“INSIDER” TIPS FOR FQHC GRANT APPLICATIONS In 2002, the Learning Teams placed a special focus on the President’s Initiative and technical assistance related to FQHC New Start and Expansion Grant applications. The following pages contain three helpful hints that were generated by these learning teams: 1. Tips for Writing New Start/Expansion Grants 2. New Start and Expansion Checklist 3. Thoughts and Suggestions from ORC Participants Tips for Writing New Start/Expansion Grants This guidance was put together by the Community Development Specialist at the Wisconsin PCA, after participating in the BPHC Objective Review Committee (ORC) panel in January, 2002. ORC panels consist of readers, drawn from BPHC funded programs and providers, who evaluate the grant applications once they have been narrowed to the final round of qualified applicants, i.e., those applications which meet all the formal criteria, needs scores, etc. Although the Presidential Initiative for Growth offers significant new start and expansion opportunities, the large number of applications has increased the competitive nature of this process. Applications submitted will need to be well organized and well written in order to yield a positive score. The following suggestions resulted from the CD specialist’s participation in this process and should serve to assist in the submission of competitive grant applications. The grant review process is very competitive. Only well written, well thought out proposals will get high scores in this process. Most applicants indicate in the narrative portion that everything is in place for a successful project, but those that include supporting documents to prove that assertion are more likely to get funded. Organization: Follow guidance in PIN 2001-18 explicitly. Grants should be well organized and follow page limits. Layout should be structured in accordance with PIN 2001-18. Pages should be numbered and table of contents included for all sections and attachments. Section headings must correspond to guidelines given in PIN 2001-18 and be highlighted in either bold or underlined type. Presentation of Material: Because all applications forwarded to the ORC panel have demonstrated need according to the Needs Assistance Criteria (PIN 2001-18, page 56) applications need to effectively convey how they are going to meet this need in the community. Documentation of Need: Documentation of Need, as found in the Service Area/Target Population section, should be well referenced (local public health “INSIDER” TIPS FOR FQHC GRANT APPLICATIONS Page 2 data/hospital/pharmacy). It is important for applicants to demonstrate clear knowledge of the health of the target population in terms of quantitative and qualitative data. Strategic Planning: Applicants must demonstrate significant collaboration with other service providers (e.g., health care agencies, social service agencies, etc.), community support (community meetings, local citizens) and support of state PCA and PCO. Collaboration with partners should be documented through letters of support, not just indicated in the narrative portion. Do not include letters of support that are format letters or vague in nature. These become a detriment to the proposal rather than an advantage. Health Care Services: Effective Health Care Plans must include measurable goals for all life cycles and a comprehensive review strategy or Quality Improvement Team to monitor progress. Health Care Plans should also include mental health, substance abuse, oral health and health education. Plans should also include a plan for addressing significant health disparities specific to target populations, as well as a plan for providing culturally and linguistically appropriate services, staff recruitment and retention and transportation. Merely indicating these concepts as important is not enough; a clear plan must indicate how these components will become a part of a clinic’s health care services. Organizational Capabilities and Expertise: Applicant should demonstrate expertise through included financial audits, copies of awards, etc. Staffing model must be explained thoroughly and an organizational chart should be included. Well-written job descriptions and resumes of key personnel should be included to illustrate organizational effectiveness. Plans for Management Information Systems (MIS) and Quality Improvement should be explained in detail. Budget: Calculate cost per user/encounter, and demonstrate that federal dollars will leverage funds. Patient income should reflect the target population. Federal funds must not supplant other funds. Make sure to describe all other possible sources of funding. Governance: Governing board must be in compliance with 330 regulations and should represent the target population in terms of income and ethnicity. Bylaws should be comprehensive and included with application. Too many poor examples of bylaws were included in review panel; board must have authority to hire/fire executive director and bylaws must be signed by the board president, not executive director. Board should detail ongoing plan for recruitment and retention and provides multiple opportunities during year for training and recruitment. Readiness: Proposals must demonstrate readiness, not just in narrative, but with leases, MOU, floor plan, provider recruitment and retention plans included. Emphasis has been placed on readiness during FY 2002. Maps are also helpful to show service area and how this site will increase access. These grant opportunities must demonstrate expanded access. They must indicate that they will further the President’s Initiative to double the number of people served nationally by Community Health Centers. They must demonstrate financial viability and an expansion of users. Expanded access includes the provision of mental health, substance abuse and dental services. Applicants must demonstrate increased access to “INSIDER” TIPS FOR FQHC GRANT APPLICATIONS Page 3 services for uninsured and sliding fee scale patients. Although at the time of grant award there does not need to be an immediate on site provision of these services, a plan should be in place for providing mental health, substance abuse and dental services in a manner that responds to the target population and increases access. New Start and Expansion Checklist To be used in conjunction with PIN 2001-18 1. SERVICE AREA/TARGET POPULATION Barriers to Care, gaps in service and special care needs area/target population Identifies other providers/ effectiveness in serving target population. Identifies the number of people to be served (users and encounters) over 2 years. 