Advance Care Planning Grant 2017

Request For Proposal (RFP)
Deadline: October 6, 2017 at 4:30 pm Central Time

ACP RFP 20171

Overview3

Background3

Purpose and Goals3

Eligible Applicants3

Funding5

Information and Assistance6

Application Process4

Application Submission Requirements4

Application Review and Award Process5

Required Contract Terms and Conditions5

Proposal Evaluation Criteria5

Preparing the Application6

Narrative6

Organizational Capacity6

Key Personnel Qualifications6

Statement of Need6

Project Objectives, Work Plan and Evaluation7

Request for Proposal Summary8

Required Forms9

Form A: Applicant Cover Sheet10

Form B: Project work Plan and Evaluation11

Form C: Budget Summary Form12

Form D: Budget Justification Form13

Form E: Due Diligence Review Form15

Appendix A: Grant Application Score Sheet Guide19

Appendix B: Invoice Template21

Appendix C: Standard Grant Agreement22

Overview

Background

The Minnesota Department of Health (MDH) is seeking proposals from qualified respondents to develop and implement a statewide advance care planning initiative. “Advance care planning” means a process of communication between individuals and their families, caretakers, and health care providers to identify, assess, and discuss end-of-life care values and document preferences in order to minimize confusion and to ensure that the individual's preferences are honored when the individual is no longer able to speak for him or herself.

Purpose and Goals

The Minnesota legislature appropriated $250,000 from the state general fund in fiscal year 2018 and 2019 ($241,000 for grants and $9,000 for administration annually) to award a grant to one or more statewide advance care planning resource organization(s).

The purpose of the grant includes:

●Increasing societal awareness of the need for advance care planning among individuals, families, caregivers, and health care providers in Minnesota;

●Encouraging and assisting individuals, families, caregivers and health care providers to begin having or continue having advance care planning discussions based on informed choices and the needs and values of the individual;

●Promoting the availability and increasing the awareness of resources available to individuals, families, caregivers, and health care providers who desire advance care planning resources including, but not limited to, health care directives;

●Providing information and training on the completion of health care directives. Health care directives reflect individual desires and identify a health care agent who can speak for individuals when they cannot speak for themselves;

●Development of measurable outcomes and effective evaluation for advanced care planning.

To meet these goals, the awarded organization must have expertise in convening and coordinating community-based strategies to encourage individuals, families, caregivers, and health care providers to begin conversations regarding advanced care planning.

Additionally, the awarded organization must coordinate efforts with the Minnesota Cancer Alliance, a broad partnership of organizations and leaders dedicated to reducing the burden of cancer across Minnesota. Through its, Cancer Plan MN 2025, the MN Cancer Alliance has identified increasing the use of advance care planning as one of its objectives. Specifically, the following 7 strategies were identified for this objective:

  1. Conduct a large-scale community awareness and education campaign about advance care planning
  2. Educate health care professionals about tools and resources they can use to facilitate meaningful, culturally sensitive conversations with patients and families about advance care planning
  3. Collaborate with electronic medical record vendors and health care systems to develop best practices for accessing, storing and retrieving advance care planning materials in the electronic medical record
  4. Promote the use of advance care planning resources shortly after the time of diagnosis or early in treatment for cancer
  5. Partner with payers to improve reimbursement for advance care planning conversations to supplement Centers for Medicare and Medicaid Services payment rates
  6. Work to mandate advance care planning services for all Minnesotans
  7. Partner with health care systems to work collaboratively to promote expanded and effective use of advance care planning

Eligible Applicants

All organizations or entities with experience and expertisein advance care planning are eligible to apply. Eligible applicants should have training experience, the potential to achieve statewide reach, and a demonstrated commitment to advance care planning. Applications from individuals will not be considered.

Funding

The total amount of funding for this project is up to a total of $482,000 until June 30, 2019. MDH will enter into a grant agreement for the provision of services outlined in the grant proposal. At least 15 % of the allotted funds must be subcontracted to nonprofit organizations to develop and implement comprehensive advance care planning initiatives targeted to specific communities, particularly communities experiencing health disparities,based upon their input, needs and values.

The grantee will be funded from approximately November 10, 2017until June 30, 2019. This is a one-time legislative appropriation. This grant cannot be renewed.

Grantees will be paid for actual expenses on a reimbursement basis either monthly or quarterly. This means grantees will pay for activity expenditures, report the expenditures to MDH on an invoice form, and then receive reimbursement. Grantees must maintain supporting documentation for all invoiced expenditures and present the documentation when requested during a financial review of the grant.

Information and Assistance

Questions concerning this grant program should be submitted by email on or before 4:30 PM on September 19, 2017 to:

MDH Staff responding to questions will be:

Donna McDuffie, Comprehensive Cancer Control (CCCP)Program Manager

Lisa Gemlo, CCCP Project Coordinator

Other personnel are not authorized to discuss or respond to questions related to this Request for Proposal.Questions, responses, and related information will be posted to the Advance Care Planning website. Applicants should check that site frequently for updated information.

