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Capital Improvement Program HRSA09244

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Title: Capital Improvement Program HRSA09244


1
Capital Improvement ProgramHRSA-09-244
  • Equipment Projects
  • IT/Equipment and HIT
  • May 8, 2009

2
Objectives
  • Discuss activities to be supported through
    Capital Improvement Program (CIP) the various
    equipment projects
  • Highlight specific application requirements
  • Provide technical assistance resources

3
CIP Funding
  • 850M one-time, 2-year project/budget period FY
    2009 grants to support
  • Construction
  • Renovation and equipment
  • Acquisition of health information technology
  • Grantees must
  • Demonstrate improvements in access to health
    services for the underserved populations
  • Create health center and construction-related
    jobs
  • 2-Year project/budget period (July 1, 2009 June
    30, 2011)
  • Maximum funding based on CY 2008 UDS Data Formula
  • All section 330 grantees eligible for 250K base
    amount
  • Plus 35 per patient served based on 2008 UDS as
    of 04/24/2009
  • New Start grantees without 2008 UDS data will
    have 250K maximum

4
CIP Funding, part 2
  • CIP guidance available May 1, 2009
  • One-time award for 2-year project/budget period
  • No on-going funding anticipated
  • Grantees will only be submitting one CIP
    application
  • Grantees may propose more than 1 project
  • Grantees will submit applications/requests
    through EHB
  • Applications due no later than June 2, 2009
    800PM ET
  • EHB-generated email
  • Eligibility code
  • Maximum eligible budget amount
  • Sent to all eligible Health Center Program
    grantees on May 2, 2009
  • Electronic application available May 4, 2009

5
Ineligible CIP Costs
  • Operating costs (e.g., funding direct services,
    clinical full-time equivalents, rent, mortgage
    payments, refinanced credit facilities).
  • Purchase of EHR systems that are not certified by
    an organization recognized by the Secretary of
    HHS.
  • Land or facility purchase costs are not eligible
    uses of CIP grant funding. Eligible projects may
    contain land/facility purchase costs however,
    individual project budgets must show sufficient
    resources other than CIP funding to cover those
    expenses.
  • None of the funds appropriated or otherwise made
    available under the Recovery Act may be used by
    any State or local government, or any private
    entity, for any casino or other gambling
    establishment, aquarium, zoo, golf course, or
    swimming pool.
  • Costs incurred prior to February 17, 2009.

6
Types of CIP Projects
  • The eligible project types are
  • Alteration/repair/renovation (a/r/r), with or
    without IT/equipment
  • Construction (new site or expansion of existing
    site), with or without IT/equipment
  • IT/equipment-only purchase
  • HIT-only purchase (non-EHR equipment)
  • Certified EHR-related purchase

7
RememberEquipment and Construction Projects
  • Equipment that will be utilized at the site at
    which an a/r/r or construction project is
    occurring should be included as part of that
    project.
  • Fixed equipment is that which requires
    installation, and should be proposed as an a/r/r
    project.
  • If IT, HIT, and EHR-related equipment will
    require significant installation, the grantee
    should propose an a/r/r or construction project
    to account for the installation of any fixed
    equipment. The grantee should also propose an
    IT/equipment, HIT, or EHR project to account for
    the purchase of all related IT, HIT, or EHR
    components.

8
Example of Equipment Projects
  • IT/Equipment-only Purchase
  • HIT-only Purchase
  • Certified EHR-only Purchase
  • These CIP project types may be
  • Site-specific
  • Multi-site
  • Organization-wide (inclusive of all sites)

9
IT/Equipment-only Purchase
  • Definition
  • Tangible, nonexpendable personal property
  • Useful life of more than 1 year
  • Acquisition costs of 5,000 or more per unit or
    the capitalization threshold established by the
    recipient, whichever is less
  • For CIP includes nonexpendable supplies costing
    less than 5,000
  • Examples
  • Generators or back-up power supply
  • Practice management system enhancements
  • Telecommunication system upgrades
  • Upgrade or purchase of mobile units (e.g., vans,
    trailers)

