MN Strong Foundations_Evidence-based Home Visiting RFP

MN Strong foundations: Evidence-Based home visiting Start-Up

Minnesota Strong Foundations: Evidence-based Home Visiting Start-Upgrant request for proposal (RFP)

Minnesota Department of HealthPO Box 64882St. Paul, MN 55164-0882651-201-4841health.fhvgrants@state.mn.us www.health.state.mn.us

12/21/2020

To obtain this information in a different format, e-mail: health.fhvgrants@state.mn.us .

Table of ContentsMinnesota Strong Foundations: Evidence-based Home Visiting Start-Up1RFP Part 1: Overview31.1General Information31.2Program Description31.3Funding and Project Dates31.4Eligible Applicants41.5Questions and Answers4RFP Part 2: Program Details62.1Priorities62.2Eligible Projects72.3Grant Management Responsibilities72.4Grant Provisions92.5Review and Selection Process12RFP Part 3: Application and Submission Instructions143.1Application Deadline143.2Application Submission Instructions143.3 Required Forms for Submission15Application Requirements22Forms23Form A: Application Information24Form C: Project Narrative25Form E: Indirect Cost Questionnaire27Form F: Due Diligence Review28Additional Documentation Required31RFP Part 4: Appendices32Appendix A: Application Evaluation Criteria33Appendix B: Definitions34Appendix C: Sample Grant Agreement37

RFP Part 1: Overview1.1 General Information

· Minnesota Strong Foundations: Evidence-based Home Visiting Start-Ups

· Minnesota Department of Health (MDH) Program Website (https://www.health.state.mn.us/communities/fhv/index.html)

· Application Deadline: 4:30 pm February 5, 2021

1.2 Program Description

The Minnesota Legislature directed the Minnesota Department of Health (MDH) to establish the Evidence-based Home Visiting grant program in 2017. The purposes of the grant program is to start up or expand evidence-based home visiting programs in counties, reservations, or regions to serve families.

· The focus of this Request for Proposals is to increase the availability of evidence-based home visiting programs through the start-up of new evidence-based home visiting models in a county, tribal reservation, or community.

· The start-up program must implement one of the following long-term evidence-based home visiting models supported by MDH: Healthy Families America (HFA), Nurse Family Partnership (NFP), Family Spirit, Early Head Start – Home Based, Maternal Early Childhood Sustained Home Visiting (MECSH), or Parents as Teachers (PAT).

1.3 Funding and Project DatesFunding

The Minnesota State Legislature has appropriated funding for the Minnesota Strong Foundations: Evidence-based Home visiting program. Funding will be allocated through a competitive process. If selected, you may only incur eligible expenditures when the grant agreement is fully executed and the grant has reached its effective date.

Funding

Estimate

Estimated Amount to Grant

$3 million

Estimated Number of Awards

5-10

Estimated Range of Awards

$40,000 - $200,000 annually

Match Requirement

No match is required.

Project Dates

The estimated grant start date is April 1, 2021, and the end date is December 31, 2022. The grant period will be contingent on satisfactory performance and funding availability. It is anticipated that MDH will release a competitive RFP in 2022 to allow the continuation of programs funded through this application and all previous evidence-based funding awards.

1.4 Eligible Applicants

Eligible applicants include community health boards, nonprofits, and tribal nations. Applicants must be located in and conduct grant activities in the state of Minnesota. Applicants must have state or federal recognition as a formal organization or entity, such as a Federal Employer Identification Number (EIN) or Minnesota Tax ID. Organizations or groups that do not have state or federal recognition must apply with a fiscal agent.

For purposes of this RFP, eligible applicants must meet the following criteria:

· Have three or more years of experience successfully implementing a home visiting program to families from prenatal to age two.

· Own or have a license for, and are trained to use, an electronic health record or case management system that meets all requirements to submit data to the Department of Health Family Home Visiting: Information for Home Visiting Evaluation (IHVE) data system. As of 12/18/2020, the following systems meet IHVE submission requirements: PH-Doc and Nightingale Notes.

· Have experience recruiting families into a home visiting program during the critical time period from prenatally to eight weeks from when the child comes home from the hospital.

· Applicants must start up one of the following long-term evidence-based home visiting models: Healthy Families America (HFA), Nurse Family Partnership (NFP), Family Spirit, Early Head Start – Home Based, Maternal Early Childhood Sustained Home Visiting (MECSH), or Parents as Teachers (PAT).

Collaboration

Multi-county community health boards must submit one joint application. For purposes of this RFP, no other joint applications will be accepted. Collaboration activities are allowed and encouraged, but should be funded through individual applications.

1.5 Questions and Answers

All questions regarding this RFP must be submitted by email or phone to health.homevisiting@state.mn.us or 651-201-4841. All answers will be posted on the Family Home Visiting website (www.health.state.mn.us/communities/fhv/grant.html) .

Please submit questions no later than 4:30 p.m. Central Time, on January 15, 2021.To ensure the proper and fair evaluation of all applications, other communications regarding this RFP including verbal, telephone, written or internet initiated by or on behalf of any applicant to any employee of the Department, other than questions submitted to as outlined above, are prohibited. Any violation of this prohibition may result in the disqualification of the applicant.

RFP Information Meeting

There will be a virtual WebEx meeting to go over the basics of the application on:

Wednesday January 6, 2021 from 9 a.m. – 10 a.m. Central Time.

Join the application Webinar (minnesota.webex.com/minnesota/j.php?MTID=ma478426b7ccc9e991aac2da43a229d16))

This meetings will be recorded and a link posted on the Family Home Visiting: Funding and Grants Management webpage (www.health.state.mn.us/communities/fhv/grant.html#Example1 )

RFP Part 2: Program Details2.1 PrioritiesHealth Equity Priorities

It is the policy of the State of Minnesota to ensure fairness, precision, equity and consistency in competitive grant awards. This includes implementing diversity and inclusion in grant-making. The Policy on Rating Criteria for Competitive Grant Review (mn.gov/admin/assets/08-02%20grants%20policy%20revision%20September%202017%20final_tcm36-312046.pdf) establishes the expectation that grant programs intentionally identify how the grant serves diverse populations, especially populations experiencing inequities and/or disparities.

The goal of the Minnesota Strong Foundations: Evidence Based Home Visiting program is to equip pregnant women, parents and other caregivers with the knowledge, skills, and tools to achieve a healthy birth and assist their children in being physically, socially and emotionally healthy, safe, and ready to succeed in school. The overall goals of the Minnesota Strong Foundations program are to:

· Expand services provided through evidence-based home visiting models in Minnesota by coordinating with and building on federally and locally funded programs;

· Improve coordination of services for pregnant women, infants and families; and,

· Identify and provide comprehensive services to improve outcomes for pregnant women, infants and families.

This grant will serve:

· Communities experiencing high poverty, high child maltreatment rates, and high rates of infants born with low birth weight

· Pregnant and parenting teens

· Underserved racial/ethnic communities

· Families experiencing homelessness

· Pregnant women, infants and families experiencing substance abuse

· Pregnant women, infants and families experiencing increased stressors due to the COVID-19 pandemic

· Rural areas with limited prenatal, postnatal and pediatric medical services

Grant outcomes include: Implement evidence-based home visiting programs that:

a. Provide voluntary home visiting as the primary service delivery strategy;

b. Target outcomes that include: improved maternal and child health; prevention of child injuries, child abuse, or maltreatment, and reduction of emergency department visits; improvement in school readiness and achievement; reduction in crime or domestic violence; improvements in family economic self-sufficiency; and improvements in the coordination and referrals for other community resources and supports.

c. Ensure the provision of high-quality home visiting services to eligible families living in at-risk communities by, in part, coordinating with comprehensive statewide early childhood systems to support the needs of those families.

