Rural Health Center ProgramCapital Project

NOTIFICATION OF NEWGRANTS

Capital Project RFA

The purpose of grants awarded under this program is to continue support for state-designated rural health centers. The Office of Rural Health and Community Care (the Division) assists underserved communities and populations with developing innovative strategies for improving access, quality, and cost-effectiveness of health care. Distribution of primary care providers in North Carolina has historically been skewed toward the cities and larger towns. Rural residents, who often face transportation barriers, find accessing primary care services difficult. Through the establishment of rural health centers, the Divisionenables local communities to provide access to their populations who would otherwise be unable to receive needed primary care services due to geographic, economic, or other barriers. Thus, rural health centers have become an integral part of the health care safety net for North Carolina’s rural and underserved residents.

Through this capital support grant, the rural health center will continue to develop and implement projects intended to increase quality driven, cost effective care to meet the transitions mandated through the Affordable Care Act and other industry trends. These funds may be used for a variety of projects including limited information technology components as deemed appropriate by the Division. In addition, these funds may include planned and unplanned structural improvements, upkeep, etc. of the facility/physical plant. If the proposed capital project may result in an insurance claim or involves information technology, please contact Parcheul Harris and/or Andrea Murphy prior to completion of this application packet. The maximum total grant award is dependent upon demonstrated need at the rural health center and the availability of funding. This is a project based grant opportunity. All funding must be expended by May 31, 2016.

Grant applications must be submitted electronically via e-mail by 5:00 pm on April 1 of the current state fiscal year (SFY). Only electronic copies sent via e-mail to Andrea Murphy and copied to Parcheul Harriswill be accepted. Incomplete applications and applications not completed in accordance with the following instructions will not be eligible.

Questions regarding the grant application may be directed to:

Andrea Murphy () 919.527.6448

Parcheul Harris () 919.527.6468

Please read the RFA instructions carefully.

RURAL HEALTH CENTERS PROGRAM

CAPITAL PROJECT RFA

INSTRUCTIONS

Forms required to complete this application packet include: Scope of Work document, Capital Budget Template, and Performance Measures Table.

Technical Assistance

Technical assistance is offered by request via email to:

  • Parcheul Harris:
  • Andrea Murphy:

Application Deadline: April 1, 2016

Grant applications must be submitted electronically by e-mail toAndrea Murphy () and copied to Parcheul Harris () by 5:00 pm on April 1 of the current fiscal year. Hard copies will not be accepted.

All applications must be e-mailed to Andrea Murphy and copied to Parcheul Harris.

Eligible Applicants

State-designated rural health centers that are 501(c)3 non-profit primary care organizationsfunded in the current state fiscal year under the Rural Health Center Operations Medical Access Plan (MAP) Grant Program are eligible to apply. Funds must be used at rural health center location(s) specified in this grant application. All applicants must complete the entire grant application as detailed below to be considered for funding.

Funding Priorities

Grant awards are based on the availability of State funding. The Division was awarded funding for this opportunity through an annual State appropriation of $350,000. The maximum total award for each grant is dependent upon demonstrated need at the rural health center and availability of funding.

Capital projects/initiatives must address one or more ofthe following categories at a state- designated rural health site:

1: Patient and/or staff comfort and safety

2: Quality of services provided

3: Efficiency of services provided

4. Facility is in compliance with current state and federal regulations

5. Health Information Technology (with prior approval)

Grant funds must be utilized at physical location(s) specified in this grant application where primary medical care is provided. Grant funds may not be used to purchase and/or lease vehicles or paydown existing mortgages and/or other loans/debts.

Scoring Criteria

Only one grant application per organization will be reviewed and considered for funding. If applicable, organizations are encouraged to coordinate and collaborate with other safety-net providers in their service area.

Application package will be reviewed and scored on the following criteria:

Scope of Work Form50 points

Performance Measures20 points

Budget Template 30 points

Budget tab (10 points)

Budget Narrative (20 points)

Total Available Points:100 points

The grant application should not exceed five (5) pagesincluding the budget template and performance measures table.