10
HIT-only Purchase
  • Definition
  • Items or services designed for or support the use
    by health care entities or patients for the
    electronic creation, maintenance, access, or
    exchange of health information
  • Examples
  • Telehealth-related equipment
  • Electronic prescribing
  • Hardware, software, and integrated technologies
  • Licenses, intellectual property, upgrades
  • Enhancements necessary to interface between
    HIT/EHR and other electronic systems

For additional information on HIT, please see
http//healthit.ahrq.gov/toolbox.
11
Certified EHR-only Purchase
  • Definition
  • Computer software that providers use to track all
    aspects of patient care
  • Examples
  • Certified EHR software costs EHR application
    costs, maintenance, computer-based training,
    provider licenses
  • Infrastructure clinical facility costs wireless
    LAN infrastructure, LAN switches, tablets,
    cameras
  • Data infrastructure costs servers, routers,
    back-up software, fire suppression, physical
    security
  • Implementation staffing core team training,
    data migration, CIO, network administration

Unless these types of costs are bundled within
a certified EHR system project, they should be
proposed as IT/equipment project.
12
Equipment and Project Sites
  • ONLY for IT/equipment projects, grantees may
    propose that the project occur
  • At a site that is currently in the grantee's
    approved scope of project (Form 5B), or
  • At a new mobile site only for the purchase of the
    mobile unit, or
  • At a site previously added as part of a recently
    submitted but unapproved (not yet approved)
    Change in Scope request, or
  • At a site added via an a/r/r or construction CIP
    project
  • If a new site is proposed, the grantee must
    complete the required information in Form 5B and
    submit an Add Site Checklist as part of the CIP
    application (pages 37-39 of application guidance)
  • This change in scope request will be processed as
    part of the CIP application

13
Project Timeline
  • CIP funds must be obligated within the 2-year
    project/budget period
  • The following milestones should be included for
    8 on the Project Cover Page
  • Planning start and end dates
  • Project development start and end dates
  • Procurement start and end dates
  • Project completion date
  • Estimated date site will be operational

For purchase of mobile unitGrantee must verify
site is operational within 60 days of actual
completion date
14
SF-424C Budget (Construction Programs)
  • Allowable/Unallowable costs under CIP (pages
    19-22 of the CIP application guidance)
  • Line 10 (Equipment) list all equipment with
    costs 5,000 or greater
  • Line 11 (Miscellaneous) list all nonexpendable
    supplies with costs less than 5,000
  • Budget examples (pages 23-24) of the guidance
  • Budget Justification Detailed line-by-line
    narrative breakdown of all costs listed on the
    SF-424C Budget Page

15
Equipment List
  • Any equipment (including nonexpendable supplies
    that are less than 5,000) to be purchased with
    CIP funds will need to be listed and specific to
    the project

16
Equipment ListTypes
  • Clinical x-ray machine, CAT scanners, dental
    exam chair, centrifuge
  • Non-clinical office furnishings, elevators,
    telephones, HVAC/cooling, generators, mobile
    vans, laptops (not supporting an existing or new
    HIT or EHR)
  • HIT/EHR
  • Include any equipment supporting a new or
    existing HIT or certified EHR system

17
Environmental Review (National Environmental
Policy Act)
  • Environmental Information and Documentation
    Checklist (EID) (template, pages 41-52)
  • Must be completed and submitted with EACH project
    (applies to all project types) as part of the CIP
    application
  • Environmental Assessment
  • HRSA does not anticipate requiring an EA for
    IT/equipment or HIT projects
  • HRSA will make determination if it is required
    for any CIP project after review of the EID

18
Additional Considerations
  • Pre-award costs
  • No costs incurred or obligated prior to February
    17, 2009 are allowed
  • Costs incurred between February 17, 2009 and the
    NGA date may be allowable but are incurred at the
    risk of the grantee, given the parameters of the
    CIP funding
  • HRSA encourages grantees to implement
    sustainable/green design practices for all
    projects
  • Equipment must be maintained, tracked, and
    disposed of in accordance with 45 CFR 74.34 and
    92.32

