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FQHC Incubator Program Community Grants
Texas Department of Health Primary Care Office Reviewer TrainingJanuary 8, 2004
In General FQHC Essentials Why We Are Here
President’s 5-Year Initiative to Increase FQHCs
How We Got Here Senate Bill 610
FQHC Incubator Program Components Evaluating the Applications Details of the RFP
Introduction to Federally Qualified Health Centers (FQHCs)
FQHC 101 Topics Benefits received from FQHC
status FQHC Essentials
Characteristics BPHC Section 330 program
expectations/requirements BPHC funding priorities and
application information
What is a Federally Qualified Health Center (FQHC)?
FQHC Federal designation from Bureau of Primary
Health Care (BPHC) assigned to private non-profit or public health
care organizations that serve predominantly uninsured or underserved populations
meet other service requirements Also called
Community/Migrant Health Center (C/MHC) Community Health Center (CHC) 330 Funded Clinic
Characteristics of an FQHC Community based non-profit or public
primary health care clinics Located in or serving a designated
Medically Underserved Area/Population (MUA or MUP)
Consumer Board governance structure Provide health services to persons in all
stages of the life cycle
Characteristics of an FQHC (cont’d)
Provide services to all persons regardless of ability to pay
Charge for services on a sliding-fee scale based on patients’ family income and size
Comply with federal program expectations/requirements and all applicable federal and state regulations
Paths to Becoming an FQHC
Apply to Bureau of Primary Health Care for Section 330 funding
Apply to be an FQHC look-alike and then later apply for 330 funding
Collaborate with an existing FQHC to apply as an expansion site
Section 330 Program Requirements
Four components: Governance Mission and Strategy Clinical program Management and finance
Program Requirements: FQHC Governance
Board composition Governed by community board
51% consumers of the clinic services Non-consumer requirements 9-25 members By-laws prescribe method for
selecting board members Employees and relatives are ineligible
Program Requirements: FQHC Governance
Board of Directors responsibilities Carries legal and fiduciary responsibility for
clinic operations and grants Strategic planning and evaluation of
progress toward organizational goals Approve Annual Budget & Grant Application Meet At Least Monthly / Keep Minutes Full authority over all aspects of clinic
operations No other entity/individual can have the
ability to override or veto governing board decisions
Program Requirements: Clinical Program
Provides a continuum of care Service Delivery Model Contracting Health Care Planning Clinical Staff Clinical Systems & Procedures
Required ServicesDirectly or Through Contract
Primary care Dental Mental health Substance Abuse Diagnostic lab and x-ray Prenatal and perinatal Cancer and other
disease screening Blood level screenings
Lead levels Communicable
diseases Cholesterol
Prenatal and perinatal
Well child services Child and adult
immunizations Eye and ear screening
for children Family planning services Emergency medical Pharmaceutical Case management Outreach and education Eligibility/Enrollment
services Transportation and
interpretation Referrals
Program Requirements: Management and Finance
Management Staff and Structure Management Systems
Utilization Financial Clinical
Facilities
Benefits of FQHC Status Access to federal grants to support costs of
providing uncompensated care Access to federal grants to support the costs
of planning and developing a health care network or plan
Prospective Payment System reimbursement for services to Medicaid/Medicare patients Reimbursement from Medicaid/Medicare based
on actual cost of providing care Access to free medical malpractice coverage
under Federal Tort Claims Act (FTCA) PHS Drug Pricing Discounts
Benefits of FQHC Status (cont’d)
Access to grant support and loan guarantees for capital improvements
Right to have out-stationed eligibility workers on-site
Reimbursement by Medicare for “first dollar” of services (deductible is waived)
Access to Vaccines for Children (VFC) Program
Access to National Health Service Corps (NHSC) Provider Placements
Public Entities & FQHC (Re)Configure Board of Directors to
include BPHC/330 Requirements- 51% consumer (user) majority
OR Form a Co-Applicant Board-establishing a
