Capital Improvement Program HRSA09244

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Capital Improvement ProgramHRSA-09-244

• Equipment Projects
• IT/Equipment and HIT
• May 8, 2009

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Objectives

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

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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

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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

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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.

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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

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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.

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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)

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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)

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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.
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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.
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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

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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
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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

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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

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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

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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

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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

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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)

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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.

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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

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Program Specific InformationProjects
Application Budget Summary Information
Update or Delete a Project
Add Project button
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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.

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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.

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Project InformationProject Cover Page
6 Standard Sections

• Site Information
• Project Management
• Contact Information
• Need
• Implementation
• Timeline

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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
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Project Information Add Equipment Information
Select from 3 Types of Equipment

• Clinical
• Non-clinical
• HIT/EHR

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Project Information Project Budget
Application Budget Summary Information
Subtotalscalculated by system
These Totals carried over to Funding form (see
next slide)
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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.

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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.

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