Capital Improvement ProgramHRSA-09-244

Alteration/Repair/Renovation andConstruction Projects

May 6, 2009

May 6, 2009 2

Objectives

Discuss activities to be supported through Capital Improvement Program (CIP) alteration/repair/renovation (a/r/r) and construction projects

Highlight specific application requirements for a/r/r and construction projects

Present review criteria

Provide technical assistance resources

May 6, 2009 3

CIP Funding

$850M one-time, 2-year project/budget period FY 2009 grants to support – Construction– Renovation and equipment– Acquisition of health information technology

Grantees must– Demonstrate improvements in access to health services for the

underserved populations– Create health center and construction-related jobs

2-Year project/budget period (July 1, 2009 – June 30, 2011)

Maximum funding based on CY 2008 UDS Data Formula– All section 330 grantees eligible for $250K base amount– Plus $35 per patient served based on 2008 UDS as of 04/24/2009– New Start grantees without 2008 UDS data will have $250K maximum

May 6, 2009 4

CIP Funding, part 2

CIP guidance available: May 1, 2009

One-time award for 2-year project/budget period

No on-going funding anticipated

Grantees will only be submitting one CIP application

Grantees may propose more than 1 project

Grantees will submit applications/requests through EHB

Applications due no later than: June 2, 2009 8:00PM ET

EHB-generated email– Eligibility code– Maximum eligible budget amount– Sent to all eligible Health Center Program grantees on May 2, 2009

Electronic application available: May 4, 2009

May 6, 2009 5

Types of CIP Projects

The eligible project types are:1. Alteration/repair/renovation, with or without

IT/equipment 2. Construction (new site or expansion of existing

site), with or without IT/equipment3. IT/equipment-only purchase4. HIT-only purchase (non-EHR equipment)5. Certified EHR-related purchase

May 6, 2009 6

Ineligible CIP Costs

Operating costs (e.g., funding direct services, clinical full-time equivalents, rent, mortgage payments, refinanced credit facilities).

Purchase of EHR systems that are not certified by an organization recognized by the Secretary of HHS.

Land or facility purchase costs are not eligible uses of CIP grant funding. Eligible projects may contain land/facility purchase costs; however, individual project budgets must show sufficient resources other than CIP funding to cover those expenses.

None of the funds appropriated or otherwise made available under the Recovery Act may be used by any State or local government, or any private entity, for any casino or other gambling establishment, aquarium, zoo, golf course, or swimming pool.

Costs incurred prior to February 17, 2009.

May 6, 2009 7

CIP Application

Alteration, Repair, & Renovation

(A/R/R) ConstructionIT/Equipment-only

Purchase HIT-only Purchase Certified EHR-only

Purchase

Application for Federal Assistance/Face Sheet SF-424 SF-424D Assurances—Construction Programs Proposal Overview Project Details SF-424C Budget Information—Construction Programs Budget Justification Schematic Drawings Environnemental Information and Documentation Checklist Facility Owner—Statement of Agreement EHR Readiness Checklist

May 6, 2009 8

Alteration/Repair/Renovation and Construction Projects

Alterations and renovations are work that makes existing space more effectively utilized or usable for another purpose. This includes the installation of fixed equipment.  Repair refers to keeping an existing space in usable condition and can also be characterized as maintenance.

Construction is work that constructs a new building or that expands an existing building Any project that proposes to increase the square footage of a

building should be categorized as construction Both a/r/r and construction projects must be site-specific Multiple a/r/r and/or construction projects may be proposed within

one CIP application

May 6, 2009 9

Equipment and A/R/R and Construction Projects

Equipment that will be utilized at the site at which an a/r/r or construction project is occurring should be included as part of that project

Fixed equipment is that which requires installation, and should be proposed as an a/r/r project.

If IT, HIT, and EHR-related equipment will require significant installation, the grantee should propose an a/r/r or construction project to account for the installation of any fixed equipment. The grantee should also propose an IT/equipment, HIT, or EHR project to account for the purchase of all related IT, HIT, or EHR components.

