U.S. Department of Health and Human Services

**Health Resources and Services Administration**

####### Bureau of Primary Health Care

State and Regional Primary Care Associations (PCAs)

**State and Regional Primary Care Associations *(PCAs)***

**Cooperative Agreement**

[]{.mark}

## New Competition 

[]{.mark}

HRSA-06-062

## Catalog of Federal Domestic Assistance (CFDA) No. 93.129 

# Program Guidance

Fiscal Year 2006

**Application Due Date: *November 1, 2005 at 5:00 P.M. ET***

Date of Issuance: **August 5, 2005**

Guidance Contact: Cicely Nelson

Public Health Analyst, Division of Health Center Development

Telephone: (301) 594-4496

Fax: (301) 594-4997

Email: <CNelson@hrsa.gov>

Authority: Public Health Service Act, Title III, Section 330(l), 42
U.S.C.254b

**EXECUTIVE SUMMARY**

**SUMMARY**

The Health Resources and Services Administration's (HRSA) Bureau of
Primary Health Care (BPHC) announces the availability of up to \$29
million in fiscal year 2006 for approximately 55 cooperative agreements
for the purpose of providing training and technical assistance (TA) to
consolidated health centers on a Statewide or regional basis. This
funding is to support the capacity of State and Regional Primary Care
Associations (PCAs) to address the following overarching goals:

1.  Expanding and maintaining access to primary and preventive care;

2.  Strengthening existing health centers; and

3.  Improving the quality of care for BPHC-supported programs.

**LESIGLATIVE AUTHORITY**

Funds awarded under the authority of Section 330(l) of the Public Health
Service Act, as amended, authorize the provision of technical and other
assistance to eligible entities to assist such entities in meeting
requirements applicable to health centers. Services provided may include
necessary technical and non-financial assistance, including fiscal and
program assistance, training in fiscal and program management,
operational and administrative support, and the provision of information
regarding available federal resources, and how those resources can be
best used to meet the health needs of the communities served.

**ELIGIBLE APPLICANTS**

Eligibility is limited to current and/or new State and Regional PCAs who
work with BPHC-supported programs or other community-based providers
with similar missions and governance throughout their State or region.

The HRSA/BPHC anticipates making approximately 55 awards across all
States and U.S. territories. In those States where both a regional and
state structure exists or is contemplated, these organizations should
collaborate to ensure that there is no overlap or duplication in
function or proposed activities in the respective applications. Awards
will be made for a 12-month budget period beginning April 1, 2006 and
ending March 31, 2007. Applicants may propose a multi-year project
period: five-years for existing grantees and three-years for new
organizations.

**BACKGROUND**

The mission of HRSA is to assure equal access to comprehensive,
culturally competent, quality health care throughout the Nation. In
particular, HRSA/BPHC works to assure the availability of quality health
care to low-income, uninsured, isolated, vulnerable, and special needs
populations and to meet these populations' unique health care needs. The
recipients of this funding are an important partner in enabling
HRSA/BPHC to achieve this mission. Because they engage with all safety
net providers throughout the State, they are uniquely positioned to work
with providers, policy makers, program administrators, and communities
to advance the goals of increasing access and reducing disparities. The
HRSA/BPHC is committed to continuing to seek ways through which
partnerships can be maintained and developed to assist with expanding,
strengthening, and improving the quality of care for consolidated health
centers.

**PRE-APPLICATION CONFERENCE CALLS**

The BPHC will hold one pre-application TA call for applicants seeking
State and Regional PCA funding. The TA call will provide an overview and
other information regarding this application guidance and will include a
question and answer session. Please visit the program website at
<http://bphc.hrsa.gov/osnp/pcapco.htm> for the date, time, dial-in, and
other information for the call.

**Applicants may obtain additional information regarding this program
guidance or the application process in general by contacting:**

> Cicely Nelson
>
> Public Health Analyst, Division of Health Center Development
>
> Attn: State and Regional PCAs
>
> Bureau of Primary Health Care, HRSA
>
> 5600 Fishers Lane, Mail Stop 17-61
>
> Rockville, MD 20857
>
> Telephone: (301) 594-4496
>
> Fax: (301) 594-4997
>
> Email: <CNelson@hrsa.gov>

**Applicants may obtain additional information related to the overall
program issues by contacting:**

> Rebecca Braccia
>
> Public Health Analyst, Division of State & Community Assistance
>
> Bureau of Primary Health Care, HRSA
>
> 5600 Fishers Lane, Mail Stop 15C-05
>
> Rockville, MD 20857
>
> Telephone : (301) 594-0817
>
> Fax : (301) 480-7833
>
> Email : <RBraccia@hrsa.gov>

**Table of Contents**

**I. FUNDING OPPORTUNITY DESCRIPTION 5**

1.  Purpose 5

2.  Background 5

3.  Program Expectations for State and Regional Primary Care
    Associations 5

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I.  **AWARD INFORMATION 6**

> Type of Award 6
>
> Summary of Funding 6

II. **ELIGIBILITY INFORMATION 7**

    1.  Eligible Applicants (Who Can Apply) 7

    2.  Cost Sharing/Matching 7

III. **APPLICATION AND SUBMISSION INFORMATION 7**

     1.  Address to Request Application Package 7

     2.  Content and Form of Application Submission 7

> Application Format Requirements 7
>
> Application Format 8

i.  Application Face Page 8

ii. Table of Contents 9

iii. Application Checklist 9

iv. Budget 9

v.  Budget Justification 10

vi. Staffing Plan and Personnel Requirements 11

vii. Assurances 11

viii. Certifications 12

ix. Project Abstract 12

x.  Program Narrative 12

xi. Appendices 16

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3.  Submission Dates and Times 16

4.  Intergovernmental Review 17

5.  Funding Restrictions 17

6.  Other Submission Requirements 17

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IV. **APPLICATION REVIEW INFORMATION 19**

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1.  Review Criteria 19

2.  Review and Selection Process 21

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V.  **AWARD ADMINISTRATION INFORMATION 22**

    1.  Award Notices 22

    2.  Administrative and National Policy Requirements 22

    3.  Reporting 22

VI. **AGENCY CONTACTS 23**

VII. **TIPS FOR WRITING A STRONG APPLICATION 24**

VIII. **ATTACHMENTS 25**

      1.  Program Expectations for State and Regional PCAs 25

      2.  Sample Project Work Plan 30

# Funding Opportunity Description

#### 1. Purpose

This announcement solicits applications for State and Regional Primary
Care Associations (PCAs) to apply for support through a cooperative
agreement from the Health Resources and Services Administration's (HRSA)
Bureau of Primary Health Care (BPHC) for a 12-month budget period
beginning April 1, 2006 and ending March 31, 2007 and up to a 5 year
project period.

The purpose of this funding opportunity is to support State and/or
Regional PCAs' capacity to address the following overarching goals:

1.  Expanding and maintaining access to primary and preventive care;

2.  Strengthening existing health centers; and

3.  Improving the quality of care for BPHC-supported programs.

***Legislative Authority***

Section 330(l) of the Public Health Service Act, as amended, authorizes
the provision of technical and other assistance to eligible entities to
assist such entities in meeting requirements applicable to health
centers. Services provided may include necessary technical and
non-financial assistance including fiscal and program management
assistance, training in fiscal and program management, operational and
administrative support, and the provision of information regarding
available Federal resources, and how these resources can best be used to
meet the health needs of communities served.

**2. Background**

The mission of HRSA is to assure equal access to comprehensive,
culturally competent, quality health care throughout the Nation. In
particular, HRSA/BPHC works to assure the availability of quality health
care to low-income, uninsured, isolated, vulnerable, and special needs
populations and to meet the unique health care needs of these
populations. The recipients of this funding are an important partner in
enabling HRSA/BPHC to achieve this mission. Because they work with all
safety net providers throughout the State, they are uniquely positioned
to work with providers, policy makers, program administrators, and
communities to advance the goals of increasing access and reducing
disparities. A key element of this partnership is HRSA/BPHC's
establishment of a cooperative agreement in each State and/or region.
These funds are intended to enable recipients to perform core functions
and achieve outcomes in their State and/or region that advance the
overall HRSA/BPHC mission.