2. STRATEGIC PLANNING Clear strategic planning process/community input/board involvement. Understanding of the health care environment/ PPS, Managed Care, SCHIP, marketplace. Priority in the statewide plan/ including marketplace analysis, SSP, and fitting into statewide priorities of the PCA and PCO. Integrated into existing system. Community support. 3. SERVICE DELIVERY STRATEGY AND MODEL Available regardless of ability to pay. Service delivery model is appropriate/responsive. System will expand access. Reduce health disparities. Collaborations in service area (MOU/contracts, referral agreements, Letters of Support (NOT Carbon Copies). Cost effective. 4. HEALTH CARE SERVICES Required primary, preventive including eligibility assistance, outreach transportation. Oral health and Mental health. Culturally and linguistically appropriate. Staffing appropriate. Recruitment and Retention. 5. ORGANIZATIONAL CAPABILITIES AND EXPERTISE Experience/Expertise in establishing a health care delivery system “INSIDER” TIPS FOR FQHC GRANT APPLICATIONS Page 4 Financial viability/ sound accounting. Management staff appropriate/employed/preferred model. Organizational structure/management appropriate/adequate. Monitor/evaluate quality/outcomes (MIS, QA, patient feedback, etc.). 6. BUDGET Annualized budget. a. Total cost per user/encounter. b. Federal request versus total budget. c. Scope of the services proposed (services paid by grantee/versus not paid by grantee). Patient income. Federal grant will not supplant other sources of funding. Federal funds used to leverage other sources. 7. GOVERNANCE Governed under the preferred model. Governing board is representative. Bylaws 330(e) Affiliation Checklist (Exhibit G): Yes_____ No____ 8. READINESS Timeline reasonable. Facility adequate for size/scope (floor plans, rental agreement etc.) Available within 90-days (lease). Operational within 90-days (renovations). Thoughts and Suggestions from ORC Participants The following suggestions are in the aggregate, compiled from readers of grant applications in the ORC process. They are intended as “Thoughts and Suggestions” to keep in mind when putting together grant applications. They were provided to the PCA’s through the Community Development Learning Team. 1. Data sources should be cited 2. Include maps of your pertinent information, both your site and other sites “INSIDER” TIPS FOR FQHC GRANT APPLICATIONS Page 5 3. You know your information well and you will need to help readers know it well, too. Your narration must be clear to a reader that wants and needs to present your proposal well to the other members of the ORC 4. Budget should be clear and realistic, what’s happening with PPS, Medicaid, etc. 5. Include job descriptions for key staff 6. Governance: this should include not only 51% consumer composition and other 330 requirements but does the board mirror your target population? 7. Know and list other providers in the area – physicians, dentists etc – are they taking uninsured, Medicaid patients? 8. Remember to have grassroots letters of support that are recently dated – very important, from the community, key stakeholders, churches, schools, etc 9. Sign and date all documents: are your by-laws current, dated and signed?? 10. Demonstrate your strengths and successes not just with newspaper articles but with a brief history of the organization in narrative form (important for Look-A- Likes applying for 330 funding) 11. New 330s should be realistic, accounting for medical, dental and mental health users in a way that can be understood. For example, is your plan expanding access for 3,000 new users and 300 new dental or 400 mental health? How did you come to that number? 12. Health Care Services: does the information that you present in your health plan relate to the health status indicators, such as diabetes, BPHC Collaborative foot, eye exam, Hg.A1C, etc? 13. PCA involvement is critical: letter of support, what resources/data sources moved your application forward, community development, marketplace analysis, SSP etc 14. Cultural competence for staff and boards is very important – in your grant application include how you will provide it 15. Collection policy should be consistent with federal requirements – not language that one would see in a department store or credit card policy 16. Reflect changes with board representation if a significant percentage of the board has experienced new membership 17. Include the costs per user in the grant 18. Create linkages with other CHCs in your state – and if you have them, document them 19. Include information on the how and who of recruitment “INSIDER” TIPS FOR FQHC GRANT APPLICATIONS Page 6 20. Regarding real access to mental and dental providers: include letters of understanding and/or support from the providers 21. Expansions: who and where are the new populations? 22. On the use of abbreviations: be merciful and don’t over-abbreviate 23. Please try not to be redundant. This does not help the reader: it’s frustrating to have repetition, and it does not strengthen the point 24. Please use your PCO & PCA to assist you with improving the grant application in a timely way 25. Grant writing is difficult, budgets are challenging and complex. Health centers know this very well – get help from other CHCs 26. Request opportunities to have grant writing courses, seminars etc 27. Work with your PCA to see if successful applicants with recent 330s and expansions will share their template/model with others Our community health centers make the critical difference in access to care for our most vulnerable populations. Let’s move with this window of opportunity and improve the health care access and status for those that need us the most. What we do to improve the health and health care access for our most vulnerable ultimately improves the health of the entire population.