Application Process

Application Submission Requirements

  • Narrative portions of the application must be written in no smaller than 11-point font, single spaced with one-inch margins.
  • All pages must be numbered consecutively.
  • Applications must meet deadline requirements. Late applications will not be reviewed.
  • Applications must be complete and signed where noted. Incomplete applications will not be reviewed.

The deadline for submission of proposals is October 6, 2017, at 4:30 pm Central Time. To meet the deadline, proposals must be electronically received by that time.

Applications must be submitted electronically. Please email one application document,including all required attachments .

Fax responses will not be accepted. Late applicationswill not be considered for review. Technical difficulties will not be a valid excuse for late submissions. The burden of proving timely receipt is upon the sender.

Application Review and Award Process

This is a competitive grant application. Proposals will be reviewed and scored according to the Proposal Evaluation Criteria found below.

Reviewers may include staff from MDH, members of the health care community, and individuals from other organizations that represent a broad range of professionals with experience in advance care or statewide planning. Reviewers will be required to identify any conflicts of interest and will not review a proposal if they have a direct relationship with the applicant. Reviewers will not score the MDH Due Diligence Form (Form E). MDH staff will review this information.

It is anticipated that grant award decisions will be made in October 2017. Applicants will be notified by email or phone by October 20, 2017 whether or not their grant proposal was funded. A grant agreement will then be initiated. MDH reserves the right to negotiate changes to budgets submitted.

Applications are private or nonpublic until opened. Once opened, the name and address of the applicant and the amount requested is public. All other data in an application is private or nonpublic data until completion of the evaluation process. After the evaluation process has been completed, all data are public.

Required Contract Terms and Conditions

The selected application will be required to comply with the terms and conditions outlined in the State of Minnesota Grant Agreement. This agreement will describe the duties required under this agreement, including reporting requirements. For this grant agreement, the selected applicant will be required to (at minimum):

  • Submit a quarterly written report of all activities related to the programs and services provided.
  • Submit monthly or quarterly invoices to MDH for expenses incurred (this will be negotiated with the selected applicant).
  • Provide MDH a final written report of all activities not more than 60 days after the end of the grant period.

It is anticipated that the effective date of the grant agreement will be November 10, 2017, or the date upon which all signatures to the contract are obtained, whichever is later. No work on grant activities can begin until a fully executed grant contract is in place. A sample grant agreement is located in Appendix C.

MDH reserves the right to revoke this request for proposals if needed.

Proposal Evaluation Criteria

Proposals that do not meet the following criteria will not be considered:

  • Proposals must be received on or before the due date and time specified in this request.
  • Proposals must be complete with all components included.

The following criteria are considered essential to the proposal:

  • Demonstrates best practices and public health research principles
  • Demonstrates that the work will lead to an increase in the percent of adults in all areas of the state who have completed a health care directive
  • Activities based upon community input, needs and values
  • Addresses health disparities and cultural differences that may exist within the communities

Only responses that meet the criteria will be evaluated. Reviewers will determine which applications best meet the criteria as outlined (Appendix A) and should be recommended for funding. Applications will be evaluated by a team of reviewersbased on the following weighted criteria:

  1. Organizational capacity, including key staff qualifications (10 points)
  2. Statement of Need (10 points)
  3. Project Objectives, Work Plan and Evaluation (50 points)
  4. Budget (10 points)
  5. Overall assessment of Grant Application (10 points)

Preparing the Application

Narrative

The project narrative provides an overall description of the organization and the proposed activities to meet the goals of this project. The Project Narrative should include the following sections.

Organizational Capacity

In this section provide a brief description of your organization, including your organization’s capacity to provide advance care planning training statewide. Provide information you think is important for grant reviewers to understand about your organization, including your capacity to administer grant funds. The applicants should provide the following:

  • A brief description of your organization’s capacity to manage this project.
  • Your organization’s expertise in convening and coordinating a statewide initiative.
  • Your organization’s experience working with patients, health care systems, providers and families on advance care planning.
  • Your organization’s demonstrated ability to work with a variety of communities.
  • Your organization’s ability to collaborate with a variety of partners.
  • Your organization’s experience working to identify barriers and address disparities that affect advance care planning.
  • Your organization’s understanding of best practices related to advanced care planning.

Key Personnel Qualifications

Applicant organizations need to identify or have the capacity to provide personnel to perform the duties outlined in their work plan. Briefly describe personnel knowledge, including education and experience working with providers, caregivers and families on advance care planning. If the applicant organization does not currently have personnelwith the desired qualifications, a plan for identifying individual(s) must be submitted, including a description of key responsibilities (e.g. job descriptions).

Statement of Need

In this section provide an overview of the need for advance care planning in Minnesota. Please include the following:

  • The importance of having an organization to provide statewide support of advance care planning.
  • A description of the population(s) you plan to serve and why their needs are not currently being met.
  • How the community(ies) provided input into the plan and expressed need.
  • Information on the services currently being provided in Minnesota and any gaps this grant will fill.
  • Describe the financial, resources and/or other problems requiring a solution that this funding can address.