2.2 Eligible Projects

Eligible projects must:

· Select and implement one of the following long-term evidence-based home visiting models: Healthy Families America (HFA), Nurse Family Partnership (NFP), Family Spirit, Early Head Start – Home Based, Maternal Early Childhood Sustained Home Visiting (MECSH), or Parents as Teachers (PAT).

· Provide home visiting services from prenatal to age two.

· Meet an identified gap in the existing continuum of early childhood services and complement, rather than duplicate, existing home visiting services.

· Demonstrate that they are supplementing, not replacing, existing funds being used for evidence-based home visiting services as of July 1, 2020.

2.3 Grant Management Responsibilities Grant Agreement

Each grantee must formally enter into a grant agreement. The grant agreement will address the conditions of the award, including implementation for the project. Once the grant agreement is signed, the grantee is expected to read and comply with all conditions of the grant agreement.

No work on grant activities can begin until a fully executed grant agreement is in place.

A sample grant agreement is attached as Attachment C. Applicants should be aware of the terms and conditions of the standard grant agreement in preparing their applications. Much of the language reflected in the sample agreement is required by statute. If an applicant takes exception to any of the terms, conditions or language in the sample grant agreement, the applicant must indicate those exceptions, in writing, in their application in response to this RFP. Certain exceptions may result in an application being disqualified from further review and evaluation. Only those exceptions indicated in an application will be available for discussion or negotiation.

The funded applicant will be legally responsible for assuring implementation of the work plan and compliance with all applicable state requirements including worker’s compensation insurance, nondiscrimination, data privacy, budget compliance, and reporting.

Accountability and Reporting Requirements

It is the policy of the state of Minnesota to monitor progress on state grants by requiring grantees to submit written progress reports at least annually until all grant funds have been expended and all of the terms in the grant agreement have been met. MDH-sponsored Family Home Visiting has mandatory reporting requirements to demonstrate that grantee-funded project staff have been appropriately trained, that families are being adequately served, and that funding is being utilized for the sole purpose and intent of providing high-quality evidence-based home visiting services to Minnesota families.

The reporting schedule will include:

· Quarterly reporting on staffing, target caseloads and total families served

· At minimum, weekly data entry of visit-level direct service evaluation data on priority benchmarks

· At a minimum, bi-annual check-in calls with FHV staff to review finance, evaluation, fidelity to the selected model and programmatic progress.

Grant Monitoring

Minn. Stat. §16B.97 and Policy on Grant Monitoring require the following:

· One monitoring visit during the grant period on all state grants over $50,000

· Annual monitoring visits during the grant period on all grants over $250,000

· Conducting a financial reconciliation of grantee’s expenditures at least once during the grant period on grants over $50,000

Technical Assistance

MDH will provide limited technical assistance to grantees to support them in fulfilling their grant objectives. MDH Family Home Visiting staff will be available to provide guidance and assistance on topics including home visiting, developmental screening, budgeting, invoicing, data collection, evaluation and other best practices.

Grant Payments

Per State Policy on Grant Payments (www.mn.gov/admin/images/grants_policy_08-08.pdf), reimbursement is the method for making grant payments. All grantee requests for reimbursement must correspond to the approved grant budget. The State shall review each request for reimbursement against the approved grant budget, grant expenditures to-date and the latest grant progress report before approving payment. Grant payments shall not be made on grants with past due progress reports unless MDH has given the grantee a written extension.

The invoicing and payment schedule will be:

April-June, 2021: Due July 20, 2021

July-September, 2021: Due October 20, 2021

October-December, 2021: Due January 20, 2022

January-March, 2022: Due April 20, 2022

April-June, 2022: Due July 20, 2022

July-September, 2022: Due October 20, 2022

October-December, 2022: Due January 20, 2023

2.4 Grant Provisions

Contracting and Bidding Requirements

(a) Municipalities. A grantee that is a municipality, defined as a county, town, city, school district or other municipal corporation or political subdivision of the state authorized by law to enter into contracts is subject to the contracting requirements set forth under Minn. Stat. § 471.345. Projects that involve construction work are subject to the applicable prevailing wage laws, including those under Minn. Stat. § 177.41, et. seq.

(b) Non-municipalities. Grantees that are not municipalities must adhere to the following standards in the event that duties assigned to the Grantee are to be subcontracted out to a third party:

i. Any services or materials that are expected to cost $100,000 or more must undergo a formal notice and bidding process consistent with the standards set forth under Minnesota Statutes 16B.

ii. Services or materials that are expected to cost between $25,000 and $99,999 must be competitively awarded based on a minimum of three (3) verbal quotes or bids.

iii. Services or materials that are expected to cost between $10,000 and $24,999 must be competitively awarded based on a minimum of two (2) verbal quotes or bids or awarded to a targeted vendor.

iv. The grantee must take all necessary affirmative steps to assure that targeted vendors from businesses with active certifications through these entities are used when possible:

· Minnesota Department of Administration’s Certified Targeted Group, Economically Disadvantaged and Veteran-Owned Vendor List Minnesota Department of Administration’s Certified Targeted Group, Economically Disadvantaged and Veteran-Owned Vendor List (www.mmd.admin.state.mn.us/process/search/);

· Metropolitan Council’s Targeted Vendor list: Minnesota Unified Certification Program Minnesota Unified Certification Program (https://mnucp.metc.state.mn.us/) or

· Small Business Certification Program through Hennepin County, Ramsey County, and City of St. Paul: Central Certification Program (https://sbcp.mn.gov/) .

v. The grantee must maintain written standards of conduct covering conflicts of interest and governing the actions of its employees engaged in the selection, award and administration of contracts.

vi. The grantee must maintain support documentation of the purchasing or bidding process utilized to contract services in their financial records, including support documentation justifying a single/sole source bid, if applicable.

vii. Notwithstanding (i) - (iv) above, State may waive bidding process requirements when:

· Vendors included in response to competitive grant request for proposal process were approved and incorporated as an approved work plan for the grant, or

· There is only one legitimate or practical source for such materials or services and that grantee has established a fair and reasonable price.

viii. Projects that include construction work of $25,000 or more, are subject to applicable prevailing wage laws, including those under Minnesota Statutes 177.41 through 177.44.

ix. Grantee must not contract with vendors who are suspended or debarred in Minnesota. The list of debarred vendors is available at: Suspended/Debarred Vendor Report (http://www.mmd.admin.state.mn.us/debarredreport.asp)

Conflicts of Interest

MDH will take steps to prevent individual and organizational conflicts of interest, both in reference to applicants and reviewers per Minn. Stat.§16B.98 and Conflict of Interest Policy for State Grant-Making.

Applicants must provide a list of all entities with which it has relationships that create, or appear to create, a conflict of interest with the work contemplated by this RFP. The list must provide the name of the entity, the relationship, and a discussion of the conflict. Submit the list as an attachment to the application. If an applicant does not submit a list of conflicts of interest, MDH will assume that no conflicts of interest exist for that applicant.

Organizational conflicts of interest occur when:

· a grantee or applicant is unable or potentially unable to render impartial assistance or advice to the Department due to competing duties or loyalties

· a grantee’s or applicant’s objectivity in carrying out the grant is or might be otherwise impaired due to competing duties or loyalties

In cases where a conflict of interest is suspected, disclosed, or discovered, the applicants or grantees will be notified and actions may be pursued, including but not limited to disqualification from eligibility for the grant award or termination of the grant agreement.

Public Data and Trade Secret Materials

All applications submitted in response to this RFP will become property of the State. In accordance with Minnesota Statute Section 13.599, all applications and their contents are private or nonpublic until the applications are opened.

