directed public and private nonprofit organizations that provide primary and preventive health care services to the Nation’s medically underserved. The purpose of the SAC funding opportunity is to ensure continued access to comprehensive, culturally competent, quality primary health care services for communities and vulnerable populations currently served by the Health Center Program. This FOA details the SAC eligibility requirements, review criteria, and awarding factors for organizations seeking funding for operational support to provide primary and preventive health care services to an announced service area under the Health Center Program, including Community Health Center (CHC – section 330(e)), Migrant Health Center (MHC – section 330(g)), Health Care for the Homeless (HCH – section 330(h)), and/or Public Housing Primary Care (PHPC – section 330(i)). For the purposes of this document, the term “health center” encompasses these types of funding (i.e., CHC, MHC, HCH, and PHPC). 2. Background The Health Center Program is authorized by section 330 of the Public Health Service (PHS) Act, as amended (42 U.S.C. 254b). Through SAC, organizations compete for Health Center Program financial support to provide comprehensive primary and preventive health care services to defined geographic areas and patient populations. The Health Center Program targets the Nation’s neediest populations and geographic areas by currently funding nearly 1,400 health centers that operate more than 9,800 service delivery sites in every state, the District of Columbia, Puerto Rico, the Virgin Islands, and the Pacific Basin. More than 23 million patients, including medically underserved and uninsured patients, received comprehensive, culturally competent, quality primary health care services through the Health Center Program. Service areas and target populations listed in the Service Area Announcement Table (SAAT) are currently served by Health Center Program award recipients whose project periods are ending in FY 2017. You must demonstrate how you will make primary and preventive health care services available in a manner that maintains continuity of care to patients already served in the announced service area. Only one award will be given for each announced service area. Funding Requirements You must document an understanding of the need for primary health care services in the service area and propose a sound plan to meet this need. The plan must ensure the availability and accessibility of primary and preventive health care services to all HRSA-17-054 1 individuals in the service area and target population. You must further demonstrate that your plan includes collaborative and coordinated delivery systems for the provision of health care to the underserved. You must demonstrate compliance with applicable Health Center Program requirements and corresponding regulations and policies, in accordance with section 330 of the PHS Act. New and competing supplement applicants (see Section II.1 below for definitions of applicant types) must propose at least one full-time (operational 40 hours or more per week) permanent, fixed building site on Form 5B: Service Sites, with the exception of projects serving only migratory and seasonal agricultural workers, which may propose a full-time seasonal (rather than permanent) service delivery site.1 A mobile medical van may be proposed only if at least one full-time (operational 40 hours or more per week) permanent (or seasonal for MHC-only applicants), fixed building site is also proposed in the application. New and competing supplement applicants must demonstrate readiness to meet the following requirements. • Within 120 days of receipt of the Notice of Award (NoA), all proposed sites (as noted on Form 5B: Service Sites and described in the Project Narrative) must have the necessary staff and providers in place to begin operating and delivering services to the proposed community and/or target population as described on Forms 5A: Services Provided, 5B: Service Sites, and 5C: Other Activities/Locations, and in Attachment 13: Implementation Plan.2 • Within one year of receipt of the NoA, all proposed providers must be in place and all sites must be delivering services for the proposed hours of operation. Note: If a new organization is awarded a service area currently served by an existing Health Center Program award recipient, the sites and/or equipment of the current award recipient will not automatically transfer to the applicant selected for funding. Regulations concerning disposition and transfer of equipment are found at 45 CFR § 75.320(e), if applicable. If you are funded, you must provide services to the number of unduplicated patients projected to be served by December 31, 2018, as indicated on Form 1A: General Information Worksheet.3 If a health center is unable to demonstrate that it is serving the cumulative total of projected patients by December 31, 2018 via the 2018 Uniform Data System (UDS) report, announced funding for the service area may be proportionally reduced. 1 See PIN 2008-01: Defining Scope of Project and Policy for Requesting Changes, which describes and defines the term “service sites.” 