Grant Opportunities for Tribes and Tribal Organizations National Indian Health Board National Tribal Health Reform Implementation Summit April 19, 2011 Marcia K. Brand, PhD Health Resources and Services Administration Department of Health and Human Services

Overview of Today’s Topics HRSA’s programs HRSA and the Affordable Care Act HRSA’s opportunities Applying for grants

HRSA - America’s Health Care Safety Net Health centers HIV/AIDS programs Maternal and child health programs National Health Service Corps Health care workforce training Rural health programs Organ and blood stem cell transplantation 340B drug pricing program

HRSA and the Affordable Care Act Increasing Access to Primary Care Services Investing in the Health Care Workforce Supporting Maternal and Child Health Broadening Access to 340B Drug Discounts Encouraging Prevention and Wellness

Bureau of Primary Health Care (BPHC) Types of Health Centers Administered by HRSA –Sec. 330 health centers –Public and private non-profit health care organizations that meet certain criteria and receive funds under the Health Center Program. –FQHC look-alikes – Health centers that have been identified by HRSA and certified by the Centers for Medicare and Medicaid Services as meeting the definitions of “health center” under Section 330, although they do not receive grant funding under Section 330.

Health Center Program FY 2010 appropriation of $2.19 billion. HRSA provides Federal grant funding to almost 1,200 health center grantees in every State, the District of Columbia, Puerto Rico, the Virgin Islands, and the Pacific Basin that deliver primary and preventive care through almost 8,500 comprehensive service sites. Health centers serve nearly 19 million patients, about 40% of whom have no health insurance. In FY 2009 $50.5 million was awarded to HRSA funded and IHS funded health centers.

Benefits of Becoming an FQHC Access to Federal grant funds to support the costs of uncompensated care (Health Center Program only) Eligible for -Enhanced reimbursement under Prospective Payment System (PPS) or other state-approved alternative payment methodology for services provided under Medicaid -Cost-based reimbursement for services provided under Medicare Participation in the 340B (discounted) Drug Pricing Program Health Professional Shortage Area Designation and participation in National Health Service Corps Federal Tort Claims Act (FTCA) malpractice coverage (Health Center Program only) Federal Loan Guarantee Program (Health Center Program only)

Health Centers and the Affordable Care Act The Affordable Care Act provides $11 billion in funding over the next 5 years for the operation, expansion, and construction of health centers throughout the Nation. $9.5 billion is targeted to: –Create new health center sites in medically underserved areas. –Expand preventive and primary health care services, including oral health, behavioral health, pharmacy, and/or enabling services, at existing health center sites. $1.5 billion will support major construction and renovation projects at community health centers nationwide.

Other Challenges Data collection –Integration of HRSA’s Uniformed Data System (UDS) requirements in the Resource and Patient Management System (RPMS). Populations served –A section 330 grantee must target services to meet the primary care needs of the entire community including all age groups, genders and ethnicities.

Health Workforce Health workforce strategy that: –Expands the capacity and improves distribution of the primary care workforce; –Encourages team-based care; –Focuses on elder care; –Reduces disparities in the health workforce; and –Develops the capacity to track and analyze health workforce data. Expands the nation’s capacity to train new primary care providers (physicians, nurse practitioners, physicians assistants) over five years.

Additional Investments in the Health Workforce Improve access to quality health care for the elderly by educating students and practitioners in geriatric patient care. Improve the diversity of the nation’s health workforce and reduce disparities. Improve our analytic capacity. –National Center for Health Workforce Analysis

Health Professions and the Affordable Care Act With $250 million from the Affordable Care Act’s Prevention and Public Health Fund: –Train new primary care providers: 500 residents; 600 nurse practitioners and mid-wives; 600 physician assistants. Fully trained by –Initiated the State Health Care Workforce Development Program. –Funded 10 Nurse Managed Health Clinics to provide access to primary care and increase community-based clinical training sites for APNs. Made an initial 11 Teaching Health Center GME awards in January. Launched the National Center for Health Workforce Analysis, a national resource on health workforce supply, demand and needs. Under the Affordable Car Act HRSA has established the Negotiated Rule Making Committee that will develop criteria for designation Medically Underserved Populations and Health Professional Shortage Areas.

