May 20091 Capital Improvement Program HRSA-09-244 Equipment Projects: IT/Equipment and HIT May 8, 2009.

Capital Improvement ProgramHRSA-09-244

Equipment Projects:IT/Equipment and HIT

May 8, 2009

May 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

May 2009 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

May 2009 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 8:00PM 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

May 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.

May 2009 6

Types of CIP Projects

The eligible project types are:1. Alteration/repair/renovation (a/r/r), with or

without IT/equipment 2. Construction (new site or expansion of existing

site), with or without IT/equipment3. IT/equipment-only purchase4. HIT-only purchase (non-EHR equipment)5. Certified EHR-related purchase

May 2009 7

Remember:Equipment 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.

May 2009 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)

May 2009 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)

May 2009 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.

May 2009 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.

May 2009 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

May 2009 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 unit—Grantee must verify site is operational within 60 days of actual completion date

May 2009 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

May 2009 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

May 2009 16

Equipment List—Types

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

May 2009 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

May 2009 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

May 2009 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)

May 2009 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_07/45cfr74_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.

May 2009 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 information—

uses of CIP grant funds

Other ARRA reporting required by Act

May 2009 22

Program Specific Information:Projects

Add Project button

Update or Delete a Project

Application Budget Summary

Information

May 2009 23

Program Specific Information:Adding 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.

May 2009 24

Program Specific Information:Projects—Status Page

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.

IT/equipment-only purchase (single or multi-site)

IT Project

May 2009 25

Project Information:Project Cover Page

1. Site Information2. Project Management3. Contact Information4. Need5. Implementation6. Timeline

6 Standard Sections:

May 2009 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

May 2009 27

Project Information: Add Equipment Information

Select from 3 Types of Equipment:• Clinical• Non-clinical• HIT/EHR

May 2009 28

Project Information: Project Budget

Subtotalscalculated by system

These Totals carried over to Funding form

(see next slide)

Application Budget Summary

Information

May 2009 29

Project Information: Form 5B—Sites

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/renovation 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.

Add Sites proposed in CIP A/R/R or Construction Project

May 2009 30

Project Information:Form 5B—Sites, Select from Scope

When picking a site from scope, simply select the site, and then click “Save and Continue.”

Site Name 1

Site Name 2

Site Name 3

Site Name 1 Address

Site Name 2 Address

Site Name 3 Address

May 2009 31

Project Information:EID Checklist

… that must be attached

EID Checklistis a

downloadable Template

May 2009 32

Help Resources

Resource Type Purpose

https://grants.hrsa.gov/webexternal/home.asp Website HRSA Electronic Handbooks URL.

Call the HRSA Call Center at

877-Go4-HRSA/877-464-4772; 301-998-7373(9:00 AM to 5:30 PM ET M-F)

Email: [email protected]

Phone and/orE-mail

System help by phone or via e-mail. Do not use this for program questions.

Call the BPHC Help Desk at

1-301-443-7356(8:30 AM to 5:30 PM ET M-F)

Email [email protected]

Phone and/orE-mail

Program help by phone or e-mail.

There will extended hours of operation for the CIP initiative beginning May 30 and ending June 2, 2009.

For these dates the hours of operation will be 7:00 AM to 7:00 PM (ET).

May 2009 33

CIP Application Technical Assistance

Frequently Asked Questions

http://bphc.hrsa.gov/recovery/

Health Information Technology Toolbox

http://healthit.ahrq.gov/toolbox

Sustainable and Green Design

http://www.usgbc.org http://www.gghc.org

Equipment http://www.epeat.net http://www.energystar.gov

Procurement http://www.access.gpo.gov/nara/cfr/waisidx_07/45cfr74_07.html

May 2009 34

CIP Contacts

Type of Assistance Needed Please Contact

Business, administrative, or fiscal issues related to this announcement

Health Resources and Services AdministrationOffice of Federal Assistance ManagementDivision of Grants Management Operations

Neal Meyerson, Telephone: 301-443-5906; Email: [email protected]

LaShawna Smith, Telephone: 301-443-4241; Email: [email protected]

Program issues Health Resources and Services AdministrationBureau of Primary Health CareOffice of Policy and Program Development

Marie Legaspi, Telephone: 301-594-4319 Meghan Ochal, Telephone: 301-594-2096 Beth Tchinski, Telephone: 301-443-1389Email: [email protected]