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  5. FY 2021 NHCI-HC Frequently Asked Questions

FY 2021 NHCI-HC Frequently Asked Questions

These are common questions and corresponding answers for the fiscal year (FY) 2021 Supplemental Funding for Hypertension (NHCI-HC) funding opportunity. Refer to the NHCI-HC Technical Assistance webpage for updates.

Project closeout

When does my project period end?

The project period end date is the same for all NHCI awardees and is December 31, 2023. You have until this date to complete your HRSA-approved work plan.

(Added: 8/25/2022)

When does my budget period end?

NHCI budget periods vary by health center. NHCI funds may be utilized through the end of your fiscal year 2023 budget period, with HRSA approved carryover. You should be aware of your H80 budget period and know the exact Notice of Award release date in the month of January 2021. Contact your H80 grants management specialist if you have additional questions.

(Added: 8/25/2022)

In the final year of the NHCI project period, may I submit a prior approval carryover request for unspent NHCI funds?

No. If there are any remaining funds, they will not be approved for carryover or expanded authority into your FY 2024 budget period. You have 90 days after the FY 2023 H80 budget period ends to spend remaining funds. 

(Updated: 12/20/2023)

Can I request a no-cost extension for NHCI funds?

No. A no-cost extension for NHCI funding is not an option due to the funding being part of the overall H80 grant. Contact your H80 grants management specialist if you have additional questions about a no-cost extension.

(Added: 8/25/2022)

Eligibility

Which health centers may receive NHCI-HC funding?

Health Center Program operational (H80) grant award recipients may request NHCI-HC funding. HRSA will only consider funding submissions from health centers that meet the following award criteria:

If you are one of the approximately 50 health centers that used a sample of patient charts to report 2019 UDS data (i.e., chart audit), then you must provide 2020 data to date that represent your entire patient chart universe to be considered for funding.

  • Attest to fully participate in the training and technical assistance activities offered in support of the award;
  • Achieved blood pressure control in less than 58.9% of patients 18 to 85 years of age who have been diagnosed with hypertension using 2019 Uniform Data System (UDS) data or 2020 data to date from their electronic health record (EHR) universe; and
  • Served at least 100 patients 18 to 85 years of age who have been diagnosed with hypertension using 2019 UDS data or 2020 data to date from their EHR universe.

(Updated: 1/19/2021)

How did HRSA notify health centers about the NHCI-HC funding?

Individuals registered as the project director, business official, and authorizing official for your H80 award received an email through EHBs. The email provides a link to the BPHC Contact Form where you will find submission guidance and resources and instructions on how to access the EHBs submission module.

(Updated: 6/2/2022)

Who do I contact if my health center did not receive the notification email and I think that I am eligible for this funding?

Check with the individuals who are the project director, business official(s), and authorizing official(s) in EHBs for your H80 award. They may need to check their spam folders. If none of these individuals received the notification email, contact the NHCI-HC technical assistance team through the BPHC Contact Form.

(Updated: 1/19/2021)

Does HRSA have enough funding to award more than 400 health centers if health centers may provide 2020 data to demonstrate alignment with award criteria?

HRSA plans to fund all eligible submissions that meet the award criteria.

(Updated: 1/19/2021)

Budget requirements

How will NHCI-HC funds be carried over into the new budget period since the entire amount was included in our H80 award?

Since NHCI-HC funding is included in the total H80 budget, those funds are automatically carried over into the new budget period under HRSA’s expanded authority rule for all H80 grants. Health centers should indicate on their annual Federal Financial Report (FFR) the NHCI-HC funding amount used under expanded authority. For more information contact your grants management specialist with any questions.

(Updated: 3/25/2022)

Can NHCI-HC funds be used for translation services for patient materials?

Yes, translation services for materials used for the NHCI-HC program are an allowable cost.

(Updated: 3/25/2022)

Is the funding amount from the November 17 email (subject: Updated EHBs Link: FY 2021 Supplemental Funding for Hypertension) available for each year?

No. The funding amount provided in the email notifying you of the NHCI-HC supplement is the total available funding that you may use across the three years, as needed. You do not need to spend it evenly across all three years.

(Updated: 1/19/2021)

If I use 2020 data to demonstrate that my health center meets the award criteria, will HRSA adjust my award amount to reflect 2020 data in the funding formula?

No. HRSA will base funding formulas on 2019 data, regardless of whether a health center uses 2019 or 2020 data to demonstrate alignment with the award criteria.

(Updated: 1/19/2021)

Who can I contact with questions about the funding distribution across sub-programs provided in my NHCI-HC notification email?

