Developing a Competitive NAP Application Forms and Attachments

Transcription

1 Developing a Competitive NAP Application Forms and Attachments September 9, 2014 from 1:00-2:30 p.m. ET Presenters: Alec McKinney, Ann Loeffler and Alexia Eslan, Senior Consultants at JSI

2 Welcome and Introductions Rebecca Gaige-Troxell, CHCANYS Alec McKinney, Ann Loeffler and Alexia Eslan (A3) JSI - Public health consulting company

3 Learning Objectives Identify all the required forms and attachments included in the NAP application and where they fit into the grant development process Gather available tools and resources Begin exploring tips and challenges for the main forms/attachments

4 Overview of Forms and Attachments Most are required Forms do NOT count towards page limit Attachments DO 14 Forms + clinical and financial performance measures and summary page 15 Attachments

5 General Tips Complete forms and attachments as soon as possible and before narrative Upload them to EHB as completed Make sure the information in the forms and attachments is consistent with the narrative You can edit the SF-424 Form you already submitted in Grants.gov through EHB

6 Form Required? Related Criterion Forms Form 1a: General Information Worksheet Required C2: Response Form 1b: BPHC Funding Request Summary Required C7: Support Requested Form 1C: Documents on File Required C6: Governance Form 2: Proposed Staff Profile Required C2: Response Form 3: Income Analysis Form Required C7: Support Requested Form 4: Community Characteristics Required C1: Need Form 5a: Services Provided Pre-populated for current grantees C2: Response Form 5b: Service Sites Pre-populated for current grantees C2: Response Form 5c: Other Activities/Locations Pre-populated for current grantees C2: Response Form 6a: Current Board Member Characteristics Required C6: Governance Form 6b: Request for Waiver Of Governance Requirements (Waivers Not Available for 330(E) General CHC Applicants). Form 8: Health Center Agreements N/A for most grantees Required C6: Governance C5: Resources and Capabilities Form 9: Need for Assistance Worksheet Required C1: Need Form 10: Annual Emergency Preparedness Report Required C5: Resources and Capabilities Form 12: Organization Contacts Required General Summary Page Required General Clinical and Financial Performance Measures Required C4: Evaluative Measures

7 Description Required? Related Criterion Attachment 1: Service Area Map Required C1: Need Attachment 2: Implementation Plan Required C2: Response Attachment 3: Project Organizational Chart Required C2: Response Attachment 4: Position Descriptions for Key Mgmt. Staff Attachment 5: Bio Sketches for Key Management Staff Required Required C2: Response and C5: Resources and Capabilities C2: Response and C5: Resources and Capabilities Attachment 6: Co-Applicant Agreement As applicable C6: Governance Attachment 7: Summary of Contracts and Agreements As applicable C2: Response Attachment 8: Independent Financial Audit Required C5: Resources and Capabilities Attachment 9: Articles of Incorporation Signed Seal Page Required C6: Governance Attachment 10: Letters of Support Required C3: Collaboration Attachment 11: Sliding Fee Discount Schedule(s) Required C2: Response Attachment 12: Evidence of Nonprofit or Public Center Status As applicable For new start applicants only (General) Attachment 13: Floor Plans As applicable C2: Response Attachment 14: Corporate Bylaws Required C6: Governance Attachment 15: Other Relevant Documents As applicable E.g., Organizational brochures, lease agreements (General)

8 Detailed Description of Criteria Related Forms and Attachments

9 Criterion 1: NEED Attachment 1: Service Area Map and Table Form 4: Community Characteristics Form 9: Need for Assistance Worksheet

10 Attachment 1 Service Area Map and Table Sample

11 Attachment 1 Service Area Map and Table Make sure to include service area zip codes, any medically underserved areas (MUAs) and/or medically underserved populations (MUPs), and Health Center Program grantees, look-alikes, and other health care providers serving the proposed service area. Source: UDS Mapper (

12 Form 4

13 Form 4: Community Characteristics Report service area and target population data for the entire scope of the project for which data are available Tip: Make sure the total numbers for the first four sections match

14 Form 9

15 Form 9: Need for Assistance Worksheet Three Main Sections Section I: Core Barriers Report data for 3 out of 4 (Difficult to score high on this section) Section II: Core Health Indicators Select one indicator per chronic condition Section III: Other Health and Access Indicators only report data for 2 out of 13 possible other indicators Source: /NAP/dataresourceguide.pdf

16 Tips for Form 9 (NFA) You need to convert the NFA worksheet score to the application need score Tip 1: Data dense worksheet, so create a separate spreadsheet to gather all necessary data and then calculate number to include on form. Tip 2: Calculate all indicators and determine which ones make more sense to select given points and relation to the need of your service area.

