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

2. May 20092 Objectives  Discuss activities to be supported through Capital Improvement Program (CIP) the various equipment projects  Highlight specific application requirements  Provide technical assistance resources

3. May 20093 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. May 20094 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

5. May 20095 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. May 20096 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/equipment 3.IT/equipment-only purchase 4.HIT-only purchase (non-EHR equipment) 5.Certified EHR-related purchase

7. May 20097 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.

8. May 20098 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. May 20099 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. May 200910 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.http://healthit.ahrq.gov/toolbox

11. May 200911 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. May 200912 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. May 200913 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

14. May 200914 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. May 200915 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. May 200916 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

17. May 200917 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. May 200918 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. May 200919 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. May 200920 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)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.

21. May 200921 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

22. May 200922 Program Specific Information: Projects Add Project button Update or Delete a Project Application Budget Summary Information

23. May 200923 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.

24. May 200924 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

25. May 200925 Project Information: Project Cover Page 1.Site Information 2.Project Management 3.Contact Information 4.Need 5.Implementation 6.Timeline 6 Standard Sections:

26. May 200926 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. May 200927 Project Information: Add Equipment Information Select from 3 Types of Equipment: Clinical Non-clinical HIT/EHR

28. May 200928 Project Information: Project Budget Subtotals calculated by system These Totals carried over to Funding form (see next slide) Application Budget Summary Information

29. May 200929 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

30. May 200930 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

31. May 200931 Project Information: EID Checklist … that must be attached EID Checklist is a downloadable Template

32. May 200932 Help Resources ResourceTypePurpose https://grants.hrsa.gov/webexternal/home.aspWebsiteHRSA 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: callcenter@hrsa.govcallcenter@hrsa.gov Phone and/or E-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 BHCMISys@hrsa.govBHCMISys@hrsa.gov Phone and/or E-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).

33. May 200933 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 Equipmenthttp://www.epeat.net http://www.energystar.gov Procurementhttp://www.access.gpo.gov/nara/cfr/waisidx_07/45cfr74_07.html

34. May 200934 CIP Contacts Type of Assistance NeededPlease Contact Business, administrative, or fiscal issues related to this announcement Health Resources and Services Administration Office of Federal Assistance Management Division of Grants Management Operations  Neal Meyerson, Telephone: 301-443-5906; Email: NMeyerson@hrsa.gov NMeyerson@hrsa.gov  LaShawna Smith, Telephone: 301-443-4241; Email: LSmith3@hrsa.gov LSmith3@hrsa.gov Program issuesHealth Resources and Services Administration Bureau of Primary Health Care Office of Policy and Program Development  Marie Legaspi, Telephone: 301-594-4319  Meghan Ochal, Telephone: 301-594-2096  Beth Tchinski, Telephone: 301-443-1389 Email: BPHCRecovery@hrsa.govBPHCRecovery@hrsa.gov