UND 17-2012 North Dakota Medicare Rural Hospital Flexibility (Flex) Program ‘11
UNIVERSITY OF NORTH DAKOTA
School of Medicine and Health Sciences
Center for Rural Health
NORTH DAKOTA
Hospital Association
NORTH DAKOTA
Healthcare Review, Inc.
NORTH DAKOTA
EMS Association
REQUEST FOR PROPOSAL
for
The North Dakota Rural Hospital Flexibility (Flex) Program ‘11
RFP #17-2012
RELEASE DATE: July 21, 2011
TECHNICAL ASSISTANCE CALL: July 27, 2011
(11am CT / 10am MT)
Participants interested in a review of the guidance; question & answer session should call: 1.866.809.4014 (pass code: 7776782#)
APPLICATION DUE DATE: August 31, 2011
AWARD DATE: September 29, 2011
These awards are contingent on UND’s receipt of federal Flex grant funding.
Prepared by the University of North Dakota Purchasing Department
PURPOSE
This Request for Proposal is released by the University of North Dakota Purchasing Department on behalf of the North Dakota Medicare Rural Hospital Flexibility (Flex) Program. The North Dakota Flex Program is administered by the University of North Dakota Center for Rural Health, School of Medicine and Health Sciences. Its partners include the North Dakota Hospital Association, the North Dakota EMS Association, and the North Dakota Healthcare Review, Inc. (North Dakota’s quality improvement organization). The Flex Program’s Steering Committee is comprised of one or more members from each of the partners. The Steering Committee sets policy, develops guidelines, and reviews and determines the hospital grant awards. The ND Flex Grant Program is designed to support the goals of the Flex Program at the local level by supporting rural hospitals in remaining viable while maintaining access to care for rural North Dakotans. The Medicare Rural Hospital Flexibility Program is funded by the federal Office of Rural Health Policy (ORHP), Department of Health and Human Services.
Critical Access Hospitals (CAH) are eligible to apply for Flex Grant funding as well as rural hospitals in the process of obtaining CAH designation. Rural hospitals wishing to explore CAH designation are eligible to apply for funds to support a pre-CAH financial assessment. Flex Grant funding is available to support network development of CAHs with other entities, EMS network development, program development, and financial viability. Areas of focus include quality improvement, patient safety, health information technology, staff development, community engagement, workforce, and organizational development.
A Critical Access Hospital can apply for more than one grant. A separate application form must be used for each area of focus.
The Medicare Rural Hospital Flexibility Program is funded by the federal Office of Rural Health Policy (ORHP), Department of Health and Human Services.
DEFINITIONS
Application Response to the RFP
CAH Critical Access Hospital
Contractor Hospital of contract award
Flex ……………………………………………………………..………Rural Hospital Flexibility Program
Memorandum of Agreement (MOA)……….. Signed document between the CAH and network members
outlining the role and responsibility of each members
Network Enhancement Program (NEP)…………………...Grant made to a CAH involved in a consortium
Network……………………………………………………...A CAH working with at least one other entity
ORHP Federal Office of Rural Health Policy
Proposal Response to the RFP
RFP Request for Proposal
Respondent Hospital responding to RFP, Applicant
Flex Steering Committee.............. University of North Dakota, Center for Rural Health
..………………………………………………North Dakota Hospital Association
North Dakota EMS Association
North Dakota Healthcare Review, Inc.
UND University of North Dakota
SECTION 1
STANDARD TERMS AND CONDITIONS
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UND 17-2012 North Dakota Medicare Rural Hospital Flexibility (Flex) Program ‘11
1.1 Please refer to the attached sample subcontract.
1.2 UND Subcontract requirements:
**NEW REQUIREMENTS FOR SUBCONTRACTS**
In order for the University to meet a federal requirement under the Federal Funding Accountability and Transparency Act (FFATA), entities receiving federal flow-through funding are now required to obtain a Dun and Bradstreet number and to registered on the U.S. Federal Contractor site prior to submitting a proposal. Below are links to the registration sites:
1. Must register at the Central Contractor Registration (or CCR) website. This tracks federal government spending.
https://www.bpn.gov/ccr/default.aspx
2. Must provide a Dun and Bradstreet number (also called the DUN’s number). This is a 9-digit identification of the physical location of your business.
http://fedgov.dnb.com/webform
Please note that there is good chance your organization is already registered with the CCR and has a DUNS number. Please check first with your contracting or business office.
