GRANT OPPORTUNITY
TITLE: Medicare Rural Hospital Flexibility (FLEX) Grant Program
Critical Access Hospital Quality Improvement Initiative
Application Submission Due Date:
March 15, 2007, 4:00 p.m.
Instructions and Application Forms
Point of Contact: Cordellia Vanover
Georgia Department of Community Health
2 Peachtree Street, NW
Grants and Vendor Management, 35th Floor
Atlanta, GA 30303-3159
Tel: 404 651-6917
Please carefully read, sign, and adhere to all attached DCH Ethics Statements and Ethics In Procurement Policy prior to responding to any Department of Community Health Request for Grant Applications (RFGA). Failure to do so could result in the disqualification of your application at any time during the application process.
Table of Contents
Medicare Rural Hospital Flexibility (FLEX) Grant Program
Critical Access Hospital Quality Improvement Initiative
I. / Background……………………………………………………… / iiiII.
III. / Purpose…………………………………………………………… / iii
Eligibility…………………………………………………………. / iv-v
IV. / Process Submittal, Content and Required Forms ……….. / 1-5
V. / Evaluation…………………………………………………………
Appendix A / Grant Application Form
Appendix B / Governing Board Resolution
Appendix C / Governing Board Composition
Appendix D / Ethics Statement
Appendix E / Ethics In procurement Policy
Appendix F / Business Associate Agreement
Appendix G / Project Budget
Appendix H / Biographical Sketch
Medicare Rural Hospital Flexibility (FLEX) Grant Program
Critical Access Hospital Quality Improvement Initiative
Program Description and Requirements
Background / The Georgia Department of Community Health (DCH) was created in 1999 (Senate Bill 241) with the responsibility for insuring over two million people in the State of Georgia to maximize the State’s health care purchasing power, to coordinate health planning for state agencies, and to propose cost-effective solutions to reducing the numbers of uninsured. Within the Department, the State Office of Rural Health works to improve access to health care in rural and underserved areas and to reduce health status disparities. Rural Georgians are more likely to be under-insured or uninsured.
Purpose / The purpose of this grant is to provide for the participation in the Human Resources Services Administration (HRSA), Office of Rural Health Policy (ORHP), Medicare Rural Hospital Flexibility (FLEX) Grant Program. The funding is to provide all thirty-five (35) of Georgia’s Critical Access (CAH) Hospitals with a quality improvement initiative that focuses on patient safety and quality of care outcomes through standardized peer review, privileging and quality improvement techniques at both the hospital and physician levels
Eligibility / Ø Must have demonstrated knowledge and experience in performance improvement and patient safety programs for Critical Access Hospitals.
Ø Must demonstrate the ability to provide both online and onsite technical assistance and instruction.
Ø Must be able to serve all thirty-five (35) CAHs
Special Conditions / Funding contingent upon the Federal Medicare Rural Hospital Flexibility (FLEX) Program Grant funding for grant year September 1, 2007 through August 31, 2008
Total Funds
Available / $150,000 - based on the availability and amount of grant funding
Funding Cycle / September 1, 2007 – August 31, 2008
Funding
Preference / · At lease five (5) years experience with Georgia’s CAHs
· Historical experience with the CAHs
Types of Projects Eligible for Funding / Not Applicable
· Indicate on all communication, marketing and promotional information that the program is funded by the Medicare Rural Hospital Flexibility Grant administered by Georgia State Office of Rural Health, a division of the Department of Community Health.
· To provide a quality improvement program that concentrates on patient safety and quality of care outcomes.
· To provide a program that provides standardized peer review, credentialing, privileging and quality improvement techniques at the hospital and physician levels.
· To provide tools to engage hospital trustees in quality improvement efforts.
· To provide Georgia’s thirty-five (35) Critical Access Hospitals with a pathway to performance data for patient quality and safety improvement activities that will produce increased data submission to Hospital Compare.
· To provide a qualified safety and quality specialist to provide data driven technical assistance to CAHs.
· To provide the experience and background of the of the quality improvement specialist.
· To provide who will be responsible for the development and execution of the program.
