Rural Emergency Health Care Services Frequent User2013-14 Planning Grant Guidelines
The Wisconsin Office of Rural Health is seeking proposals for our Rural Emergency Health Care Services Frequent User Project. We will award one planning grant up to $5,000 to a ruralCritical Access Hospital. This planning grant will enable a coalition of arural hospital(s), emergency medical services, public health department and other stakeholders to develop a program that addresses the problem of frequent users of emergency medical services. Upon successful completion of planning project goals, the Office will award the coalition up to $20,000 in 2014-15 to implement a program that addresses the frequent user problem in their community.[1]
“Frequent users” are defined as individuals who use EMS and emergency department services frequently, out of proportion to others in the community or for inappropriate purposes. There can be many reasons for this frequent use: lack of transportation, un- and under-insured, inability to treat chronic conditions on their own, substance abuse issues, etc. Whatever the reason, the impact on patients, EMS and hospitals can be significant. Frequent users:
- often have chronic health problems that are better treated outside an emergency setting;
- use ambulance and emergency room time that may be needed for acute emergencies;
- use EMS and emergency room staff time that is already limited, in particular EMS and first responder staff that are often volunteers;
- can cause EMS and hospitals to incur significant costs, which have the potential to be reduced through a targeted program.
The Office of Rural Health will award a planning grant to a community coalition, led by a rural hospital, which is committed to finding solutions to this problem. We are interested in proposals that are innovative, involve stakeholders throughout the community and that have the potential for replication in other rural communities. We believe the community coalition approach to problem solving has a greater chance of success. Therefore, a successful proposal will represent a community-wide effort.
Proposals are due in the Office of Rural Health July 1, 2013. In order to be considered for a grant, email Kevin Jacobson () at the Office of Rural Health by May 1that you intend to apply.
Planning Grant Activities
The goal of the planning grant is to assist coalitions in determining the extent of a frequent user problem in their community and in developing a program to address this problem. A successful proposal will identify the scope and financial impact of frequent users. It will also describe the roles of current coalition members and describe the steps to develop appropriate actions to address the frequent user problem. At the end of this planning process the coalition should have the necessary information, experience and commitment to preparea well-developed implementation program proposal.
Eligible planning activities can include identifying and recruiting additional coalition members, conducting a needs assessment, compiling data on frequent users (such as the frequency and cost of their use of emergency services) and program and evaluation planning.
Proposal Format
Include the following information in your proposal:
- Cover sheet (see attachment. This will not be included in the page count)
- Executive Summary: A brief description of the problem in your community and how you will use planning grant funds.
- Coalition Information: Describe the current coalition members and their role in this project as well as any other potential partners.
- Problem Identification: Provide information on the Frequent User problem in your community. You may have preliminary data, anecdotal information, etc. This is your opportunity to describe the extent of the problem and how it impacts patients, EMS, hospital EDs, hospital budgets, etc.
- Work Plan: Describe the activities your coalition will undertake and who is responsible for the activity. The work plan should include output measures. For example, EMS and hospital ED staff will each identify the top 40 frequent users and the cost associated with their serviceor The coalition will meet 10 times during the year.
- Budget: Use the format below. Allowable expenses include Wages, Fringe Benefits, Travel, Supplies, Consultants/Sub-Contracts and Other. Equipment purchases are not allowed with planning grant funds. No match or in kind is required. Include a brief narrative describing how you will spend funds in each category, relating them to your Work Plan.
The proposal should be no longer than five pages, not counting the cover sheet. Prepare your proposal using Microsoft Word (do not submit the proposal in pdf format). Text should be single spaced and normal font and margins.
Submitting the Proposal and Award Process
If you plan to apply, email Kevin Jacobson () by May 1, 2013 to let him know that you intend to apply. You may contact him with any questions. Email your completed proposal to Kevin Jacobson by July 1, 2013.
Office of Rural Health staff and external partnerswill review proposals and make final award decisions. The grant period for this planning grant is Sept. 1, 2013 through August 31, 2014. In order to receive implementation funding for 2014-15, the coalition must submit an implementation program plan by August 1, 2014 for approval by the Office of Rural Health. This must include a report on the results of the planning process, a logic model, a workplan, an evaluation plan, a budget and a sustainability plan. In addition the coalition must submit a mid-year progress reportsummarizing activities to date.
The University of Wisconsin-Madison will send a sub-contract agreement for review and signature to the contact person. When the agreement is fully executed through the University, UW Purchasing will send invoicing instructions to the contact person. You should not begin projects until the grant agreement is fully executed. We anticipate this will be in September. Your proposal and reports will be posted on the Office of Rural Health website. This is a reimbursable grant; you will submit invoices on a regular basis to the University of Wisconsin for reimbursement. All grant funds must be spent by August 31, 2014. There is no carryover provision.
Contact Information
Kevin Jacobson
WI Office of Rural Health
310 N. Midvale Blvd. Suite 301
Madison, WI 53705
608-261-1888
Budget
This is the required format for your project budget. You may insert additional rows as necessary. You are not required to have expenses in every category. Include a brief description of each item, e.g., X hours of work at $10.00/hour, 75 miles @ $.51/mile. Expand on the descriptions in the separate budget narrative. You may use either Microsoft Excel or Word, but you must follow this format. Federal funding guidelines prohibit spending grant funds on food and drinks.
BUDGET CATEGORY / DESCRIPTION / AMOUNT REQUESTEDWages
Fringe Benefits
Travel (use mileage rate of $.51/mile)
Supplies
Consultants/ Contracts
Other Costs
TOTAL
Wisconsin Rural Hospital Flexibility Program
Rural ED/EMS Frequent User Planning Grant 2013-2014
GRANT APPLICATION COVER SHEET
Project Title: ______Coalition Name: ______Grant Amount Requested: ______
- Applicant Organization (entity with which the grant contract is to be executed)
Address
Phone FAX
- Administrator, Executive Director, or CEO
Title ______
Phone ______
Email ______/
- Contact Person for Application
Title ______
Phone ______
Email ______
- Person authorized to sign the grant contract
Title ______/
- Federal ID # of applicant organization:
- List all active partners (those responsible for activities). Use an additional page if necessary—this will not count against your page total:
I certify that the information contained within this application is true and accurate to the best of my knowledge. I submit this application on behalf of the applicant organization. / Signature/Date
1
[1] All grants are contingent upon the Office of Rural Health’s receipt of federal funding. The final implementation award amount will be determined after consultation with the Office of Rural Health.