FY 2020 CARES Supplemental Funding Guidance: Reporting Requirement for Health Centers

Purpose

The fiscal year (FY) 2020 Coronavirus Aid, Relief, and Economic Security (CARES) Act provides one-time funding to support health centers funded under the Health Center Program¹ to:

• Detect coronavirus (SARS-CoV-2)
• Prevent, diagnose, and treat COVID-19
• Maintain or increase health center capacity and staffing levels during a coronavirus-related public health emergency

Funding Summary

The CARES Act (P.L. 116-136) (PDF - 933 KB) (PDF), appropriated $1.32 billion for FY 2020 supplemental awards for the detection of coronavirus and/or the prevention, diagnosis, and treatment of COVID-19, including maintaining or increasing health center capacity and staffing levels during a coronavirus-related public health emergency. The Health Resources and Services Administration (HRSA) determined your CARES award amount using the following formula:

• Base value of $503,000, plus
• $15.00 per patient reported in the 2018 Uniform Data System (UDS), plus
• $30.00 per uninsured patient reported in the 2018 UDS.

Your award is aligned with your current Health Center Program funding proportions² and may support a wide range of in-scope activities, dating back to January 20, 2020. CARES funding complements the previous FY 2020 Coronavirus Supplemental Funding for Health Centers (COVID-19).

You have flexibility in how you use the funding as the coronavirus and related community, patient, and organizational needs evolve.³ Ensure that your activities to address COVID-19 are consistent with CDC guidance for health care professionals and federal, state, territorial and local public health recommendations. Among other uses, funding may be used to:

• Ensure patient and health center personnel safety and otherwise minimize COVID-19 exposure within the health center and in other locations where in-scope services are delivered.
• Address emergent COVID-19 issues, including testing and laboratory services, and patient and community education.
• Restore, sustain, and strengthen health center capacity and staffing levels by reinstating and reassigning providers, hiring new providers or contractors, and/or increasing staff time to respond to coronavirus and continue comprehensive primary care operations.
• Expand the use of telehealth to support virtual assessment and monitoring of COVID-19 symptoms and other primary care services to alleviate surge at emergency rooms and hospitals.
• Complete minor alteration and renovation (A/R) activities⁴ to adapt and improve physical infrastructure to maximize isolation precautions, facilitate the use of telehealth, and reconfigure space as needed.
• Purchase equipment, including health information technology and telehealth equipment, vehicles, triage tents, and mobile medical units.
• Purchase supplies, including COVID-19 therapeutics and vaccines, when available.

A more extensive list of example uses of funding is available on the CARES technical assistance webpage.

Required Supporting Documents

As stated on your notice of award, you should submit the following information via the HRSA Electronic Handbooks (EHBs) within 30 days of the award release date.

1. CARES Activity Overview. Provide a brief narrative (1-2 pages) describing how funds have been (dating back to January 20, 2020), are being, or will be used to support activities to maintain and increase capacity to provide comprehensive primary care, and detect, prevent, diagnose, and treat COVID-19, using the categories below. Descriptions of each category provide only general guidance; CARES activities and uses of funds may apply to more than one category.

   • Safety – Ensure that health centers are safe for staff and patients
   • Response – Detect, prevent, diagnose, and treat COVID-19
   • Capacity – Maintain and increase health center capacity to provide comprehensive primary health care

   Note: HRSA acknowledges that your plans to use CARES funding may change over time to respond to changing community, patient, and organizational needs. Rebudgeting is allowable (except as noted below) as long as activities meet the intent of CARES funding (adhere to the CARES Act funding authority), consistent with the terms and conditions of the award. If the amount of the costs to be rebudgeted constitutes a significant rebudgeting (exceeds 25% of the total federal budget), you must submit a prior approval request for review and approval by HRSA.

2. Budget Form. Provide an SF-424A budget form that includes only the CARES funds awarded. You do NOT need to break the funding out by current funding streams (i.e., CHC, MCH, HCH, PCHP), since it has already been awarded aligned with these proportions.

   The following are ineligible costs:

   • Costs already supported with H80 or H8C funding;
   • Purchase or upgrade of an electronic health record (EHR) that is not certified by the Office of the National Coordinator for Health Information Technology;⁵
   • New construction activities (new stand-alone structure) and/or associated work required to expand a structure to increase the total square feet of a facility;
   • Major alteration or renovation (A/R) projects valued at $500,000 or greater in total federal and non-federal costs (excluding the cost of allowable moveable equipment);
   • Significant site work such as new parking lots or storm water structures;
   • Work outside of the building other than improvements to the building entry for handicapped accessibility, generator concrete pads, and other minor ground disturbance;
   • Installation of a permanently affixed modular or prefabricated building; and
   • Facility or land purchases.