SECTION 2
SCOPE OF WORK
Critical Access Hospitals (CAH) are eligible to apply for Flex Grant funding as well as rural hospitals in the process of obtaining CAH designation. Rural hospitals wishing to explore CAH designation are eligible to apply for funds to support a pre-CAH financial assessment. The ND Flex Grant Program is designed to support the goals of the Flex Program at the local level by supporting rural hospitals in remaining viable while maintaining access to care for rural North Dakotans.
Funding is available to support network development of CAHs with other entities, EMS network development, program development, and financial viability. Areas of focus include quality improvement, patient safety, health information technology, staff development, community engagement, workforce, and organizational development. A description of each of the aforementioned follows.
A. Network Enhancement Program
The purpose of this grant is to assist in the formation, development, and implementation of Critical Access Hospital based networks. These are intended to be “consortia” grants involving more than one legal entity working in collaboration to accomplish a set purpose.
Under this grant, a network arrangement will operate involving, at a minimum, a Critical Access Hospital and at least one other legal entity. These consortia can consist of two CAHs (or more); a CAH and a network hospital; a group of CAHs with a network hospital; a CAH and other non-CAH hospitals; a CAH in a vertical network (i.e. long term care, public health, RHC, social services, schools, etc.); or another arrangement. Existing or new hospital cooperatives or health care alliances are eligible. The CAH can partner with other public entities or with private entities. The CAH can partner with organizations in other rural communities or counties. The CAH can partner with organizations in urban/metropolitan statistical areas. The applicant and contractor, however, must be a CAH. It will be the lead agency and will assume fiscal responsibility for the awarded grant funds.
There must be a signed Memorandum of Agreement (MOA) between the network members. The MOA must clearly outline and establish the roles and responsibilities of each network member. If equipment purchases are to be made through this grant, the MOA should also state which entity will own the property at the end of the grant period.
It is important that the applicant convey to the steering committee how the network will function in a manner that bestows benefit to all of the members and the communities that they represent. The CAH and the network can request funds to cover a variety of activities meant to either create a new collaborative relationship or to expand and/or enhance an existing network structure. This can include, but is not limited to, the following activities: shared services, programs, health career awareness for students (K-12), staffing, training, etc.; service/program diversification; quality improvement/quality of care; access to care; cost control; recruitment/retention; organizational restructuring; financial/management assessments relating to rural health clinic, federally qualified health center, and community health center alternatives; other specialized studies; and other projects. The Flex Program will not support “equipment wish-lists” but will fund equipment that is needed in order to support a program. A thorough description of the program and its benefits should be the focus of the application along with the need to form/enhance a network.
Requests for equipment over $5,000 require a minimum of two estimated cost proposals with the applicant providing rationale for the vendor of their choice.
Requests for consultant services require a minimum of two bids both including a detailed budget narrative and a thorough description of what the analysis will include. The applicant must then provide rationale for using their consultant of choice. The Flex Steering Committee does not wish to interfere with the hospital’s right to choose their own consultant but does wish to understand the available options and a detailed description of the benefits that the analysis will provide to the specific hospital and its community.
The CAH and network members may be asked to participate in a meeting with members of the Flex Steering Committee for the purposes of providing a planning and/or progress report(s) sometime within the grant period (September 1, 2011 to August 31, 2012). Steering Committee members are available to facilitate strategic planning and evaluation-related sessions for grant recipients at no cost.
B. Critical Access Hospital Program Grant
Critical Access Hospitals (CAH) are eligible to apply for program grants as well as rural hospitals in the process of obtaining CAH designation. Rural hospitals wishing to explore CAH designation are eligible to apply for funds to support a pre-CAH financial assessment.
There are three broad areas that can be addressed through this grant initiative: financial audits/assessments, program development, and community engagement. The following provides a description of each.
