Rural Health Centers Program Medical Access Plan and Project Grant SFY 2021- 2022

RFA Title: State Designated Rural Health Centers Support Grants 

Funding Agency Name: North Carolina Office of Rural Health (NC ORH) 

Funding Agency Address: 311 Ashe Avenue, Raleigh, NC 27603

RFA opens: March 24, 2021 
RFA deadline: April 23, 2021

New applications deemed eligible for funding will be asked to complete the readiness assessment described below within 60 days of notification.

State Designated Rural Health Centers RFA Information Session:

Information Session Recording – password: X2TeayKV5x2

Information Session Slide deck: Link

Background

NC ORH assists underserved communities and populations with developing innovative strategies for improving access, quality, and cost-effectiveness of health care.  Distribution of primary care providers in North Carolina has historically been skewed toward cities and larger towns.  Rural residents, who often face transportation issues, find accessing primary care services difficult.  Through the establishment of State Designated Rural Health Centers (SDRHC), NC ORH partners with local communities to provide funding to improve ability to serve underserved populations who would otherwise be unable to access needed primary care services due to geographic, economic, or other barriers. Thus, State Designated Rural Health Centers have become an integral part of the health care safety net for North Carolina’s rural and underserved residents. 

The purpose of the state designation is to support health care access in primary care sites that do not fit the CMS_RHC or FQHC designation. Recognizing the need for access to healthcare as the demographics of NC, as well as access points, change (due to FQHC growth and multi-site practice locations) is necessary for incubating and supporting the growth of new access points for health care in rural NC.  

ORH defines an SDRHC as a health care safety net organization that is a 501(c)3 non-profit, community-owned organization with an active board that has as its primary mission to provide primary health care services to those residing in its community.  SDRHCs must be located within communities that are both rural and underserved and must currently be delivering primary health care services or can serve patients within six months in its proposed service area.  

The State Designated Rural Health Center Guide is available as a resource for more detailed information about the Office of Rural Health’s work to increase access to quality care in rural and underserved communities. The Guide outlines the process for receiving State Designation as Rural Health Center and the activities the funds support. Link to guide.

RFA Description

The North Carolina Office of Rural Health (NC ORH) is accepting applications for continuing and new State Designated Rural Health Centers. The purpose of grants awarded under this program is to support state designated rural health centers.

The SFY 2021 RFA supports developing sustainable models of care as well as partnering with community-based organizations to ensure access to transportation, food, housing, and personal violence resources.

NC Department of Health and Human Services (NC DHHS) has developed tools to support the development and implementation of the Waiver and assist communities in improving health, not just paying for health care.  North Carolina received approval of its Medicaid 1115 Waiver and transformation.

Healthy Opportunities are the foundation for Medicaid Transformation.  
For that reason, applicants are encouraged to implement a variety of strategies that align with transformation including:

•    Healthy Opportunities Screening
•    Telehealth (including Telepsychiatry) and Integrated Care 
•    Opioid Disorder Treatment
•    Incorporating Community Health Workers into the care setting

As a new requirement for this application cycle, each applicant must participate in a new practice assessment coordinated and/or funded by NC ORH.

Type (s) of applications sought:   
New Rural Health Center Applicants:  An organization that is not currently funded through the NC ORH State Designated Rural Health Center grant and seeks to serve an underserved service area and uninsured target population with one or more permanent service delivery site (s). 
The organization may have received funds from other NC ORH programs but not as a State Designated Rural Health Center (SDRHC).     

Capacity Funding Applicants: New applicant organizations may apply for Capacity Funding or new applicants not selected to be a SDRHC will have an opportunity to receive capacity funding towards building a management system as well as programs. The funds can help an organization improve their community coordination, collaboration, and strengthen the organization’s ability to apply to become a SDRHC.     
•    Types of Capacity – staffing, organizational, communication, and collaboration, structural (procedures), and material (equipment)
•    Levels of Capacity – information, skills, structures, and processes
•    Stages of Capacity-building – exploration, emerging implementation, full implementation, and sustainability

Rural Health Center Continuing Applicants: A current State Designated Rural Health Center (SDRHC) that has received funds from the NC ORH and seeks to continue serving its current service area and target population.  
1) Continuing applicants are required to attach an attestation sheet along with their application indicating that their site is currently offering primary care services, has an established board of directors, is actively using an identified EHR system, and is in compliance with the State of North Carolina.  
Continuing applicants seeking to serve a different service access point or service area must include justification along with the attestation. This is subject to approval. 
Attestation Sheet click to download.

Grant Funding Descriptions

A.    Medical Access Plan (MAP) – Grant funds available for primary health care coverage. These visits are reimbursable at a rate of $100.00 per an encounter to the health center based on medically necessary on-site face-to-face provider encounters, as follows: onsite x-rays, in-house labs, surgical procedures, services performed by practice providers, prophylaxis, and telemedicine.    
 
B.    Behavioral Health Funds – Grant funds available for behavioral health and mental health counseling services. The visits are reimbursable at a rate of $75.00 per an encounter to the health center based on on-site face-to-face behavioral health provider encounters: The eligible providers are licensed clinical social workers, advanced practice registered nurses, psychologists, and psychiatrists.    