Once the applications are opened, the name and address of each applicant and the amount requested is public. All other data in an application is private or nonpublic data until completion of the evaluation process, which is defined by statute as when MDH has completed negotiating the grant agreement with the selected applicant.

After MDH has completed the evaluation process, all remaining data in the applications is public with the exception of trade secret data as defined and classified in Minn. Stat. § 13.37, Subd. 1(b). A statement by an applicant that the application is copyrighted or otherwise protected does not prevent public access to the application or its contents. (Minn. Stat. § 13.599, subd. 3(a)).

If an applicant submits any information in an application that it believes to be trade secret information, as defined by Minnesota Statute Section 13.37, the applicant must:

· Clearly mark all trade secret materials in its application at the time it is submitted,

· Include a statement attached to its application justifying the trade secret designation for each item, and

· Defend any action seeking release of the materials it believes to be trade secret, and indemnify and hold harmless MDH and the State of Minnesota, its agents and employees, from any judgments or damages awarded against the State in favor of the party requesting the materials, and any and all costs connected with that defense.

· This indemnification survives MDH’s award of a grant agreement. In submitting an application in response to this RFP, the applicant agrees that this indemnification survives as long as the trade secret materials are in possession of MDH. The State will not consider the prices submitted by the responder to be proprietary or trade secret materials.

MDH reserves the right to reject a claim that any particular information in an application is trade secret information if it determines the applicant has not met the burden of establishing that the information constitutes a trade secret. MDH will not consider the budgets submitted by applicants to be proprietary or trade secret materials. Use of generic trade secret language encompassing substantial portions of the application or simple assertions of trade secret without substantial explanation of the basis for that designation will be insufficient to warrant a trade secret designation.

If a grant is awarded to an applicant, MDH may use or disclose the trade secret data to the extent provided by law. Any decision by the State to disclose information determined to be trade secret information will be made consistent with the Minnesota Government Data Practices Act (Minnesota Statutes chapter 13) and other relevant laws and regulations.

If certain information is found to constitute trade secret information, the remainder of the application will become public; in the event a data request is received for application information, only the trade secret data will be removed and remain nonpublic.

Audits

Per Minn. Stat. §16B.98 Subdivision 8, the grantee’s books, records, documents, and accounting procedures and practices of the grantee or other party that are relevant to the grant or transaction are subject to examination by the granting agency and either the legislative auditor or the state auditor, as appropriate. This requirement will last for a minimum of six years from the grant agreement end date, receipt, and approval of all final reports, or the required period of time to satisfy all state and program retention requirements, whichever is later.

Affirmative Action and Non-Discrimination Requirements for all Grantees

The grantee agrees not to discriminate against any employee or applicant for employment because of race, color, creed, religion, national origin, sex, marital status, status in regard to public assistance, membership or activity in a local commission, disability, sexual orientation, or age in regard to any position for which the employee or applicant for employment is qualified. Minn. Stat. §363A.02. The grantee agrees to take affirmative steps to employ, advance in employment, upgrade, train, and recruit minority persons, women, and persons with disabilities.

The grantee must not discriminate against any employee or applicant for employment because of physical or mental disability in regard to any position for which the employee or applicant for employment is qualified. The grantee agrees to take affirmative action to employ, advance in employment, and otherwise treat qualified disabled persons without discrimination based upon their physical or mental disability in all employment practices such as the following: employment, upgrading, demotion or transfer, recruitment, advertising, layoff or termination, rates of pay or other forms of compensation, and selection for training, including apprenticeship. Minnesota Rules, part 5000.3500

The grantee agrees to comply with the rules and relevant orders of the Minnesota Department of Human Rights issued pursuant to the Minnesota Human Rights Act.

2.5 Review and Selection ProcessReview Process

Funding will be allocated through a competitive process with review by a committee representing content and implementation specialists with home visiting knowledge. The review committee will evaluate all eligible and complete applications received by the deadline.

MDH will review all committee recommendations and is responsible for award decisions. The award decisions of MDH are final and not subject to appeal. Additionally:

· MDH reserves the right to withhold the distribution of funds in cases where proposals submitted do not meet the necessary criteria.

· The RFP does not obligate MDH to award a grant agreement or complete the project, and MDH reserves the right to cancel this RFP if it is considered to be in its best interest.

· MDH reserves the right to waive minor irregularities or request additional information to further clarify or validate information submitted in the application, provided the application, as submitted, and substantially complies with the requirements of this RFP. There is, however, no guarantee MDH will look for information or clarification outside of the submitted written application. Therefore, it is important that all applicants ensure that all sections of their application are complete to avoid the possibility of failing an evaluation phase or having their score reduced for lack of information.

Selection Criteria and Weight

The review committee will be reviewing each applicant on a 100-point scale. A standardized scoring system will be used to determine the extent to which the applicant meets the selection criteria.

The scoring factors and weight that applications will be judged on are based on a score sheet (See Appendix A).

Grantee Past Performance and Due Diligence Review Process

· It is the policy of the State of Minnesota to consider a grant applicant's past performance before awarding subsequent grants to them.

· State policy requires states to conduct a financial review prior to a grant award made of $25,000 and higher to a nonprofit organization, in order to comply with Policy on the Financial Review of Nongovernmental Organizations

Notification

MDH anticipates notifying all applicants via email of funding decisions by February 26, 2021.

RFP Part 3: Application and Submission Instructions3.1 Application Deadline

All applications must be received by MDH no later than 4:30 p.m. Central Time, on February 5, 2021.

Late applications will not be accepted. It is the applicant’s sole responsibility to allow sufficient time to address all potential delays caused by any reason whatsoever. MDH will not be responsible for delays caused by mail, delivery, computer or technology problems.

3.2 Application Submission Instructions

Submit application materials via the MN Strong Foundations Application (redcap.health.state.mn.us/redcap/surveys/?s=ACYCC4C88N). Once submitted, you will receive a confirmation email to the email address entered in your application. If you do not receive a confirmation within one hour of submission, please contact health.homevisiting@state.mn.us to request assistance.

You must submit the following in order for the application to be considered complete:

1. Form A: Applicant Information

2. Form B: Work Plan and Staffing Plan

3. Form C: Project Narrative

4. Form D: Budget Summary, Details and Justification

5. Form E: Indirect Cost questionnaire

6. Non-profit applicants must submit Form F: Due Diligence Review Form

Incomplete applications will not be considered or evaluated.

Applications must include all required application materials, including attachments. Do not provide any materials that are not requested in this RFP, as such materials will not be considered nor evaluated. MDH reserves the right to reject any application that does not meet these requirements.

By submitting an application, each applicant warrants that the information provided is true, correct, and reliable for purposes of evaluation for potential grant award. The submission of inaccurate or misleading information may be grounds for disqualification from the award, as well as subject the applicant to suspension or debarment proceedings and other remedies available by law.

All costs incurred in responding to this RFP will be borne by the applicant.

3.3 Required Forms for SubmissionForm A: Applicant Information

Form A is embedded into the REDCap survey. A copy of the form and questions is included in Appendix A so that applicants can be prepared to complete the information when submitting their application.

Form B: Work plan and Staffing workbook

A draft work plan is included in the template of Form B. Applicants should edit the work plan to adapt objectives and activities to meet their local needs, but should submit a final work plan that is similar in scope for a start-up home visiting program. Staff and timelines should be updated to fit applicant plans and timeline. The work plan timeline must extend across the period of performance (4/01/2021 to 12/31/2022) and include start and completion dates for activities. All proposed objectives should be in the SMART format (S=Specific, M=Measurable, A=Achievable, R=Realistic, and T=Time-bound).

