FY 2021 American Rescue Plan Funding for Health Centers (H8F) Activities and Allowable Uses of Funds

Funds made available through this funding opportunity are required to be used for the following purposes:

• Plan, prepare for, promote, distribute, administer, and track COVID–19 vaccines, and carry out other vaccine-related activities.
• Detect, diagnose, trace, and monitor COVID–19 infections and related activities necessary to mitigate the spread of COVID–19, including activities related to, and equipment or supplies purchased for, testing, contact tracing, surveillance, mitigation, and treatment of COVID-19.
• Purchase equipment and supplies to conduct mobile testing or vaccinations for COVID-19, purchase and maintain mobile vehicles and equipment to conduct such testing or vaccinations, and hire and train laboratory personnel and other staff to conduct such mobile testing or vaccinations, particularly in medically underserved areas.
• Establish, expand, and sustain the health care workforce to prevent, prepare for, and respond to COVID–19, and to carry out other health work force-related activities.
• Modify, enhance, and expand health care services and infrastructure.
• Conduct community outreach and education activities related to COVID–19.

The categorized listing of activities below aligns with these purposes and reflects the Project Overview Form that you will complete in the HRSA Electronic Handbooks (EHBs). Please note that some activities could fit within more than one category. The listing of activities below is not exhaustive. There may be other allowable uses of funds consistent with the above purposes, and as further described in the terms and conditions of your award. You will have the option to describe other activities in the EHBs form under “Other” for each category.

Note that funding may support costs dating back to January 31, 2020, expended on any of the purposes described above. To propose to use funds for pre-award costs, select “Other” under the appropriate category and provide a detailed description of the pre-award costs that aligns with your budget narrative.

When selecting or describing activities, consider how you can use H8F funding to address:

• Equitable access to COVID-19 vaccination, testing, and treatment.
• Other current and anticipated COVID-19 and primary health care needs in the service area.
• Population and social determinants of health that may impact access to care, contribute to poor health outcomes, and exacerbate health disparities.

You must receive any necessary Scope Adjustment and Change in Scope approvals before implementing a new service, service delivery method, or service delivery site or location in support of your H8F project activities. See the Scope of Project webpage and related emergency-specific scope of project FAQs and Program Assistance Letter at Considerations for Health Center Scope of Project and the COVID-19 Public Health Emergency. For additional information, contact the Investments Specialist listed as the Program Official on your notice of award.

COVID-19 Vaccination Capacity

Support to plan, prepare for, promote, distribute, administer, and track COVID-19 vaccines, and to carry out other vaccine-related activities, including outreach and education.

• Vaccine Administration: Administer vaccinations at permanent and temporary health center service sites or other locations, including through mobile, drive-up, walk-up, or community-based vaccination events. Such vaccine administration activities should address the unique and evolving access barriers experienced by underserved and vulnerable populations and be carried out in alignment with CDC, state/jurisdiction, and other public health guidance.
• Outreach: Perform vaccine-related outreach and education, including promoting health center vaccination efforts and supporting COVID-19 vaccine acceptance. Such activities should include a focus on providing services to racial and ethnic minorities, homeless individuals and families, agricultural workers, residents of public housing, individuals with limited English proficiency, and other underserved and vulnerable populations at greatest risk for COVID-19 exposure or severe disease.
• Enabling Services: Expand or increase health center enabling services (e.g., transportation, translation, interpretation) that facilitate access to COVID-19 vaccination.
• Supplies and Equipment: Purchase COVID-19 vaccination supplies (e.g., PPE, hygiene and other disposable supplies), storage (including back-up systems), sterilization equipment, and moveable physical barriers, along with temporary signage to promote vaccination locations.
• Vaccine Administration Workflows and Clinical Support: Modify, enhance, and expand systems and workflows to efficiently and effectively administer COVID-19 vaccine, including aligning workflows with current and evolving public health guidance, enhancing and maximizing use of patient registries, enhancing clinical decision support and use of data from electronic health records (EHR), and coordination and collaboration with jurisdictions and other community partners.
• Vaccine Management and Distribution: Support vaccine ordering, distribution to administration sites, and inventory management, including activities necessary for participation in the CDC COVID-19 Vaccination Program and/or the Health Center COVID-19 Vaccine Program.
• Personnel: Hire and/or contract additional health center providers, clinical staff, and other personnel (e.g., pharmacy personnel, community health workers, patient/community education specialists, billing staff, case managers, information technology staff) as needed to support COVID-19 vaccination.
• Training: Train health center workforce on vaccine handling, storage, and administration; assessment and prioritization of patients; and social and other barriers to accessing care.
• Data Systems and Reporting: Establish and enhance health center data systems that ensure that vaccine administration data are available, secure, complete, timely, valid, and reliable and support related data reporting activities.
• Health Information Interoperability: Purchase or enhance health information technology software and hardware that support interoperability of health center data systems with federal, state, and local vaccine administration and distribution data systems.
• Adverse Events Monitoring: Establish and enhance workflows and personnel skills to diagnose, treat, and report potential COVID-19 vaccination adverse events.
• Hours and Availability: Support increased access to COVID-19 vaccination through extended health center operating hours; enhanced telephone triage capacity; mobile, virtual, and home services; and establishment of temporary service sites and locations.
• Develop and Deploy Digital Tools: Develop and/or enhance health center websites, patient portals, digital applications, and other tools to support scheduling, show rates, and follow up for COVID-19 vaccination.

