Post-Award Technical Assistance

1. Affordable Care ActPatient Center Medical Home – Facility Improvements (PCMH-FI)Grant ProgramHRSA-14-073 Post-Award Technical Assistance

2. Objectives • Describe the outcome of the Patient Centered Medical Home – Facility Improvement (PCMH-FI) Program funding opportunity • Discuss project management and critical compliance requirements • Review the terms and conditions of the PCMH-FI Notices of Award (NoA) • Explain the process for PCMH-FI post-award submission and review

3. Awards • HRSA awarded $35.7 million in PCMH-FI awards to 147 health centers • Grants awarded with a 2-year project period • The awards will fund one distinct, site-specific, stand-alone facility project for either: • Alteration/Renovation (A/R) for an existing facility, or • Construction for a new site or expansion of existing site

4. Administrative Notes • HRSA Activity Code: C8C • Separate PMS sub-account code located in Box 17 of the NoA • Funds must be accounted for and reported separately from section 330 funds and from other Affordable Care Act (ACA) funds • If other sources of funding exist to support the PCMH-FI project, PCMH-FI funds should be drawn down proportionately to approved total (Federal and non-Federal) costs

5. Ineligible Costs • Ineligible costs include, but are not limited to: • All costs incurred before 90 days prior to the award date • All physical construction costs incurred prior to the award date • Costs that do not meet federal procurement guidelines as listed in 45 CFR 74.40 – 74.48 or Part 92 • Land and building purchases or lease payments • Operating costs (e.g., funding direct health care services, clinical full-time equivalents, rent, mortgage payments) • Permanent relocation costs • Expenditures for personnel unrelated to the project • Mobile vans • EHR ongoing operations and maintenance • Abatement of site and building hazardous material • Disposable office, medical, or educational supplies

6. Before Starting Construction • Review all terms and conditions in the Notice of Award (NoA) • Do not begin construction or draw down funds for demolition, site preparation, or construction activities until all grant conditions have been approved and are lifted in a revised NoA • Grantees may only incur costs or draw down funds to pay for related non-construction activities: • Preparation/preliminary work (site plans, architectural and engineering schematics, environmental and historic preservation requirements) • Administrative planning costs directly related to the project

7. Electronic Handbook (EHB) • A folder for the C8C grant has been created for your organization's EHB portfolio • The Authorized Official needs to ensure he/she has added the PCMH-FI grant to the portfolio and that the correct staff are assigned to roles and functions in the C8C grant folder • The following EHB Help Resource can guide you through these processes: • https://grants.hrsa.gov/webexternal/help/hlpPage.asp?hF=grants_management#HowToAdd

8. Roles - Project Officer • Provides guidance on overall programmatic objectives • Reviews and processes revised budgets, schematics, concept/site plans, and construction timelines • Reviews and processes prior approval requests (i.e., changes to project scope, project period extensions) • Provides ongoing program/project monitoring and technical assistance • Closeout

9. Roles - Grants Management Specialist • Provides ongoing financial and grants management monitoring and technical assistance • Reviews federal interest, lease documentation, revised budgets • Reviews annual Federal Financial Reports (FFR) • Processes prior approval requests (e.g., Project Director changes) • Closeout

10. Roles – Administrative Notes • The PO listed in your C8C grant folder is responsible for managing and monitoring the award. It is imperative to work with your C8C PO. PO’s for other grants, including your H80 PO are not responsible for this award and cannot authorize actions for it. • Ann Piesen is identified as the HRSA Project Officer for all PCMH-FI grants. HRSA will assign another Project Officer to each C8C/PCMH-FI grant. The assigned Project Officer has or will be contacting you shortly with their contact information.

11. Roles – Administrative Notes How do I find out who my current PO and GMS are? • Click on the Grants Tabin EHB • Find your C8C grant and click on the Grant Folder in EHB. • Within the C8C grant folder, select HRSA Contacts. • Under the HRSA Contacts section, the PO and GMS contact information will be viewable.