May 6, 2009 10

Project Sites

For a/r/r and construction projects, grantees may propose that the project occur: At a site that is currently in the grantee's approved scope of project

(Form 5B), or At a new site

If a new site is proposed, the grantee must complete the required information in Form 5B and submit an Add Site Checklist as part of the CIP application (pages 37-39 of application guidance)

This change in scope request will be processed as part of the CIP application

If a grantee proposes expansion (construction) of a facility as well as a/r/r at that same facility, both projects should be addressed within one construction project in the application

May 6, 2009 11

Service Area Overlap

Proposing a new site as part of the CIP application does NOT guarantee that the site will be allowed and approved in scope

Service Area Overlap analyses will be completed for all new proposed sites, based on information provided by the grantee (e.g., address, zip codes and census tracts to be served)

Consistent with HRSA policy for Service Area Overlap (PIN 2007-09, available at http://bphc.hrsa.gov/policy/pin0709.htm), if the project will result in service area overlap that doesn’t demonstrate sufficient unmet need and/or that will negatively impact on the operation of another health center, the project will not be eligible

If the project is deemed ineligible due to service area overlap issues, HRSA will work with the grantee to determine other uses for the requested CIP project funds and re-budget as necessary

May 6, 2009 12

Notice of Federal Interest

Grantees will be required to file a Notice of Federal Interest (NFI) for: All CIP construction projects Each CIP alteration/renovation project having a

total allowable project cost of more than $500,000, excluding equipment costs

If the grantee owns the property, the grantee will file the NFI directly

If the grantee leases the property, the property/facility owner must submit the NFI

May 6, 2009 13

Notice of Federal Interest (cont.)

The NFI states that the approval of HRSA must be given before the property can be mortgaged, sold, transferred, or used for a purpose inconsistent with the application. The period of the NFI is in perpetuity. Before the project begins, a notarized NFI must be filed in the appropriate public records office of the jurisdiction in which the property is located and, upon filing, a copy must be provided to the appropriate HRSA Grants Management Specialist.

An NFI must be notarized and filed with the appropriate public records office before the project begins.

Once it is filed, the grantee must submit a copy of the NFI to its HRSA Grants Management Specialist.

May 6, 2009 14

Leasehold Improvements

If the proposed project site is leased and the project is:

a construction project, or

an alteration/renovation project with a net project cost (total project cost less equipment costs) of greater than $500,000; then,

The grantee must either:

Provide a signed statement of agreement from the facility owner as part of the application; or,

Certify in the application that a statement of agreement from the facility owner will be submitted to HRSA prior to expending CIP project grant funds.

If the project site is leased and the project is an alteration/repair/renovation project with a net project cost (total project cost less equipment costs) of $500,000 or less, then the application must include a certification by the health center grantee that the existing lease gives the health center reasonable control of the project site and is consistent with the scope of the CIP project.

May 6, 2009 15

Leasehold Improvements (cont.)

The statement of agreement from the facility owner must address the following components: Approval of the scope of the CIP project. Agreement to provide the grantee health center

reasonable control of the project site for at least 10 years.

Agreement to file an NFI in the land records of the local jurisdiction when the project begins.

May 6, 2009 16

SF-424C Budget (Construction Programs)

Allowable/Unallowable Costs under CIP (pages 19-22 of the CIP application guidance)

EHB will automatically calculate certain cell amounts.