**3. Program Expectations for State and Regional Primary Care
Associations**

Please refer to Attachment 1 -Program Expectations for State and
Regional Primary Care Associations. These expectations describe core
functions that HRSA/BPHC expects organizations to achieve with funding.
Based on its assessment of the State, market, and community environment,
and as a result of successful partnering and collaboration, each
organization will engage in activities which support HRSA/BPHC funded
programs and have a measurable and positive impact on the health status
of the underserved and/or vulnerable populations.

In support of HRSA/BPHC's overarching goals to expand and maintain
access to primary and preventive care, strengthen existing health
centers, and improve the quality of care, PCAs are expected to focus on
the following seven core functions:

1.  Maintaining and Strengthening Health Centers

2.  Surveillance

3.  Health Center Growth Assistance

4.  Workforce

5.  Liaison/Collaboration/Partnering

6.  Clinical Quality

7.  Leveraging and Enhancing Health Center Revenues

# II. Award Information

#### 1. Type of Award

Funding will be provided in the form of a cooperative agreement.
Cooperative agreements are a type of Federal assistance that involves a
substantial level of government participation in funded activities.

***Federal Responsibilities***

Federal responsibilities under the cooperative agreement, in addition to
the usual monitoring and technical assistance, include, but are not
limited to, the following:

-   Collaborate on the development and coordination of the proposed work
    plan for activities funded through the cooperative agreement based
    on HRSA/BPHC priorities.

-   Final approval of the work plan.

-   Ongoing monitoring of the activities of the work plan through
    face-to-face and telephone meetings and the review of progress
    reports and key deliverables for activities funded through the
    cooperative agreement.

-   Attend and participate in appropriate meetings (e.g., State,
    national, committee).

-   Coordinate with other Bureaus within HRSA to develop synergies in
    programs.

***PCA responsibilities***

-   Collaborate on the development and coordination of the proposed work
    plan for activities funded through the cooperative agreement based
    on HRSA/BPHC priorities.

-   Attend and participate in appropriate meetings (e.g., State,
    national, committee).

-   Complete deliverables (e.g., Strategic Plan updates, Environmental
    Assessment, Semi Annual Report, non-competing application) as
    outlined by HRSA/BPHC.

## 2. Summary of Funding

Up to \$29 million is expected to be available to fund an estimated 55
awards. In those States and U.S. territories where both a regional and
state structure exists or is contemplated, these organizations should
collaborate to ensure that there is no overlap or duplication in
function or proposed activities in the respective applications.

It is expected that Federal support will not exceed the annual level of
Federal section 330 funding that is currently provided to a State or
region for functions and/or activities that continue to be a HRSA
priority for the State. The determination of final funding levels
awarded will be based on factors such as: the funds available,
performance, a State's TA/Training needs, and current HRSA priorities
such as support of Phase II of the President's Initiative and new start
Health Centers. Budgets presented in the application should be
reasonable and appropriate based on the proposed functions and
activities and consistent with the work-plan presented.

Applicants may propose a multi-year project period: five-years for
existing grantees and three-years for new organizations. Funding beyond
the first year is dependent on the availability of appropriated funds,
grantee satisfactory performance, and a determination that continued
funding is in the best interest of the Government.

**III. ELIGIBILITY INFORMATION**

### 1. Eligible Applicants (Who Can Apply)

Eligibility is limited to current and/or new State and Regional Primary
Care Associations who work with BPHC-supported programs or other
community-based providers with similar missions and governance
throughout their State or region.

### 2. Cost Sharing/Matching

There is no cost sharing or matching required for this funding
opportunity.

# IV. Application and Submission Information

### 1. Address to Request Application Package

Applicants must submit proposals using the appropriate Public Health
Service (PHS) Application Form 5161-1. This form contains additional
general information and instructions for grant applications, proposal
narratives, and budgets. The form may be obtained from the following
sites by:

a.  Downloading from
    [www.hrsa.gov/grants/forms.htm](http://www.hrsa.gov/grants/forms.htm);
    or

b.  Contacting the HRSA Grants Application Center at:

> The Legin Group, Inc.

###### Attn: State and Regional PCA Cooperative Agreement

> *Program Announcement No. HRSA-06-062*
>
> *CFDA No. 93.129*
>
> 901 Russell Avenue, Suite 450

Gaithersburg, MD 20879

> Telephone: (877) 477-2123
>
> Email: <HRSAGAC@hrsa.gov>
>
> []{.mark}

Instructions for preparing portions of the application that must
accompany PHS Application Form 5161-1 appear in the "Application Format"
section below.

### 2. Content and Form of Application Submission

#### 

#### *Application Format Requirements*

If applying on-line, the total size of all uploaded files **may not
exceed the equivalent of 80 pages when printed by HRSA, approximately 10
MB.** **This 80-page limit includes the abstract, project and budget
narratives, attachments, appendices and letters of commitment and
support.**

> If applying on paper, **the entire application may not exceed 80 pages
> in length.** Pages must be numbered consecutively.

**Applications, whether submitted on paper or electronically, that
exceed the specified limits (80 pages or approximately 10 MB, or that
exceed 80 pages when printed by HRSA) will be deemed non-compliant. All
non-compliant applications will be returned to the applicant without
further consideration.**

a.  Number of Copies (Paper Applications only)

> Please submit one original and two unbound copies of the application.
>
> Please do not bind or staple the application. Application must be
> single sided.

b.  Font

> Please use an easily readable serif typeface, such as Times Roman,
> Courier, or CG Times. The text and table portions of the application
> must be submitted in not less than 12 point and 1.0 line spacing.
> Applications not adhering to 12 point font requirements may be
> returned.
>
> []{.mark}

c.  Paper Size and Margins

> For scanning purposes, please submit the application on 8 ½" x 11"
> white paper. Margins must be at least one inch at the top, bottom,
> left and right of the paper. Please left-align text.
>
> []{.mark}

d.  Numbering

> Please number the pages of the application sequentially from page 1
> (face page) to the end of the application, including charts, figures,
> tables, and appendices.

e.  Names

> Please include the name of the applicant on each page.

f.  Section Headings

> Please put all section headings flush left in bold type.

#### *Application Format*

Applications for funding must consist of the following documents in the
following order:

##### Application Face Page 

> Public Health Service (PHS) Application Form 5161-1 is provided with
> the application package. Prepare this page according to instructions
> provided in the form itself. For information pertaining to the Catalog
> of Federal Domestic Assistance (CFDA), the CFDA Number is 93.129.
>
> **DUNS Number**
>
> All applicant organizations are required to have a Data Universal
> Numbering System (DUNS) number in order to apply for a grant from the
> Federal Government. The DUNS number is a unique nine-character
> identification number provided by the commercial company, Dun and
> Bradstreet. There is no charge to obtain a DUNS number. Information
> about obtaining a DUNS number can be found at
> [http://www.hrsa.gov/grants/preview/dunsccr.htm](http://www.hrsa.gov/grants/preview/dunsccr.htm )
> or call 1-866-705-5711. Please include the DUNS number next to the OMB
> Approval Number on the application face page. Applications ***will
> not*** be reviewed without a DUNS number.
>
> Additionally, the applicant organization will be required to register
> with the Federal Government's Central Contractor Registry (CCR) in
> order to do electronic business with the Federal Government.
> Information about registering with the CCR can be found at
> [http://www.hrsa.gov/grants/preview/dunsccr.htm](http://www.hrsa.gov/grants/preview/dunsccr.htm ).

##### Table of Contents

> Provide a Table of Contents for the remainder of the application
> (including appendices), with page numbers.