19
Additional Considerations (cont.)
  • CIP projects must be distinct stand-alone
    projects (e.g., may not be used to plan for
    upcoming competitive opportunity)
  • Mobile units are allowable as IT/equipment
    projects permanently affixing modular units is
    allowable as a construction project
  • If the CIP project will result in a new service,
    the grantee should consider its capacity to
    maintain the service and must request to add the
    service as part of a separate Change in Scope
    request (not part of the CIP application)

20
General Post-Award Reminders
  • For any contract, grantees will need to make sure
    they follow the standard procurement principles
    that apply to all HHS grants.
  • HHS 45 CFR Parts 74 and 92 In order to ensure
    objective contractor performance and eliminate
    unfair competitive advantage, contractors that
    develop or draft grant applications, or contract
    specifications, requirements, statements of work,
    invitations for bids and/or requests for
    proposals shall be excluded from competing for
    such procurements.
  • (http//www.access.gpo.gov/nara/cfr/waisidx_07/45
    cfr74_07.html)
  • If the grantees find out that the CIP budget
    obligates money beyond 25 of the approved budget
    for all projects or 250,000, projects will need
    to be reviewed and possibly changed.

21
CIP Reporting
  • Impact of CIP funding
  • Number of new/improved sites
  • Number of health center jobs created and retained
  • Number of construction-related jobs created
  • Completion status ( complete)
  • Actual versus projected budget informationuses
    of CIP grant funds
  • Other ARRA reporting required by Act

22
Program Specific InformationProjects
Application Budget Summary Information
Update or Delete a Project
Add Project button
23
Program Specific InformationAdding a Project
  • Choose a project type from the list
  • If you select and confirm the wrong project type,
    you will not be able to change it. You will have
    to delete the project from the application and
    start over.
  • Enter a project title.

24
Program Specific InformationProjectsStatus Page
IT/equipment-only purchase (single or multi-site)
IT Project
  • Each project consists of numerous sections.
  • Each project has its own Status page.
  • Click the Update link in the Project Status
    table to open a section for editing.

25
Project InformationProject Cover Page
6 Standard Sections
  • Site Information
  • Project Management
  • Contact Information
  • Need
  • Implementation
  • Timeline

26
Project Information Project Impact
Direct Impacts indicated in terms of
  • Square feet improved
  • Square feet increased
  • of providers using the EHR or HIT
  • patients with EHR

Projected FTEs
27
Project Information Add Equipment Information
Select from 3 Types of Equipment
  • Clinical
  • Non-clinical
  • HIT/EHR

28
Project Information Project Budget
Application Budget Summary Information
Subtotalscalculated by system
These Totals carried over to Funding form (see
next slide)
29
Project Information Form 5BSites
Add Sites proposed in CIP A/R/R or Construction
Project
Pick Sites from Current Scope of Project
  • Grantees may not add a new site as part of an
    IT/equipment-only, HIT, or certified EHR-related
    project, although they may propose that these
    types of projects occur at a site added
    previously as part of an alteration/repair/renovat
    ion or construction project in the same
    application. (CIP Announcement HRSA-09-244 pages
    3-4)
  • By default the completion status of the site is
    marked as COMPLETE for sites picked from scope.
    You will not be allowed to update any information
    for such sites in the CIP application.

30
Project InformationForm 5BSites, Select from
Scope
Site Name 1
Site Name 1 Address
Site Name 2
Site Name 2 Address
Site Name 3
Site Name 3 Address
  • When picking a site from scope, simply select the
    site, and then click Save and Continue.

31
Project InformationEID Checklist
EID Checklistis a downloadable Template
that must be attached
32
Help Resources
33
CIP Application Technical Assistance
34
CIP Contacts
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