If you have questions about the maximum funding request distribution across sub-programs (i.e., Community Health Center (CHC), Migrant Health Center (MHC), Health Care for the Homeless (HCH), and/or Public Housing Primary Care (PHPC)) that HRSA provided in the notification email, contact the NHCI-HC technical assistance team through the BPHC Contact Form.

(Updated: 1/19/2021)

Who can I contact if I have questions about other budget-related issues?

All budget condition and business, administrative, and fiscal questions should be directed to the grants management specialist listed on your notice of award.

(Updated: 1/19/2021)

Should I include non-federal funding in my NHCI-HC budget proposal?

You are not required to include non-federal funding in your NHCI-HC budget proposal. If you choose to do so, include only non-federal funds that you will leverage to support your NHCI-HC project, and do not duplicate previously projected non-federal resources under your H80 award.

(Updated: 1/19/2021)

How will I present my NHCI-HC funding request if there is only one award for all three years?

All NHCI-HC funding will be awarded in FY 2021, so you will request the total across all three years of funds on the SF-424A form. You will, however, show how you plan to use the funding in year 1, year 2, and year 3 separately in the Budget Narrative.

(Updated: 1/19/2021)

Will NHCI-HC funding continue beyond the three years?

No. NHCI-HC funding can support NHCI-HC activities over a three-year period through the end of your FY 2023 H80 budget period, subject to performance and HRSA approval of carryover requests.

(Updated: 1/19/2021)

May NHCI-HC funding be used to increase full time equivalents (FTEs) of existing salary of existing personnel who are currently compensated at less than 100% FTE with federal funding?

NHCI-HC funding may be used to compensate personnel with a commensurate increase in FTE, in alignment with your existing written policies and procedures and 45 CFR §75.430. Salaries may not exceed 100% across all federal awards.

(Updated: 1/19/2021)

May NHCI-HC funding be used to incentivize patients’ participation in NHCI-HC-supported activities?

Patient participation incentives are permitted only if they are a documented and required part of a clinically-proven program to be used in carrying out the project (i.e., program provides a gift card of nominal value to purchase healthy food after a patient attends a certain number of sessions). Your budget narrative must provide the evidence base for any incentive that you plan to purchase. If patient-related incentives are included in the NHCI-HC budget, they must align with your organization’s established policies and procedures and should be for a specific type of purchase (e.g., can only purchase food) or the card recipient must sign a waiver that the cards will not be used for prohibited items such as alcohol, tobacco, or firearms.

(Updated: 1/19/2021)

May NHCI-HC funding be used to reimburse my health center for revenue lost when a provider is participating in a NHCI-HC-supported activity, such as a training?

No. NHCI-HC funding may not be used to offset lost revenue or productivity. However, you may use NHCI-HC funding to support a substitute provider who provides temporary clinical services in the absent provider’s place.

(Updated: 1/19/2021)

If I plan to contract FTEs, must I include them on the Personnel Justification Table?

Yes. You must include on the Personnel Justification Table all direct hire and contractual personnel FTEs that you propose to support with NHCI-HC funding, including current personnel whose FTE you will increase using NHCI-HC funds. The annualized salary and FTE must be included, along with the federal amount requested.

(Updated: 1/19/2021)

Am I required to submit my indirect cost rate agreement?

Only provide your indirect cost rate agreement if it has recently been negotiated or updated and you include indirect costs in your proposed budget. If you do not have an indirect cost rate agreement, costs that would be included in such a rate (e.g., accounting services) may be charged as direct line-item costs. Under 45 CFR § 200.414(f), organizations that have never received a negotiated indirect cost rate may elect to charge a de minimis rate of 10% of modified total direct costs, which may be used indefinitely. If chosen, this methodology must be used consistently for all Federal awards.

(Updated: 1/19/2021)

Are there any formatting guidelines for the Budget Narrative attachment?

Yes. Use single line spacing and an easily readable font, such as Times New Roman, Arial, or Courier. The font should be size 10-point or larger. You may submit a Microsoft Excel file, but limit the Excel workbook to one tab (i.e., spreadsheet) and ensure that the print area is set to the information HRSA needs to review, minimizing blank cells where possible. 

(Updated: 6/2/2022)

What is the threshold to submit a formal budget revision?

HRSA requires health center awardees to seek prior approval for re-budgeting which exceeds 25% of the total approved H80 budget (inclusive of direct and indirect costs and federal funds and required matching or cost sharing) for that budget period.

(Updated: 1/19/2021)

The funding provided does not support the cost of providing SMBP devices to a majority of our hypertensive patients. What are the options available to be able to meet the requirements?