17 Attachments Criterion 2: RESPONSE Attachment 2: Implementation Plan Attachment 3: Project Organizational Chart Attachment 7: Summary of Contracts and Agreements Attachment 11: Sliding Fee Discount Schedule(s) Attachment 13: Floor Plans

18 Attachment 2 Sample Implementation Plan

19 Attachment 2 Implementation Plan o Use the template provided by HRSA o o Make sure the implementation plan is for the first 120 days of the project Source: NAP/napimplementationplan.doc

20 Attachment 3 Project Organizational Chart o One-page document o Include: governing board, key personnel, staffing and any sub-recipients or affiliated organizations

21 o Attachment 7 Summary of Contracts and Agreements Upload a summary describing all current or proposed patient service-related contracts and agreements supporting the proposed project o If a contract or agreement will be attached to Form 8, denote this with an asterisk (*) o Items attached to Form 8 will not count against the page limit. Items included in Attachments 7 and 15 will count against the page limit

22 Address: Attachment 7 (cont.) o o o Name and contact for each affiliated agency. Type of contract or agreement Brief description of the purpose and scope of each contract or agreement o Timeframe for each contract or agreement

23 Attachment 7 (cont.) o Attach agreement for a proposed site if operated by a sub-recipient (as identified in Form 5B) o Upload each agreement (up to 5 for each organization) in full o Agreements that exceed these limits should be included in Attachment 15

24 Attachment 11 Sliding Fee Discount Schedule(s) o o Discount schedule must provide a full discount to individuals with annual incomes at or below 100% of Federal poverty guidelines ( Upload current or proposed sliding fee discount schedule

25 Attachment 13 Floor Plans o Provide floor plans of the proposed new access point(s), including proposed exam rooms and waiting area(s)

26 Criterion 2: RESPONSE Forms Form 1A: General Information Worksheet Form 2: Proposed Staff Profile Form 5A: Services Provided Form 5B: Service Sites Form 5C: Other Activities/Locations

27 Form 1A

28 Form 2

29 Form 2: Staffing Profile Allocate staff FTE, average annual salary, and total federal support requested per staff Do NOT duplicate an individual s FTE across positions and ensure the FTE is never greater than 100% FTE Do NOT report contracted staff or volunteers Source - For position descriptions refer to UDS manual: stics/reporting

30 Form 5A

31 Form 5A: Services Provided Data for forms 5A, 5B and 5C are pre-populated for current grantees Identify services that will be available and how they will be provided Include evidence of the relationship for services provided through referrals Will determine the scope of project for the NAP grant

32 Form 5A (cont.) Specialty services and other services may not be included in an applicant s proposed scope of project at the NAP submission Source - Specialty Services and Health Centers Scope of Project available at: ies/pdfs/pin pdf

33 Form 5B

34 Form 5B: Service Sites Identify the NAP site(s) Certify on the Summary Page Form that all sites included on Form 5B will be open and operational within 120 days of Notice of Award At least one proposed service site must be a full-time permanent service delivery site that provides comprehensive primary medical care

35 Form 5C

36 Criterion 3: COLLABORATION Attachment 10 - Letters of Support (LoS) from: Existing health centers (330 grantees or LALs) Rural health clinics Critical access hospitals State and local health departments Private primary care provider groups Other community organizations State Health Departments/State PCOs State Medicaid agencies

37 Attachment 10: Letters of Support (cont.) Include tailored LoS from patients LoS count towards page limit Include required letters, at least one per group, and then others, if you have room Tip: If you are not able to get a LoS from all of the required organizations, explain why in the narrative. Focus on your strengths and the LoS that you did get.

38 Criterion 4: EVALUATIVE MEASURES Clinical and Financial Performance Measures Clinical and Financial Performance Measures set the clinical and financial goals for the two-year project period

39 Clinical Performance Measures

40 Clinical Performance Measures Outline time-framed and realistic goals with baselines that are responsive to the health needs identified in the NEED section 16 required measures Sample forms: /NAP/sampleclinicalperformancemeasure.do cx

41 Financial Performance Measures

42 Financial Performance Measures Outline time-framed and realistic goals with baselines that are responsive to the financial needs identified through strategic planning 5 required measures Sample forms: /NAP/samplefinancialperformancemeasure.d ocx

43 Criterion 5: RESOURCES AND CAPABILITIES Attachment 4: Position Descriptions for Key Management Staff Attachment 5: Biographical Sketches for Key Management Staff Attachment 8: Independent Financial Audit Form 8: Health Center Agreements Form 10: Annual Emergency Preparedness (EP) Report