subsidiary 501 (c) 3 Meets BPHC/330 requirements Public entity cannot have authority over
FQHC board with exception of general personnel and fiscal policies
FQHC Look-Alike Clinics Meet all of the Section 330
program expectations/requirements, but… Do NOT receive grant support Do NOT receive coverage under
Federal Tort Claims Act (FTCA)
FQHC Look-Alike Benefits
Prospective Payment System reimbursement
PHS Drug Pricing Discounts Outstationed eligibility workers on-site “First Dollar” Medicare reimbursement Vaccines for Children (VFC) Program National Health Service Corps (NHSC)
Provider Placements
FQHCs Recap Community based clinic Full scope primary care to underserved
and uninsured populations Care for all ages Does not turn away people because of
an inability to pay Bureau of Primary Health Care Model
Applicants to this federal program have to meet the model of an FQHC, not just provide the services of an FQHC
President Bush’s New Access Point Initiative
President Bush’s New Access Point Initiative
5-year initiative announced in August 2001 Plan to double the number of persons CHCs
serve Funding for 1,200 new or expanded health
center sites 6 million new patients served by health centers
$1.2 billion of additional funding to Section 330 program $175 million additional in FY 2002 $114 million additional for FY 2003
All funding on nationally competitive basis
How Texas Is Doing High levels of uninsured High health disparities Only 7% of uninsured served by
FQHCs Applications coming from non-
operational clinics Only operational clinics are getting
funded Lots of need, but not getting funded
0
5
10
15
20
25
Millions
AK AZ
AR
CA
CO CT
DE FL
GA HI
ID IL IN IA KA
KY LA ME
MA
MD M
IM
NM
SM
OM
TN
CN
DN
H NJ
NM
NY
NE
NV
OH
OK
OR
PR PA RI
SC
SD TN TX
UT
VA
VT
WV
WA WI
WY
Where the Money is Going by State (June 2003)
Status of FQHCs in Texas 2 New Access Points FY 02 6 New Access Points in FY 03 33 Existing Prior to Incubator Program Texas Association of Community
Health Centers Strategic Plan Information 50 new locations-132,663 new users Capacity expansions-158,230 users
We are not meeting these projections
Barriers to FQHC Funding Lack of technical assistance resources Existing CHCs have not adjusted to
“competitive” environment Non-operational clinics Simple mistakes in federal application
Narrative=>Healthcare/Business Plan=>Budget
Budget numbers don’t match Not following evaluation criteria Incorrectly filling out forms
FQHC Incubator Program
Mission: Leverage additional federal funds through new and
expanded FQHC and FQHC Look-Alike Clinics by helping
organizations ramp-up to meet the federal requirements.
How We Got Here—Senate Bill 610 Part of Gov. Perry’s Campaign Platform 2002 Introduced by Senator Nelson and passed
with bi-partisan support $10 million per biennium Including $150,000 RFP for additional technical
support Funds must be spent by TDH by March 1,
2004 Seed Money Only! Not Available after FY05 TDH Goal
17 new or expanded FQHCs or FQHC-LAs
FQHC Incubator Program Components
Planning Grants
Development Grants
Transitional Operating Support
Capital Infrastructure Grants
Estimate of Dollar Breakdown
Component Top Award
Est. # Estimated Total
Planning $ 5,000 18
$ 67,500
Development
$ 75,000 17 $ 907,000
Transitional Operating Support (TOS)
$250,000 17 $3,125,000
Capital Improvement
$100,000 10 $ 750,000
Incubator Plan Components Component 1: Planning Grants are
designed to support specific technical assistance activities that are key to successful applications. Organizational feasibility studies Board development & 501 (c) 3 application Strategic planning & work plan development Community involvement & collaborations Needs and asset mapping Basic training on FQHC requirements
Incubator Plan Components Component 2: Development Grants
provide support for development of the organizational and collaborative capacities required of FQHCs. FQHC-Look Alike application development Grant writing Negotiating formal collaborations and
memorandums of understanding (MOUs) Staffing to develop collaborative &
organizational capacities Technical assistance on any of the above
activities
Incubator Plan Components Component 3: Transitional Operating
Support intends to operationalize community based clinics which increases the likelihood of receiving FQHC & FQHC-LA designation. Funding for Direct Care. Medical supplies Salaries for staff (Physician, Nurse, CEO) Contract Rent Information systems
Self-sustaining!