2B.1 Financial Analysis/Assessments: Pre-CAH Assessment: It is anticipated that hospitals seriously exploring the CAH option will have a financial assessment performed. Such an assessment would look at the financial implications of cost based reimbursement versus remaining in the Prospective Payment System (PPS). It would present an analysis of multiple years of cost data. It would address the gradual implementation of the Balanced Budget Act and its implications. CAH conversion creates potential operational cost savings (e.g. flexibility in staffing). The implications of these operational changes need to be addressed. The CAH grant program can cover up to $10,000 for a pre-CAH financial assessment performed by a qualified accounting firm with history and experience in the area of health care finance. A non-CAH may apply for an additional pre-CAH financial analysis if it has been at least 2 years since the last analysis. Such an application must include an explanation of changes that have occurred since the previous financial analysis and why CAH conversion was not undertaken as a result.
Other Financial Analysis: Other financial analysis encompasses any other form of financial analysis that can be conducted to assist the CAH. This can take the form of analyzing the impact of post-CAH conversion reimbursement, Chargemaster review, regulatory change (e.g., increased reliance on mid level providers, etc.), outpatient reimbursement changes, service development/diversification feasibility studies, clinic/outpatient services review and comparison (federally certified Rural Health Clinics, Federally Qualified Health Centers, Community Health Centers), and other forms of financial assessment proposed.
NOTE: All application requests for financial analysis must include a minimum of two bids from different consultants, both including a detailed budget narrative and a thorough description of what the analysis will include. The applicant must then provide rationale for using their consultant of choice. The Flex Steering Committee does not wish to interfere with the hospital’s right to choose their own consultant, but does wish to understand the available options and a detailed description of the benefits that the analysis will provide to the specific hospital and its community.
2B.2 Program Development: Critical Access Hospitals wishing to develop new programming
or enhance existing programming can request funds to address a variety of focus areas:
quality improvement, health information technology, patient safety, staff training,
organizational development, workforce, cardiac rehabilitation, as well as other
development needs.
NOTE: Requests within this category (program development) should not be “equipment wish-lists” but rather may include requests for equipment that are needed in order to implement a program. A thorough description of the program and its benefits should be the focus of the application.
Requests for equipment over $5,000 require a minimum of two estimated cost proposals with the applicant providing rationale for the vendor of their choice.
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UND 17-2012 North Dakota Medicare Rural Hospital Flexibility (Flex) Program ‘11
2B.3 Community Engagement: While becoming a CAH impacts the hospital directly, it can impact other providers and area residents. Hospitals may want to take advantage of the CAH process by exploring ways to build stronger local relationships with other providers and key leaders in local business, government, education, and the religious community.
Community engagement can be achieved in a number of ways. The Flex Program supports the strategies listed below but is also open to your ideas in relation to community engagement and will consider other ideas. Each of these strategies could become a spring-board for future grant development such as the Rural Health Outreach Grant Program of the Federal Office of Rural Health Policy.
a. Local Health Task Force: Funds may be used to develop and support a local health task force. Task forces are a vehicle to discuss and plan future directions and/or projects for the overall local health system, to include the hospital and health sector in discussions and/or projects related to economic development, and to secure the hospitals leadership position within the community.
b. Marketing Information: Funds may be used to educate community members of available services and to support specific campaigns geared toward health promotion within the CAH’s service area.
c. Community Meetings: Funds may be used to hold community meetings for the purposes of exploring ideas related to health care services, outreach, program development, etc.
d. Education: Funds may be used to provide educational opportunities for community members and/or staff.
NOTE: Rural Hospital Flexibility funds cannot be used to purchase or acquire real property or to improve existing property. The funds cannot be used for building and/or physical structural improvements.
SECTION 3
RULES FOR APPLICATION
3.1 It is the sole responsibility of the Respondent to be certain that it has received a full set of the Proposal Documents when preparing to respond. Upon submission of its Application, the Respondent shall be deemed conclusively to have been in possession of a full set of proposal documents.
Respondents are expected to examine the entire RFP, including all specifications, requirements, and instructions. Failure to do so will be at the Respondent’s risk.
3.2 UND will not be responsible for any costs incurred by Respondents which may result from preparation or submission of application to this RFP.
3.3 Proposal Application
Respondents should use the attached application form. An electronic copy is also available at: http://ruralhealth.und.edu/projects/flex/grants.php
Each sheet must be identified with the hospital’s name. A Critical Access Hospital can apply for more than one grant. A separate application form must be used for each area of focus.