FQHC Open Enrollment Training Fiscal Year (FY)2009

1. FQHC Open Enrollment Training Fiscal Year (FY)2009 Texas Primary Care Office (TPCO) Federally Qualified Health Clinic (FQHC) Incubator Program August 19, 2008

2. Agenda • Welcome & Program Update Connie Berry • What is Open Enrollment & Why Change Connie Berry • Outcomes for FQHC Incubator Program • How Does Open Enrollment Work? Sharmaine Key • Application and Forms Review Sharmaine Key • Standards of Evidence for Completed Deliverables Kate Martin • Questions and Answers • (to be submitted electronically (TexasPCO@dshs.state.tx.us and will be found in Bid Package 4) • Closing Remarks Connie Berry

3. Topics of Discussion • FQHC Incubator Program Overview and Updates…........... Page 4 • What is Open Enrollment • What is “Rolling” Enrollment • How Does Open Enrollment Work? • Proper Completion of the Open Enrollment Application ….. Page 10 • Application and Forms Review • Descriptions and Rates • Standards of Evidence for Completed Deliverables • Frequently Asked Questions………………………………….. Page 19 • Contact Information

4. FQHC Open Enrollment Training Fiscal Year (FY)2009 FQHC Incubator Program Overview and Updates

5. Texas Primary Care Office • Who we are • What we do (besides the Incubator program) • Incubator and FQHC expansion 2001-2008 • Reauthorization during the upcoming session • Focus Groups and On-line Survey

6. Why Open Enrollment? Goal: Award $4.85 million that will: Increase the number and success of applications for federal funding. • New and easier process • Apply when ready • Higher funding level for first time applicants • Supporting Development (new FQHCs) and Expansion (existing FQHCs)

7. What is Open Enrollment? • Open Enrollment refers to a specific amount of time FQHC Incubator funding is available. • Open Enrollment is the opportunity for eligible applicants to advance with expansion to meet program goals at their own rate and work with DSHS to make changes to contracts during the fiscal year. This continued enrollment provision is called “rolling” enrollment. • Deadlines to apply for Open Enrollment • An applicant may apply for Open Enrollment beginning July 18, 2008 and will remain open until April 1, 2009. • Applications will not be accepted after April 1, 2009 but the contract period can range from one month to a full 12 months depending on start dates. • Funds through the FQHC Incubator Program are available at the start of each DSHS fiscal year which is September 1st for projects completed by August 31, 2009. • All applications must be submitted at least 60 days prior to proposed project date.

8. How Does Open Enrollment Work? • An Open Enrollment notification is sent to eligible organizations.  • Bid Packages 1 and 2 contain the Open Enrollment documents with DSHS requirements, limitations, eligible providers and rates that DSHS will fund during the contracting cycle. • Applicant must provide a brief project description of how the proposed services will develop or expand the program • Applicant must identify specific services by indicating the amount requested and projected start date for each proposed project requested. • The Standards of Evidence lists all requirements necessary to request funding.

9. How Does Open Enrollment Work? • Upon receipt of an Open Enrollment application, the DSHS TPCO will have up to 20 working days to review and determine if the applicant is eligible for an award; • if further application clarification is requested and not submitted within the specified time period, • A delay in determining eligibility and disqualification of the applicant could occur. • Disqualified applications will be returned to the applicant with specific recommendations to meet qualifications. • Disqualified applications may be re-submitted if qualifications for the category can be met within the Open Enrollment timeline. ****Please Note: Awarded contracts are contingent upon the continued availability of funding and can be based on the performance of the organization.

10. FQHC Open Enrollment Training Fiscal Year (FY)2009 Proper Completion of the Open Enrollment Application

11. Application Forms • Application Forms • FORM A: FACE PAGE – Proposal for Financial Assistance • This form requests basic information about the applicant, including the signature of the authorized representative. • The face page is the cover page of the proposal and shall be completed in its entirety. • FORM B: TABLE OF CONTENTS AND CHECKLIST • Indicate page number for completed forms and attachments. • The resulting checklist will ensure the application is complete • FORM C: IRS 501 (c) (3) DOCUMENTATION • Provide IRS Letter indicating IRS 501(c) (3) status • FORM D: Minimum Qualifications • Provide the appropriate Federal Certification according to categorical requirements

12. Descriptions and Rates • FORM E1-4: Deliverable Descriptions And Rates Schedule • Applicant should determine funding amount eligibility. • Identify specific services by indicating the amount requested and projected start date for each proposed project requested. • Provide a brief project description of how the proposed services will expand the program goals. • Organization shall leverage FQHC Incubator Program funds with other resources if the actual cost of the deliverable exceeds the allowable and contracted amount. ***Please Note: See Standards of Evidence for a complete list of documentation required before services can be contracted.

13. Standards of Evidence for Completed Deliverables • This document provides information on general and specific requirements for receiving a FQHC Incubator Program contract as well as requirements to receive payment once a deliverable has been completed. Required forms for documentation and examples are also included. • Requirements • Deliverables Defined • Forms and Examples ***Please note: Carefully review the revised Standards of Evidence before submitting an application.