Incubator Plan Components Component 4: Capital Improvement
Grants are designed to increase the infrastructure of FQHCs and FQHC look-alikes. Major equipment purchases Management information systems, hard
and software Major renovations, configuring existing
office space, central air conditioning, Purchase or lease of mobile units or
temporary facilities
FQHC Incubator Program RFP
Eligible Applicants Any public or private non-profit entity
investigating or developing or expanding a Federally Qualified Health Center (FQHC)
Development Grants, Transitional Operating Support, and Capital Infrastructure Grants have additional requirements
Includes existing FQHCs if they are planning to apply for Bureau of Primary Health Care (BPHC) New Access Point (NAP) Expanded Medical Capacity (EMC) Service Expansion Grants (SExp)
Using the Funds These funds may not replace other
funds All contracts will begin on March 1
Expenses incurred before March 1 will not be reimbursed
All grant related expenses must be incurred by August 31, 2004
6 month budget
Performance Measures: Beginning of the Logical Plan We provided them with the
performance measures they needed to meet
The performance measures provide to you and the applicant are the required steps of developing an FQHC!
Performance Measures tables should be filled in
Performance Measures: Opportunity to Tailor Applicant may have additional
performance measures Select key performance measures
should/could be identified as budget deliverables
In-kind (internal and external) resources should be identified in leveraged box
Present a Logical Plan Work plan should be a description
of how they are going to achieve performance measures
Budget should reflect that they have adequate resources to accomplish the activities in the work plan
Development Grants Performance Measures Correction: “Completed 330 funding
application AND/OR FQHC-LA application” A 330 funding application can be prepared
after the last federal deadline (June, 2004) so that it is ready for FY 05 funding cycles
Identify technical assistance performance measures if applicant is a young organization
Transitional Operating Support (TOS) Performance Measures Expectation is, regardless of success in
obtaining 330 grant dollars, a new clinic or expanded services will be sustainable after FQHC Incubator Program funds end in FY 05.
If applicant also is requesting Development Grant, the timeline measures provided by TOS may dictate application completion dates the Development Grant performance measures section.
This is a 6-month budget.
Capital Infrastructure Performance Measures Service delivery plan refers to the
plan developed under FQHC Incubator Program Development Component OR applicant’s current service delivery plan.
Identify additional performance measures that pertain to applicant’s particular project
Work Plan Planning grant only applicants:
Do not make this more complicated than it is Max of 3 pages where 5 questions answered
Identified areas technical assistance and how applicant will go about obtaining
Applicants instructed to refer back to the Evaluation Criteria in writing their work plan
Applicants for Development Grants in combination with TOS and/or Capital Infrastructure
May not have all of the details worked out for TOS and/or Capital Infrastructure work plans and budgets
Should indicate what remains to be developed
Budget Deliverables based
Applicant will be paid when deliverable is completed and documentation provided to the Texas Primary Care Office
If deliverables not completed, will not be paid Categorical information will be tracked
Salaries, travel, equipment, etc. If in the development process may not have
details. Should have provided what is known.
Program Income If it is TOS Component, patient revenue
should be identified in Program Income. The percentage of total budget that
comes from the FQHC Incubator Program is the percentage of Program Income that belongs to the FQHC Incubator Program
TOS = 10% of total budget then 10% of program income must
be applied to project
Total Budget If TOS Component, total cost of
operating your clinic/satellite site should be documented (Budget Summary page 51).
Include in-kind, other grants
Request for Proposal (RFP) Evaluations
RFP Evaluation Process TDH review Panel Review Final Selections Contract Negotiations with
Applicants Contract Start Date March 1, 2004
Why A Panel Review? Opportunity for stakeholder
participation Imitates federal process Brings a variety of experiences and
perspectives to the table to review applications
Creates a transparent process
What to Look For in RFP Grant writing and reviewing is not rocket
science Logical plan on how they are going to
develop an FQHC and when they will apply for additional federal funding
Grant budget should be reasonable & logical Applications should reflect community
support TDH/PCO wants applicants to succeed!