Project Objectives, Work Plan and Evaluation

In this section, provide a description of how the project will be implemented with the funding awarded. Form B can be used to assist you with this section of the narrative. You may adapt the form to more adequately address your proposed work plan.

Project Objectives (10 points)

State the objectives for your project. Objectives are statements of the short-term or intermediate-term outcomes related to achieving the goals of this project. These objectives should be tangible, specific, measurable and achievable/reasonable based on the funding and timeframe of the project.

Project Partners (10 points)

Describe the partnerships and plans of work to ensure that at least 15 % of the allotted funds are subcontracted to nonprofit organizations to develop and implement comprehensive advance care planning initiatives targeted to specific communities,particularly communities experiencing health disparities, based upon their input, needs and values. Also describe how you will work with the Minnesota Cancer Alliance to sustain broader alignment in Advance Care Planning as outlined in Cancer Plan Minnesota 2025.

Project Work Plan (20 points)

The work plan should provide a clear, detailed description of how grant funds will be used to achieve each of your stated objectives. The work plan should be specific to what will be accomplished with the funding available. The work plan should include the following:

  • Describe the proposed project and how the project will meet the goals and objectives of the funding.
  • Provide a description of activities/strategies, based on best practices, to achieve your stated objectives.
  • Describe the target audience(s) for each objective, as appropriate.
  • Describe the training and other technical assistance that you will provide to achieve your stated objectives.
Project Evaluation (10 points)

Include a brief description of how your organization will know it has achieved its stated objectives. The applicant should also provide a brief description of how they will evaluate the overall success of the program.

Note: If your application is approved and funded at the level requested, the Work Plan and Evaluation (Form B) will be incorporated into MDH’s contract with the grantee agency as contractor’s duties. Work Plans must be completed according to directions so they can be separated easily from the rest of the application.

Request for Proposal Summary

Topic / Summary
Eligibility for Grant Funds / All organizations or entities with experience and expertisein advance care planning are eligible to apply. Eligible applicants should have training experience, the potential to achieve statewide reach, and a demonstrated commitment to advance care planning. Applications from individuals will not be considered.
Total Funds Available / The total amount of funding for this project is up to a total of $482,000.
Application Deadline / All proposals must be received no later than 4:30 PM on October 6, 2017.
Grant Cycle / November 10, 2017 (or date upon which all signatures to the contract are obtained, whichever is later) to June 30, 2019.This grant cannot be renewed.
Grant Purpose / To award a grant(s) to statewide advance care planning resource organization(s) that has expertise in convening and coordinating community-based strategies to encourage individuals, families, caregivers, health care systems and providers to begin conversations regarding end-of-life care choices that express an individual’s health care values and preferences and are based on informed health care decisions.
Application Requirements / The application narrative must use a minimum of an 11 point font.
All pages should be numbered consecutively
All printed pages should be printed on only one side
Order of Completed Application Submission / Signed Application Cover Sheet (Form A)
Application Narrative
Work Plan and Evaluation (Form B)
Budget Summary (Form C)
Budget Justification (Form D)
MDH Due Diligence (Form E)
Application Delivery / E-mail submission:

Required Forms

In addition to the project narrative, the following forms should be included with your application. All forms are available with this document.

Form A: Applicant Cover Sheet

Form B: Project Work Plan and Evaluation

Form C: Budget Summary

Form D: Budget Justification

Form E: Due Diligence Review Form

Form A: Applicant Cover Sheet

GENERAL APPLICANT INFORMATION

Applicant Agency Legal Name:
Applicant Agency Address:
Main Office Phone Number:
Website Address:
Minnesota Tax ID Number:
Federal Tax ID Number:

DIRECTOR OF APPLICANT AGENCY

Name:
Address:
Phone Number:
Email:

FINANCIAL CONTACT OF APPLICANT AGENCY

Name:
Address:
Phone Number:
Email:

DESIGNATED CONTACT PERSON FOR ADVANCE CARE PLANNING GRANT

Name:
Address:
Phone Number:
Email:

REQUESTED FUNDING

Total Amount on Proposed Budget / $

CERTIFICATION

I certify that the information contained herein is true and accurate to the best of my knowledge and that I submit this application on behalf of the applicant agency.

Signature of Authorized Agent for Grant Agreement / Title / Date

Form B: Project work Plan and Evaluation

You may adapt this form to more adequately address your proposed work plan. Note: If your application is approved and funded at the level requested, the Work Plan (Form B) will be incorporated into MDH’s contract with the grantee agency as thegrantee’s duties. Work Plans must be completed according to directions so they can be separated easily from the rest of the application.

Objective / Key Activities/Strategies / People Responsible / Timeline / Measure of Success

Overall Program Evaluation:

Provide a logic model or description of your evaluation plans, including the benchmarks and data you intend to use.

Form C: Budget Summary Form