Applicants should complete and submit a staffing plan for the grant period.

The Excel workbook containing templates for both of these is available on the Family Home Visiting website (www.health.state.mn.us/communities/fhv/grant.html)

Titled “MN Strong Foundations_Work Plan and Staffing.xlxs”

Form C: Project Narrative

All grant applicants shall complete and submit Form C: Project Narrative as part of their application. The project narrative describes community needs and resources and clearly justifies why the selected evidence-based home visiting model is appropriate for addressing the identified gap in services for at-risk families. Pay attention to section page limits. Any text that exceeds the section limits will be removed prior to scoring.

Form D: Budget

Applicants are required to submit grant program costs listed below using the Excel format of the Budget Summary, Detail and Justification that is provided. The file must be submitted as an Excel Workbook; a PDF will not be reviewed. Form D is available with the RFP information on the Family Home Visiting website (www.health.state.mn.us/communities/fhv/grant.html)

Titled “MN Strong Foundations_Budget Template.xlxs”.

· The budget period for this grant award is April 1, 2021 to December 31, 2022.

· The maximum cost per family for core home visiting services is $6500 per family for the 12-month period from July 1, 2021 to June 30, 2022 and $3300 per family for the 6-month period from July 1, 2022 to December 31, 2022.

· No more than 10 percent of the grant amount, or up to your federally approved indirect rate, may be spent on costs associated with administering the grant (indirect).

Introduction

You must account for all of your grant program costs under six different line items. The following paragraphs provide detailed information on what costs are allowable and associated with each of the six line items. You will be required to show detailed calculations to support your costs. Failure to include the required detail could result in a delayed grant agreement if your application is selected for funding. Please use whole dollar amounts, no decimals.

All costs under this grant must be prorated to reflect fair share of the expense to this program. For example, if a computer is purchased for one staff person who works .5 FTE on this grant and .5 FTE on another program, the cost for that computer should be split 50/50 by this grant and the other program.

We strongly suggest that applicants incorporate into their budgets the costs of appropriate financial staff to provide financial oversight to the grant. This could be through contracting with an individual or organization or a direct hire.

Salary and Fringe

For each proposed staff person who will work directly on the grant, applicants must list the following:

a. Position title and name of the staff person, if known

b. Full-time equivalent (FTE) to be charged to the grant (for example, 1 FTE would be one full-time staff person’s time, and 0.5 FTE would be half of a full-time staff person’s time)

c. Actual or expected rate of pay

d. Fringe benefits

e. Total amount expected to be paid for the staff person

The staff included in this section of the budget narrative should be the same as the staff included in the work plan. Grant funds may only be used for salary and fringe benefits for staff members directly involved in applicant’s proposed activities.

The salaries of administrative support, accounting, human resources, or IT support MUST be supported by some type of time tracking in order to be included in the Salary and Fringe line. Salary and fringe expenses not supported by time reporting documentation may be included in the indirect line if these unsupported salaries and fringe were included on the Indirect Cost Questionnaire form and approved by MDH. Any salary and fringe expenses not supported, not included on the Indirect Cost Questionnaire, and not approved by MDH are unallowable and may not be charged to this grant.

A brief description of the key duties that each staff will perform MUST be included in the Budget Justification. Staffing ratios must conform to model guidance.

All staff must be prorated to the anticipated time that they will work on the grant. If a position needs to be hired, grantees must prorate the final salary to account for delays in posting, recruiting and hiring the position based on their typical agency hiring practices and history.

Contractual Services

Applicants must identify any subcontracts that will occur as part of carrying out the duties of this grant program as part of the Contractual Services budget line item in the proposed budget. The use of contractual services is subject to State review and may change based on final work plan and budget negotiations with selected grantees.

Applicant responses must include:

· Description of services to be contracted;

· Anticipated contractor/consultant’s name (if known) or selection process to be used;

· Length of time the services will be provided;

· Hourly rate; and

· Total amount to be paid to the contractor.

Travel

Briefly explain and list the expected travel costs for staff working on the grant, including mileage, parking, hotel, and meals. Applicants must budget for home visitors and supervisors to attend:

· Required essential trainings for their chosen home visiting model

· Mileage for travel to home visits and reflective practice

If project staff will travel during the course of their jobs or for attendance at educational events, describe the purpose of the event, how it supports the chosen home visiting model, and itemize the costs, frequency, and the nature of the travel. Grant funds cannot be used for out-of-state travel without prior written approval from MDH. Minnesota will be considered the home state for determining whether travel is out of state.

Non-tribal applicants:

Budget for travel costs (mileage, lodging, and meals) using the rates listed in State of Minnesota Commissioner's Plan (www.health.state.mn.us/communities/practice/lphact/lphgrant/docs/CommissionersPlanOverview.pdf).

Hotel and motel expenses should be reasonable and consistent with the facilities available. Grantees are expected to exercise good judgement when incurring lodging expenses.

Mileage will be reimbursed at the current IRS rate at the time of travel.

Tribal Nation applicants:

Budget for travel costs (mileage, lodging, and meals) using the rates provided by the General Services Administration (GSA) (www.gsa.gov/travel/plan-book/per-diem-rates/per-diem-rates-lookup)). Current lodging amounts and meal reimbursement rates vary depending on where the travel occurs in Minnesota.

Consult the breakdown of the GSA meal and incidental expenses reimbursements (www.gsa.gov/travel/plan-book/per-diem-rates/mie-breakdown) for current rates for Tribal Nations.

Mileage will be reimbursed at the current IRS rate at the time of travel.

Supplies and Expenses

Briefly explain the expected costs for items and services the applicant will purchase to implement the home visiting program. These might include additional telephone equipment, postage, printing, photocopying, office supplies, training materials, and equipment. Include the costs expected to be incurred to ensure that community representatives, partners, or clients who are included in the applicant’s process or program can participate fully. Examples of these costs are fees paid to translators or interpreters. Grant funds may not be used to purchase any individual piece of equipment that costs more than $5,000, or for major capital improvements to property.

Supplies for participating families including developmental, safety, and other home visiting supplies must be related to content covered by the home visiting model and must not exceed $150/family each year.

Other

Describe expected grant-related costs that do not fit any other line item. Expenses in this line item must be directly related to the grant project and linked to an activity or strategy in the work plan. Examples include staff training, media expenses, childcare for participants during programming/events, participant incentives or stipends. Grant funds cannot be used for capital purchases, permanent improvements, cash assistance paid directly to individuals, or any cost not directly related to the grant. Expenses in the “Other” line item should represent the appropriate fair share to the grant.

Indirect Costs

MDH policy caps indirect costs at either a grantee’s federally negotiated rate or at 10 percent of the grant’s direct costs. Grantees who wish to charge indirect at a federally negotiated rate must be able to provide a copy of the federal rate agreement. If awarded a grant, a copy of the agreement will be requested before a grant agreement is signed.

Third-Party Reimbursement

Applicants must list and provide a brief description of their anticipated amount of third-party reimbursement, if they are able to bill for services.

Cost per Family

The maximum cost per family for core home visiting services is $6500/family for the 12 month period from July 1, 2021 to June 30, 2022 and $3300 for the last 6 month period.

Ineligible Expenses

Ineligible expenses include but are not limited to:

· Fundraising

· Taxes, except sales tax on goods and services

· Lobbyists, political contributions

· Bad debts, late payment fees, finance charges, or contingency funds

· Continuous or ongoing essential or emergency supplies are not allowed:

· Items such as diapers, wipes, or other consumable products should not be purchased and provided to families on an ongoing basis.

· Food such as formula, baby food or groceries should not be purchased and provided to families on an ongoing basis.

