Capital Improvement Program HRSA-09-244

1. Alteration/Repair/Renovation and Construction Projects May 6, 2009 Capital Improvement ProgramHRSA-09-244

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

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

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

5. Types of CIP Projects • The eligible project types are: • Alteration/repair/renovation, with or without IT/equipment • Construction (new site or expansion of existing site), with or without IT/equipment • IT/equipment-only purchase • HIT-only purchase (non-EHR equipment) • Certified EHR-related purchase

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.

7. CIP Application

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

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.

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

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

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

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.

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.

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.

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

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

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

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

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

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

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

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

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

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

26. Outline • Getting Started on EHB • Starting the CIP Application • CIP Alteration, Repair, Renovation and Construction Projects Application Process in HRSA’s EHB

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

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

29. Starting the CIP Application Click Funding Opportunities Enter HRSA-09-244 here … … then click the Search button

30. Click the Go button to begin the CIP Application Starting the CIP Application

31. Starting the CIP Application • 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. • Click the Continue button. 1 2

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.

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

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. Program Specific Information Project #1 Project #2 Project #3

35. Program Specific Information:Status Page

36. Program Specific Information:Proposal Cover Page 4 Sections: • Purpose • Sustainability Plan • Green/Sustainable Design Principles • Service Impacts Service Impacts • Projected # additional • Provider FTEs • # additional patients served • # additional visits

37. Program Specific Information:Assurances Download and Attach Assurances Template

38. Program Specific Information:Projects Application Budget SummaryInformation Update or Delete a Project Add Project button

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.

40. Program Specific Information:Add Project Confirmation

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.

42. Project Information:Project Cover Page 6 Sections: • Site Information • Project Management • Contact Information • Need • Implementation • Timeline

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

44. Project Information:Equipment List Click to Add Equipment

45. Project Information: Add Equipment Information Select from 3 Types of Equipment: • Clinical • Non-clinical • HIT/EHR

46. Project Information: Add, Update, or Delete Equipment Select Desired line firstto Update or Delete Add New Equipment line

47. Project Information:Project Budget Application Budget Summary Information Subtotalscalculated by system These Totals carried over to Funding form (see next slide)

48. Project Information:Funding Sources These Totals carried over from ProjectBudget form

49. Project Information:Budget Justification Budget Justification is an attached document

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.