1. The State Offices of Rural Health Grant The State Offices of Rural Health Grant Keith J. Midberry, MHSA Department of Health & Human Services Health Resources and Services Administration Office of Rural Health Policy SORH Orientation Rockville, MD September 10, 2014

2. SORH Grant Program  Authorized by Public Health Service Act  Funded since 1991  FY 14 is 24 th year!  Primary goal -to assist States in strengthening rural health care delivery systems by creating a focal point for rural health in each State  Provides institutional framework to link rural communities with State / Federal resources.

3. State Offices of Rural Health  Single grantee in each of 50 States  Flexibility in deciding where to locate SORH 36 in State Health Departments / Agencies 36 in State Health Departments / Agencies 11 in institutes of higher learning 11 in institutes of higher learning 3 are not-for-profit organizations 3 are not-for-profit organizations  Many SORH Directors are also Directors of State Primary Care Organization (PCO )

4. Three Core Functions of SORH  Defined in authorizing legislation 1. Establish and maintain clearinghouse for collecting / disseminating information on: Rural health care issues; Rural health care issues; Research findings related to rural health; and Research findings related to rural health; and Innovative approaches to the delivery of care in rural areas (best practices). Innovative approaches to the delivery of care in rural areas (best practices).

5. Three Core Functions of SORH 2. Coordinate activities within state to avoid duplication of effort and activities. 3. Identify Federal, State and NGO programs and resources and provide technical assistance regarding application and participation.

6. SORH Funding  Federal-State Partnership  3:1 State matching funds required  FY14 is 24th year of the SORH program! – First appropriation in FY 91 was $1.6M – FY14 appropriation ~ $10M  Awarded ~$8.6M in FY 14, 45 States received $172,950 (~5% less than FY 12 award $180K)  Others: $168K (1), $163K (2), $158K (1) & $153K (1)  11 states had off-set of FY 12 un-obligated funds totaling $159K ($208K prior year)

7. SORH FYApprop. $MCumulative $M 911.6 9223.6 932.56.1 942.88.9 952.811.7 962.814.5 972.817.3 982.820.1 992.722.8 20002.725.5 20013.829.3 2002736.3 20038.444.7 20048.453.1 20058.361.4 20068.269.6 20078.277.9 20087.985.9 20099.295.1 201010105.1 201110115.1 201210124.9 20139.5134.4 20149.5143.9

8. State - Matching Funds  $3 State match for every $1 of Federal funds requested - Leveraged ~ $4025M to date  Covered by Title 45 CFR - Part 74 for nonprofits and university based models - Part 72 for State governments / agencies  Budget and Budget Justification must include use of State matching funds

9. Grant Limitations  May not be used for: providing health care services providing health care services purchasing medical equipment, vehicles or communications equipment purchasing medical equipment, vehicles or communications equipment to purchase or improve real property to purchase or improve real property conduct activity regarding a certificate of need conduct activity regarding a certificate of need lobbying purposes lobbying purposes

10. Grant Limitations (cont.)  No more than 10 percent of funds may be used for research purposes  Indirect charge allowed only if SORH has current indirect rate approved by HHS - Attach form or explain, usually a percent of salaries / fringe or direct costs  - 15% cap no longer applies

11. Required Meetings  State travel restrictions still impact some SORHs  ORHP recently sent letter signed by Associate Administrator, will contact state if requested  Three required meetings as condition of award: 1. NRHA Annual Meeting – Philadelphia, PA / April 2015 2. SORH Regional Meetings - May thru Sep. 2015 3. NOSORH Annual meeting - Omaha, NE / Oct. 21-23, 2014  SORH funds can be used for non-required meetings (i.e. NRHA Policy Institute *, CAH conference)  Travel estimates must be itemized in budgets!

12. Performance Measures FY 08 started collection of two “new” performance / GPRA measures: - Number of technical assistance encounters provided directly by SORH FY 08 started collection of two “new” performance / GPRA measures: - Number of technical assistance encounters provided directly by SORH - Number of unduplicated clients that received TA directly by SORH - Number of unduplicated clients that received TA directly by SORH - Provide examples - Provide examples - Submit directly into EHB / Performance Information Measurement System (PIMS) by August 30th - Submit directly into EHB / Performance Information Measurement System (PIMS) by August 30th

13. PIMS  FY 13 data submitted via EHB by August 30, 2013  Some SORHs modified their collection instrument  Total TA increased from 64,321 to 83,878  Total Unduplicated Clients increased from 27,259 to 28,072  Ratio of TA to Client increased from ~2.3:1 to ~3:1  Confusion about affiliated versus non-affiliated clients appears to have waned  After discussion with RL, input may still be revised  Collect same way during FY 13, watch trend  Will soon provide display of six year trend (FY 08 – 13)  (Change to PIMS report FY 10, examples must match TA & Client total  NOSORH collecting optional measures and offering TruServe reporting tool to SORHs

14. SORH Unobligated Balance Issue Determined when Federal Financial Form submitted Total UOB decreased from $1.1M in FY 10 (13%) to $642K (7%) in FY 11, to $XXXXK (X%) in FY 12. Now have six year look back - FY 07 thru FY 12. Five year total - $4.2M, average of ~10% per year. 10 SORHs account for ~65% of total UOB. 25 SORHs averaged less than $10K per year and of those17 had less than $5K per year! Only 4 SORHs have had no UOB during past five years! Your Project Officer can provide UOB history. Program integrity requires UOB history be factor in determining future awards.

15. What’s Next?  Unprecedented times!  FY13 UOBs, up or down?  FY15 budget to be determined.  Emphasis program integrity / scrutiny travel & meetings.  Re-authorization / Indirect cap / match?  Apply lessons learned to FY 15 competing continuation, draft FOA by fall 2015.  Base awards, compete for balance?  Determine rurality, any ideas?  NOSORH input valuable and desired!  See you in Omaha, NC – I hope!

17. Contact Information  Office of Rural Health Policy http://ruralhealth.hrsa.gov (301) 443-0835  Keith J. Midberry, MHSA SORH Program Coordinator kmidberry@hrsa.gov kmidberry@hrsa.gov (301) 443-2669 (301) 443-2669