· Takeout or delivery meals cannot be provided to families at their homes.

· Alcohol or illegal substances

· Firearms

· Commercial Tobacco

· Any cost not related to the implementation and subsequent delivery of evidence-based home visiting services

· Capital improvements

· Cash assistance paid directly to individuals to meet their personal or family needs

· Donations

· Costs incurred prior to executing your grant agreement

· Direct patient medical or dental services

· Gifts for staff

· Staff meals

· Supplanting of funds from other sources

COVID-19 Pandemic:

Funds may not be used to support direct COVID-19 pandemic response duties or expenses.

Incentives

Applicants proposing activities that involve the use of incentives for program participation must include the costs for purchasing incentives in the “Other” line of the budget and follow the guidelines stated below.

Incentives may include gift cards or specific items and may only be given to eligible participants. This includes:

· Gift cards and infant supplies may be used as incentives for participating mothers and caregivers receiving evidence-based home visiting services.

Applicants must adhere to the following rules regarding incentives:

· A participant may not receive more than $150 worth of incentives per year. If using gift cards as incentives, multiple cards can make up the $150 maximum as long as the $150 is not surpassed.

· Incentives must be kept in a secure locked location at all times (e.g., locked drawer, locked cabinet).

· The applicant/grantee must track which client/participant received the incentive and the dollar value of that incentive. Applicants/grantees must ensure data privacy when tracking the distribution of incentives.

· Incentives must be distributed in the funding year in which they are purchased.

· In order for the expense of incentives to be reimbursable, the applicant must:

· address the use of incentives in the narrative of the RFP application

· account for the incentives in the “Other” line of the budget justification

· obtain MDH’s approval of the budget justification that includes the incentives

Form E: Indirect Cost Questionnaire

Indirect costs are expenses of doing business that cannot be directly attributed to a specific grant program or budget line item. These costs are often allocated across an entire agency and may include administrative, executive and/or supervisory salaries and fringe, rent, facilities maintenance, insurance premiums, etc.

The following are examples that could be included in indirect costs:

· Your department pays a general percentage to the city/county attorney’s office or the sheriff’s department and these costs cannot be specifically attributed to an individual grant.

· Your CHB or department pays a fee or percentage to the county/city human resources department and these costs are not tied to a specific grant.

· Your CHB’s accounting system does not allow the community health services (CHS) administrator’s time to be directly attributed to specific grant activities.

In contrast, administrative costs are expenses not directly related to delivering grant objectives, but necessary to support a particular grant program. These are items that, while general expenses, can be attributed and appropriately tracked to specific awards. These items should be included in the grantee budget as direct expenses in the appropriate lines of Salaries and Fringe, Supplies, Contractual Services, or Other. They should not be included in the Indirect line.

The following are examples of administrative costs that should be included in the direct lines of the budget and/or invoice:

· The CHS administrator’s time that can be tracked through time studies to a specific grant (include in the Salary/Fringe line).

· A portion of secretarial/administrative support, accounting, human resources or IT support staff expenses that can be tracked through time studies to a specific grant (include in the Salary/Fringe line).

· Printing and supplies that your accounting system is able to track (for example through copy codes) to a specific grant (include in the Supplies line item).

Indirects should only be charged on the first $25,000 of any contract and should only be done if accounting costs are listed as part of the indirect costs.

Form F: Due Diligence Review

Purpose

The Minnesota Department of Health (MDH) must conduct due diligence reviews for non-governmental organizations (NGOs) applying for grants, according to MDH Policy 240.

Definition

Due diligence refers to the process through which MDH researches an organization’s financial and organizational health and capacity (MDH Policy 240). The due diligence process is not an audit or a guarantee of an organization’s financial health or capacity. It is a review of information provided by a NGO and other sources to make an informed funding decision.

Instructions

As an applicant for MDH funds you must answer the following questions about your organization, and return the form (along with any required additional documentation) to the grant manager.

Application RequirementsSubmission Checklist

· Current/previous grantees: log in to SWIFT and confirm that your organization’s name, address, locations, banking information, phone numbers, and other contact information is correct.

· Form A: Applicant information (questions in Application survey)

· Form B: Work Plan and Staffing (Excel format required)

· Form C: Project Narrative must be 12-point font, single spaced, with one-inch margins, adhering to the page limits specified in parenthesis next to lettered section headings.

· Form D: Budget Summary, Details and Justification (Excel format required)

· Form E: Indirect Cost Questionnaire

· If applicant is a non-profit, the Due Diligence Review is required (Form F) is required

· Maximum cost per family cap has not been exceeded.

· Submit application materials via the MN Strong Foundations Application survey (redcap.health.state.mn.us/redcap/surveys/?s=ACYCC4C88N). Submitted documents should be limited to Word, Excel and/or PDF files as per instructions.

· Submission deadline is 4:30 pm (CST) on Wednesday, February 5, 2021. No late or incomplete applications will be accepted or reviewed

· If applicant is using a fiscal agent, it must be stated on the Applicant Information. A fiscal agent is an organization that assumes full legal and contractual responsibility for the fiscal management and award conditions of the grant funds and that has authority to sign the grant agreement. A fiscal agent is a different entity than the entity that will actually perform the work/grantee’s duties

Forms

Form A: Applicant Information (to be entered into Application survey)

Form C: Project Narrative

Form E: Indirect Cost Questionnaire

Form F: Due Diligence Review

Form A: Application Information

This information will be entered directly into questions in the REDCap survey. The questions are provided here so you may be prepared to answer the questions once in the survey.

General Applicant InformationApplicant Legal Name (do not use a “doing business as” name):      Business Address (street, city, state, zip):      Minnesota Tax Identification Number:      Federal Tax Identification Number:      SWIFT Vendor ID Number:      

Authorized Representative for Applicant Agency InformationName:      Title:      Phone Number:      Email:      

Primary Contact for this ApplicationName:      Phone Number:      Email:      

Requested FundingTotal Amount Requested $     

List Communities, Counties or Tribal Nations to be Served      

Evidence-Based Home Visiting Model     

I certify that the information contained above is true and accurate to the best of my knowledge; that I have informed this agency’s governing board of the agency’s intent to apply for this grant; and, that I have received approval from the governing board to submit this application on behalf of the applicant.

Signature of Authorized Agent for Applicant:       Date of Signature:      

Form C: Project Narrative

Applicants are encouraged to provide brief, concise, and direct answers to the questions. Applicants should use 12-point font with one-inch margins for the Project Narrative.

Applicant Experience and Capacity (two pages or less; If an applicant submits a joint application through a multi-county Community Health Board, the limit is two pages per county for this section).

1. Briefly summarize the applicant’s history of providing family home visiting services including a brief description of your staff, their education and experience.

2. Briefly describe the support the applicant has related to this grant application including applicant or governing body support, programmatic leadership support and support from the home visiting staff.

3. Describe the organizational infrastructure in place to budget and manage funds, submit invoices and reports on time, and provide or be able to hire and/or contract, for the provision of services.

4. If you are an agency applying on behalf of a county or tribal region, 1) provide a statement that indicates all parties are in agreement of this application, 2) briefly describe the relationship in a few sentences, and 3) upload documentation of the relationship in the Supporting Documents question (e.g., MOU, Joint Powers of Agreement, Letter of Support).

Model and Target Population (one page or less)

1. Briefly describe the target population to receive family home visiting services, highlighting unmet needs in at-risk populations.

2. Clearly state your Target Caseload to be achieved by December 2022 (see definition in Appendix B).

3. Briefly describe the exploration your team has done of various evidence-based home visiting models and how your selected model fits with a) your home visiting workforce and b) the needs of your community and families to be served.