HRSA expects that all health centers receiving NHCI awards will be able to make SMBP devices available to a majority of hypertensive patients, both controlled and uncontrolled, over the course of the project period. HRSA provided all funds for the project with the release of the notice of award.

Health centers have options on how to make SMBP devices available to a majority of hypertensive patients beyond purchasing SMBP devices for each patient. Health centers may choose to create a loaner program where SMBP devices are provided to hypertensive patients for a period of time and then returned so that the SMBP device may be issued to another patient. Health centers may also work with Medicaid and insurance companies to obtain SMBP devices for insured patients with hypertension or may work with other organizations to supply SMBP devices.

Health centers may also use program income or other funding sources to support the NHCI project and maximize the benefit to patients. Other grant funding that supports primary care may also be used to augment the NHCI funding. If you choose to use other grant funding, remember that the same costs are not permitted to be charged to more than one grant. NHCI funding must supplement, not supplant, other federal, state, local or private resources. Health centers should reach out to GMS for further guidance.

(Added: 6/25/2021)

What are the required documents for the annual expenditure report?

The NHCI Annual Expenditure Report is tied to the budget period of health centers’ H80 funding. The Notice of Award for the NHCI-HC funding states:

Due Date: Within 90 Days of the Budget End Date, health centers must submit into HRSA's Electronic Handbooks (EHBs) a detailed SF-424A and line-item narrative description of Federal costs incurred for the completed activities supported with FY 2021 National Hypertension Control Initiative (NHCI-HC) supplemental funding and expensed in your current budget period. Health centers must also submit an equipment list (when applicable) for all equipment purchased in the current budget period. The SF-424A, a sample narrative, and a blank equipment list can be found at the NHCI-HC technical assistance webpage.

Health centers need to submit the following as part of the annual expenditure report:

  • Detailed SF-424A and line-item narrative description of Federal costs incurred for the completed activities supported with the NHCI-HC funding and expensed in the current budget period.
  • An equipment list (when applicable) for all equipment purchased in the current budget period.
  • If needed, a cover letter capturing/explaining any impactful circumstances, such as the need to modify the work plan.

(Added: 10/6/2021)

Is this project currently covered under the Expanded Authority?

No. Since this is the final year of the NHCI project period, there is no expanded authority or carryover of funds once your FY 2023 H80 budget has ended.

(updated: 12/20/2023)

Program requirements

How does HRSA define “make available”?

HRSA defines make available as offering a SMBP device to a hypertensive patient for their use to monitor blood pressure at home as one way to help patients control their blood pressure. Health centers should provide training to patients on how to use the SMBP device.

Patient education and training tools are available on the Million Hearts® SMBP webpage, Target: BP SMBP Patient Training Checklist, and the American Medical Association's SMBP Patient Checklist (PDF - 131 KB).

(Added: 8/25/2022)

How is HRSA determining the majority requirement for the NHCI funding? Does this include only uncontrolled hypertensive patients?

HRSA is using a simple majority calculation of the total number of hypertensive patients to determine if health centers meet this requirement. All hypertensive patients, both controlled and uncontrolled, are included in this calculation.

For example, if a health center reported 8,000 as the total number of hypertensive patients in the funding application, they must make SMBP devices available for at least 4,001 patients (8,000 x 50% plus 1). This includes patients with both controlled and uncontrolled hypertension.

Contact the HRSA NHCI Support Team using the BPHC Contact Form for clarity on the majority patient number/target requirement.

(Updated: 6/2/2022)

We provided 2020 year to date data in the NHCI application in addition to the 2019 UDS data. Which number is HRSA using as the basis for meeting the requirement to make SMBP devices available to a majority of hypertensive patients? Will this number change over the course of the project period as our number of hypertensive patients change?

HRSA is using the lower of the 2019 UDS data or the 2020 data reported in the NHCI application. There are a few exceptions where some health centers were required to report 2020 data because they used chart audits to report 2019 UDS data. If you are unsure which number HRSA is using for the baseline for the NHCI project, please contact the NHCI Support Team using the BPHC Contact Form HRSA will not change the baseline number used to determine if a health center is meeting the requirement to make SMBP devices available to a majority of hypertensive patients.

(Updated: 6/2/2022)

What happens if we offer a SMBP device to a patient and they refuse the SMBP device? Does this count toward meeting the majority requirement?

HRSA recognizes that some patients may choose not to participate in the NHCI program and use a SMBP device. Health centers will be able to count patients who were offered a SMBP device but refused toward meeting the requirement to make SMBP devices available to a majority of hypertensive patients.

HRSA encourages health centers to develop a system to track the number of patients who are offered, accepted, and refused a SMBP device. This documentation will allow the health center to demonstrate that they have met the NHCI funding requirements.