##### Application Checklist 

> Use PHS Application Form 5161-1, provided with the application
> package.

##### Budget (for Multi-Year Awards)

> This announcement is inviting applications for project periods[^1] of
> up to five years. Awards to be issued on a competitive basis will be
> for a one-year budget period, although a project period may be for up
> to five years. Applications for continuations funded under these
> awards beyond the one-year budget period but within the five year
> project period will be entertained in subsequent years on a
> noncompetitive basis---subject to availability of funds, satisfactory
> progress of the grantee, and a determination that continued funding
> would be in the best interest of the Government.

######### 

> Use PHS Application Form 5161-1 provided with the application package.
> It is expected that the request for Federal support and the budgets
> presented in the application will be reasonable and appropriate for
> the scope of the proposed activities. **It is the responsibility of
> the applicant to demonstrate in their application that requested funds
> are not duplicative and will not be used to supplant or replace other
> funding sources (see page 17 for further information on Funding
> Restrictions).** The budget section consists of the following:

a.  SF-424A

> Use PHS Application Form 5161-1 provided with the application package.
> *Please complete Sections A, BC, E, and F, and then provide a line
> item budget for each requested year of funding using the budget
> categories in the SF 424A.*

b.  Line Item Budget

> Applicants must submit 12-month budgets that reflects (i) the total
> necessary costs for the proposed projects and (ii) the total number of
> years funding is being requested (i.e., if an applicant is requesting
> a five year project period, five 12-month budgets will need to be
> submitted with the application).

##### Budget Justification

> Provide a narrative that explains the amounts requested for each line
> in the budget. The budget justification should specifically describe
> how each item will support the achievement of proposed objectives. The
> budget period is for ONE year (12 months, from April 1, 2006 to March
> 31, 2007).
>
> Applicants should also provide the total cost associated with each
> objective in the work plan by the seven core functions. Please refer
> to Attachment 2, Sample Project Work Plan, as an example.
>
> The applicant must submit one-year budgets for each of the subsequent
> requested budget period years (up to five years) at the time of
> application. No breakdown by objective is required for the subsequent
> requested budget period years (year two - year five). Line item
> information must be provided to explain the costs entered in the
> appropriate form, PHS Application Form 5161-1. The budget
> justification must clearly describe each cost element and explain how
> each cost contributes to meeting the project's objectives/goals.
> Please provide a justification for each item in the "other" category.
> The budget narrative MUST be concise. Do NOT use the budget
> justification to expand the project narrative. The budget (and budget
> justification) should be consistent with the project work plan
> proposed in the application.
>
> Include the following in the Budget Justification narrative.
>
> *Personnel Costs:* Personnel costs should be explained by listing each
> staff member who will be supported from funds, including the name (if
> possible), position title, percent full time equivalency, annual
> salary, and the exact amount requested for each budget year.

-   Identify each key position referred to in the Project Narrative or
    work plan and provide the names of each person filling this
    position, along with his/her annual salary. Indicate if the position
    is currently vacant.

-   Provide a listing of all filled and vacant personnel positions
    supported by this cooperative agreement, percent of time allocated
    to program, and projected salaries. Applicants may provide this
    listing by position category.

> []{.mark}
>
> *Indirect Costs:* Indirect costs are those costs incurred for common
> or joint objectives which cannot be readily identified but are
> necessary to the operations of the organization, e.g., the cost of
> operating and maintaining facilities, depreciation, and administrative
> salaries. If indirect costs are requested in the budget, applicants
> must submit a copy of the organization's most current and approved
> Federal negotiated indirect cost rate agreement. For institutions
> subject to OMB Circular A-21, the term "facilities and administration"
> is used to denote indirect costs. If an applicant does not have an
> indirect cost rate, it may apply for one by visiting the Division of
> Cost Allocation website at http://rates.psc.gov/.
>
> []{.mark}
>
> *Fringe Benefits:* List the components that currently comprise what is
> included in the PCA's fringe benefit rate (e.g., health insurance,
> taxes, unemployment insurance, life insurance, retirement plan, and
> tuition reimbursement). The fringe benefits should be directly
> proportional to the amount of time or effort employees devote to the
> grant-supported project provided such costs are incurred under
> formally established and consistently applied policies of the
> organization. Provide an explanation for any increase greater than
> five percent over the prior year rate.
>
> *Travel:* Itemize travel costs according to traveler type \[Executive
> Director (ED), Project Director, Board Member, etc.\] and explain how
> the amounts were developed. Estimate number of trips and the costs
> associated with each trip (e.g., ED with 12 trips @ \$1,200 each). The
> budget should also reflect the travel expenses associated with
> participating in meetings and other proposed trainings or workshops.
> Adequate travel costs must be budgeted to include at least one trip to
> HRSA/Central Office to meet with the project officer to finalize goals
> and objectives under the cooperative agreement, and one trip to the
> HRSA/BPHC All Grantee Annual Meeting.
>
> *Equipment:* List equipment costs and provide justification for the
> need of the equipment to carry out the program's goals. Extensive
> justification and a detailed status of current equipment must be
> provided when requesting funds for the purchase of computers and
> furniture items. Only major equipment items (with a cost over \$5,000
> per unit) need to be itemized. Items costing less than \$5,000 should
> be aggregated with a brief explanation.
>
> *Supplies:* List the items that the project will use. In this
> category, separate office supplies from medical and educational
> purchases. Office supplies could include paper, pencils, and the like;
> medical supplies are syringes, blood tubes, plastic gloves, etc.; and
> educational supplies may be pamphlets and educational videotapes.
> Remember, they must be listed separately. Describe how estimates or
> projections for supplies were made.
>
> []{.mark}
>
> *Subcontracts:* To the extent possible, all subcontract budgets and
> justifications should be standardized, and contract budgets should be
> presented by using the same object class categories contained in the
> Standard Form 424A. Provide a clear explanation as to the purpose of
> each contract, how the costs were estimated, and the specific contract
> deliverables.
>
> *Other:* Put all costs that do not fit into any other category into
> this category and provide a clear explanation of each cost in this
> category. In some cases, consultant costs for technical assistance,
> legal fees, grantee rent, utilities, and insurance fall under this
> category if they are not included in an approved indirect cost rate.

##### Staffing Plan and Personnel Requirements

> Applicants must present a staffing plan and provide a justification
> for the plan that includes education and experience qualifications and
> rationale for the amount of time being requested for each staff
> position. Copies of biographical sketches or resumes for any key
> currently employed personnel that will be assigned to work on the
> proposed project must be included in Appendix A.

##### Assurances

> Application Form 5161-1 provided with the application package.

##### Certifications

> Application Form 5161-1 provided with the application package.

##### Project Abstract \[Recommended one to two pages\]

> Provide a summary of the application. Because the abstract is often
> distributed to provide information to the public and Congress, please
> prepare this so that it is clear, accurate, concise, and without
> reference to other parts of the application. It must include a brief
> description of the proposed grant project including the needs to be
> addressed, the proposed services, and the population group(s) to be
> served.
>
> Please place the following information at the top of the abstract:

-   Applicant name

-   Address

-   Contact information (name, title, voice, fax, email)

-   Web address, if applicable

> **The project abstract must be single-spaced and limited to two pages
> in length.**

##### Program Narrative

> This section provides a comprehensive framework and description of all
> aspects of the proposed program. It should be succinct,
> self-explanatory, and well organized so that reviewers can clearly
> understand the proposed project.
>
> Use the following section headers for the Narrative:
>
> 1\. NEED: State and/or Regional Needs Assessment \[Recommended three
> to four pages\]
>
> This section should describe/define the needs within the State and/or
> region. It should help reviewers understand the needs to be fulfilled
> by the proposed project and should provide the context and rationale
> for the proposed work plan and budget. For example, if the State
> and/or region have experienced rapid growth with new start
> organizations, it is expected that an increased focus be provided to
> assist with operational implementation. The work plan and budget
> should reflect the needs identified accordingly.
>
> This section should include the following information:

a.  A description of the State and/or region and its unmet health needs
    including major access barriers and health disparities in the State
    and the needs of special populations (i.e., migrant and seasonal
    farmworkers, homeless persons, and residents of public housing) as
    well as other subpopulations (racial and ethnic minorities, elderly
    persons, etc.) in the State and/or region. Demographic data should
    be used and cited whenever possible to support the information
    provided. Use indicators such as uninsured, penetration of health
    centers into unserved populations, etc.

b.  A description that identifies the current number of consolidated
    health center grantees and sites in the State and/or region,
    including new and expanded health centers and the needs identified.

c.  A description of the major State and/or regional environmental and
    marketplace issues affecting underserved populations and their
    providers. The applicant should have a broad perspective and
    understanding on issues that affect the underserved in their State.
    Examples of topics to be covered and addressed may include: major
    State health policy issues, key marketplace trends, opportunities
    and threats.