COVID-19 Response and Treatment Capacity

Support to detect, diagnose, trace, monitor, and treat COVID–19 infections and related activities necessary to mitigate the spread of COVID–19, including outreach and education.

• Testing: Support self, mobile, drive-up and/or walk-up testing that addresses the unique and evolving access barriers experienced by underserved and vulnerable populations in the community.
• Hours and Availability: Support increased access to COVID-related services (e.g., screening, testing, and treatment) through extended health center operating hours; enhanced telephone triage capacity; mobile, virtual, and home services; and temporary service sites and locations.
• Develop and Deploy Digital Tools: Develop and/or enhance websites, patient portals, digital applications, and other tools to support scheduling, show rates, and follow up for COVID-related services including screening, vaccination, testing, and contact tracing.
• Personnel: Hire and contract additional clinical staff and other personnel (e.g., community health workers, behavioral health specialists, billing staff, case managers) who will support health center outreach, testing, delivery of test results, COVID-19 treatment, and related behavioral health services.
• Laboratory: Support health center COVID-19 testing and laboratory costs, including purchasing COVID-19 tests; distribution of home tests to established health center patients; specimen handling and collection; and storage and processing equipment.
• Treatment: Provide health center-based treatment for patients with COVID-19, as appropriate (including monoclonal antibody therapy).
• Care Coordination: Support care coordination with other health care providers for patients that require hospitalization or other advanced care and treatment not available through the health center.
• Workflows: Enhance workflows using CDC guidance to facilitate access to testing and necessary follow up services, including risk modification education, plans for repeat testing, and treatment.
• Interoperability: Enhance health information exchange capacity to support communications with public health partners, emergency response teams, centralized assessment locations, reporting entities and registries, and/or other health care providers.
• Reporting: Report information on COVID-19 infection to federal, state, and local public health agencies consistent with applicable law (including laws relating to communicable disease reporting and privacy).
• Supplies and Equipment: Purchase equipment and supplies to diagnose and treat COVID-19 (e.g., COVID-19 tests, radiological equipment, health information technologies, PPE, hygiene and other disposable supplies), along with temporary signage to promote testing and treatment locations.
• Outreach: Conduct outreach and education to patients who may be at risk of COVID-19 exposure or severe illness, have need for extra precautions, or who have barriers to accessing testing or treatment, including enrollment in affordable health insurance coverage options.
• Enabling Services: Expand or increase health center enabling services (e.g., transportation, translation, interpretation) that facilitate access to COVID-19 education, testing, and treatment.
• Contact Tracing: In coordination with federal, state, and local public health activities, notify identified contacts of infected health center patients of their exposure to COVID-19, consistent with applicable law (including laws relating to communicable disease reporting and privacy).

Maintaining and Increasing Capacity

Support to establish, modify, enhance, expand, and sustain the accessibility and availability of comprehensive primary care services to meet the ongoing and evolving needs of the service area and its vulnerable patient populations.