14. Standards of Evidence for Completed Deliverables • Requirements • Must Submit federal application “whenever an opportunity becomes available”. • FQHC Look Alike Application Review • Official Communication to/from BPHC • Medicaid and Medicare Numbers • Technical Assistance (Federal 2% must be Expended Prior to Incubator Reimbursement) • Development Funding (Resume, Sample Writing, References) • Capital Improvement (Contracts/Signed Bids Required with Application Submittal) • Salary Support (Signed Contracts/Employment Agreements Required with Application Submittal)

15. Standards of Evidence for Completed Deliverables • Deliverables Defined • Technical Assistance • Receipts-registration, travel, & per diem • Receipts from TACHC for Dues &/or Manuals • Development • Contract • Draft document for TPCO review • Complete copy of final, board-approved document (Look Alike, Feasibility, etc.) • Capital Improvement/Equipment • Lease • Contract including budget, schedule, floor plan, payment schedule, description of work to be completed • Invoice for completed work • Certificate of Occupancy • Receipts for purchased equipment • Completed Equipment Form

16. Standards of Evidence for Completed Deliverables • Salary Support • Clinic Provider/CFO • Monthly Data Report • Monthly Board Minutes and Financial Statement Including FQHC Incubator Program Expenditures • Contracts • CMO or Medical Director • Direct Patient Care Hours Per Month • Supervision Hours • Monthly Update on Health Care Goals Recorded in Monthly Board Minutes • Monthly Update of Community Leadership Work • Health Care Plan within 60 Days of Contract Start Date

17. Standards of Evidence for Completed Deliverables • Salary Support • CEO or Health Center Development Coordinator (Category) • Monthly Data Report Documenting Hours Worked • Monthly Update of Activities • Board Minutes (identified above)

18. Standards of Evidence for Completed Deliverables • Forms and Examples • Monthly Data Report for use with Salary Support • Travel Voucher • Capital Improvement/Equipment List ***Please Note: See Standards of Evidence document for sample forms.

19. FQHC Open Enrollment Training Fiscal Year (FY)2009 Recently Asked Questions

20. Questions and Answers Question (Q): Do I ask for everything I want at one time? Answer (A): No. The Open Enrollment allows Eligible applicants to request funds which will allow the organization to advance in expansion to meet program goals at their own pace. Q: What qualifies as “expanding program goals”? A: State legislation is specific about the FQHC Incubator Grant funds being used to expand existing and develop new FQHCs. Expanding FQHCs means adding services such as Mental Health or Dental, or developing a new clinic site that are eligible for additional Federal grants. These funds are not intended to sustain a clinic or replace activities that are funded under the federal 330 grant or other funding sources. Q: Can we expand our waiting room so that medical and dental have separate waiting areas? A: No. Expanding or separating a waiting room does not expand services. 

21. Questions and Answers Q:Will the Incubator Program support staff such as Medical Assistants or Receptionist? A: No. The TPCO will only fund billable staff. This means positions that can bill Medicaid and Medicare. Q: What constitutes a “new” position? A: A new position is one that has never been in an organization’s budget and has not been supported with Incubator Program funds in prior years.  Positions are linked to a service, so for example: An organization that has had Incubator funds for a FTE women’s health nurse practitioner and would like to add a nurse practitioner for the Children’s Clinic would be fundable. Adding another women’s health nurse practitioner would not be fundable. Q: If funds are awarded for a position but were not completely used, can the clinic request continuation funds this fiscal year?  A: No. The TPCO will not fund the same position. The organization must request funds for a new positions providing a new service only.

22. Questions and Answers Q: Will you accept a signed bid from a contractor rather than a signed contract? A: Yes. Q: To participant in the Incubator Program do I have to submit a federal grant application? A: Yes. The goal of the Incubator program is to develop and expand FQHCs. This is explained in the Standards of Evidence, page 3 Q:How will my request be tied to federal funding? For example: If my federal funding is to expand service on my satellite clinic can I request funds for the main site? A: A request for funding must be for expanded services. If the main site is being expanded, the expectation is that a federal application would be submitted in FY 09 for this main site expansion. Q: Can Incubator Program funds be used to pay for the data storage that TACHC is offering? A: No

23. Questions and Answers Q: Is Form E the only part of the application that I mail to your office? Is everything else sent via email? A: NO! The entire application, including Form E must be mailed to DSHS, TPCO. No electronic applications will be accepted. Q: I received a New Access Point in 2007, can I request Incubator Program funds A: Yes. Funds may be requested for billable staff not included in the Federal Application. Q: What is considered “new construction”? -  does renovation only mean that all work has to be within the confined walls of the present space? A: Construction is defined as changing the footprint of a facility, while “renovation” is considered any internal improvement only to an existing structure.  In other words, modifications that expand the walls or roof of the structure are considered construction; modifications within the existing structure are considered renovation. Only renovations may be done with Incubator funding, as identified in the DSHS contract.

24. Contact Information For more information or questions, please contact: TexasPCO@dshs.state.tx.us Look for further Questions and Answers on the ESBD site. Mailing Address: Department of State Health Services Texas Primary Care Office FQHC Incubator Program Open Enrollment– MC1937 Attn: Connie Berry, Manager 1100 West 49th Street PO Box 149347 Austin TX 78714-9347