Funding Cycle

It is anticipated that notification of grant awards will be made upon review and approval within the current state fiscal year. Regardless of application or approval date, grant funds must be expended by May 31 of the current state fiscal year.

Application Package

SECTION I:Scope of WorkForm 50 points

Complete the Scope of Work Formbased on the following instructions.

Background

Detail who will be involved in the development, implementation and execution of the capital project. Provide background of the applying organization, and relevance of the background to the request for capital funding.

Purpose (20 points max)

Detail specifics of the capital project and anticipated outcome(s). Outcome specific details should include the impact of the capital project on a least one of the following categories:

  1. Patient and/or staff comfort and safety
  2. Quality of services provided
  3. Efficiency of services provided
  4. Compliance with current state and federal regulations
  5. Health Information Technology (with prior approval).

In addition, detail the location(s) where tasks/goals of the capital project will be met.

Performance Requirements (10 point max)

Detail the timeline for specific tasks/goals to be completed during the capital project period ending May 31, 2016.Additionally, provide information about the following:

  1. Detail how the capital project activities previously outlined above in the “Purpose” section above will be accomplished. This section should be an in-depth description of the process that will be used to complete the capital project within the grant period.
  2. Describe how progress toward meeting the outlined performance measures will be tracked. Include details of process, tools used, funding sources and any other pertinent information.

Program Success (20 point max)

Detail the expected gain for the applicant throughthis capital project. Will the result of this capital project impact the long-term sustainability of the applicant? If yes, detail the anticipated impact. If no, provide a detailed explanation.

SECTION II: Performance Measures Table 20 points

A minimum of two capital project-specific performance measuresmust be developed and submitted on thePerformance Measures Table. The performance measuresmust be specific to the capital project described in the application. Baseline and target values should use the same unit of measurement (e.g., encounters to encounters, patients to patients, number of parking spaces to number of parking spaces, etc.). The evaluation criteria must be quantifiable. Measures submitted on thePerformance Measures Table must be pertinent to evaluating the success of thecapital project.

SECTION III: Budget Template30 points

The budget template provided with this RFA (see RequiredBudget Template) MUST be completed.If the budget template is not used, zero points will be awarded for this section. The budget should be for the stated capital project period endingMay 31, 2016. This budget should be specific to the capital project, NOT for the entire organization.

On the Budget Tab, provide a detailed cost breakdown for the capital project and identify all sources of funding for the project. Clearly identify which capital project costs will be covered with Rural Health Center Program Capital funds and enter these costs in Column A. All other project costs should be entered in Column B. A maximum of 10 points is available for the Budget Tab.

On the Budget Narrative Tab, provide detailed explanation for the budget request. This is a required component of the Required Budget Template. A maximum of 20 points is available for the Budget Narrative Tab.Include estimates from vendors as appropriate.

Rural Health Center Program Capital Project funds may not be used to purchase and/or lease vehicles or paydown existing mortgages and/or other loans/debts.

The maximum total grant award is dependent upon demonstrated need at the rural health center and the availability of funding.

Application Packet Checklist

Send all documents in one e-mail to SVC_DHHS.RHCMAP.orhccgrants by 5:00 pm on April 1, 2016.

Scope of WorkForm with subheadings used to identify each section of the grant. Pages should be numbered sequentially and include the applicant’s legal name on each page.

Budget Template

Capital Project-Specific Performance Measures Table

Organizational Information and Signature Sheet

If not previously submitted within the current calendar year include:

  • Conflict of Interest Acknowledgement and Policy
  • IRS Tax Exemption Verification Form (Annual)
  • (Verification of 501 (c ) 3 non-profit status)
  • Conflict of Interest Verification (Annual)
  • State Grant Certification – No Overdue Tax Debts
  • Contractor Certifications Required by North Carolina Law

The grant application should not exceed five (5) pagesincluding the budget template and performance measures table.

Questions regarding the grant application may be directed to:

Andrea Murphy: 8

Parcheul Harris: 8

Complete all capital project work and submit all invoices by May 31, 2016.

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SFY 2015-2016Capital Grant RFA – Instructions 8/7/2015