(Added: 6/25/2021)

Progress reporting

What is the timeline to have a certain percentage or number of patients onboard with the project?

Health centers should adhere to their HRSA-approved work plan, including timelines established for completing various goals and objectives related to patient involvement. This will ensure health centers meet the requirement for recruiting and engaging the majority of patients participating by the end of the three-year project period.

 

(Updated: 3/25/2022)

For question 2a, what constitutes an outreach or engagement “encounter”?

The definition of an encounter will depend upon how the health center’s hypertension program is designed. An encounter can include, but is not limited to, a face-to-face, virtual, telephone, or email outreach or engagement.

(Updated: 3/25/2022)

For question 2e, please elaborate on what HRSA is asking for in regards to “Collect and share data to support participation in initiative evaluation and reporting activities”.

All NHCI-HC awardees must complete and submit timely, semi-annual NHCI-HC progress reports and quarterly data collection requests. As the initiative evolves over the three-year project period, health centers will be asked to commence quarterly data collection for NHCI evaluation purposes. More information on quarterly data collection will be provided by NHCI technical assistance, data collection, and evaluation partners.

(Updated: 8/25/2022)

What attachments would be helpful to include in the submission?

Health Centers are not required to submit attachments to the Progress Report. Attachments may be used to support answers provided in the progress report, not to replace them. Examples include, but are not limited to, initiatives and/or programs for patient outreach and recruitment and pamphlet or patient education materials that health centers developed to promote the use of SMBP devices. Health Centers may upload up to five attachments.

(Added: 10/6/2021)

What are the requirements for national training and technical assistance activities?

NHCI-HC awardees are required to participate in training and/or technical assistance (T/TA) activities offered in support of the NHCI-HC award. Currently, we are recommending that health centers participate in one training and/or technical assistance webinar per quarter, facilitated by one of our partners. Partners include HRSA's NHCI technical assistance team, the American Heart Association's technical assistance team, the American Medical Association, Million Hearts®, or the National Association of Community Health Centers. Future T/TA events and resources will be announced through the NHCI Quarterly Communication emails and NHCI-HC TA webpage.

(Updated: 8/25/2022)

How do we report on the training and technical assistance activities we attended?

Health centers should report on participation in T/TA activities in the semi-annual progress report, under question 2b. Health centers must check the status (in-progress or planned) and provide a narrative response. Where possible, include the T/TA activity title, date, and number of health center participants. While we do not require documentation of participation, attachments can be submitted to complete the response.

(Added: 10/6/2021)

Do local and/or collaborative T/TA opportunities related to hypertension control count as acceptable participation in T/TA activities?

The NHCI-HC guidance states that award recipients will participate in T/TA activities offered in support of this award and engage in T/TA activities provided by the NHCI-HC T/TA partners. NHCI-HC awardees may participate in local T/TA opportunities as a supplement to T/TA offered through the NHCI-HC initiative. Local T/TA opportunities are not a substitute for T/TA offered through the NHCI-HC initiative.

(Added: 10/6/2021)

Can we include activities completed under another project or initiative that overlap with the NHCI activities?

Activities completed under another project or initiative that overlap with the NHCI-HC initiative should only be included in the progress report if those activities are in the HRSA-approved project plan.

(Added: 10/6/2021)

Will HRSA acknowledge SMBP devices utilized by patients purchased through a different funding source?

Yes, the devices purchased and distributed under a different funding source may count towards meeting the funding requirement. SMBP devices that were donated or purchased by payers (Medicare, Medicaid, private health insurance) also count towards meeting the funding requirement. Health centers must report the number of devices your health center acquired through another funding under progress report question 2c.

(Added: 10/6/2021)

For question 2c, will patients who decline to participate in the SMBP program in the outreach phase or drop out prematurely from the program count towards meeting the requirement to “Ensure Access to and Support the Use of Bluetooth or Wireless-Enabled SMBP Devices for a Majority of Patients with Hypertension?”

Yes, patients offered SMBP devices who decline the SMBP device or drop out of the SMBP program prematurely count towards goal to “Ensure Access to and Support the Use of Bluetooth or Wireless-Enabled SMBP Devices for a Majority of Patients with Hypertension.”

HRSA encourages health centers to develop a system to track the number of patients who are offered, accepted, and refused a SMBP device. This documentation will allow the health center to demonstrate that they have met the NHCI-HC funding requirements.

(Added: 10/6/2021)

Are budget forms required as part of the progress report submission?

No. The progress report does not require submission of budget forms.