Budget examples (pages 23-24) of the guidance

Budget Justification: Detailed line-by-line narrative breakdown of all costs listed on the SF-424C Budget Page

May 6, 2009 17

Project Timeline

CIP funds must be obligated within the 2-year project/budget period

The following milestones should be included for #8 on the Project Cover Page: Planning start and end dates Project development (including bid advertisement

and contract award dates) start and end dates Implementation start and end dates Project completion date Estimated date site will be operational*

*Grantee must verify site is operational within 60 days of actual completion date

May 6, 2009 18

Schematic Drawings

Simple line drawings; must include square footage

Do NOT submit blueprints

Schematic drawings do NOT need to be completed by an architect

Critical to Architectural and Engineering Reasonableness Review

May 6, 2009 19

Cultural and Historic Preservation

HRSA will determine whether historic preservation assessment is necessary

If the assessment is necessary, HRSA will authorize the grantee to consult with its State Historic Preservation Office or Tribal Historic Preservation Office (SHPO or THPO) (page 14 of the guidance)

Post-award—Assessment findings include:

Property is not historic

Property is historic—no adverse effect

Property is historic—adverse effect and MOA to minimize the effect

May 6, 2009 20

Environmental Review (National Environmental Policy Act)

Environmental Information and Documentation Checklist (EID) (Template, pages 41-52) Must be completed and submitted with EACH project

(applies to all project types) as part of the CIP application

Environmental Assessment Required for construction projects HRSA will make determination if it is required for an a/r/r

project after review of the EID Grantee may start EA process pre-award if they know the

EA will be required If an EA is required, the project may not begin (other than

design and permitting stage) until HRSA makes a determination

May 6, 2009 21

Additional Considerations for A/R/R and Construction Projects

Pre-award costs No costs incurred or obligated prior to February

17, 2009 are allowed Costs incurred between February 17, 2009 and

the NGA date may be allowable but are incurred at the risk of the grantee, given the parameters of the CIP funding

HRSA encourages grantees to implement sustainable/green design practices for all projects

May 6, 2009 22

Additional Considerations (cont.)

CIP projects must be distinct stand-alone projects (e.g., may not be used to plan for upcoming competitive opportunity)

Permanently affixing modular units is allowable as a construction project

If the CIP project will result in a new service, the grantee should consider its capacity to maintain the service and must request to add the service as part of a separate Change in Scope request (not part of the CIP application)

Procurement Requirements for Federal Grantees

May 6, 2009 23

Review of CIP Submissions

CIP proposals will be subject to an internal review (as applicable): Completeness Eligibility Service Area Overlap Architectural & Engineering Reasonableness Federal Interest EHR Readiness Environmental Review Historic & Cultural Preservation

May 6, 2009 24

Construction-related Jobs

Must project FTEs created as part of application (Project “Direct Impact” section)

Must report on actual FTEs through quarterly ARRA reporting

HRSA will provide guidance on estimating projections

Davis-Bacon Act applies to all ARRA funded projects

May 6, 2009 25

CIP Reporting

Impact of CIP funding Number of new/improved sites Number of health center jobs created and

retained Number of construction-related jobs created Completion status (% complete) Actual versus projected budget information—

uses of CIP grant funds

Other ARRA reporting required by Act

May 6, 2009 26

Outline

Getting Started on EHB

Starting the CIP Application

CIP Alteration, Repair, Renovation and Construction Projects Application Process in HRSA’s EHB

May 6, 2009 27

Getting Started on EHB (All Users)

All users who wish to work on the application must register in the HRSA EHBs.

Go to https://grants.hrsa.gov/webexternal/login.asp.

If you have registered before, you do not have to register again. Use the same username and password.

Contact the HRSA Call Center if you do not remember your username or password.

Click here to create a

new account

Click here to learn about roles and responsibilities

May 6, 2009 28

Starting Your CIP Application in EHB

Any EHB user that is associated with the organization can create the CIP Application

The EHB user that creates the CIP Application is considered “the Owner of the CIP application”

This user will be able to control which users from the organization can see and work on this application

The “Owner of the CIP Application” must assign the Authorizing Official associated with the grantee organization

Only Authorizing Officials can submit the CIP Application

May 6, 2009 29

Starting the CIP Application

Enter HRSA-09-244 here …

… then click the Search button

Click Funding Opportunities

May 6, 2009 30

Starting the CIP Application

Click the Go button to begin the CIP Application

May 6, 2009 31

Starting the CIP Application

1. Enter the Eligibility Code from HRSA’s e-mail. If you do not have the code, contact the HRSA Call Center or the program contact listed on the program instructions document.