3. Budget Narrative. Your budget narrative must clearly detail costs for each federal object class category, with calculations for how each cost is derived, and not include any ineligible costs. Include a detailed list of personnel to be supported with CARES funding. As provided for in Office of Management and Budget Memorandum M-20-11 (PDF - 1 MB) (PDF - 1.3 MB) - Administrative Relief for Recipients and Applicants of Federal Financial Assistance Directly Impacted by the Novel Coronavirus (COVID-19), your budget may include requested reimbursement of allowable costs incurred retroactive to January 20, 2020.

4. Equipment List (as indicated). If your budget includes equipment, provide an Equipment List Form. Equipment is tangible personal property (including information technology systems) that has a useful life of more than one year and a per-unit acquisition cost of at least $5,000. Moveable equipment can be readily shifted from place to place without requiring a change in the utilities or structural characteristics of the space. Any equipment purchased with CARES funds must be procured through a competitive process, and maintained, tracked, and disposed of in accordance with 45 CFR Part 75. While M-20-11 remains in effect, you may request that HRSA waive the procurement requirements contained in 2 CFR § 200.319(b) regarding geographical preferences, and 2 CFR § 200.321 regarding contracting small and minority businesses, women's business enterprises, and labor surplus area firms.

   For each item on the Equipment List Form, the following fields must be completed:

   • Type – Select clinical or non-clinical.
   • Item Description – Provide a description of each item.
   • Unit Price – Enter the price of each item.
   • Quantity – Enter of the number of each item to be purchased.
   • Total Price – Multiply the unit price by the quantity entered.

   The selection of equipment should be based on a preference for recycled content, non-hazardous substances, non-ozone depleting substances, energy and water efficiency, and consideration of final disposal (disposed in a manner that is safe, protective of the environment, and compliant with all applicable regulations), unless there are conflicting health, safety, and performance considerations. You are strongly encouraged to employ the standards established by either the Electronic Product Environmental Assessment Tool (EPEAT) or ENERGY STAR®, where practicable, in the procurement of equipment. Following these standards will mitigate the negative effects on human health and the environment. Additional information for these standards can be found at EPEAT and Energy Star.

5. Minor A/R (as indicated). You may use up to $500,000 in CARES funds for minor A/R activities at one or more in-scope service delivery sites to support activities in any of the categories of use for CARES funds. The total site-specific project cost must be less than $500,000 (excluding the cost of moveable equipment). Minor A/R includes work required to modernize, improve, and/or reconfigure the interior arrangements or other physical characteristics of a facility. Permanently affixed equipment (e.g., heating, ventilation, and air conditioning (HVAC), generators, lighting) and its installation is categorized as minor A/R. Minor A/R projects may not increase the total square footage of existing buildings (e.g., by construction of a building addition) and may not be part of larger construction projects.

   CARES funding cannot be used for new construction activities (including work that requires ground disturbance such as new parking surfaces or expansion of a building footprint) or major A/R that has a total project cost of $500,000 or greater.

   If your budget includes minor A/R, provide the following minor A/R information for each site-specific minor A/R project:

   • Detailed Budget Narrative;
   • Environmental Information and Documentation checklist;
   • Schematics and/or Floor Plans showing the location and dimensions of the proposed renovation area in the existing building; and
   • Other Requirements for Sites Form addressing site control, federal interest, cultural resources, and historic preservation considerations.

Technical Assistance

See the CARES technical assistance webpage for:

• Access information for two technical assistance calls to support your 30-day reporting requirement submission
• Example funding uses
• Blank and/or sample forms

COVID-19 frequently asked questions and resources are available at Emergency Preparedness and Recovery Resources for Health Centers.

Questions regarding your CARES funding, the 30-day reporting requirement, or COVID-19 should be submitted via the BPHC Contact Form. Select Requestor Type (Applicant), under Health Center or EHBs Question, select Coronavirus Inquiries (COVID-19) and select CARES Supplemental Funding for programmatic questions.

Footnotes

¹ Under Section 330 (d)

² Health Center Program funding streams are Community Health Centers (CHC), Migrant Health Centers (MHC), Health Care for the Homeless (HCH), and Public Housing Primary Care (PHPC).

³ HRSA award recipients may not use grant funds for costs that are reimbursed or compensated by other federal or state programs that provide for such benefits, including but not limited to the Small Business Administration’s Paycheck Protection Program, the $100 billion in the Public Health and Social Services Emergency Fund, or unemployment compensation.

⁴ Up to $500,000 may be used for minor A/R projects, with no project totaling more than $499,999

⁵ The Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health Information Technology have established standards and other criteria for structured data.