(Added: 10/6/2021)

The progress report asks about changes to budget or planned activities. Are we able to indicate changes in the report or do we have to submit a prior approval for this?

Yes. If there are changes to any of the approved activities or the budget, provide a description of how the changes to planned/implemented activities continue to meet the intent of the NHCI-HC funding, in addition to, details on changes that impact the approved budget. If it is determined that the changes reported do not align with approved activities and/or budget, the health center will be instructed to submit a Prior Approval request.

(Added: 10/6/2021)

Project implementation

Do self-measured blood pressure (SMBP) monitors need to be Bluetooth enabled, or will you allow automatic SMBP monitors that are not Bluetooth enabled?

Per the NHCI-HC guidance, SMBP devices must be Bluetooth or wireless-enabled. However, cellular devices are also acceptable as these devices allow patients to electronically transfer their blood pressure readings to their providers. The goal is to decrease barriers to patients actively engaging in their health care and in their hypertension treatment plan.

(Updated: 10/6/2021)

Are there specifications on the Bluetooth devices and do we need to provide you the details of a specific brand and model number? Is my health center required to purchase HRSA-approved SMBP devices?

HRSA does not have an approved SMBP device list and does not require a specific Bluetooth enabled or wireless device to be purchased. However, we strongly suggest you select a device that has been validated for clinical accuracy as determined through an independent review process.

While there are no HRSA-approved SMBP devices, here are the resources to find independently validated devices:

(Updated: 8/25/2022)

Is group purchasing for SMBP devices available through HRSA?

No, group purchasing is not available through HRSA. Where possible, health centers may like to purchase devices from manufacturers in bulk and centralize shipping to save on costs.

(Updated: 8/25/2022)

Should we wait to purchase the SMBP devices until we receive further technical assistance?

Although HRSA plans to provide additional technical assistance to support this initiative, there is no need to delay purchasing these SMBP devices. Here are resources that may help your health center with purchasing an SMBP device:

  • Buying Home Blood Pressure Monitors to Support SMBP: How to Get Started: Learn about key considerations in purchasing home blood pressure monitors, learn the difference between a clinically validated and FDA certified device, hear tips on getting the best price, and engage directly with top manufactures who will showcase their products and answer your questions.
  • Tools to Establish an SMBP Program (PDF - 1 MB): A list of resources from the Million Hearts® Hypertension Control Change Package that can help assign care team roles for an SMBP program and guide patients on selecting a home blood pressure monitor.

(Updated: 8/25/2022)

Do SMBP devices need to be integrated into Electronic Health Records (EHR)?

No, however, SMBP data are to be electronically transmitted from the patient to the health center.

There is evidence that the use of the EHR and patient registries is beneficial for identification of patients with undiagnosed or undertreated hypertension as well as guiding quality improvement efforts designed to improve hypertension control.

Health centers should determine different approaches for transferring SMBP data to inform hypertension treatment plans.

(Added: 6/25/2021)

How should we implement a SMBP device loaner program to reach the majority of hypertensive patients?

A loaner program is one way in which health centers can use a smaller number of SMBP devices to meet the requirement to make SMBP devices available to a majority of hypertensive patients. Health centers have flexibility in creating a SMBP loaner program that will work for their hypertensive patients and there is no one size fits all approach to SMBP loaner programs. The length of time that a patient uses a device will depend upon the intended purpose including the stage and patient response during that stage. Some patients may only need a SMBP device for a short period and other patients may require a SMBP device for a longer period. Health centers should follow evidence-based clinical guidelines for treatment of hypertension and use of SMBP devices to determine how long a patient should use a SMBP device from the health center loaner program.

The following resources provide information about setting up a SMBP device loaner program:

(Added: 6/25/2021)

Are there special safety precautions around loaner programs during pandemic?

Please refer to the following resources regarding recommended infection prevention process for SMBP devices loaned to patients:

(Added: 6/25/2021)

What specific data items need to be tracked (in addition to UDS metrics) related to project implementation?

In addition to UDS metrics, awardees are required to report project status through submission of semi-annual progress reports. More information will be provided regarding semi-annual progress reports in June 2021. Quarterly data collection will be collected from NHCI technical assistance and data collection partners throughout the initiative. More details will be provided by the NHCI technical assistance and data collection partners.

(Updated: 8/25/2022)

What are acceptable and unacceptable methods of transferring SMBP readings?