12. Electronic Document Submissions in EHB • Grantees are required to submit all documentation identified as a condition of award or reporting requirement on the NoA into HRSA’s Electronic Handbook (EHB) • By default, the grantee’s Project Director as shown on the NoA will have access to all EHB submissions • All other users must be given privileges to view, edit, or submit by the Project Director or other user with the ability to Administer User Privileges in the Grant Handbook • HRSA Program or Grants Office Personnel may also request other information through the EHB by either requests for information or additional conditions

13. Condition Deliverables and Due Dates • If an extension to a submission deadline is needed: • Please discuss with your assigned C8C Project Officer and/or Grants Management Specialist. • You must include a justification for your extension request and describe the impact of the extension on the overall construction timeline. • Submit extension requests through the EHB within each submission in the “request an extension” function. • Conditions with Award Issue Date deadlines: Please be aware that the deadline for demonstrating that these conditions have been met is based on the date the awards are released to Award Recipients, which may be later than the Award Issue Date in Box 1 of the NoA.

14. Federal Interest Conditions • The federal government always retains interest in property constructed, acquired, or improved with federal funds: • All construction projects, regardless of cost, must file a Notice of Federal Interest (NFI) • A/R projects with total (federal and non-federal) costs more than $500,000 (excluding moveable equipment) must file a Notice of Federal Interest (NFI) • Applicants not required to file an NFI (A/R projects with total federal and non-federal costs less than $500,000) • Federal Interest still exists • Maintain documentation regarding protection of all Federal Interest • Additional resources are available at found at http://bphc.hrsa.gov/policiesregulations/capital/nfifilingguide.pdf

15. Leasehold Improvement Conditions • Funds may not be used to pay lease costs • Funds for a leased property cannot address needs that are part of the terms of the lease (i.e., the responsibility of the lessor) • If funds address improvements that would impact terms of the lease (e.g., double paned windows) applicants must have written evidence of negotiated offset in the rent • The Landlord Letter of Consent/Statement of Agreement from the facility owner must address the following: • Approval of the scope of the project • Agreement to provide the applicant health center reasonable control of the project site for required number of years • Agreement to file a Notice of Federal Interest (NFI) in the land records of the local jurisdiction before the project begins (if applicable) • HRSA will determine if the term of the lease is sufficient for the full value of the grant-supported improvements to benefit the grant activity. HRSA will take into account the purpose and duration of the grant, the expected life of the facility, and the use of the facility for grant-supported purposes. • The lease agreement must provide the applicant reasonable control

16. Environmental and Historic Preservation Conditions • Most projects will include several conditions for environmental and/or historic preservation reviews and compliance with federal laws • DO NOT begin construction or draw down funds for demolition, site preparation, or construction activities until these conditions have been approved and are lifted • PLEASE PLAN ACCORDINGLY in project schedules; consultation under Section 106, takes a minimum of a month to prepare, while an environmental assessment may take several additional months to prepare, review, and distribute for public comment • Grant recipients should work closely with their C8C Project Officer and environmental reviewer • Technical assistance for environmental and historic preservation requirements is available at http://bphc.hrsa.gov/policiesregulations/capital/environmentandhistoric/capitaldevelopment.html/

17. Procurement Rules • Grantees must comply with applicable procurement regulations: • All contracts for goods and services equal or greater than $100,000 must be competitively bid • Technical assistance on this topic is available at http://bphc.hrsa.gov/policiesregulations/capital/postaward/faqprocurment.pdf • The simplified acquisition threshold applies to work < $100,000 • Recipients should keep in mind that they still need to get more than one quote (not bids) for the work to determine that the costs are reasonable, and the threshold shall not be broken down into several purchases or artificially reduced to smaller quantities to permit negotiations under simplified acquisition procedures

18. Other Policy Requirements • Projects must be also compliant with the following: • Uniform Relocation Assistance, 45 CFR Part 15 • ADA Accessibility Guidelines for Building and Facilities (28 CFR Part 36), and the 2010 Standards for Accessible Design) • Real Property insurance, maintenance, disposition, and federal interest, 45 CFR Part 74.31-.37, and 92.31 and DHHS Grants Policy Statement