2 HRSA may issue Notices of Award up to 60 days prior to the project period start date. 3 For this purpose, the term “patients” refers to individual patients and not patient visits; each individual patient counts as a single “patient,” notwithstanding multiple encounters/visits. HRSA-17-054 2 Failure to meet SAC funding and Health Center Program requirements may jeopardize Health Center Program grant funding per Uniform Guidance 2 CFR part 200 as codified by HHS at 45 CFR part 75. HRSA will assess award recipients for program compliance prior to and during the project period. When non-compliance is identified (e.g., an organization fails to become operational at all sites within 120 days, does not demonstrate compliance with Health Center Program requirements), HRSA will place a condition on the recipient’s award, which follows the Progressive Action process. The Progressive Action process provides a time-phased approach to resolve compliance issues. If an organization fails to successfully resolve conditions via the Progressive Action process, HRSA may withdraw support through cancellation of all or part of the grant award. For more information, see Program Assistance Letter 2014-08: Health Center Program Requirements Oversight. In addition to the Health Center Program requirements, specific requirements for applicants requesting funding under each health center type are outlined below. COMMUNITY HEALTH CENTER (CHC) APPLICANTS: • Ensure compliance with PHS Act section 330(e) and program regulations, requirements, and policies. • Provide a plan that ensures the availability and accessibility of required primary and preventive health care services to underserved populations in the service area. MIGRANT HEALTH CENTER (MHC) APPLICANTS: • Ensure compliance with PHS Act section 330(g); and, as applicable, section 330(e), program regulations, requirements, and policies. • Provide a plan that ensures the availability and accessibility of required primary and preventive health care services to migratory and seasonal agricultural workers and their families in the service area. Migratory agricultural workers are individuals principally employed in o agriculture and who establish temporary housing for the purpose of this work, including those individuals who have had such work as their principal employment within 24 months as well as their dependent family members. Agricultural workers who leave a community to work elsewhere are classified as migratory workers in both communities. Aged and disabled former agricultural workers should also be included in this group. Seasonal agricultural workers are individuals employed in agriculture on a o seasonal basis who do not establish a temporary home for purposes of employment, including their family members. Agriculture means farming in all its branches, as defined by the OMB- o developed North American Industry Classification System under codes 111, 112, 1151, and 1152 (48 CFR §219.303).4 4 For more information about the North American Industry Classification System, see https://www.census.gov/eos/www/naics/index.html. HRSA-17-054 3 HEALTH CARE FOR THE HOMELESS (HCH) APPLICANTS: • Ensure compliance with PHS Act section 330(h); and, as applicable, section 330(e), program regulations, requirements, and policies. • Provide a plan that ensures the availability and accessibility of required primary and preventive health care services to people experiencing homelessness, defined as patients who lack housing, including residents of permanent supportive housing, transitional housing, or other housing programs that are targeted to homeless populations, in the service area. This plan may also allow for the continuation of services for up to 12 months to individuals no longer homeless as a result of becoming a resident of permanent housing. • Provide substance abuse services. PUBLIC HOUSING PRIMARY CARE APPLICANTS: • Ensure compliance with PHS Act section 330(i); and, as applicable, section 330(e), program regulations, requirements, and policies. • Provide a plan that ensures the availability and accessibility of required primary and preventive health care services to residents of public housing and individuals living in areas immediately accessible to public housing. Public housing means public housing agency-developed, owned, or assisted low-income housing, including mixed finance projects. It does not mean public housing that is only subsidized through Section 8 housing vouchers. • Consult with residents of the proposed public housing sites regarding the planning and administration of the program. II. Award Information 1. Type of Application and Award Types of applications sought: • Competing continuation – A current Health Center Program award recipient whose project period ends April 30, 2017 that seeks to continue serving its current service area. • New – A health center not currently funded through the Health Center Program that seeks to serve an announced service area through the proposal of one or more permanent service delivery sites. • Competing supplement – A current Health Center Program award recipient that seeks to serve an announced service area, in addition to its current service area, through the proposal of one or more new permanent delivery sites. Funding will be provided in the form of a grant. 