Per the NHCI-HC guidance, acceptable methods of transferring patients’ blood pressure data stored in SMBP devices include:

  • Electronic transmission directly from the patient’s SMBP device to the health center 
  • Patients take device to the health center and healthcare provider or team member transfers blood pressure readings from the device directly into the patient’s electronic health record

The following method of SMBP data transfer is considered to be unacceptable:

  • Patient self-reported readings (e.g., verbal report, written log, emailing or texting results to the health center)

(Updated: 6/2/2022)

Training and technical assistance

Who is receiving the informational emails? Are they being sent to certain individuals? If so, is there a way to get on the email list?

HRSA NHCI-HC informational emails are sent to all NHCI-HC awardees. Emails are sent to all Project Directors listed on the Notice of Award and other health center staff, as requested by the health center, via the BPHC Contact Form. To add a recipient, please submit the person’s name, email, and role at the health center.

(Updated: 3/25/2022)

How do I find out which training and technical assistance group my health center is in?

On September 10, 2021, each NHCI-HC awardee received an email from HRSA designating the health center’s training and technical assistance group. The email was sent to the health center’s Project Director for its H80 grant. If you need assistance with determining your training and technical assistance group, please reach out to the HRSA NHCI-HC team via the BPHC Contact Form.

(Updated: 3/25/2022)

Are health centers required to participate in training and technical assistance (T/TA) activities?

Yes. NHCI-HC awardees are required to participate in T/TA activities. The NHCI-HC guidance requires health centers’ full participation in T/TA activities offered in support of the award. It is up to the health center to decide whom and how many people from their organization should attend these activities, at a minimum, on a quarterly basis.

(Updated: 8/25/2022)

What are the different types of T/TA activities that will be provided?

HRSA T/TA partners will provide T/TA opportunities such as webinars, workshops, forums, and office hours to cover topics such as use of EHR data for patient and performance monitoring, work and data flow, team-based care, hypertension diagnosis and treatment algorithms, patient education and support, and social determinant of health and community linkages, among other topics. T/TA activities and topics covered may evolve as new areas of needs are identified.

Here are some T/TA resources you can access:

  • American Heart Association’s NHCI webinars – recordings are available to the public on the Community Health Center hub
  • NHCI Learning Collaboratives and Office Hours offered by the NHCI contractor – invitations are sent to awardees via email
  • Million Hearts® SMBP Forum – a forum to explore the roles and opportunities for patients, clinicians, care teams, and other SMBP supporters for implementing SMBP
  • Million Hearts® Learning Lab – a bi-monthly learning series for clinicians, quality improvement and other staff focused on cardiovascular disease prevention and management topics

(Updated: 8/25/2022)

How can we access the prior TA webinar recordings and slides?

Past NHCI TA webinar recordings and slides can be found on the BPHC Contact Form under “Past Webinar Recordings" or on the American Heart Association’s Community Health Center Hub. Health centers also receive the NHCI Quarterly Communications email, which will include all past TA webinar recordings.

(Updated: 8/25/2022)

Allowed uses of funds

Can health centers use NHCI funds for supplies, such as tablets, phones, webcams, and biometric devices, and provide these to health center patients so that they may participate in telehealth, virtual care, or remote monitoring from their homes?

Yes. NHCI funds may be used to purchase supplies necessary for use by health center patients to access in-scope services via telehealth or virtual care or to support such services via remote monitoring technology. Items may include health and wellness-related technology hardware and software, computer and mobile phone applications, and devices that support patient participation in virtual appointments, remote home monitoring, and engagement in care through telemedicine.

NHCI funds may not be used to provide these items as incentives to individuals to induce them to select the health center as their provider. Additionally, you must ensure such purchases align with your organization's policies and procedures, and maintain appropriate records and cost documentation as required by 45 CFR §75.302.

As a reminder, health centers providing services via telehealth must assure that any services provided remotely are consistent with Federal and state law, including HIPAA and applicable CMS requirements. For more information, see:

HRSA encourages you to review the following guidance on the federal anti-kickback and physician self-referral law. In particular, you cannot provide incentives conditioned on an individual’s past or anticipated future use of services that are reimbursable in whole or in part by federal health care programs. For specific inquiries, please contact OIGComplianceSuggestions@oig.hhs.gov.

(Added: 12/17/2021)

Do I have to use NHCI-HC funds to purchase and distribute self-measured blood pressure (SMBP) devices?

You must ensure access to and support of the use of Bluetooth or wireless-enabled SMBP devices for a majority of your patients with hypertension. Ensuring access may include the purchase of devices and/or the use of such devices already available at the health center to be distributed to patients.

(Updated: 1/19/2021)

What are the bulk costs for SMBP devices?

HRSA anticipates that bulk purchased devices will cost about $60 per unit. Technical assistance will be available on SMBP device options and considerations to award recipients soon after awards, including potential guidance to support bulk purchasing.