> 2\. RESOURCES/CAPABILITIES: Organizational and Functional Structure of
> Organization \[Recommended four to five pages\]
>
> This section should describe the organizational and functional
> infrastructure of the PCA that enables them to foster collaboration,
> assess unmet needs and health disparities, and plan accordingly to
> meet the need identified in the State and/or region. These
> organizations must have the capacity to respond quickly and in a
> coordinated fashion to the changes taking place in each State's health
> care environment. State/community data and information systems that
> integrate key State health policy, unmet needs, marketplace, and
> health disparities data/information should be in place to guide
> current/future strategic planning and developmental efforts. This
> section should describe the applicant's organizational effectiveness
> in response to the aforementioned, specifically its capacity to
> advance the goals of HRSA/BPHC to increase access to primary and
> preventive care, and improve the health status of underserved and
> vulnerable populations, particularly by strengthening and expanding
> the Nation's health centers and safety net.
>
> This section should include the following information:

a.  Key leadership positions/project personnel and the skill sets
    necessary to implement and complete the project's activities, goals
    and objectives.

b.  Operational structure and processes that demonstrates the PCA is an
    effective and efficient organizational that represents the diverse
    needs of the consolidated health center program. Specifically
    describe the assessment and evaluation methods of TA to ensure
    responsiveness to topical areas and the organizational strategic
    planning process, and its information systems that are in place to
    help guide this process.

c.  Key partnerships and working relationships with organizations in the
    State(s) and nationally that share similar missions and/or
    commitments to the underserved. Provide a short description of any
    formal or informal relationships that currently exist and how these
    partnerships will help the PCA to strengthen their ability to carry
    out the proposed objectives.

d.  Past performance to date and a brief overview of the following:

    -   Key accomplishments over the past two to three years.

-   Lessons learned including barriers encountered and the strategies
    developed to overcome them and how those may help to complement
    proposed activities.

> 3\. RESPONSE: Project Work Plan \[Maximum ten to eleven pages\]
>
> This section provides a format for applicants to demonstrate the
> clarity, feasibility, and scope of proposed goals and measurable
> objectives. The work plan's goals and objectives should be aligned
> with, and appropriate for, the needs assessment, proposed budget, and
> organizational capacity.
>
> **There are two components to this section: a.** Work Plan Matrix,
> which depicts the relationship between program goals, objectives,
> responsible person(s), timelines, and measures of success; and **b.**
> Work Plan Narrative, which expands on the work plan matrix to provide
> details of program implementation. These sections should address the
> PCA's seven core functions described in the program expectations.

a.  Work Plan MATRIX

> Applicants must submit a 12-month work plan for the budget period
> starting April 1, 2006 and ending March 31, 2007 that is broken down
> by each of the seven core functions. This work plan must provide a
> justification for funds being requested and should clearly demonstrate
> how ALL activities will be made available to ALL consolidated health
> center grantees in the State/region, regardless of membership status.
> It is strongly recommended that applicants use a landscaped
> orientation to format the work plan. The work plan should be
> structured as follows:

-   Goals/Core functions;

-   Objectives;

-   Action steps;

-   Identification of deliverables and performance indicators (as
    applicable/available);

-   Responsible individual(s); and

-   Due date(s).

> It is important to remember the work plan will provide the basis for
> the continued monitoring and reporting of proposed activities. A
> sample format for the work plan is included in the guidance as
> Attachment 2.

b.  WORK PLAN NARRATIVE

> This section should expand upon the work plan matrix. Specifically,

-   Describe how the project will be implemented.

-   Provide evidence of how the work plan addresses the needs identified
    in the Need section.

-   Address all core functions within the program expectations relative
    to identified needs.

-   Discuss challenges that are likely to be encountered in designing
    and implementing the activities described in the proposed work plan
    and approaches that will be used to resolve such challenges.

-   Provide evidence that training and technical assistance provided
    with BPHC funds will be made available to all consolidated health
    centers regardless of membership status.

> 4\. EVALUATIVE MEASURES: Program Performance Plan \[Recommended two
> pages\]

This section should describe an appropriate plan for evaluation of the
activities carried out under the cooperative agreement that ensures
monitoring and measurement of progress towards the corresponding goals
and objectives and uses the evaluation of findings to improve program
performance. Identify performance indicators (i.e.,
qualitative/quantitative indicators) or benchmarks to be achieved
through the proposed project and demonstrate the ability to assess and
document to what extent the objectives have been met. It is understood
measures in this section may be more process (than outcome) oriented.

> 5\. IMPACT \[Recommended two to three pages\]
>
> This section should include a description of (i) the organization's
> strategic plan; (ii) the organization's intermediate and long-term
> goals and the objectives projected outward for the duration of the
> proposed project period; and (iii) projected outcomes to meet the
> needs of underserved populations. Describe projected objectives and
> outcomes from year two until the end of the project period. Applicants
> should structure this section according to expanding and maintaining
> access to primary and preventive care, strengthening existing centers,
> and improving the quality of care for all BPHC-supported programs.

##### Appendices

> Please provide the following items to complete the content of the
> application. Please note that these are supplementary in nature and
> are not intended to be a continuation of the project narrative. Be
> sure each appendix is clearly labeled.

######## *Appendix A: Biographical Sketches/Resumes of Key Personnel*

Include biographical sketches/resumes for key personnel positions. Each
sketch/resume should not exceed two (2) pages in length. In the event
that a vacancy exists for a key project position, please include a job
description and a status of filling that position.

######## *Appendix B: Overview of Healthy People 2010*

Provide a brief overview of the relationship of the proposed project and
which objectives/ activities relate to the goals of the Healthy People
2010 Initiative in this section. Refer to section VI, Award
Administration Information below for additional information.

(1) *Appendix C: Earmarked Migrant Health Activities \[Recommended one
    to two pages}*

> For those PCAs that are proposing to use a portion of the funds
> allotted under this cooperative agreement to support the costs for a
> Migrant Stream Forum and/or a Migrant Health Coordinator, please
> include information on the activities to be undertaken as described in
> the work plan section, FTEs committed, and total cost for these
> activities.  For those states that conduct more than one of these
> activities, please show each of these activities as separate
> components. PCAs should also briefly describe any collaborative
> relationships with National cooperative agreement organizations.

### 3. Submission Dates and Times

#### *Application Due Date* 

The due date for applications under this grant announcement is November
1, 2005 at 5:00 P.M. ET.

Applications will be considered as meeting the deadline if they are
either:

> \(1\) Received on or before the due date; or
>
> \(2\) Post marked or E marked on or before the due date, and received
> in time for the Independent Review Committee review.

The Chief Grants Management Officer (CGMO) or a higher level designee
may authorize an extension of published deadlines when justified by
circumstances such as acts of God (e.g. floods or hurricanes),
widespread disruptions of mail service, or other disruptions of
services, such as a prolonged blackout. The authorizing official will
determine the affected geographical area(s).