2. Click the Continue button.

1

2

May 6, 2009 32

HRSA EHBs Notes

HRSA EHBs allows you to work on your application in parts, save it online and return to complete it later.

Multiple users can work on the application at the same time.

HRSA EHBs have two views—one for data entry and one for review.

The view for “review” appears just like the printed form

The view for “data entry” is set up for user friendly data entry

The system “times out” after 30 minutes of inactivity!

You must hit a Save , Continue, or navigation button within 30 minutes!

Some forms may take a long time to complete. Saving work at regular intervals is strongly recommended.

May 6, 2009 33

CIP Application Status Page

Note theSuggestedNext Step

Note that no Authorizing Official is

assigned to this Application

This “CIP application owner” can manage other

users (“Peers”)

Application Forms to be completed

May 6, 2009 34

CIP Application:Program Specific Information

This diagram shows the structure of a Capital Improvement Program application, using the left side menus from the EHBs.

The application has one Program Specific Information section that includes one or more projects.

Project forms need to be completed for each proposed project.

Multiple projects can be proposed within a single application.

Complete Application

Program Specific Information

Project #1

Project #2

Project #3

May 6, 2009 35

Program Specific Information:Status Page

May 6, 2009 36

Program Specific Information:Proposal Cover Page

4 Sections:

1. Purpose2. Sustainability Plan3. Green/Sustainable

Design Principles4. Service Impacts

• Projected # additional• Provider FTEs• # additional patients served• # additional visits

Service Impacts

May 6, 2009 37

Program Specific Information:Assurances

Download and Attach Assurances Template

May 6, 2009 38

Program Specific Information:Projects

Add Project button

Update or Delete a Project

Application Budget Summary

Information

May 6, 2009 39

Program Specific Information:Adding a Project

Choose a project type from the list If you select and confirm the wrong project type, you will not be able to change it. You will

have to delete the project from the application and start over. Enter a project title.

May 6, 2009 40

Program Specific Information:Add Project Confirmation

May 6, 2009 41

Program Specific Information:Projects—Status Page

Each project consists of numerous sections.

Each project has its own Status page.

Click the “Update” link in the Project Status table to open a section for editing.

May 6, 2009 42

Project Information:Project Cover Page

1. Site Information2. Project Management3. Contact Information4. Need5. Implementation6. Timeline

6 Sections:

May 6, 2009 43

Project Information:Project Impact

Direct Impacts indicated in terms of:

• Square feet improved• Square feet increased• # of providers using the EHR or HIT• # patients with EHR

Projected FTEs

May 6, 2009 44

Project Information:Equipment List

Click to Add Equipment

May 6, 2009 45

Project Information: Add Equipment Information

Select from 3 Types of Equipment:• Clinical• Non-clinical• HIT/EHR

May 6, 2009 46

Project Information: Add, Update, or Delete Equipment

Add New Equipment lineSelect Desired line firstto Update or Delete

May 6, 2009 47

Project Information:Project Budget

Subtotalscalculated by system

These Totals carried over to Funding form

(see next slide)

Application Budget Summary

Information

May 6, 2009 48

Project Information:Funding Sources

These Totals carried over from

Project Budget form

May 6, 2009 49

Project Information:Budget Justification

Budget Justification is an attached

document

May 6, 2009 50

Project Information:Form 5B—Sites

Pick Sites from current Scope of Project

If you are creating an A/R/R or Construction project, you can insert a site in Form 5B by either picking sites from your current scope of project adding a completely new site

You can only insert one site per project in A/R/R and Construction projects!