(Updated: 1/19/2021)

What costs are allowed to support the use of SMBP devices?

Allowed costs include personnel (e.g., health information technology staff, patient educators), training (e.g., adopting new workflows that follow clinical guidelines, teaching patients to use SMBP devices), supplies (e.g., SMBP devices, outreach materials), and equipment (e.g., servers, EHR purchase or upgrade). 

(Updated: 1/19/2021)

Are costs to ensure the security of data transmitted by Bluetooth and wireless-enabled devices allowed?

Yes. You are responsible to protect the confidentiality, integrity, and availability of personal health information, including safeguarding data from accidental and intentional disclosure. Detailed resources are available in the Office of the National Coordinator for Health Information Technology Health IT Playbook Chapter 7: Privacy & Security. You may use funds to support the safety of patient data, including servers, firewall protection software, and training for personnel and patients on topics such as proper use of devices and patient portals, security of passwords, and available data safety features.

(Updated: 1/19/2021)

Are costs to support sufficient internet access to use the SMBP devices allowed?

Yes. You may use funds to support patients’ use of SMBP devices, such as hot spots and facilitating the enrollment individuals in the Federal Communication Commission’s (FCC) Lifeline subsidy program, which provides data, voice plans, and often phones to eligible individuals. If you choose to do so, you must maintain records describing how you determined the necessity of this cost. In addition, the NHCI-HC award-specific training and technical assistance may address patients’ internet access barriers.

(Updated: 1/19/2021)

Are costs for other hypertension treatment activities allowed?

Yes. You may use funds to support the use of hypertension treatment strategies other than remote patient monitoring through SMBP devices if they directly address the NHCI-HC purpose and requirements. Examples of such costs include nutrition counseling and patient education.

(Updated: 1/19/2021)

Are NHCI-HC awards subject to telecommunications and video service and equipment prohibitions?

Yes. Federal Register Notice (FRN) 85 FR 49506 prohibits you from procuring or contracting to procure certain telecommunications or video surveillance equipment or services produced by Huawei Technologies Company, ZTE Corporation, Hytera Communications Corporation, Hangzhou Hikvision Digital Technology Company, and Dahua Technology Company, as well as their subsidiaries and affiliates. Additional information is provided in the FRN and in your NHCI-HC Notice of Award. HHS is developing an implementation strategy and guidance. You should incorporate these new requirements into procurement policies and procedures.

(Updated: 1/19/2021)

Am I required to add personnel as part of my NHCI-HC project?

There is no required FTE increase for this one-time funding that is not expected to continue beyond three years. You may use NHCI-HC funds to add new personnel or increase part-time personnel FTE to support your health center with achieving the NHCI-HC purpose and objectives.

(Updated: 1/19/2021)

Can I use NHCI-HC funding to hire a driver to transport patients or for transportation vouchers?

Yes. Transportation is an allowed enabling service if it moves health center patients to or from a service on your currently approved Form 5A (i.e., the service is within the scope of your Health Center Program project) and the service is provided by a health center provider. NHCI-HC funds cannot be used to purchase or lease a vehicle to transport patients.

(Updated: 1/19/2021)

Project overview form

Is it required to fully participate in training and technical assistance activities offered in support of the award?

You must select “Yes” to indicate that you will fully participate in future training and technical assistance activities offered in support of your award to be considered for funding. This will also include data submission requirements to support initiative evaluation and continuous quality improvement.

(Updated: 1/19/2021)

What 2020 data may I use to demonstrate that my health center meets the award criteria?

You can submit 2020 data from your EHR universe to demonstrate alignment with the award criteria. These data should be from January 1, 2020 to date. However, if you are using population health management tools to assist with aggregation and analysis of your clinical quality measure (CQM) reporting across sites, then you may use the latest data available. Please clearly describe the data source and measurement period in the 2020 Data Source field on the Project Overview Form.

(Updated: 1/19/2021)

Can I use patient chart samples to report data for the hypertension metrics?

No. You must use data that represent your entire patient chart universe to provide 2020 data. This should be from your EHR, if available.

(Updated: 1/19/2021)

What resources are available to help me determine if my NHCI-HC project will require a change in scope?

The scope of project webpage provides technical assistance materials. Contact your project officer for any additional guidance.

(Updated: 1/19/2021)

Can I make changes to my scope of project through the NHCI-HC submission?

No. However, you may submit a change in scope (CIS) request for HRSA prior approval, including scope adjustment or formal CIS through your project officer whenever you are ready. It is recommended that you submit such requests approximately 60 days before implementing a change, and you may submit a prior approval before receiving your NHCI-HC award.