44 Attachment 4: Position Descriptions for Key Management Staff Key Management Staff might include: CEO or ED, CFO, CIO, COO, PD Indicate if positions are combined and/or part-time Limit each description to one page Include: position title, description of duties and responsibilities, position qualifications, supervisory relationships, skills, knowledge, experience requirements, travel requirements, salary range, and work hours

45 Attachment 5: Biographical Sketches for Key Management Staff Bio sketches or resumes Limit each to two pages If individual is not yet hired, include a letter of commitment along with bio/resume

46 Attachment 8: Independent Financial Audit Upload organization s most recent audit Audit must include: All balance sheets Profit and loss statements Audit findings Management letter Noted exceptions

47 Attachment 8: Independent Financial Audit (cont.) Organizations that have been operational less than one year and do not have an audit may submit monthly financial statements for recent six-months Organizations that are not yet operational and/or do not have an audit or financial statements must provide a detailed explanation of the situation, including supporting documentation

48 Form 8

49 Form 8 Health Center Agreements Items attached to Form 8 will not count against the page limit If a proposed site is operated by a subrecipient or contractor, as identified in Form 5B, the applicant must attach the agreement or contract

50 Form 10

51 Criterion 6: GOVERNANCE Attachment 6: Co-Applicant Agreement Attachment 9: Articles of Incorporation Signed Seal Page Attachment 12: Evidence of Non-profit or Public Center Status Attachment 14: Corporate Bylaws Form 1C: Documents on File Form 6A: Current Board Member Characteristics

52 Attachments (Criterion 6) Attachment 6: Co-Applicant Agreement Only applicable to public center applicants that have a co-applicant board Public centers were referred to as public entities in the past Attachment 9: Articles of Incorporation Upload the official signatory page (incl. state seal) Public centers with a co-applicant, upload the coapplicant s Articles of Incorporation

53 Attachments Attachment 12: Evidence of Non-profit or Public Center Status Upload the applicant organization s evidence of nonprofit or public center status Attachment 14: Corporate Bylaws Upload organization s most recent bylaws Bylaws must be signed and dated by the appropriate individual indicating review and approval by the governing board.

54 Form 1C

55 Form 1C Documents on File Provide the date that each document listed was last reviewed and revised Provides a summary of documents that support the implementation of Health Center Program requirements and key areas of health center operations Source:

56 Form 6A

57 Form 6A Current Board Member Characteristics List all current board members and how they meet Board requirements Source for Board requirements: licies/pin html

58 Criterion 7: SUPPORT REQUESTED Form 1B: BPHC Funding Request Summary SF-424A: Budget Information Form 3: Income Analysis

59 Form 1B

60 Form 1B BPHC Funding Request Summary Collects the funding request for the application The maximum amount of funding in Year 1 and Year 2 is $650,000 One-time funding requested for equipment or minor alteration and renovation (up to $150,000) is included in the $650,000 Before completing Form 1B, the SF-424A: Budget Information form must be completed

61 SF-424A

62 Form SF-424A Budget Information The budget must clearly indicate the projected revenue and expense for the first 12-month period Budget amounts must be rounded to the nearest whole dollar Source for sample SF-424A: /form424a.docx

63 Form 3

64 Form 3 Income Analysis Complete Form 3 to show the projected patient services and projected income from all sources for each year of the proposed NAP project period Base ONLY on the proposed NAP project Income is divided into two parts: (1) program income (known as patient service revenue) and (2) all other income

65 Summary Page GENERAL This form will enable applicants to verify key application data utilized by HRSA when reviewing the NAP applications Content will be pre-populated from the Program Specific Forms. Make sure to review the pre-populated data for accuracy Attachment 15: Other Relevant Documents Include other relevant documents to support the proposed project (e.g., charts, organizational brochures, lease agreements)

66 Form 12

67 Reminders Complete forms and attachments as soon as possible. Upload them to EHB as completed Make sure the information in the forms and attachments is consistent with the narrative Forms: With the exception of Form 3, all Program Specific Forms will be completed online in HRSA EHB The Clinical and Financial Performance Measures will be completed online in HRSA EHB

68 Reminders (cont.) Attachments: Number the electronic attachment pages sequentially, resetting the numbering for each attachment (i.e., start at page 1 for each attachment) Merge similar documents (e.g., Letters of Support) into a single document. Add a table of contents page specific to the attachment.

69 Resources NAP Application Resources: NAP/ UDS Mapper: Specialty Services and Health Centers Scope of Project: ies/pdfs/pin pdf