**Electronic Submission:**

Applications must be submitted by 5:00 P.M. ET. **To ensure that you
have adequate time to follow procedures and successfully submit the
application, we recommend you start submission no later than noon on the
due date.** Applications submitted electronically will be time/date
stamped electronically, which will serve as receipt of submission.

**Paper Submission:**

Upon receipt of a paper application, the Grants Application Center will
mail an acknowledgement of receipt to the applicant organization's
Program Director.

In the event that questions arise about meeting the application due
date, applicants must have a legibly dated receipt from a commercial
carrier or the U.S. Postal Service. Private metered postmarks will not
be accepted as proof of timely mailing.

**Late applications:**

Applications which do not meet the criteria above are considered late
applications. Health Resources and Services Administration (HRSA) shall
notify each late applicant that its application will not be considered
in the current competition.

### 4. Intergovernmental Review

The State and Regional PCA is a program subject to the provisions of
Executive Order 12372, as implemented by 45 CFR 100. Executive Order
12372 allows States the option of setting up a system for reviewing
applications from within their States for assistance under certain
Federal programs. Application packages made available under this
guidance will contain a listing of States which have chosen to set up
such a review system, and will provide a State Single Point of Contact
(SPOC) for the review. Information on states affected by this program
and State Points of Contact may also be obtained from the Grants
Management Officer listed in the AGENCY Contact(s) section, as well as
from the following Web site:
<http://www.whitehouse.gov/omb/grants/spoc.html>.

All applicants other than federally recognized Native American Tribal
Groups should contact their SPOC as early as possible to alert them to
the prospective applications and receive any necessary instructions on
the State process used under this Executive Order.

Letters from the State Single Point of Contact (SPOC) in response to
Executive Order 12372 are due sixty days after the application due date.

### 5. Funding Restrictions

Requests for funds that duplicate, supplant, or replace funding
currently received from other sources---including other BPHC funds,
i.e., *Integrated Service Development Initiative* (ISDI), *Shared
Integrated Management Information Systems* (SIMIS), *Information and
Communication Technology* (ICT)*, Health Disparities Collaboratives*
(HDC)---will not be considered. It is the responsibility of the
applicant, in their application, to demonstrate that requested funds are
not duplicative and will not be used to supplant or replace other
funding sources.

### 6. Other Submission Requirements 

**Electronic Submission**

You may submit your application to us either in electronic or paper
format. To submit an application electronically, please use the
[http://www.Grants.gov](http://www.Grants.gov/) Apply site. If you use
Grants.Gov you will be able to download a copy of the application
package, complete it off-line, and then upload and submit the
application via the Grants.gov site. You may not e-mail an electronic
copy of a grant application to us.

Please note the following if you plan to submit your application
electronically via Grants.Gov:

> • Electronic submission is voluntary
>
> • When you enter the Grants.Gov site, you will find information about
> submitting an application electronically through the site, as well as
> the hours of operation. We strongly recommend that you do not wait
> until the application deadline date to begin the application process
> through Grants.Gov. The registration process is a separate process
> from submitting an application. **Applicants are, therefore,
> encouraged to register early**. The registration process can take
> approximately two weeks to be completed. Therefore, registration
> should be done in sufficient time to ensure it does not impact your
> ability to meet required submission deadlines. You will be able to
> submit your application online anytime after you receive your
> e-authentication credentials.
>
> • To use Grants.gov, you, as the applicant, must have a DUNS Number
> and register in the Central Contractor Registry (CCR). You should
> allow a minimum of five days to complete the CCR registration.
>
> • You will not receive additional point value because you submit a
> grant application in paper format.
>
> • You may submit all documents electronically, including all
> information typically included on the SF424 and all necessary
> assurances and certifications.
>
> • Your application must comply with any page limitation requirements
> described in this program announcement.
>
> • After you electronically submit your application, you will receive
> an automatic acknowledgement from Grants.Gov that contains a
> Grants.Gov tracking number. The Health Resources and Services
> Administration will retrieve your application from Grants. Gov.
>
> • You may access the electronic application for this program on
> [http://www.Grants.gov](http://www.Grants.gov/).
>
> • You must search for the downloadable application package by the CFDA
> number.
>
> • The grants.gov website provides customer support via (800)
> 518-GRANTS (this is a toll-free number) or through e-mail at
> [**support@grants.gov**](mailto:support@grants.gov). The customer
> support center is open from 7:00 a.m. to 9:00 p.m. Eastern time,
> Monday through Friday, except federal holidays, to address grants.gov
> technology issues. For technical assistance to program related
> questions, contact the number listed in the Program Section of the
> program you are applying for.

Online applications are required to submit ONLY one form in signed hard
copy: the SF-424/5161 Face Sheet, since all other elements of the
application have been captured and transmitted electronically. 

**Formal submission of the electronic application:** Applications
completed online are considered formally submitted when the Authorizing
Official electronically submits the application to HRSA. However, to
complete the submission requirements, a hard-copy of the SF-424/5161
Face Sheet must be printed, signed, and submitted to the HRSA Grants
Application Center. The SF-424/5161 can be printed from the online
application.

 

> For an online application, the signed SF-424/5161 must be sent to the
> HRSA GRANTS APPLICATION CENTER at the address below, and received by
> HRSA by no later than five days after the application due date.
>
> Applications will be considered as having met the deadline if: (1) the
> application has been successfully transmitted electronically by your
> organization's Authorizing Official through Grants.Gov or before the
> deadline date and time, and (2) the signed SF-424/5161 Face Sheet is
> received by HRSA no later than five days after the deadline date.

 

REMINDER: Only applicants who apply online are permitted to forego
hard-copy submission of all application forms EXCEPT the signed
SF-424/5161.

 

If the application is submitted as a hard-copy, the rules of submission
as described elsewhere in this guidance must be followed.

**Paper Submission**

If you choose to submit paper copy, please send the original and two
copies of the application to:

> The HRSA Grants Application Center
>
> The Legin Group, Inc.
>
> Attn: *State and Regional Primary Care Association (PCA)*
>
> Program Announcement No. *HRSA-06-062*
>
> CFDA No. *93.129*
>
> 901 Russell Avenue, Suite 450
>
> Gaithersburg, MD 20879
>
> Telephone: 877-477-2123

In the event that questions arise about meeting the application due
date, applicants must have a legibly dated receipt from a commercial
carrier or the U.S. Postal Service. Private metered postmarks will not
be accepted as proof of timely mailing.

#### V. Application Review INFORMATION

### 1. Review Criteria

Procedures for assessing the technical merit of grant applications have
been instituted to provide for an objective review of applications and
to assist the applicant in understanding the standards against which
each application will be judged. Critical indicators have been developed
for each review criterion to assist the applicant in presenting
pertinent information related to that criterion and to provide the
reviewer with a standard for evaluation. Review criteria are outlined
below with specific detail and scoring points.

Review Criteria are used to review and rank applications. The State and
Regional Primary Care Association has six review criteria:

Criterion 1: NEED \[Maximum 15 points\]

-   The extent to which the applicant uses State/community data that
    describes the statewide and/or regional unmet needs, including major
    access barriers, health disparities and the needs of special
    populations (i.e., migrant and seasonal farmworkers, homeless
    persons, and residents of public housing) as well as other
    subpopulations (racial and ethnic minorities, elderly persons, etc)
    in the State/region.

-   The extent to which the application identifies and describes health
    centers' needs, particularly for new and expanded health centers.

-   The applicant provides a sufficient overview of the major State
    and/or regional environmental and marketplace issues affecting
    underserved populations and their providers.

-   The extent to which the State and/or regional needs assessment
    provide the context and rationale for the proposed work plan.