(Updated: 1/19/2021)

Project plan form

Why do I need to include an activity description in the milestone field?

It is necessary to identify the related activity in the Milestone field because the system will not link activities and milestones.

(Updated: 1/19/2021)

What is the difference between the Target Date field and the Milestone field?

For each listed activity, you must click on the calendar icon next to the Target Date field to enter the milestone target accomplishment date. Then, in the Milestone field, state whether it will be ongoing or limited to year 1, year 2, or year 3.

(Updated: 1/19/2021)

Who should outreach activities engage?

Proposed outreach should reach new and existing patients who may be at risk for hypertension, or who may otherwise benefit from hypertension prevention, treatment, and related services.

(Updated: 1/19/2021)

Does ensuring access to remote monitoring for a majority of patients diagnosed with hypertension mean that more than half of my hypertensive patients need to use remote monitoring SMBP devices each year?

No. By the end of the 3-year period, you must have made access to SMBP devices available to a majority of your patients diagnosed with hypertension. You have flexibility in how you meet this requirement. In addition to devices you purchase and provide to patients, you may include devices already in use by your hypertensive patients and those provided through SMBP device loaner programs. HRSA understands that not every patient to whom you make a SMBP device available will participate. Technical assistance will be available on SMBP device options and considerations to award recipients soon after award.

(Updated: 1/19/2021)

Is there a minimum requirement for the number of SMBP devices distributed?

You must ensure access to and support the use of SMBP devices for a majority (greater than 50%) of your adult patients with hypertension. This includes patients with both controlled and uncontrolled hypertension. However, HRSA understands that not every patient to whom you make a SMBP device available will participate.

(Updated: 6/25/2021)

What target date of accomplishment should I use for ongoing activities?

Use December 31, 2023 for all ongoing activities, even if this is not the FY 2023 budget period end date for your H80 award.

(Updated: 1/19/2021)

Equipment list form

Do I need to complete an Equipment List Form for each year that I request NHCI-HC funds to purchase equipment?

Yes. Select the Equipment List Form that correlates with the budget year (i.e., Year 1, Year 2, or Year 3 tab in EHBs).

(Updated: 1/19/2021)

What is the total allowed equipment request amount for this submission?

The total for equipment costs cannot exceed $150,000 across all three years (i.e., Year 1, Year 2, and Year 3).

(Updated: 1/19/2021)

How do I determine if an equipment item is clinical or is non-clinical?

To differentiate between non-clinical and clinical equipment, refer to the definitions of “general equipment” and “specialized equipment,” respectively, in 45 CFR § 75.2. An example of non-clinical equipment is information technology equipment. Examples of clinical equipment include point of care laboratory tests, EHR systems and upgrades, and telehealth systems.

(Updated: 1/19/2021)

How should I categorize equipment that costs less than $5,000?

For budget purposes, the only items that should be listed on the Equipment line are those with a unit price of $5,000 or more. Items with a unit cost of less than $5,000 are listed under Supplies.

(Updated: 1/19/2021)

Resources

What resources are available for me to help me with my submission?

  • Visit the Million Hearts website for more information regarding self-measured blood pressure monitoring. 
  • The ONC Health IT and ONC Patient Engagement Playbooks provide strategies, recommendations, and best practices to implement and use health information technology. 
  • HRSA has several strategic partnerships that provide national-level training and technical assistance. The HITEQ Center offers training on integrating EHR and health information technology, or health IT systems. Health Center Controlled Networks (HCCNs) work together to improve clinical practices by making health information technology easier for patients and providers to use, increasing the security of patient information, and using data to improve patient care. 
  • The Federal Communications Commission (FCC) Lifeline subsidy program is a program to help make communications services more affordable for eligible consumers.

(Updated: 1/19/2021)

Other

What if I have additional questions or issues with my progress report submission?

For submission information, please refer first to the resources available on the NHCI-HC technical assistance webpage. You may also contact the NHCI Support Team at NHCI-Support@hrsa.gov to submit your questions. You may also use the BPHC Contact Form. Under the category, “Supplemental grant award (i.e., COVID/ARP, PCHP, Capital)” complete your contact information, and then choose “National Hypertension Control Initiative (MHCI-HC) supplemental grant award.”

(Updated: 3/25/2022)

What if I have issues with the EHBs?

If you have any EHB-related questions about the progress report, please use the BPHC Contact Form. Under the category, Technical Support, choose “EHBs Tasks/EHBs Technical Issues” then the “Progress Reports” sub-category. You may also call 1-877-464-4772 between 8am - 8pm ET, Monday - Friday except on federal holidays.

(Updated: 3/25/2022)

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