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  5. FY 2021 American Rescue Plan Funding for Health Centers (H8F) Award Submission Requirement Guidance

FY 2021 American Rescue Plan Funding for Health Centers (H8F) Award Submission Requirement Guidance

Purpose

The American Rescue Plan Act (P.L. 117-2) (PDF - 652 KB) provides one-time funding (H8F) to support health centers funded under the Health Center Program to:

  1. Plan, prepare for, promote, distribute, administer, and track COVID–19 vaccines, and to carry out other vaccine-related activities.
  2. 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.
  3. 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.
  4. Establish, expand, and sustain the health care workforce to prevent, prepare for, and respond to COVID–19, and to carry out other health workforce-related activities.
  5. Modify, enhance, and expand health care services and infrastructure.
  6. Conduct community outreach and education activities related to COVID–19.

Funding Summary

The Health Resources and Services Administration (HRSA) awarded approximately $6.1 billion appropriated by the American Rescue Plan Act to health centers that are current Health Center Program operational (H80) grant award recipients, under section 330 of the Public Health Service Act, to respond to and mitigate the spread of COVID-19 and enhance health care services and infrastructure as described in items (1) – (6) as listed above.

This is one-time funding, with no expectation of continued funding beyond the 2-year period of performance.

Your award amount was calculated using the following formula:

  • Base value of $500,000, plus
  • $125 per patient reported in the 2019 Uniform Data System (UDS), plus
  • $250 per uninsured patient reported in the 2019 UDS.

Your award is aligned with your current Health Center Program (H80) funding proportions1 and may support a wide range of in-scope activities during the 2-year period of performance, as well as pre-award costs dating back to January 31, 2020. This H8F funding is in addition to the previous FY 2020 Coronavirus Supplemental Funding for Health Centers (activity code H8C), Coronavirus Aid, Relief, and Economic Security (CARES) Act Supplemental Funding for Health Centers (activity code H8D), and Expanding Capacity for Coronavirus Testing (ECT) Supplemental Funding for Health Centers (activity code H8E).

Funding must be used for the purposes described in items(1) - (6), to support activities in the following categories (see the H8F example activities for a complete list) consistent with those purposes:

  • 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.
  • 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.
  • 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 vulnerable patient populations.
  • 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.
  • Infrastructure: Minor Alteration/Renovation (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.

Within the required purposes described in items (1) - (6), health centers have flexibility in how to use the funding consistent with those purposes as COVID-19 circumstances and related community, patient, and organizational needs evolve over the 2-year period of performance. You are encouraged to leverage 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; and
  • Population and social determinants of health that may impact access to care, contribute to poor health outcomes, and exacerbate health disparities.

Required H8F Award Submission

As stated on your notice of award, you must complete and submit the following components via the HRSA Electronic Handbooks (EHBs) within 60 days of the award release date.

  1. SF-424A Form (PDF - 176 KB): Upload the SF-424A Budget Information Form for the H8F 2-year period of performance. You do not need to break the funding out by your current funding streams (i.e., CHC, MHC, HCH, PHPC), since it has already been awarded in alignment with these proportions.

    • In Section A – Budget Summary, under New or Revised Budget, enter the federal and non-federal project funding for the entire 2-year period of performance. The federal funding amount cannot exceed the total H8F award amount. In the SF-424A, do not include any amount under Estimated Unobligated Funds. If you are considering or plan to relinquish all or part of the funding, see the related term on your notice of award.
    • In Section B – Budget Categories, enter an object class category (line item) budget for the entire 2-year period of performance. You may request up to $500,000 for minor A/R (i.e., A/R projects with a value less than $500,000 in total federal and non-federal costs). If requesting funds for minor A/R, include that amount on the construction line.
    • In Section C – Non-Federal Resources, enter the amount of all other sources of funding (i.e., non-H8F grant funding supporting the H8F project for the entire 2-year period of performance), if any. Do not include any other Health Center Program funding (e.g., H80, H8C, H8D, H8E funding).