By default the completion status of site is marked as COMPLETE for sites picked from scope. You will not be allowed to update any information for such sites in the CIP application.

May 6, 2009 51

Project Information:Form 5B—Sites, Select from Scope

When picking a site from scope, simply select the site, and then click “Save and Continue.”

May 6, 2009 52

Project Information:Form 5B—Sites, Add New Site

Site Qualification Criteriafor a New Site

May 6, 2009 53

Project Information:Form 5B—Sites, Add New Site

Note the Instructions here

Click here toRegister the New Site

May 6, 2009 54

Project Information:Registering a New Site

Site Type Options are:- Fixed- Mobile

May 6, 2009 55

Project Information:Registering a New Site

Standard Address fields

Existing Addresses in Scope of Project

Non- Standard Address fields

May 6, 2009 56

Project Information:Registering a New Site

Add New Site Confirmation screen

Click Finish button

New Site now appears in list of

Pre-registered Performance Sites

Click Select radio button and then

Select This Locationbutton

May 6, 2009 57

Project Information:Updating Service Site Information

Provide detailed information on the New Site

May 6, 2009 58

Project Information: Form 5B—Sites

Proposed New Site now appears in Form 5B: Sites

Click Save and Continue button

May 6, 2009 59

Project Information:Add Site Checklist

The Add Site Checklist page is only required for A/R/R, Construction and IT/Equipment-only Purchase projects

where the applicant is proposing to add a new site.

May 6, 2009 60

Project Information:Other Requirements for Sites

Federal Interest

Historic Preservation

Attach Agreement Statement

May 6, 2009 61

Project Information:EID Checklist

EID Checklistis a

downloadable Template

… that must be attached

May 6, 2009 62

Project Information:Schematic Drawings

Schematic Drawings

are attached documents

May 6, 2009 63

Help Resources

Resource Type Purpose

https://grants.hrsa.gov/webexternal/home.asp Website HRSA Electronic Handbooks URL.

Call the HRSA Call Center at

877-Go4-HRSA/877-464-4772; 301-998-7373(9:00 AM to 5:30 PM ET M-F)

Email: callcenter@hrsa.gov

Phone and/orE-mail

System help by phone or via e-mail. Do not use this for program questions.

Call the BPHC Help Desk at

1-301-443-7356(8:30 AM to 5:30 PM ET M-F)

Email BHCMISys@hrsa.gov

Phone and/orE-mail

Program help by phone or e-mail.

There will extended hours of operation for the CIP initiative beginning May 30th and ending June 2nd, 2009.

For these dates the hours of operation will be 7:00 AM to 7:00 PM (ET).

May 6, 2009 64

CIP Application Technical Assistance

Frequently Asked Questions

http://bphc.hrsa.gov/recovery/

Federal Construction Requirements

http://hrsa.gov/hcofconstruction/fedconstructionreq.htm

Sustainable and Green Design

http://www.usgbc.org http://www.gghc.org

Cultural and Historic Preservation

http://www.ncshpo.org/index.htm http://www.nathpo.org/mainpage.html

Prevailing Wage Requirement

http://www.gpo.gov/davisbacon/index.html

Equipment http://www.epeat.net http://www.energystar.gov

May 6, 2009 65

CIP Contacts

Type of Assistance Needed Please Contact

Business, administrative, or fiscal issues related to this announcement

Health Resources and Services AdministrationOffice of Federal Assistance ManagementDivision of Grants Management Operations

Neal Meyerson, Telephone: 301-443-5906; Email: NMeyerson@hrsa.gov

LaShawna Smith, Telephone: 301-443-4241; Email: LSmith3@hrsa.gov

Program issues Health Resources and Services AdministrationBureau of Primary Health CareOffice of Policy and Program Development

Marie Legaspi, Telephone: 301-594-4319 Meghan Ochal, Telephone: 301-594-2096 Beth Tchinski, Telephone: 301-443-1389Email: BPHCRecovery@hrsa.gov