What TDH Does Reviews all applications Screens for eligibility Make sure all of the required attachments are
in place Provides staff person to each review
committee Provides technical assistance to reviewers on
RFP and federal requirements Compiles scores and advisory comments Scrutinizes the budget Makes funding decisions
Overall Evaluation CriteriaCriteria Valu
e
Applicant BackgroundInvolvement in healthcareFocused on community primary care needsCultural competencyWork thus far on developing an FQHC including board training from Texas Association of Community Health Centers or the Texas Primary Care Office
10
Assessment NarrativeDescription of socio-economic and demographic indicatorsOther safety net sites, Medicaid/Medicare providers in the communityAnalysis of barriers to securing FQHC funding or FQHC-LA designation
5
…Overall Evaluation Criteria
Criteria Value
Collaborative EffortsPartnerships to increase access to health care specific to this projectCurrent coordination with other FQHCs or potential applicants on this project. If not, then a reasonable explanation for lack of collaboration on this project.Significant history of coordination with the Texas Association of Community Health Centers and/or the Texas Primary Care Office
15
Overall FQHC funding feasibilityCommitment of organization to develop safety net clinicTarget area will support expanded servicesAbility and commitment to meeting all FQHC requirementsGoverning board educated on FQHC requirements and committed to meeting requirements of new or expanded funding
20
Evaluation Criteria Per Component
Criteria Value
Performance Measures and Workplan and TimelineFor each of the performance measures listed in Section L, how well does the applicant plan to accomplish each of these measures.Timelines are reasonable; yet show diligent commitment to securing FQHC funding and/or FQHC-LA designationAble to complete in 6 monthsDoes the applicant plan to secure technical expertise and user input at appropriate junctures?
10
…Evaluation Criteria Per Component
Criteria Value
Deliverables and BudgetReasonableness of budgetDeliverables reflect significant development milestonesDeliverables are sufficiently specificApplicants with well-developed internal resources (i.e. existing FQHCs, hospitals, local health departments) demonstrate that significant internal resources are leveraged
10
…Evaluation Criteria Per Component
Criteria Value
Readiness for this ComponentReasonable preparation thus far for this componentAmount of work to complete between award and beginning the activities of this component minimalLikelihood that applicant will not be able to or might choose not to complete some of the performance measures
10
TOTAL PER COMPONENT 30
Final ScoreOverall Criteria Total Possible 65
Per Component Total Possible 30 per component
1 Component Applied for Total Possible Points
95
2 Components Applied forTotal Possible Points
125
3 Components Applied for Total Possible Points
155
4 Components Applied forTotal Possible Points
185
Final Score Percentage of Total Points Possible Received
Review Process Each application assigned to 3
reviewers Primary Reviewer Secondary Reviewer Reader
Reviewers read and score applications Reviewer Tool (purple form and on disk)
Present strengths and weaknesses of applications during committee meeting
Primary Reviewer Duties Read the application and be the lead
presenter during the committee meeting Fully complete the Reviewer Tool on the
disk provided before the committee meeting
Bring the completed Reviewer Tool on disk and a printed copy to committee meeting
Add comments from other committee members to Reviewer Tool during the meeting
Secondary Reviewer Duties
Read the application and be prepared to augment the presentation of the Primary Reviewer or bring up points of disagreement
Complete a written copy of the Reviewer Tool
You may choose to complete on disk, but are not required to.
If you choose to complete on disk, bring a printed copy to the committee meeting.
Be prepared to step in as Primary Reviewer if the assigned Primary Reviewer is unable to complete his/her duties
Reader Duties Read the application and be prepared to
augment the presentation of the other Reviewers or bring up points of disagreement
Complete a written copy of the Reviewer Tool You may choose to complete on disk, but are
not required to. If you choose to complete on disk, bring a
printed copy to the committee meeting.
Reviewer Tips Draw on your area expertise in evaluating the
application Be internally consistent on your scoring and the
review in general You can agree to disagree with other reviewers Do not ding applicants for listing their barriers
to completing the federal process instead… Evaluate if they have given sufficient consideration to
what barriers exist Evaluate their plan to address their barriers
Use the Texas Primary Care Staff as resources on the RFP and federal requirements
Reviewer Essentials 4 Components
Planning Grants Development Grants Transitional Operating Support Capital Development Funds
Logical Plan Describe in work plan how they will be performance measures
and budget enough money to get it done You are not responsible for knowing every detail of the
RFP Use Advisory Comments to address areas of concern Bring your area of expertise to the review committee Be internally consistent
Concerns If you have concerns about being able to complete
your reviews, please contact someone in the Primary Care Office immediately.
It is much easier to find a substitute reviewer now than the day before the committee meetings.
We know you are all doing this without any additional compensation and we are eternally grateful.
We want to make this as easy as possible so please call us if there is something that we can do.
Questions? Program or RFP Questions:
Jennifer Jones, Kate Martin, Cliff [email protected]@[email protected]
Logistics Questions:Vickie Hamilton or Mike [email protected]@tdh.state.tx.us