    The following are ineligible costs for purposes of this funding opportunity:

    • Costs already paid for by H80, H8C, H8D, or H8E funding.
    • Purchase or upgrade of an electronic health record (EHR) system that is not certified by the Office of the National Coordinator for Health Information Technology.2
    • 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 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 accessibility for people with disabilities, generator concrete pads, and other minor ground disturbance.
    • Purchase or installation of a permanently affixed modular or prefabricated building.
    • Facility or land purchases.

    You 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, HRSA COVID-19 Uninsured Program, CARES Act Provider Relief Fund, Health Center COVID-19 Vaccine Program, or unemployment compensation.

  2. Budget Narrative (PDF - 477 KB) : Upload a detailed budget narrative that clearly details federal and non-federal costs by object class category for each year of the 2-year period of performance. The sum of line item costs for each category must align with those on the SF-424A, Section B. Include the calculations for how you derive each cost and a detailed list of personnel to be supported with H8F funding.3

    Funding may support costs dating back to January 31, 2020 expended in alignment with the purpose of H8F funding. In your budget narrative, provide a detailed description of the pre-award costs, including the date incurred, as well as any costs incurred between the award date and your submission date. See the H8F sample budget narrative (PDF - 477 KB) for how to document such costs.

    Your budget may include indirect costs if your organization has an existing negotiated indirect cost rate agreement. If you have never received a negotiated indirect cost rate, you may elect to charge a de minimis rate of 10 percent of modified total direct costs. Costs must be consistently charged as either indirect or modified total direct costs, and may not be double charged or inconsistently charged as both. If the de minimis rate is chosen, this methodology must be used consistently for all your federal awards until such time as you choose to negotiate an indirect cost rate agreement. Upload your indirect cost rate agreement, if applicable.

  3. Federal Object Class Categories (FOCC) Form (PDF - 199 KB): In EHBs, break out the object class category totals from the SF-424A, Section B (e.g., Personnel, Equipment, Contractual) across years 1 and 2 of the 2-year period of performance (consistent with your Budget Narrative). If you plan to use funding for minor A/R, enter minor A/R costs on the construction line.

  4. Project Overview Form (PDF - 214 KB): In EHBs, indicate the activities you will conduct using your H8F funds over the 2-year period of performance.

    The Work Plan section of the form includes pre-populated activity options under the following categories:

    • COVID-19 Vaccination Capacity
    • COVID-19 Response and Treatment Capacity
    • Maintaining and Increasing Capacity
    • Recovery and Stabilization
    • Infrastructure: Minor Alteration/Renovation (A/R), Mobile Units, and Vehicles

    Select activities under one or more categories to describe your planned 2-year H8F activities. See the complete list of H8F example activities for reference. This list is not exhaustive, and you may write in self-defined activities under “Other” within each category. All activities must be consistent with the purpose of the funding and the terms of your award. To propose to use funds for activities dating back to January 31, 2020, select “Other” under the appropriate category and provide a detailed description of the pre-award activities that align with your budget narrative and the purpose of the funding.

    In the Scope of Project section of the form, indicate if changes will be required to your Form 5A: Services Provided, Form 5B: Service Sites, and/or Form 5C: Other Activities/Locations. All activities supported by H8F funding must align with your Health Center Program (H80) scope of project.4 All activities supported by H8F funding must align with your Health Center Program (H80) scope of project.5 You must receive approval for any changes in scope before implementing a new service, service delivery method, or service delivery site or location in support of your H8F project activities. For additional information, review the technical assistance materials on the Scope of Project webpage and related Considerations for Health Center Scope of Project and the COVID-19 Public Health Emergency. Contact the Program Official listed on your notice of award for guidance.