4. Describe how you will reach, engage, recruit, enroll, and retain the targeted families in need of home visiting services in the identified service provision areas.

Linkages and Collaboration (1/2 page or less)

1. Describe how you currently or plan to collaborate with other home visiting programs and community partners to identify, educate and refer families to the home visiting program that best fits their needs and has openings.

a. For communities, counties, and tribal nations that are co-located or have a shared geographical region, describe current or planned efforts to reach out, coordinate, and address unmet need to deliver home visiting services.

Implementation Plan for the Proposed Evidence-Based Home Visiting Model (one page or less for questions 2-4).

1. Complete the required Home Visitor Staffing Plan table in Form B.

2. Describe your plan for providing referrals from your program to other community resources and how you will follow up on referrals made.

3. Describe specific activities you will engage in to assure fidelity to the selected evidence-based home visiting model including the provision of reflective supervision.

4. Describe how you will meet the grant requirements to bill for eligible third-party reimbursements (e.g., developmental screening, CHW or PHN eligible home visiting services under Medicaid).

5. Discuss your plans for establishing or continuing to use an existing local advisory council to provide input on proposed home visiting services.

Health Equity (one page or less)

1. Describe how the applicant organization’s staff, leadership and board reflect the population the applicant proposes to serve. If staff, leadership and board are not reflective of the population(s) served, please include an activity in your work plan to improve in this area.

2. Describe specific activities that you will carry out to assure culturally and linguistically appropriate services. Include a brief description of how these activities support your identified priority population.

Data Collection and Reporting (½ page or less)

Awarded applicants are required to collect and submit evaluation data to MDH according to the requirements for state-funded Evidence-Based Home Visiting (EBHV) grantees as described in the current FHV Reporting Requirements document: Family Home Visiting Reporting Requirements for 2020 (www.health.state.mn.us/docs/communities/fhv/reportingreq2020.pdf).

1. Please check which electronic health record or case management system(s) you will use to submit data to the Information for Home Visiting Evaluation (IHVE) data system. Multi-county community health boards may select more than one system if applicable. Please note: the IHVE REDCap forms administered by MDH do not qualify as an electronic health record or case management system.

· PH-Doc

· Nightingale Notes

· Other electronic health record or case management system (response to next question is required)

2. If you checked “Other” in question 1 and will use an electronic health record or case management system other than PH-Doc or Nightingale Notes, describe how you will ensure that the system will meet IHVE submission requirements by the project start date (April 1, 2021).

Form E: Indirect Cost QuestionnaireBackground

Applicants applying may request an indirect rate to cover costs that cannot be directly attributed to a specific grant program or budget line item. This allowance for indirect costs is a portion of any grant awarded, not in addition to the grant award. Please refer to page 29 for more detailed information on indirect costs.

Instructions

Please complete the information below and return this form as part of the application.

1. Name of applicant agency:      

2. Are you requesting an indirect rate?

|_| Yes |_| No

3. Do you have an approved Indirect Cost Rate Agreement with a Federal agency?

|_| Yes – Please submit a copy of your current rate with this completed form.

|_| No – Please continue completing the rest of this form.

4. Non-federal indirect rate being requested:      

Up to 10 percent of the direct expenses in the budget for the grant program listed above can be used for indirect costs per CFR Part 200 - Uniform Administrative Requirements, Costs Principles, and Audit Requirements for Federal Awards, and per MDH policy for State funds.

5. Please list the expenses included in your indirect cost pool below, or attach a copy of your current indirect cost allocation plan to this form.

     

     

     

     

     

     

     

     

Form F: Due Diligence Review

This form is only required from non-profit applicants.

Purpose

The Minnesota Department of Health (MDH) must conduct due diligence reviews for non-governmental organizations (NGOs) applying for grants, according to MDH Policy 240.

Definition

Due diligence refers to the process through which MDH researches an organization’s financial and organizational health and capacity (MDH Policy 240). The due diligence process is not an audit or a guarantee of an organization’s financial health or capacity. It is a review of information provided by a NGO and other sources to make an informed funding decision.

Instructions

As an applicant for MDH funds you must answer the following questions about your organization, and return the form (along with any required additional documentation) to the grant manager.

Organization Information Questionnaire

Question

Response

1. How long has your organization been doing business?

2. How many employees does your organization have (both part time and full time)?

3. What was your organization's total revenue in the most recent 12-month accounting period?

4. How many different funding sources does the total revenue come from?

5. Does your organization have a current 501(c) 3 status from the IRS? Circle Yes or No.

Yes

No

6. Has your organization done business under any other name(s) within the last five years? Circle Yes or No.

If yes, list name(s) used.

Yes

No

7. Is your organization affiliated with or managed by any other organizations, such as a regional or national office? Circle Yes or No.

If yes, provide details.

Yes

No

8. Does your organization receive management or financial assistance from any other organizations? Circle Yes or No.

If yes, provide details.

Yes

No

9. Have you been a grantee of the Minnesota Department of Health within the last five years? Circle Yes or No.

If yes, from which division(s)?

Yes

No

10. Does your organization have written policies and procedures for accounting processes? Circle Yes or No.

If yes, please attach a copy of the table of contents.

Yes

No

11. Does your organization have written policies and procedures for purchasing processes? Circle Yes or No.

If yes, please attach a copy of the table of contents.

Yes

No

12. Does your organization have written policies and procedures for payroll processes? Circle Yes or No.

If yes, please attach a copy of the table of contents.

Yes

No

13. Which of the following best describes your organization's accounting system? Circle one response.

Manual

Automated

Both

14. Does the accounting system identify the deposits and expenditures of program funds for each grant separately? Circle one response.

Yes

No

Not sure

15. If your organization has multiple programs within a grant, does the accounting system record the expenditures for each program separately by budget line items? Circle one response.

Yes or Not applicable

No

Not sure

16. Are time studies conducted for employees who receive funding from multiple sources? Circle one response.

Yes or Not applicable

No

Not sure

17. Does the accounting system have a way to identify over-spending of grant funds? Circle one response.

Yes

No

Not sure

18. If grant funds are mixed with other funds, can the grant expenses be easily identified? Circle one response.

Yes

No

Not sure

19. Are the officials of the organization bonded? Circle one response.

Yes

No

Not sure

20. Did an independent certified public accountant (CPA) ever examine the organization's financial statements? Circle one response.

Yes

No

Not sure

21. Has any debt been incurred in the last six months? Circle Yes or No.

If yes:

What is the reason for the new debt?

What is the funding source for paying back the new debt?

Yes

No

22. What is the current amount of unrestricted funds compared to total revenues?

23. Are there any current or pending lawsuits against the organization? Circle Yes or No.

Yes

No

24. If yes, could there be an impact on the organization's financial position? Circle one response.

Yes

No or Not applicable

25. Has the organization lost any funding due to accountability issues, misuse, or fraud? Circle Yes or No.

If yes, please describe the situation, including when it occurred and whether issues have been corrected.

Yes

No

Additional Documentation Required

The following documentation is required from non-governmental organizations in addition to the due diligence form.

IF you’re an NGO with annual income:

THEN submit your most recent:

under $50,000

OR have not been in existence long enough to have a completed IRS Form 990 or audit

board-reviewed financial statements

examples: Statement of Activities; Statement of Financial Position

$50,000 – $750,000

IRS Form 990

over $750,000

certified financial audit

RFP Part 4: Appendices

Appendix A: Application Evaluation Criteria

Appendix B: Definitions

Appendix C: Sample Grant Agreement

Appendix A: Application Evaluation Criteria

A numerical scoring system will be used to evaluate eligible applications. Scores will be used to develop final recommendations.