· To provide a biographical sketch of those key persons.
· To provide a plan describing how the grantee will secure maximum CAH participation in the initiative.
· To provide to the SORH the number of onsite consultations to be provided to each of the thirty-five (35) Critical Access Hospitals.
· To provide a description of how State and Federal requirements for quality improvement and reporting will be combined to decrease the burden on participating hospitals.
Deliverables / · Grantee shall submit no less than four (4) quarterly reports to the SORH that includes hospital specific data, including graphs, that clearly demonstrates quality of care outcomes, evidence of hospital trustees’ involvement in the quality improvement process and enhanced data submission to Hospital Compare no more than thirty (30) days following the close of each quarter.
· Each quarterly report will contain the number and identities of all site visits made during the preceding quarter.
· Each quarterly report will include evidence of peer review, credentialing and privileging conducted as part of the quality improvement activities.
· A final report will be due to the SORH no more than thirty (30) days after the close of the grant project period that contains hospital specific data, including graphs, which clearly demonstrates the hospitals’ and physicians’ individual performance improvement progress.
· Status reports may be requested as needed by the federal grant.
· Submit quarterly invoices for payment no more than thirty-days following the close of each quarter.
Format / · Narrative demonstration of need (no more than 3 pages)
· Work Plan (format provided in separate document)
· Desired outcome (no more than 2 pages)
· All pages should contain footer with organization name and page number.
Evaluation Criteria / · Applications received will be evaluated based upon-experience with Critical Access Hospital Performance Improvement and Patient Safety Programs and other key areas as identified within the Evaluation Section.
Deadline for Submission of Questions
Funding Application Deadline / Questions must be submitted in writing to by 4:00 p.m. on 2/15/07.
Responses to questions will be posted on 2/20/07 at www.dch.ga.gov
March 15, 2007, 4:00 p.m.
Application Submittal
An original, five (5) copies and two (2) CDs of the Grant Application must be received by 4:00 p.m. on March 15, 2007. Applications must be delivered in hard copy format via overnight mail, United State Post Office, or hand delivery to:
Mailing Address:
Cordellia Vanover, Grants Administrator
Georgia Department of Community Health
Vendor and Grant Management,
2 Peachtree Street, NW, 35th Floor
Atlanta, GA 30303-3159
Tel: 404 651-6917
Email:
Application Format
Please follow the outline provided in the “application content” section. Page format preference includes: 1 inch margins, page numbers, and name of applicant on each narrative page (not necessary on form pages or supporting documents.)
Application Content
The following outline and instructions should be used to prepare the grant application. Applications must be typewritten and follow the order and format provided in the “Program Requirements” and “Format” sections.
I. Required Forms (Appendices A,B,C,D,E,F,G,H)
A.Grant Application Form
B. Governing Board Resolution
C. Governing Board Composition
D.Ethics Statement
E. Ethics in Procurement Policy
F Business Associate Agreement
G Project Budget
H Biographical Sketch
II. Organization Information (not to exceed 5 typewritten pages)
III. Project Description (not to exceed 5 typewritten pages)
A. Problem Statement – provide a statement illustrating desired outcome and need for providing Georgia’s Critical Access Hospitals with an objective, measurable performance improvement and patient safety program.
B. Type of Project – declare type of project and provide a description.
C. Project Need – provide a statement illustrating the need for providing a Critical Access Hospital performance improvement and patient safety program.
D. Project Objectives – provide statements of the short term or intermediate term outcomes related to securing training. Objectives are to be tangible, measurable and achievable and should be specific to the proposed grant project and budget.
E. Project Work Plan or Methods – provide a detailed work plan of how the objectives will be reached through clearly defined strategies or activities. Work Plan must outline the following:
1. Participant(s)
2. Training and associated cost
3. Travel expenses (conservative and reasonable)
4. Evidence of return on investment
5. Developmental goals
F. Timeline – provide a timeline for the grant period under which activities and objectives will be accomplished.
G. Evaluation – describe a process for documenting results of this project, including whether or not project objectives have been met.