Bureau of Clinician Recruitment and Service (BCRS) National Health Service Corps Loan Repayment Program -$50,000 toward repayment of student loans -Potential for additional years of support National Health Service Corps Scholarship Program -Tuition, fees and other educational costs -Living stipend

The National Health Service Corps (NHSC) Site Eligibility Provide comprehensive primary medical, oral, or mental health care services Site Development Be located in a Health Professional Shortage Area NHSC Application Process Recruitment and Retention FY 2010 loan repayment award goals of 4,000 NHSC clinicians

Additional BCRS Programs Nursing Education Loan Repayment Program Nurse Scholarship Program Faculty Loan Repayment Program Native Hawaiian Health Scholarship Program

NHSC Resources NHSC Job Opportunities List HRSA’s Geospatial Data Warehouse (HGDW) NHSC Call Center: RTSC: BCRS main line:

The Maternal and Child Health Bureau (MCHB) MCHB administers programs that serve more than 40 million women, infants and children each year. Title V Block Grants -$662 million in FY State Formula Block Grants -Special Projects of Regional and National Significance (SPRANS) -Community Integrated Service Systems (CISS) Healthy Start -101 Healthy Start sites in 38 states, the District of Columbia and Puerto Rico -There are 6 Healthy Start sites that serve a predominately AI/AN population.

Maternal and Child Health and the Affordable Care Act Maternal, Infant, and Early Childhood Home Visiting Program The Affordable Care Act authorizes and appropriates $1.5 billion for home visitation through In FY States, the District of Columbia, and five territories received funding through the program totaling approximately $88 million. Family-to-Family Health Information Centers The Affordable Care Act authorizes and appropriates $5 million per year through FY  $4.9 million in funding was announced in continued support to 50 states and the District of Columbia.  The funding announcement was released on October 26, 2010, with applications due on December 15, Awards anticipated by May 1, 2011.

Additional MCH Programs Universal Newborn Hearing Screening Traumatic Brain Injury Emergency Medical Services for Children Children with Autism and Epilepsy

HIV/AIDS Bureau Ryan White HIV/AIDS Program -Funds primary health care -Provides support services and medications The AIDS Drug Assistance Program (ADAP) -State-run ADAPs provide antiretroviral medications to patients who cannot afford them The Global HIV/AIDS Program -Part of the President’s Emergency Plan for AIDS Relief (PEPFAR); funds HIV care and treatment, health manpower and organizational capacity

The Ryan White Program Part A Heavily Impacted Cities Part B AIDS Drug Assistance Program (ADAP) Part C HIV Primary Care Part D Funding for women, infants, children, youth and families Part F Special Projects of National Significance AIDS Education and Training Centers Program Dental Reimbursement and Community-based Dental program Minority AIDS Initiative

Office of Rural Health Policy (ORHP) Supports and funds State Offices of Rural Health Administers various grant programs Conducts research Provides technical assistance Oversees the University of North Dakota’s Rural Assistance Center

ORHP Funding Opportunities Telehealth Resource Center Rural Health Outreach Program Rural Health Network Planning Grant Rural Health Network Development Grant Rural Health Quality Improvement Grant Rural Health Network HIT Program

Healthcare Systems Bureau (HSB) Organ and Blood Stem Cell Transplantation Programs Poison Control Program 340B Drug Pricing Program National Vaccine Injury Compensation Program

The Grant Process Overview of the competitive grant making process –What makes a successful application? –What makes a successful grantee? Process for becoming a grant reviewer

Office of Regional Operations Develop a partnership between HRSA regional offices, IHS Area Offices and tribes/urban Indian entities. Support HHS Regional Director in meaningful collaboration with tribal/urban Indian partners. Increase the culturally competent health professional workforce serving tribal/urban Indian communities (pipeline, scholarships & loans repayment, R&R). Support HRSA initiatives that reduce the burden of disease and improve the health of AI/AN people.

Key Resources HRSA Health Information Workforce Center Rural Assistance Center Grants.gov

Contact Information Marcia K.Brand, PhD Deputy Administrator, HRSA Tonya Bowers Director, Office of Policy and Program Development Bureau of Primary Health Care