Criterion 2: RESOURCES/CAPABILITIES \[Maximum 20 points\]

-   The applicant provides evidence that demonstrates the presence of an
    effective infrastructure and capacity (i.e., staff) to carry out the
    proposed activities. Key project personnel are qualified by training
    and/or experience to implement and carry out the proposed
    activities.

-   The applicant provides evidence that demonstrates an effective PCA
    in terms of operational structure for management and administrative
    functions.

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-   The applicant demonstrates the ability to effectively collaborate
    with other organizations to achieve proposed objectives. The
    applicant adequately describes the key partnerships and working
    relationships with organizations in their State as well as across
    the Nation that share similar missions and/or commitments to the
    underserved. The applicant describes how these partnerships will
    help strengthen their ability to carry out their proposed
    objectives.

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```
-   The applicant demonstrates how past performance/accomplishments and
    the lessons learned will be used to coordinate and complement the
    proposed activities.

Criterion 3: RESPONSE \[Maximum 35 points\]

-   The applicant demonstrates the proposed activities are consistent
    with the stated need.

    -   The applicant provides a work plan with sufficient and
        appropriate detail. Specifically, the work plan uses
        time-framed, measurable terms to describe the following items:

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    -   Project objectives and key action steps for each proposed goal

    -   Deliverables, performance indicators, and responsible entity
        (person, committees, etc.)

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-   The applicant provides a work plan that clearly addresses the core
    functions as outlined in the program expectations relative to
    identified needs.

-   The elements of the work plan are appropriate to meet the proposed
    goals and objectives (i.e., the work plan is realistic and
    attainable).

    -   The applicant adequately describes how it will address the
        challenges to be encountered in program implementation.

    -   There is evidence that technical assistance and training
        provided with BPHC funds will be made available to all section
        330 consolidated health center programs, regardless of
        membership status.

Criterion 4: EVALUATIVE MEASURES \[Maximum 10 points\]

-   The performance indicators or benchmarks are appropriate to meet the
    proposed goals, objectives, and activities for the project.

-   The applicant describes how the PCA's progress will be measured,
    monitored, and evaluated.

Criterion 5: IMPACT \[Maximum 10 points\]

-   The proposal demonstrates that the activities will have a measurable
    impact on the stated need.

-   The applicant sufficiently summarizes the organization's strategic
    plan, intermediate and long-term goals, and objectives projected
    outward from year two until the duration of the proposed project
    period being requested.

-   The extent to which the organization demonstrates it will have a
    measurable and positive impact on expanding and maintaining access
    to primary and preventive care, strengthening existing health
    centers and improving the quality of care.

Criterion 6: SUPPORT REQUESTED \[Maximum 10 points\]

-   The applicant demonstrates the budget and budget narrative are
    reasonable and appropriate in relation to the objectives, complexity
    of the activities, and anticipated results.

-   There is consistency between the stated need, budget, and work plan.
    For example, if the State and/or region has experienced rapid growth
    with new start organizations, and will focus an increased emphasis
    on operational implementation, the need section, budget and work
    plan should be aligned and clear.

-   The requested funding is sufficient to allow the applicant to meet
    the proposed goals, objectives, and activities, based on the needs
    identified.

### 2. Review and Selection Process

The Division of Independent Review is responsible for managing objective
reviews within HRSA. Applications competing for federal funds receive an
objective and independent review performed by a committee of experts
qualified by training and experience in particular fields or disciplines
related to the program being reviewed. In selecting review committee
members, other factors in addition to training and experience may be
considered to improve the balance of the committee, e.g., geographic
distribution, race/ethnicity, and gender. Each reviewer is screened to
avoid conflicts of interest and is responsible for providing an
objective, unbiased evaluation based on the review criteria noted above.
The committee provides expert advice on the merits of each application
to program officials responsible for final selections for award.

# VI. Award Administration Information

### 1. Award Notices

Each applicant will receive written notification of the outcome of the
objective review process, including a summary of the expert committee's
assessment of the application's merits and weaknesses, and whether the
application was selected for funding. Applicants who are selected for
funding may be required to respond in a satisfactory manner to
Conditions placed on their application before funding can proceed.
Letters of notification do not provide authorization to begin
performance. The Notice of Grant Award, which is signed by the Grants
Management Officer and is sent to the applicant agency's Authorized
Representative, is the authorizing document. It will be sent prior to
the start date of April 1, 2006.

### 2. Administrative and National Policy Requirements

# *Title 45 of the Code of Federal Regulations*

Successful applicants must comply with the administrative requirements
outlined in 45 CFR Part 74 or 45 CFR Part 92, as appropriate.

[]{.mark}

***Public Health Policy Issuance: Healthy People 2010***

**Healthy People 2010** is a national initiative led by HHS that sets
priorities for all HRSA programs. The initiative has two major goals:
(1) To increase the quality and years of a healthy life; and (2)
Eliminate our country's health disparities. The program consists of 28
focus areas and 467 objectives. HRSA has actively participated in the
work groups of all the focus areas, and is committed to the achievement
of the Healthy People 2010 goals.

Applicants must summarize the relationship of their projects and
identify which of their programs objectives and/or sub-objectives relate
to the goals of the Healthy People 2010 initiative. Please attach the
summary as Appendix B.

Copies of the Healthy People 2010 may be obtained from the
Superintendent of Documents or downloaded at the Healthy People 2010
website: [http://www.health.gov/healthypeople/document]{.underline}/.

***Smoke Free Workplace***

The Public Health Service strongly encourages all award recipients to
provide a smoke-free workplace and to promote the non-use of all tobacco
products. Further, Public Law 103-227, the Pro-Children Act of 1994,
prohibits smoking in certain facilities (or in some cases, any portion
of a facility) in which regular or routine education, library, day care,
health care, or early childhood development services are provided to
children.

### 3. Reporting

The successful applicant under this guidance must:

i.  Comply with audit requirements of OMB Circular A-133. Information on
    the scope, frequency, and other aspects of audits can be found at
    [www.whitehouse.gov/omb/circulars](http://www.whitehouse.gov/omb/circulars).

ii. Submit a Payment Management System Quarterly Report. The reports
    identify cash expenditures against the authorized funds for the
    grant. Failure to submit the report may result in the inability to
    access grant funds. Submit the electronic report to the:

> Division of Payment Management
>
> DPM/FMS/PSC/ASAM/HHS
>
> PO Box 6021
>
> Rockville, MD 20852
>
> Telephone: (301) 443-1660

iii. Submit a Financial Status Report. A financial status report is
     required within 90 days of the end of each grant year. The report
     is an accounting of expenditures under the project that year and
     should be submitted by hard copy to the Grants Management Office.

iv. Submit a Progress Report(s). The purpose of the Semi Annual Report
    (SAR) is to report progress and results of activities performed and
    services provided by PCAs within the scope of their cooperative
    agreements. SAR due dates are June 1 and December 1. The web-based
    SAR should be submitted electronically. Further information will be
    provided to successful applicants.

**VII. Agency Contacts**

Applicants may obtain additional information regarding business,
administrative, or fiscal issues related to this grant announcement by
contacting:

Mike Rowland

HRSA, Division of Grants Management Operations

> 5600 Fishers Lane, Room 11A-16
>
> Rockville, MD 20857
>
> Telephone: (301) 594-4243
>
> Email: <MRowland@hrsa.gov>

Applicants may obtain additional information related to the overall
program issues by contacting:

> Rebecca Braccia
>
> Public Health Analyst, Division of State & Community Assistance
>
> Bureau of Primary Health Care, HRSA
>
> 5600 Fishers Lane, Mail Stop 15C-05
>
> Rockville, MD 20857
>
> Telephone : (301) 594-0817
>
> Fax : (301) 480-7833
>
> Email : <RBraccia@hrsa.gov>

Technical assistance regarding this funding announcement may be obtained
by contacting:

> Cicely Nelson
>
> Public Health Analyst, Division of Health Center Development
>
> Bureau of Primary Health Care, HRSA\
> 5600 Fishers Lane, Mail Stop 17-61
>
> Rockville, MD 20857
>
> Telephone: (301) 594-4496
>
> Fax: (301) 594-4997
>
> Email: <CNelson@hrsa.gov>

**VIII.** **TIPS FOR WRITING A STRONG APPLICATION**

**Keep your audience in mind.** Reviewers will use only the information
contained in the application to assess the applicant. Therefore, the
applicant should be sure the application and responses to the program
requirements and expectations are complete and clearly written. Do not
assume that reviewers are familiar with the applicant organization. Keep
the review criteria in mind when writing the application.