19. Design Considerations • Grantees are encouraged to consider the following: • NFPA 101 Life Safety Code (2015 edition) • AIA Guidelines for Design and Construction of Hospital and Health Care Facilities (2009 edition) • Sustainable design practices for both renovation and construction • Green Guide for Health Care http://www.gghc.org/ • Leadership in Energy and Environmental Design principles (LEED) http://www.usgbc.org/ • Sustainable Equipment Purchases • Electronic Product Environmental Assessment Tool (EPEAT) Silver Rated products http://www.epeat.net • Energy Star Products http://www.energystar.gov

20. Routine Reporting • Quarterly Progress Reports (starting January 1, 2015) • Includes information on the progress of the planning and implementation of the project. • Additional information on the Quarterly Progress Report (QPR) requirement can be found at http://bphc.hrsa.gov/policiesregulations/capital/ • QPR Manual • QPR Quick Guide • QPR Presentation – walkthrough of the submission process • A separate Technical Assistance Call will be scheduled in December 2014 in preparation for the first QPR reporting period for the C8C grant

21. Routine Reporting • Federal Financial Report (FFR) • Reviewed by Grants Management Specialist • Includes: • Financial Status Report (submitted annually) • Federal Cash Transaction Report (PMS) (submitted quarterly) • Additional information is available at: • http://www.hrsa.gov/grants/manage/technicalassistance/federalfinancialreport/ffrquickguide.pdf • http://www.dpm.psc.gov/grant_recipient/ffr_info/ffr_info.aspx?explorer.event=true

22. Routine Reporting • Federal Funding and Transparency Act Reporting (FFATA) • For each Federal sub-award of $25,000 grantees must report information about the recipient and the project being funded. • FAQs and additional reporting requirement information are available at: http://www.hrsa.gov/grants/ffata.html

23. Monitoring—Required • The following documentation must be submitted during the course of the project: • Project Implementation Certification • Certification of Final Design • Bonding Coverage Certification • Construction Contract Information • Copy of the selected contract • Letter of contract certification by the hired architect • Copy of the formal recommendation(s) of award or award letter(s) • Statement of determination that the selected contractor is not on the US General Services Administration Lists of Parties Excluded from Federal Procurement or Non-Procurement Programs (debarred list) found at http://sam.gov • If the contract is awarded to any qualified bidder other than the lowest bidder, provide proper documentation for your decision • Templates are available at http://bphc.hrsa.gov/policiesregulations/capital/

24. Monitoring (as necessary) • HRSA may request additional documentation to verify the status of the project, such as: • Milestone chart/construction schedule • Field observation reports • Application and certificate for payment (AIA G702) • Specific documentation (such as permits and invoices) as necessary

25. Prior Approval Requests • Grantees may be required to request prior approval from HRSA for changes that occur during the grant period. These changes includes, but are not limited to: • Significant changes in the approved project budget, including a significant increase or decrease to the total project cost, as well as significant changes to each budget line item • Changes to the approved physical project scope (i.e., change in the square footage affected, change in the orientation of the modified physical space) • Changes to the Project Director • Extensions to the project period • HRSA approval of a prior request will be provided in a NoA

26. Closeout and Property Reports • Closeout documentation is required within 90 days of the completion of the PCMH-FI project • The closeout documentation consists of the following items: • Project Completion Certification • A certificate of occupancy or evidence of acceptance by the permitting authority • A certificate of substantial completion • Property insurance statement • Final budget information / Final equipment list • Photos of the completed project as well as before photos • Tangible Personal Property Report (SF-428)

27. EHB Resources

28. Post-Award Technical Assistance • TA call presentation and transcripts will be available at http://www.hrsa.gov/grants/apply/assistance/PFI/ • All other TA materials will be posted at http://bphc.hrsa.gov/policiesregulations/capital/ • Submission templates • Program FAQs • Environmental review forms and compliance FAQs • Historic Preservation FAQs sheets • Procurement FAQs • Federal Interest FAQs