Applicants are encouraged to score their own application using the evaluation score-sheet before submitting their application. This step is not required, but may help ensure applications address the criteria evaluators will use to score applications.

Project Narrative (55 points)

· Organizational experience, capacity and commitment to implement an evidence-based home visiting model (20 pts)

· Linkages and collaboration (5 pts)

· Implementation plan for the proposed evidence-based home visiting model (20 pts)

· Health Equity focus (5 pts)

· Data collection and reporting (5 pts)

Work Plan and Staffing (25 pts)

· Staffing is adequate and realistic for a start-up program and target caseload. (5 pts)

· Activities support implementation of the proposed model (10 pts)

· Health Equity activities are identified (10 pts)

Budget and Budget Justification (20 pts)

· Budget narrative description supports the activities described in the project narrative and work plan (10 pts)

· Budget expenses are reasonable, allowable and allocable (10 pts)

Appendix B: Definitions

At-Risk Family – A family experiencing risk factors who resides in an identified community and is eligible to receive home visiting services.

Community – A geographically distinct area that is defined by the applicant. Communities should be areas that hold local salience and may be defined as a neighborhood, town, city, county or other geographic area. Services provided within a particular community should be distinguishable from services provided in other communities.

Community Health Board (CHB) – The community health board as defined by Minnesota Statute 145A.02 is the legal governing authority for local public health in Minnesota. Community health boards work with MDH in partnership to prevent diseases, protect against environmental hazards, promote healthy behaviors and healthy communities, respond to disasters, ensure access to health services, and assure an adequate local public health infrastructure.

Evaluation Data – Individual-level data collected on families served by the evidence-based home visiting model and reported to the State for evaluation purposes. All awarded applicants will be required to collect evaluation data on participating families, and enter or upload the data into a system designated by MDH. Evaluation data will include demographic and service data, as well as data needed to calculate process and outcome evaluation measures. A list of the planned state FHV evaluation measures is provided in Appendix E.

Evidence-based Home Visiting Model – A home visitation model that has been in existence for at least three years and is research-based, grounded in relevant empirically-based knowledge, linked to program-determined outcomes, and associated with a national organization or institution of higher education that has comprehensive home visitation program standards that ensure high quality services delivery and continuous program improvement, and has demonstrated significant, positive outcomes on indicators described in federal legislation, when evaluated using a well-designed and rigorous randomized controlled research design and/or quasi-experimental research design, and the results of which have been published in a peer-reviewed journal.

Home Visiting Models– Programs or initiatives in which home visiting is a primary service delivery strategy and in which services are offered on a voluntary basis to clients including, but not limited to, pregnant women, expectant fathers, and parents and caregivers of children ages birth to kindergarten entry, targeting specific participant outcomes. For the purposes of this RFP, the following evidence-based home visiting models are eligible for priority funding: Healthy Families America (HFA), Nurse-Family Partnership (NFP), Family Spirit (FS), Early Head Start - Home Based (EHS), Maternal Early Childhood Sustained Home Visiting (MECSH), and Parents as Teachers (PAT). Information on these models and the model developers is available on the HomVEE website (https://homvee.acf.hhs.gov).

Informed Consent – Written permission from an individual to allow a government entity to release the individual’s private data to another government or non-government entity or person, or to use the individual’s private data within the entity in a different way (Minnesota Statutes, section 13.05, subdivision 4). A valid informed consent must be voluntary and not coerced, be in writing, and explain why the use or release of data is necessary. Awarded applicants must have a process that asks clients for their written informed consent to provide the State with their identifiable individual level data for the purpose of evaluating the evidence-based home visiting model. Awarded applicants must inform their clients that the client’s decision regarding informed consent will not in any way impact that family’s access to services.

Maintaining Fidelity of a Model – Providing services which meet the specified criteria and components of the identified evidence-based home visiting model on an on-going basis.

National model developer – Entity responsible for the development of an identified evidence-based home visiting model.

Non-Profit Organization – An entity granted tax-exempt status by the Internal Revenue Services and that does not seek or produce a profit.

Priority Population –

· Programs enrolling and serving families prenatally to three months post-partum

· Communities experiencing high poverty

· Communities with high child maltreatment rates

· Communities with high rates of infants born with low birth weight

· Tribal nations and tribal communities

· Pregnant and parenting Teens

· Underserved racial/ethnic communities

· Incarcerated parents

· Families experiencing homelessness

· Pregnant women and families experiencing substance abuse

· Pregnant women and families with mental illness

Reflective Supervision – Reflective supervision is a distinctive form of competency-based professional development that is provided to multidisciplinary early childhood home visitors who are working to support very young children’s primary caregiving relationships. Reflective supervision is a practice which acknowledges that very young children have unique developmental and relational needs and that all early learning occurs in the context of relationships. Reflective supervision is distinct from administrative supervision and clinical supervision due to the shared exploration of the parallel process, that is, attention to all of the relationships is important, including the relationships between home visitor and supervisor, between home visitor and parent, and between parent and infant/toddler. Reflective supervision supports professional and personal development of home visitors by attending to the emotional content of their work and how reactions to the content affect their work. In reflective supervision, there is often greater emphasis on the supervisor’s ability to listen and wait, allowing the supervisee to discover solutions, concepts and perceptions on his/her own without interruption from the supervisor.

Review Panel– A group of reviewers with backgrounds, knowledge and experience in maternal and child health and early childhood development selected by MDH to evaluate and score applications submitted in response to this RFP.

Target Caseload – The target caseload is the total number of family slots that will be added as a result of this funding. Only active cases as defined by the evidence-based home visiting model may be counted toward the target caseload when reporting. Awarded applicants will identify a target caseload that will be achieved and maintained throughout the grant agreement.

Tribal Nation – A federally recognized American Indian tribe considered a sovereign nation.

Appendix C: Sample Grant Agreement

Minnesota Department of Health

Grant Award Cover Sheet

You have received a grant award from the Minnesota Department of Health (MDH). Information about the grant award, including funding details, are included below. Contact your MDH Grant Manager if you have questions about this cover sheet.

DATE: April 1, 2021

ATTACHMENT: Grant Project Agreement

CONTACT FOR MDH: Dawn Reckinger, Manager Family Home Visiting, 651-201-4841, Dawn.Reckinger@state.mn.us

Minnesota Department of Health

Community Health Board Grant Project Agreement

This Grant Project Agreement, and amendments and supplements, is between the State of Minnesota, acting through its Commissioner of Health ( “STATE”) and GRANTEE, an independent organization, not an employee of the State of Minnesota, address GRANTEE ADDRESS, (“GRANTEE”).

1. Under Minnesota Statutes 144.0742, the STATE is empowered to enter into a contractual agreement for the provision of statutorily prescribed public health services;

2. The STATE and the GRANTEE have entered into Master Grant Contract number Insert Master Grant Contract number for this Community Health Board (“Master Grant Contract”) effective January 1, 2015 or subsequent Master Grant Contracts and amendments and supplements thereto;

3. The STATE, pursuant to Minnesota Statutes Minnesota Session Laws 2017, First Special Session, Chapter 6, Article 18, Section 3, Subdivision 2 is empowered to support community health boards, tribal nations and nonprofits providing evidence-based home visiting models identified by the STATE in their communities; and

4. The GRANTEE represents that it is duly qualified and willing to perform the duties described in this grant project agreement to the satisfaction of the STATE. Pursuant to Minnesota Statutes Section 16B.98, subdivision 1, the GRANTEE agrees to minimize administrative costs as a condition of this grant.

NOW, THEREFORE, it is agreed:

1.Incorporation of Master Grant Contract. All terms and conditions of the Master Grant Contract are hereby incorporated by reference into this grant project agreement.