**Start preparing the application early.** Allow plenty of time to
gather required information from various sources.

**Follow the instructions in this guidance carefully.** The instructions
call for a particular organization of the materials, and reviewers are
accustomed to finding information in specific places. Do not have
reviewers hunting through your application for information.

**Be brief, concise, and clear.** Make your points understandable.
Provide accurate and honest information, including candid accounts of
problems and realistic plans to address them. If any required
information or data is omitted, explain why. Make sure the information
provided in each table, chart, attachment, etc., is consistent with the
proposal narrative and information in other tables.

**Be organized and logical.** Many applications fail because the
reviewers cannot follow the thought process of the applicant or because
parts of the application do not fit together.

**Be careful in the use of appendices.** Do not use the appendices for
information that is required in the body of the application. Be sure to
cross-reference all tables and attachments located in the appendices to
the appropriate text in the application.

**Carefully proofread the application.** Misspellings and grammatical
errors will impede reviewers in understanding the application. Be sure
pages are numbered (including appendices) and that page limits are
followed.

**Limit the use of abbreviations and acronyms**, and define each one at
its first use and periodically throughout application. If using specific
methodological, clinical terms be sure to define these as well.

**Contact program staff.** Finally, please contact the persons listed in
the "Agency Contacts" section, above, if any questions arise when
preparing the application.

#### ATTACHMENT 1 

**Program Expectations for State and Regional Primary Care
Associations**

**INTRODUCTION**

The mission of the HRSA/BPHC is to increase access to primary and
preventive care and to improve the health status of underserved and
vulnerable populations, particularly by strengthening and expanding the
nation's health centers and safety net system. The HRSA/BPHC is
committed to continuing to seek ways through which strong partnerships
can be maintained and strengthened to advance these goals. These
partners will provide State level leadership, work with consolidated
health center grantees in the State and/or region to provide training
and technical assistance, and exhibit the following attributes and
capabilities:

-   **Mission Oriented.** These organizations are interested in the
    viability of---as well as strengthening and expanding---the health
    care safety net and consolidated health center program across the
    State and/or region, and have a long-term mission and commitment to
    serve underserved, vulnerable populations.

-   **Maintain an Effective Infrastructure.** These organizations have
    adequate, appropriate, effective infrastructure and capacity (i.e.,
    systems, leadership, resources) to carry out activities.

-   **Foster Collaboration.** These organizations are adept at forming
    collaborative linkages and developing relationships that strengthen
    the safety net within the State and/or region. They foster
    collaboration among a diverse membership as well as other State and
    regional safety net providers with similar missions in order to
    strengthen and expand the safety net.

# overview of PCA core FUNCTIONS 

These expectations describe core functions that HRSA/BPHC expects
organizations to achieve with funding. Based on its assessment of the
State, market, and community environment, and as a result of successful
partnering and collaboration, each organization will engage in
activities which support HRSA/BPHC funded programs and have a measurable
and positive impact on the health status of the underserved and/or
vulnerable populations.

It is important to HRSA/BPHC that State and/or regional organizations in
which they invest demonstrate an ability to assess unmet needs and
health disparities and plan accordingly to meet the need identified in
the State and/or region. These organizations must develop the capacity
to respond quickly and in a coordinated fashion to the changes taking
place in each State's health care environment. State/community data and
information systems that integrate key State health policy, unmet needs,
marketplace, special populations and health disparities data/information
should be developed. This data infrastructure will guide current/future
strategic planning, developmental efforts, and work plan activities and
should be available to the PCA either internally or externally (i.e.,
via a contract).

The PCA should coordinate with the HRSA and other State and National
organizations to link appropriate training and technical assistance
(T/TA) needs of all BPHC-supported programs. It is expected that the
decision-making process surrounding use of BPHC funds and program
implementation will be representative of the diverse needs of
consolidated health center program grantees across the State and/or
region. It is not expected that the PCA will provide all T/TA directly
(i.e., it may be provided through a contract). However, any activity for
which the PCA uses BPHC funds should be made available to
**[all]{.underline}** consolidated health center grantees regardless of
PCA membership status.

Further, PCAs are expected to commit to excellence in clinical practice
as an organizational priority, and encourage and facilitate health
center participation in clinical quality improvement activities. PCAs
are expected to demonstrate a clinical presence within the functioning
of their organization to guide programs (i.e., training, TA).

Each organization will be expected to report on their results relative
to these guidelines twice a year, through the Semi Annual Report (SAR).
The focus of the SAR will be to demonstrate the outcomes achieved
through HRSA/BPHC funding and to link these outcomes to improvements in
access and reductions in disparities.

**Each PCA is expected to perform the seven core functions listed below
based on HRSA priorities and the needs of health centers in their State.
For any State and/or region with new start organizations, it is expected
that targeted assistance will be provided.**

1.  Maintaining and Strengthening Health Centers

> a\. Training and TA to all Health Centers
>
> b\. Targeted Assistance to New Starts

2.  Surveillance

3.  Health Center Growth Assistance

4.  Workforce

5.  Liaison/Collaboration/Partnering

6.  Clinical Quality

7.  Leveraging and Enhancing Health Center Revenues

**[EXAMPLES]{.underline} of activities that the PCA may need to carry
out based on HRSA priorities and the needs of the health centers in
their State include:**

1\. Maintaining and Strengthening Health Centers.

a.  Training and TA to all Health Centers

    i.  Board Training and Development

    ii. Financial and Operations Planning and Management Training (i.e.,
        coding and billing)

    iii. Leadership Development and Mentoring Opportunities

    iv. Health Center Network Development

    v.  Strategic Planning

    vi. UDS Training

    vii. HIPAA Training

    viii. RVU Analysis

    ix. Provide TA on Risk Management, FTCA, Credentialing, etc.

    x.  Capital Needs Assessment and Planning

    xi. Support of special populations programs and initiatives (i.e.,
        state-wide meetings, targeted TA, clinical activities, etc.)

b.  Targeted Assistance to New Starts

    i.  Review their TA needs with them and provide an overview of
        available PCA resources.

    ii. Systematically arrange/facilitate mentors for new health center
        staff (particularly administrators, medical directors, and Chief
        Financial Officers) with staff from existing health centers.

    iii. Provide focused TA on governance requirements (i.e., governing
         board functions and responsibilities).

    iv. Provide focused TA on fiscal operations/systems such as billing
        systems, coding, Medicare and Medicaid, cost reports, budget
        tracking and financial reports, and sliding fee scales.

    v.  Provide focused TA for management staff (i.e., leadership
        development, management and staff structure).

> 2\. Surveillance

a.  Identify health centers where technical assistance and training is
    needed to resolve problems/issues that threaten its viability.

b.  Monitor and report on important developments regarding the
    development and implementation of State programs and policies that
    affect the need for and availability of primary care services for
    the underserved. This includes Medicaid, Medicare, managed care, the
    prospective payment system, child health insurance, the uninsured,
    health workforce, and other key issues affecting the underserved and
    their providers of care. To the extent possible, this may include
    representing and/or facilitating state based workgroups to
    positively influence and impact outcomes for the underserved.

c.  Develop and monitor Medicaid Prospective Payment System
    Implementation.

d.  Provide information and analysis to HRSA regarding State regulatory,
    administrative and legislative activities and the associated impact
    on FQHCs and their patients.

e.  Conduct health center needs assessment activities

    1.  Environmental Assessment

    2.  Strategic Planning (SP)

    3.  Inventory health center technical assistance and training needs

    4.  Assist the Primary Care Office (PCO) with identifying potential
        areas for designations

> 3\. Health Center Growth Assistance

a.  Provide training and technical assistance to existing grantees to
    increase their readiness to expand services, consistent with the
    documented need and marketplace forces.

b.  Provide information and assistance on the BPHC statutory and
    regulatory requirements and health center expectations as well as
    funding opportunities and grant writing workshops. The anticipated
    audience is potential grantees who are seeking to meet the
    requirements to be a section 330- grantee or a designated FQHC
    Look-Alike.

c.  Community development.

