The State Offices of Rural Health Grant Program Application

1. The State Offices of Rural Health Grant Program Application  Keith J. Midberry, MHSA Department of Health & Human Services Health Resources and Services Administration Office of Rural Health Policy New SORH Directors OrientationRockville, MD November 5, 2008

2. SORH Grant Program Authorized by Public Health Service Act Funded since 1991/ FY 08 is 18th year! Primary goal -to assist States in strengthening rural health care delivery systems by creating a focal point for rural health in each State Provides institutional framework to link rural communities with State / Federal resources.

3. State Offices of Rural Health Single grantee in each of 50 States Flexibility in deciding where to locate SORH 36 in State Health Departments / Agencies 11 in institutes of higher learning 3 are not-for-profit organizations Many SORH Directors are also Directors of State Primary Care Organization (PCO)

5. State Offices of Rural Health (cont) Federal-State Partnership State matching funds required Awarded $7.2M in FY 08, 47 States received $147,700 Grant program covers activities funded by both State and Federal funds Leveraged over $230M in past 18 years

6. State - Matching Funds $3 State match for every $1 of Federal funds requested Covered by Title 45 CFR - Part 74 for nonprofits and university based models- Part 72 for State governments / agencies Budget and Budget Justification must include use of State matching funds

7. Three Core Functions of SORH Defined in authorizing legislation  1. Establish and maintain clearinghouse for  collecting / disseminating information on: Rural health care issues; Research findings related to rural health; and Innovative approaches to the delivery of care in rural areas (best practices).

8. Three Core Functions of SORH 2. Coordinate activities within state to avoid  duplication of effort and activities.  3. Identify Federal, State and NGO  programs and resources and provide  technical assistance regarding application and participation.

9. Two Additional Program Goals 1) Encourage, but not directly fund, the recruitment and retention of health professionals in rural areas. - 49 States participate in 3RNet 2) Participate in strengthening State, local and Federal partnerships in rural health.

10. Grant Limitations May not be used for: providing health care services; purchasing medical equipment, vehicles or communications equipment; to purchase or improve real property; or conduct activity regarding a certificate of need.

11. Grant Limitations (cont.) No more than 10 percent of funds may be used for research purposes Indirect charge may not exceed 15 percent of the total direct charges. Used to be 15% of tatal award. - Max possible for $150K award is $19, 565. Funds cannot be used for lobbying purposes

12. Budget Information SF-424A Section A � use only columns e, f & g  under New or Revised Budget Include non-Federal funds in Sections A,B & D and Totals Indirect charge allowed only if SORH has current indirect rate approved by HHS- Attach form or explain, usually a percent of  salaries / fringe or direct costs - Cannot exceed 15 percent of direct charge 

13. Budget Justification Narrative provides detail - the why and what behind the number Include State matching funds and explain linkage to rural health issues and programs Fully explain Contractual Object Class (often the State matching funds), includeexplanation of deliverables

14. Travel Explain in and out of State � purpose, duration, traveler, type of transportation, cost, etc. Include meetings, training, workshops Four meetings required as condition of award: - SORH Regional Meeting - SORH Annual Grantee Meeting (every  other year will be All Programs Meeting) - National Organization of State Offices of Rural Health (NOSORH) annual meeting- National Rural Health Association (NRHA) Annual Meeting

15. Staffing and Personnel Include Federal and State funded positions Position descriptions to include:- Role and responsibilities- Qualifications: education and/or experience - Rational for amount of time Narrative  (as full-time equivalent)  Provide biographical sketches or resumes and Organization Chart as attachments.

16. Program Narrative Introduction - Describe population served by ORHP and State definitions of rural - List programs administered with Federal and State matching funds Current Year Progress and Performance Measures - Describe progress since last application - Narrative format or optional table  - Discuss activities funded by Federal and  State match

17. Program Narrative Describe Significant Changes - Since last application or anticipated - List rationale and impact on program Upcoming Budget Period Plans and  Performance Measures - For three core and two additional functions - Narrative format or optional table  - Activities funded by Federal and State $

18. Optional Table May be used instead of narrative format List Goals Objectives Products / Services / Activities Progress and Process Measures Qualitative Impact

19. GPRA Measures Mandatory as of FY 05 cycle Each applicant required to report on same two questions / measures Limited to activities funded by SORH program (Federal and State Match) Process should be established to capture data Responses not tied to funding level NOSORH workgroup working on optional measures

20. New GPRA Measures FY 08 starts collection of two �new� GPRA measures:- Number of technical assistance encounters provided directly by SORH - Number of clients that received TA - Submit directly into EHB by Aug. 1, 2009

21. Attachments Staffing Plan Job description key personnel - 1 page Biographical sketch or resumes � max 2 pages Program Organizational Chart � how SORH relates to larger organization Organizational authority- Specifically for rural health- by laws or legislative authority- may not apply to some university models - may answer none

22. Office Performance Review (OPR) OPR has reviewed 30 SORHs over last 3 years Overall feedback has been positive 11 SORHs scheduled for calendar year 2009- AK, AL, CA, FL, LA, NY, ME, MI, MO, PA, WY NOSORH Cooperative agreement is tentatively scheduled for review FLEX grant reviews still under discussion FY 09 Guidance requires discussion of review and action plan activities (if applicable)

23. FY 09 Application Non-competitive continuation Anticipate release early December Due Grants.gov � February 2, 2009 Due in EHB � February 16, 2009 Change from Pure Edge Viewer to Adobe Staffing Plan as attachment #1 New OPR section Webinar in late Dec. or early Jan. 2009

24. SORH Challenges Reauthorization / appropriation sunset Relatively flat appropriation Decreasing amount of awards Equity among States Linkage of State matching funds to rural Indirect charge limitation Recurrent large carryovers Travel requirements Performance measurement

25. Contact Information Office of Rural Health Policy http://ruralhealth.hrsa.gov (301) 443-0835 Keith J. Midberry, MHSASORH and SHIP Program Coordinator kmidberry@hrsa.gov (301) 443-2669