2. Summary of Funding Approximately $152.9 million is expected to be available annually to fund 69 recipients. HRSA-17-054 4 Award amounts will not exceed the total annual Health Center Program funding available for each service area (listed as Total Funding in the SAAT) in any budget year of the proposed three-year project period. Funding must be requested and will be awarded proportionately for all population types within the service area as currently funded under the Health Center Program. No new population types may be added. Due to supplemental awards for the announced service area, Total Funding indicated in the SAAT may be adjusted while this funding opportunity is open. You must propose to serve at least 75 percent of the SAAT Patient Target by December 31, 2018. If you propose to serve fewer than the total number of patients indicated in the SAAT, you must reduce your funding request according to the following table. If you propose to serve fewer than the total number of patients indicated in the SAAT, but do not reduce the funding request, HRSA will reduce the award accordingly. A funding calculator is available to determine if a funding reduction is required. Table 1: Funding Reduction by Patients Projected to Be Served Patient Projections Compared to Funding Request Reduction SAAT Patient Target (%) (%) 95-100% of patients listed in the No reduction SAAT 90-94.9% of patients listed in the 0.5% reduction SAAT 85-89.9% of patients listed in the 1% reduction SAAT 80-84.9% of patients listed in the 1.5% reduction SAAT 75-79.9% of patients listed in the 2% reduction SAAT < 75 % of patients listed in the Not eligible for funding SAAT The federal request for funding on the SF-424A and Budget Narrative must accurately reflect required reductions. This program announcement is subject to the appropriation of funds and is a contingency action taken to ensure that, should funds become available for this purpose, applications can be processed and funds can be awarded in a timely manner. Funding beyond the first year of the three-year project period is dependent on the availability of appropriated funds for the Health Center Program in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government. Effective December 26, 2014, all administrative and audit requirements and the cost principles that govern federal monies associated with this award are subject to the Uniform Guidance 2 CFR part 200 as codified by HHS at 45 CFR part 75, which HRSA-17-054 5 supersede the previous administrative and audit requirements and cost principles that govern the use of federal award monies. See Section IV.2.iii for instructions on the development of the application budget. III. Eligibility Information You must meet all of the following eligibility requirements. 1. Eligible Applicants 1) You must be a public or nonprofit private entity, as demonstrated through the submission of the Evidence of Non-profit/Public Center Status outlined in Section IV.2.vi. Faith-based and community-based organizations, Tribes, and tribal organizations are eligible to apply. 2) You must propose to operate a health center that makes all required primary health care services, including preventive and enabling health care services, available and accessible in the service area, either directly or through established arrangements, without regard to ability to pay.5 You may not propose to provide only a single type of service, such as dental, behavioral, or prenatal services. 3) You must provide continuity of services, ensuring availability and accessibility in the service area, by proposing to serve an announced service area and its patients identified in the SAAT. a) The total unduplicated patients projected to be served by December 31, 2018, entered on Form 1A, must be at least 75 percent of the SAAT Patient Target. See the Summary of Funding section above if your patient projection is less than the SAAT Patient Target. b) Zip codes entered in the Service Area Zip Codes field on Form 5B: Service Sites for service delivery sites (administrative-only sites will not be considered) must be those where at least 75 percent of the current patients reside.6 Refer to the SAAT to determine the zip codes where the majority of patients reside. c) Through the request for federal funding on the SF-424A, you must propose to serve all currently targeted populations (i.e., CHC, MHC, HCH, PHPC) and maintain the current funding distribution (as identified in the SAAT). Funding must be requested and will be made available proportionately for all 5 Refer to the Service Descriptors for Form 5A: Services Provided for details regarding required comprehensive primary, preventive, and enabling health care services. 6 HRSA considers service area overlap when making funding determinations for new and competing supplement applicants if zip codes are proposed on Form 5B: Service Sites beyond those listed in the SAAT. For more information about service area overlap, refer to Policy Information Notice 2007-09. HRSA-17-054 6