• Personnel: Ensure the availability of comprehensive primary and behavioral health care, through in-person and virtual visits, to meet the needs of underserved and vulnerable populations in the community by supporting salaries and benefits for health center personnel providing in-scope services.
• Immunization (other than COVID-19 vaccination): Establish and/or expand adult and childhood immunization/vaccination programs, including aligning workflows with current public health guidance, maximizing use of patient registries, enhancing clinical decision supports and use of data from electronic health records (EHR), leveraging community partners, increasing staff, purchasing vaccines and supplies, storage, and outreach.
• Facilitating Access: Expand or increase enabling services (e.g., transportation, translation, outreach, eligibility assistance) and other strategies, such as home and/or virtual visits, that facilitate access to care and address social and other risk factors, including those amplified or worsened by the public health emergency.
• Broadband: Increase the health center’s broadband capacity to support virtual care models and assist patients in connecting to virtual care by referring them to government subsidy programs such as the Emergency Broadband Benefit program and the Lifeline program.
• Telehealth: Expand and enhance health center telehealth capacity to perform triage, deliver care, support care transitions, and support follow-up via telehealth, including the use of home monitoring devices and video to provide care to patients in their homes, community settings, and other locations. Support access to virtual care for patients with unstable or no housing or other barriers to accessing care.
• Training and Education: Train personnel on digital platforms, devices, and workflows supporting the use of telehealth, and provide patient education that will increase digital literacy and competence using digital devices and applications that promote health.
• Develop and Deploy Digital Tools: Develop and/or enhance software and digital applications to support patients’ access to and engagement in virtual care, including patient self-management tools, remote patient monitoring, patient portals, digital applications, websites, and use of social media.
• Cybersecurity: Enhance telehealth and health information technology cybersecurity infrastructure, including mobile device management, patient portals, and digital applications; develop and implement plans for data risk management, mitigation, and recovery; and update software and operating systems.
• Equipment and Supplies: Purchase equipment and supplies to support the provision of comprehensive primary care (e.g., clinical and diagnostic equipment; telehealth equipment; information technology systems to enhance data collection, exchange, reporting, and billing; equipment and supplies for use by remotely located staff to ensure continuity of health center services).
• Electronic Health Record (EHR): Purchase or upgrade an EHR that is certified by the Office of the National Coordinator for Health Information Technology.
• Recuperative Care: Provide or support short-term health services to individuals recovering from an acute illness or injury. Such services do not include health services provided in lieu of or concurrent to hospitalization, skilled nursing, or other residential health care.
• Behavioral Health: Enhance or expand access to behavioral health (mental health and substance use disorder) services.
• Community Partnerships: Establish and strengthen community partnerships and referrals for housing, child care, food banks, employment, education counseling, legal services, and other related services.
• Early Childhood Health – Note this is an example you may include under “Other”: Enhance developmental promotion, screening, and follow up to support early childhood health and family well-being by hiring and training new personnel (e.g., developmental-behavioral pediatricians, early childhood mental health consultants, developmental psychologists, community health workers, case managers, health education specialists).
• Access for Families – Note this is an example you may include under “Other”: Expand workflows to optimize virtual care and home visiting for activities such as developmental screening, behavioral health, care coordination, and health education to address childhood developmental delays and social risk factors.

Recovery and Stabilization

Support for ongoing recovery and stabilization, including enhancing and expanding the health care workforce and services to meet pent up demand due to delays in patients seeking preventive and routine care; address the behavioral health, chronic conditions, and other needs of those who have been out of care; and support the well-being of personnel who have been on the front lines of the pandemic.