> 4\. Workforce

a.  Assist health centers with the development of Recruitment and
    Retention plans, as needed (for clinical and non-clinical staff).

b.  Partner with the National Health Service Corp and State Loan
    Repayment offices.

c.  Partner with academic management schools, medical, dental, pharmacy,
    nursing schools and residency programs.

> 5\. Liaison/Collaboration/Partnering
>
> Work collaboratively with organizations including, but not limited to:
> HRSA, HRSA funded national organizations, State PCO, Area Health
> Education Centers, State Medicaid Office, faith based organizations,
> private providers, business community, universities, local health
> departments, other statewide, regional, and local organizations and
> governments, and health center networks.
>
> 6\. Clinical Quality

a.  Facilitate and encourage health center participation in clinical
    quality improvement activities such as care management (e.g., the
    Health Disparities Collaboratives) and clinical risk management (to
    include external accreditation and continuing education) activities.
    Assess current levels of involvement to increase and maintain health
    center participation in these activities.

b.  Assist health centers to identify common and successful methods for
    implementing clinical quality activities/programs and disseminate
    results to health centers and HRSA/BPHC.

c.  Provide State level leadership, where appropriate, for the
    integration of health centers into Statewide and community
    preparedness and response plans and direct assistance to centers in
    the area of emergency preparedness planning.

> 7\. Leveraging and Enhancing Health Center Revenue Activities

a.  Use data collected to inform stakeholders and potential partners
    about health centers' strengths, challenges, opportunities and
    threats, and about the needs of the underserved. Stakeholders
    include: policy makers, health centers, other safety net providers,
    community leaders, and potential partners.

b.  Work with private foundations, and other resources for operations
    and/or capital expansion or improvement.

c.  Coordinate statewide outreach and enrollment activities.

**ATTACHMENT 2**

**Sample Project Work Plan by Seven Core Functions**

+--------+-------------------+--------------+-------------+-----------+
|        | **ACTION STEPS**  | **DE         | **          | **DUE     |
|        |                   | LIVERABLES** | RESPONSIBLE | DATE**    |
|        |                   |              | PARTY**     |           |
|        |                   | Identify     |             |           |
|        |                   | deliverables | (Executive  |           |
|        |                   | and          | Director,   |           |
|        |                   | measurable   | Community   |           |
|        |                   | performance  | Development |           |
|        |                   | indicators   | staff,      |           |
|        |                   |              | etc.)       |           |
+========+===================+==============+=============+===========+
| *      |                   |              |             |           |
| *Maint |                   |              |             |           |
| aining |                   |              |             |           |
| and    |                   |              |             |           |
| S      |                   |              |             |           |
| trengt |                   |              |             |           |
| hening |                   |              |             |           |
| Health |                   |              |             |           |
| Cen    |                   |              |             |           |
| ters** |                   |              |             |           |
|        |                   |              |             |           |
| A.     |                   |              |             |           |
|   **Tr |                   |              |             |           |
| aining |                   |              |             |           |
|        |                   |              |             |           |
|    and |                   |              |             |           |
|     TA |                   |              |             |           |
|     to |                   |              |             |           |
|        |                   |              |             |           |
|    all |                   |              |             |           |
|        |                   |              |             |           |
| health |                   |              |             |           |
|        |                   |              |             |           |
|    cen |                   |              |             |           |
| ters** |                   |              |             |           |
|        |                   |              |             |           |
| B.     |                   |              |             |           |
|   **Ta |                   |              |             |           |
| rgeted |                   |              |             |           |
|        |                   |              |             |           |
|   Assi |                   |              |             |           |
| stance |                   |              |             |           |
|     to |                   |              |             |           |
|        |                   |              |             |           |
|    New |                   |              |             |           |
|        |                   |              |             |           |
| Starts |                   |              |             |           |
|        |                   |              |             |           |
|   (For |                   |              |             |           |
|        |                   |              |             |           |
|  those |                   |              |             |           |
|        |                   |              |             |           |
| states |                   |              |             |           |
|        |                   |              |             |           |
|   with |                   |              |             |           |
|        |                   |              |             |           |
|    New |                   |              |             |           |
|        |                   |              |             |           |
|  Start |                   |              |             |           |
|        |                   |              |             |           |
|   Orga |                   |              |             |           |
| nizati |                   |              |             |           |
| ons)** |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+
| ID     |                   |              |             | TOTAL     |
| ENTIFY |                   |              |             | COST      |
| OBJ    |                   |              |             |           |
| ECTIVE |                   |              |             |           |
| 1 HERE |                   |              |             |           |
|        |                   |              |             |           |
| (List  |                   |              |             |           |
| action |                   |              |             |           |
| steps  |                   |              |             |           |
| below  |                   |              |             |           |
| that   |                   |              |             |           |
| are    |                   |              |             |           |
| asso   |                   |              |             |           |
| ciated |                   |              |             |           |
| with   |                   |              |             |           |
| ach    |                   |              |             |           |
| ieving |                   |              |             |           |
| this   |                   |              |             |           |
| obje   |                   |              |             |           |
| ctive) |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+
| 1.1.   |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+
| 1.2.   |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+
| ID     |                   |              |             | TOTAL     |
| ENTIFY |                   |              |             | COST      |
| OBJ    |                   |              |             |           |
| ECTIVE |                   |              |             |           |
| 2 HERE |                   |              |             |           |
|        |                   |              |             |           |
| (List  |                   |              |             |           |
| action |                   |              |             |           |
| steps  |                   |              |             |           |
| below  |                   |              |             |           |
| that   |                   |              |             |           |
| are    |                   |              |             |           |
| asso   |                   |              |             |           |
| ciated |                   |              |             |           |
| with   |                   |              |             |           |
| ach    |                   |              |             |           |
| ieving |                   |              |             |           |
| this   |                   |              |             |           |
| obje   |                   |              |             |           |
| ctive) |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+
| 2.1.   |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+
| 2.2.   |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+
| **Su   |                   |              |             |           |
| rveill |                   |              |             |           |
| ance** |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+
| ID     |                   |              |             | TOTAL     |
| ENTIFY |                   |              |             | COST      |
| OBJ    |                   |              |             |           |
| ECTIVE |                   |              |             |           |
| 1 HERE |                   |              |             |           |
|        |                   |              |             |           |
| (List  |                   |              |             |           |
| action |                   |              |             |           |
| steps  |                   |              |             |           |
| below  |                   |              |             |           |
| that   |                   |              |             |           |
| are    |                   |              |             |           |
| asso   |                   |              |             |           |
| ciated |                   |              |             |           |
| with   |                   |              |             |           |
| ach    |                   |              |             |           |
| ieving |                   |              |             |           |
| this   |                   |              |             |           |
| obje   |                   |              |             |           |
| ctive) |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+
| 1.1.   |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+
| 1.2.   |                   |              |             |           |
+--------+-------------------+--------------+-------------+-----------+

[^1]:
    > A project period is the time for which the cooperative agreement
    > has been programmatically approved and usually encompasses more
    > than one budget period of 12 months duration. The budget period is
    > the time period during which Federal funds can be
    > expended/obligated. This period is usually 12 months.