C.     Operating/Infrastructure Funds – An organization applying for funds in this category must demonstrate the ability to create systems and processes that promote sustainability of the organization being funded. Funding shall assist with accomplishing one of the following goals:

A.    Advanced Medical Home - Supports efforts to become recognized as a National Committee for Quality Assurance (NCQA) Patient Centered Medical Home (PCMH). 
Grant funds must support either:
•    An outside subject matter expert to assist with PCMH/AMH recognition or 
•    Costs associated with educating site personnel with becoming a PCMH Certified Content Expert and/or Advanced Medical Home

B.    Supports the creation and implementation of sustainable technological infrastructure that enhances access to health care and improves quality. These efforts may include:
1.    Technological infrastructure (hardware, software, telehealth applications etc.) 
Administrative and clinical innovations that sustain primary medical care delivery models through the adoption of Electronic Health Records (EHR) technology, and using the North Carolina HealthConnex, formerly known as the Health Information Exchange. In 2015 North Carolina passed a law (NCGS 90-414.7) establishing the North Carolina Health Information Exchange Authority (NC HIEA) to oversee and administer the NC Health Information Exchange Network called NC HealthConnex. 
2.    Methods for expanding the ability to collect, exchange, store, and disseminate health information while augmenting the practice’s capacity to provide access to and delivery of primary health care. 

C.    Supports rural health center’s activities that increase and/or improve efficiencies, effectiveness, transformation, sustainability, quality, or access to care. Provides rural health centers with funding to hire or retain professional services including but not limited to legal aid, actuarial services, and other professional services deemed prudent and necessary for business operations. Grantees must use the practice assessment/workplans completed to inform request for funds in this category.

D.    Funding to support innovative strategies including but not limited to:
•    Accountable Care Organizations (ACOs)  
•    Clinically Integrated Network (CINs) 
•    Healthy Opportunities Screening
•    Telehealth (including Telepsychiatry), Community Paramedicine, Integrated Care, etc. 
•    Opioid Disorder Treatment
•    Incorporating Community Health Workers into the care setting
•    Innovative collaboration with Community-Based Organizations to support Healthy Opportunities
•    Staffing and contract services  
•    The use of NC HealthConnex to promote access, exchange, and analysis of health information to improve patient care and coordination of care. 

D.    Capacity Funds – Grant funds available for capacity building. Eligible organizations may seek funding for capacity building when the assessment or application indicates further development is warranted before SDRHC status can be received. A Rural Health Operations staff member will work alongside the organization.

Award Information:  Applicants may apply for multiple funding options within the same application.  For example: An applicant can apply for behavioral health funds and operating/infrastructure funds. The maximum total grant award is dependent upon demonstrated needs and operating structure at each of the rural health centers and is contingent upon funding availability. Grant funds must be used at physical locations where primary medical care is provided and may not be used for vehicles or to pay down loans.

Funding Cycle: The funding cycle is July 1, 2021 through June 30, 2022. All grantees must fully expend grant funds prior to June 30, 2022.   All invoices for completed and projected work must be submitted to NC ORH for reimbursement no later than June 7, 2022. 
 
Requirements:  Your application must document the need for primary health care services in the service area and propose a comprehensive plan that demonstrates alignment to the NC ORH mission and vision. The plan within the application must ensure the availability and accessibility of primary health care services to all individuals in the service area and target population with collaborative and coordinated delivery systems for the provision of health care to the underserved.   
 
As a condition of receiving state funds, the SDRHC agrees to comply with the standards of the NC Division of Controllers Office, NC Office of Management and Budget standards, and ORH Operations Program. Link  for the detail requirements includes (1) Compliance Standards (Completion of all NC DHHS Contract Approval Forms), (2) Contractual Agreement, and (3) Program Operations.

How to Apply: Applicants must submit their application electronically through an electronic survey.  To receive a personalized link to the application requires a two-step process. The link below will request information about your organization and a contact person. The e-mail submitted in the link will be sent a personalized link to apply to the Rural Health Centers Support Grants RFA.  Use the following document as guidance to the electronic version of the application.

Click link to access electronic version of application:https://ncruralhealth.az1.qualtrics.com/jfe/form/SV_5ngAqyHY7Y7Sd2B

How to Obtain Further Information:   All questions regarding the application should be sent to the regional Rural Health Operation’s Program Team member based on the selected Medicaid Region or by contacting our office number 919-801-1642 or the Rural Health Operations email: RuralHealthOperations_Grantees@dhhs.nc.gov  

Dorothea Brock, Program Manager
Dorothea.Brock@dhhs.nc.gov

Scoring Criteria

Grant awards will be based on the following criteria. Failure to fully describe all sections will impact the funded amount. Applications will be reviewed and scored according to the following criteria regardless of the funding category applied for:

Overview of the Organization: 10 Points
 Community Need: 20 Points
 Improved Access to Care: 15 Points 
Community Collaboration (e.g., health departments, departments of social services, housing authority, etc.): 15 Points
Work Plan: 15 Points 
Performance Measure: 10 Points
Sustainability Model: 5 Points
Budget: 10 Points
Total Points Awarded: 100 Points
 

Attached Documents

SFY 2021_2022 Budget Narrative template

SFY2021_2022 Final Attestation SDRHC

SFY2021_2022 Final Budget Template RHC

SFY2021_2022 FINAL NC Readiness Assessment tool guide

SFY2021_2022 Final SDRHC Manual

SFY2021_2022 FINAL_SD Rural Health Center Application