H. Project Outcome – describe desired outcome in measurable goals.
IV. Budget and Justification (not to exceed 3 typewritten pages)
A. Budget Form (Appendix G) - Categorize your proposed expenses on the budget form provided.
B. Budget Justification - For each of the cost items on the budget form for which grant funds are requested, provide a rationale and details relative to how the budgeted cost items were calculated. This concise narrative should be labeled “Budget Justification” and be attached to the budget form.
1.Contracted Services – For each contract, provide the name of the contractor, components or services to be provided by the contractor, and cost per service, client or unit. If a subcontractor has been chosen, please include background information about that subcontractor including how the subcontractor’s previous experience relates to the project.
2.Other – Whenever possible, include proposed expenditures in the categories listed above. If it is necessary to include expenditures in this general category, include a detailed description of the activities as it relates to the project. If possible, include a separate line item budget and budget narrative.
3. The Department of Community Health (DCH) takes great pride in its ability to make grant awards to those who satisfy award requirements. Among those requirements is the limitation upon the application of indirect costs to the funding associated with the grants awarded by DCH. With limited exceptions, the current cap is set at up to and no more than *10%; although, applications requesting no direct costs are strongly encouraged.
It is DCH’s intent to provide grant dollars for the purposes expressed in the grant applications and that the greatest portion of those dollars should be applied directly to the services associated with the purpose of the grant. This serves as the basis for the indirect cost limitation of 10%.
For your information, listed below are DCH’s definition of indirect costs and a list of categories and examples of indirect costs. As noted above, limited exceptions to the 10% indirect cost limitations may be considered. Exceptions for consideration may be submitted based on the following table.
Length of time in operation / Maximum percentage of indirect costs allowed for considerationStart-up through first year in operation / 50%
Second years in operation / 40%
Three years in operation / 30%
Four years in operation / 20%
Five or more years in operation / 10%
For the purpose of clarification, please note that length of time in operation pertains to the entity requesting funding, not the length of a time a specific program has been in operation. For example, ABC Nonprofit has been in existence for fifty years. ABC submits a application for a new program to be implemented in 2007. Based on DCH’s policies relating to indirect costs, ABC Nonprofit’s application will not be considered if the application contains a request for more than 10% indirect costs.
I It should be noted that while DCH will consider applications containing indirect costs based on the chart above; it is under no obligation to approve all or any indirect costs associated with any application.
* On a "case-by-case" basis indirect costs which exceed the limits indicated above may be considered. For special consideration, a written request should be submitted to:
Cordellia Vanover
Department of Community Health
Grants and Contracts
2 Peachtree Street, NW, 35th Floor
Atlanta, Georgia 30303
DCHwill provide a written approval notification upon review. This request may be made prior to formal submission of the grant.
Indirect costs are those costs that cannot be directly identified with a specific, single, final cost objective. The two most commonly used general classifications for indirect costs are “overhead” and “general and administrative costs”.
Below are categories and examples of indirect costs.
Financial
· Bookkeeping and accounting
· Annual independent audit
· Bank charges
· Grants administration
Occupancy
· Facilities lease or mortgage
· Utilities
· Maintenance and sanitation (janitorial, grounds, trash removal)
· Security
· Capital improvements
Administration
· Executive staff
· Clerical and support staff
· Personnel administration (executive search, benefits programs, staff orientation, retreats, employee recognition)
· Insurance
· Office equipment (copiers, fax machines, etc.)
· Office furnishings
· Telephone system and reception function
· Technology (computers, information management)
· Office supplies
· Internal agency communication and coordination
Resource Development and Marketing
· Development staff
· Fundraising expenses
· Donor acknowledgment and reports for funders
· Marketing and community outreach
· Website design and management
· Annual report and agency newsletters
Governance
· Strategic planning
· Board governance and development
· Legal counsel
Program Quality Control
· Licenses, permits, accreditation process
· Professional development and staff training
· Membership fees, subscriptions and professional conferences
· Evaluation
Evaluation
The grant application will be evaluated according to the following assessment criteria:
The thoroughness of the application
The application is complete, clear and concise
The application follows the prescribed format