2.Term of Agreement.

2.1 Effective date. This grant project agreement shall be effective on April 1, 2021, or the date the STATE obtains all required signatures under Minnesota Statutes 16B.98. Subd. 5(a), whichever is later. The GRANTEE must not begin work until this contract is fully executed and the State’s Authorized Representative has notified the GRANTEE that work may commence.

2.2 Expiration date. June 30, 2022, or until all obligations have been fulfilled to the satisfaction of the STATE, whichever occurs first, except for the requirements specified in this grant project agreement with completion dates which extend beyond the termination date specified in this sentence.

3.Grantee’s Duties and Responsibilities. The GRANTEE shall:

3.1 Work Plan. Complete the duties set forth in Exhibit A-Work Plan, which is attached and when approved, incorporated into this grant project agreement. Any changes to the Work Plan require prior written approval from the STATE’S Authorized Representative. Approved changes to the Work Plan will be incorporated into this grant project agreement. An amendment to the grant project agreement will be required if the changes alter the fundamental GRANTEE’S duties and responsibilities.

3.2Target. After the end of the first year of the contract, if the GRANTEE’S caseload of family slots (see Work Plan) falls below and stays below 85 percent for one month, the GRANTEE must notify the STATE within 30 days. The STATE will work with the GRANTEE to determine how to achieve and maintain the target caseload.  

3.3 Billing Third Parties. GRANTEE must seek third party reimbursement for MN Strong Foundations: Evidence-Based Home Visiting (EBHV) program services provided to Medicaid-enrolled families. Earned program income generated by grant supported activities must go back into the GRANTEE’s MN Strong Foundations: EBHV program, may be used for allowable costs only and must be reported to the STATE as required on Quarterly Reports.

3.4 Informed Consent for Release of Individual Level Data. GRANTEE must have a process that asks clients for written informed consent to provide the STATE with their individual level data including personal identifiers for the purpose of evaluating the EBHV program. GRANTEE must inform the clients that a client’s decision to not grant consent will not in any way impact the client’s family’s access to services. The STATE agrees to protect not public data as outlined in Exhibit B which is attached and incorporated into this agreement.

3.5 Evaluation. GRANTEE will participate in the STATE’s EBHV program evaluation and reporting activities. GRANTEE must provide the STATE with data on clients and families served by the EBHV program for evaluation purposes at a time and in a format required by the STATE. GRANTEE will provide the STATE with individual level data including personal identifiers in accordance with the level of informed consent given by the client. GRANTEE will provide the STATE with aggregate data on clients served by the grant program, including clients that do not grant informed consent to release any individual level data to the STATE.

4.Consideration and Payment.

4.1 Consideration. The STATE will pay for all services performed by the GRANTEE under this grant project agreement as follows:

(a) Compensation. The GRANTEE will be paid according to the breakdown of costs contained in Exhibit C, which is attached and incorporated into this agreement.

(b) Total Obligation. The total obligation of the STATE for all compensation and reimbursements to the GRANTEE under this grant project agreement will not exceed $XXXXXX, as follows:

Budget Period Amount

(c) Budget Modifications. Modifications greater than 10 percent of any budget line item in the most recently approved budget (listed in 4.1(a) or incorporated in Exhibit C) requires prior approval from the STATE and must be indicated on submitted reports. Failure to obtain prior approval for modifications greater than 10 percent of any budget line item may result in denial of modification request and/or loss of funds. Modifications equal to or less than 10 percent of any budget line item are permitted without prior approval from the STATE provided that such modification is indicated on submitted reports and that the total obligation of the STATE for all compensation and reimbursements to the GRANTEE shall not exceed the total obligation listed in 4.1(b) or Exhibit C.

4.2 Terms of Payment.

(a) Invoices. The State will promptly pay the GRANTEE after the GRANTEE presents an itemized invoice for the services actually performed and the State's Authorized Representative accepts the invoiced services. Invoices must be submitted in a timely fashion and according to the following schedule: Quarterly, by the 20th day of the following month.

(b) State Funds. Payments under this grant project agreement will be made from state funds

5.Conditions of Payment. All services provided by GRANTEE pursuant to this grant project agreement must be performed to the satisfaction of the STATE, as determined in the sole discretion of its Authorized Representative. Further, all services provided by the GRANTEE must be in accord with all applicable federal, state, and local laws, ordinances, rules and regulations.

6.Ownership of Equipment. Disposition of all equipment purchased under this grant project agreement shall be in accordance with Code of Federal Regulations, Title 45, Part 74, Subpart C or, for Notice of Grant Awards issued on or after December 26, 2014, in accordance with Code of Federal Regulations, Title 2, Subpart A, Chapter II, Part 200. For all equipment having a current per unit fair market value of $5,000 or more, the STATE shall have the right to require transfer of the equipment, including title, to the Federal Government or to an eligible non-Federal party named by the STATE. This right will normally be exercised by the STATE only if the project or program for which the equipment was acquired is transferred from one grantee to another.

7.Authorized Representatives.

7.1 STATE’s Authorized Representative. The STATE’s Authorized Representative for purposes of administering this grant project agreement is Dawn Reckinger, Manager Family Home Visiting, P.O. Box 64882, St. Paul, MN 55101, 651-201-4841, Dawn.Reckinger@state.mn.us , or his/her successor, and has the responsibility to monitor the GRANTEE’s performance and the final authority to accept the services provided under this grant project agreement. If the services are satisfactory, the STATE’s Authorized Representative will certify acceptance on each invoice submitted for payment.

7.2 GRANTEE’s Authorized Representative. The GRANTEE’s Authorized Representative is insert name, title, address, telephone number, and e-mail, or his/her successor. The GRANTEE’s Authorized Representative has full authority to represent the GRANTEE in fulfillment of the terms, conditions, and requirements of this agreement. If the GRANTEE selects a new Authorized Representative at any time during this grant project agreement, the GRANTEE must immediately notify the STATE.

8.Termination.

8.1Termination by the STATE. The STATE or GRANTEE may cancel this grant project agreement at any time, with or without cause, upon thirty (30) days written notice to the other party.

8.2Termination for Cause. If the GRANTEE fails to comply with the provisions of this grant project agreement, the State may terminate this grant project agreement without prejudice to the right of the STATE to recover any money previously paid. The termination shall be effective five business days after the STATE mails, by certified mail, return receipt requested, written notice of termination to the GRANTEE at its last known address.

8.3Termination for Insufficient Funding. The STATE may immediately terminate this grant project agreement if it does not obtain funding from the Minnesota legislature or other funding source; or if funding cannot be continued at a level sufficient to allow for the payment of the work scope covered in this grant project agreement. Termination must be by written (e-mail, facsimile or letter) notice to the GRANTEE. The STATE is not obligated to pay for any work performed after notice and effective date of the termination. However, the GRANTEE will be entitled to payment, determined on a pro rata basis, for services satisfactorily performed to the extent that funds are available. The STATE will not be assessed any penalty if this grant project agreement is terminated because of the decision of the Minnesota legislature, or other funding source, not to appropriate funds. The STATE must provide the GRANTEE notice of the lack of funding within a reasonable time of the STATE receiving notice of the same.

9.Publicity. Any publicity given to the program, publications, or services provided from this grant project agreement, including, but not limited to, notices, informational pamphlets, press releases, research, reports, signs, and similar public notices prepared by or for the GRANTEE or its employees individually or jointly with others, or any subgrantees shall identify the STATE as a sponsoring agency and shall not be released, unless such release is approved in advance in writing by the STATE’S Authorized Representative. If federal funding is being used for this grant project agreement, the federal program must also be recognized.

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