• Pent Up Demand: Bring sites, services, and staff to an operational capacity sufficient to meet pent up demand for services, including addressing the needs of patients and other vulnerable populations who have been without care and whose conditions and needs may have been exacerbated by the social and financial impacts of COVID-19.
• Patient Registries: Develop new and/or update existing patient registries to support continuity of services to patients, including those who have delayed care due to factors related COVID-19.
• Virtual Care: Expand and enhance virtual care to respond to evolving service area and patient needs and to support access to equitable, high quality care for populations served by the health center.
• Care Transitions and Coordination: Support transitions in care settings and coordination with health care and public health partners to address changing needs by enhancing workflows, updating telehealth plans, and enhancing health information and data exchange capacity.
• Outreach: Conduct outreach to patients and residents of the service area who have been out of care or who may be in need of a medical home.
• Facilitating Access: Expand or enhance enabling or other services to address the unique and evolving access barriers experienced by underserved and vulnerable populations who have been without care and whose conditions and needs may have been exacerbated by the social and financial impacts of COVID-19.
• Population Health and Social Determinants: Enhance or update patient population and community needs assessments; update strategic plans, policies, and procedures to reduce disparities in access, care delivery, and clinical quality measures; expand or develop new partnerships with social services organizations that can address identified social determinants of health; and develop or enhance the data infrastructure necessary to track and close social service referral loops.
• Patient Engagement: Enhance patient activation and engagement, including through virtual and in-person outreach and education, self-management programs and techniques, partnerships with families and caregivers, patient-centered care coordination, and other evidence-based interventions to support self-care.
• Workforce Well-being: Assess needs and develop interventions to support staff well-being and address needs related to burnout and recovery, productivity, stress, professional fulfillment, diversity, and inclusion.
• Training: Adapt and deliver staff training to meet new and returning patients’ needs, including training to assess and address social risk and other barriers to accessing and engaging in care provided by the health center.
• Continuity of Care: Increase team-based and inter-professional service delivery through both in-person and virtual visits to provide continuity of care.
• Strategic Planning: Align strategic plans to reflect recovery and stabilization needs.
• Early Childhood Health Partnerships – Note this is an example you may include under “Other”: Establish and expand partnerships and referral networks with community services to address developmental delays and social risk factors, such as housing, child care, food security, violence prevention, and medical-legal partnerships.
• Access for Families – Note this is an example you may include under “Other”: Enhance capacity to engage families that have fallen out of care during the COVID-19 public health emergency to ensure that they receive the recommended comprehensive care and resources that align with the child’s age, development, and social risk factors, including hiring and training new personnel (e.g., outreach workers, case managers, community health workers, other enabling personnel) to support vaccinations, developmental screenings, intervention referrals, and health education and counseling.

Infrastructure: Minor Alteration/Renovation¹(A/R), Mobile Units, and Vehicles

Modify and improve physical infrastructure, including minor A/R and purchase of mobile units and vehicles, to enhance or expand access to comprehensive primary care services, including costs associated with facilitating access to mobile testing and vaccinations, as well as other primary care activities.

• General Physical Infrastructure Improvements: Enhance the health center physical infrastructure to ensure continued access to comprehensive primary care services (e.g., roof repairs, ADA-compliant entrances, new foot traffic pathways to facilitate physical access to health center services).
• Facilitating Access: Adjust space to support access through enhanced cultural and linguistic competency (e.g., examination rooms that can accommodate support staff/chaperones/family, screens to facilitate face-to-face translation) and provide enhanced enabling services that address social determinants of health and promote health equity.
• Virtual Care Access: Reconfigure space to maximize the ongoing use of telehealth technology (e.g., configuring spaces to better accommodate video screens and creating telehealth command centers).
• Team-based Care: Renovate space to support team-based and inter-professional service delivery models needed to provide continuity of care in public health emergencies, including new or further integration of behavioral health, oral health, vision, and/or pharmacy services.
• Physical Distancing: Reconfigure space to support physical distancing of patients and/or maximize isolation precautions for individuals being evaluated for possible COVID-19 infection and those testing positive for COVID-19 and other communicable diseases.
• HVAC: Enhance or install heating, ventilation, and air conditioning (HVAC) systems to improve facility air quality and hygiene, including addressing needs specific to mitigate the spread of COVID-19.
• Mobile Unit: Purchase and maintain a mobile unit(s) that may be used to provide comprehensive primary care services and to conduct COVID-19 testing and/or vaccination.
• Vehicles: Purchase and maintain a vehicle to transport patients for health services, including to vaccination and testing locations; deliver equipment, supplies, and vaccines to service sites and locations; and/or to transport health center personnel to service sites and locations.

¹Up to $500,000 may be used for minor A/R projects, with no single A/R project totaling $500,000 or more in federal and nonfederal funds.