  5. Equipment List (PDF - 169 KB) (as applicable). If you propose to use H8F funds for equipment, complete the Equipment List form(s) in EHBs for year 1 and/or year 2 (consistent with the FOCC form, section B of the SF-424A, and your Budget Narrative). Include all moveable equipment that has a useful life of more than one year and a per-unit acquisition cost of at least $5,000, including information technology systems. 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 H8F funds must be procured, maintained, tracked, and disposed of in accordance with 45 CFR part 75.

    Complete the following fields for each item on the Equipment List Form:

    • 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 – Calculated in EHBs.

    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 the EPEAT Registry and Energy Star.

  6. Minor A/R Information (as applicable). You may use up to $500,000 in H8F funds for minor A/R activities at one or more in-scope H80 sites to support H8F activities. The total site-specific minor A/R 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.

    If you propose to use H8F funds for minor A/R, provide the following minor A/R information for each site-specific minor A/R project. See the Other Requirements for Sites form (PDF - 201 KB) for instructions.

    • In EHBs, click on “Add New” to answer questions addressing site control, federal interest, cultural resources, and historic preservation considerations.
    • Upload a detailed Minor A/R Project Budget Justification. See the minor A/R budget example and instructions (PDF - 145 KB).
    • Upload the completed Environmental Information and Documentation (EID) Checklist. See the EID template and instructions (PDF - 512 KB) (also included in EHBs for download).
    • Upload Schematics and/or Floor Plans showing the location and dimensions of the proposed minor A/R in the existing building.
    • Upload Property information (title, deed, or lease).
    • Upload signed Landlord Letter of Consent (PDF - 61 KB) (required for leased property).

H8F Progress Reporting and Outcomes

As stated on your notice of award, you must submit quarterly progress reports. Reports will describe the status of the activities and use of H8F funds, and include submissions related to minor A/R-related activities, if applicable. Details about progress reporting will be posted to the H8F technical assistance webpage when available.

HRSA will use the Uniform Data System (UDS) and other data sources to assess the outcomes of this funding, understanding that H8F resources are one-time, the allowable uses of funds are expansive within the parameters noted above, and there is flexibility to use funds to address immediate and evolving needs as well as costs incurred back to January 31, 2020.

In aggregate, BPHC expects that H8F funding will result in outcomes across the Health Center Program in several areas, that may be evaluated by examining increases in the:

  • Number of COVID-19 vaccinations completed, including by race and ethnicity
  • Number of COVID-19 tests, including by race and ethnicity
  • Number of patients screened for social risk factors
  • Number of health center patients/visits, including those receiving COVID-19 treatment
  • Number and type of virtual care visits
  • Number of enabling services patients
  • Number of new mobile units

Because resources are one-time and flexible (as detailed above), HRSA will consider your performance as indicated through progress reports and may consider measures noted above as they relate to your approved project to inform decisions regarding potential future no-cost extension requests.

Technical Assistance

See the H8F technical assistance webpage for:

  • Access information for two technical assistance calls to support this submission.
  • Activities and allowable funding uses.
  • Blank and/or sample forms.

COVID-19 frequently asked questions and resources are available at COVID-19 Information for Health Centers.

Submit questions to the correct HRSA technical assistance support team via the BPHC Contact Form using the following steps.

  • Choose the Question Type – click on Coronavirus Inquiries (COVID-19)
  • Choose the appropriate BPHC Sub Category
    • Questions about H8F funding and the Award Submission Requirement – click on ARP Health Center (H8F) Funding
    • Questions about EHBs – click on ARP Health Center (H8F) Funding – EHBs Questions
    • Questions about Health Center Program policy and requirements – click on COVID-19 General Inquiry

Footnotes

1 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).

2 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 that EHRs must meet to qualify for use in the Promoting Interoperability Programs.

3 Award funds may not be used to pay the salary of an individual at a rate in excess of Executive Level II, which is currently $199,300. This amount reflects an individual’s base salary exclusive of fringe and any income that an individual may be permitted to earn outside of the duties to your organization.

4 See Policy Information Notice 2008-01, section III.B.1.g (PDF - 224 KB): Other Activities for additional information.

5 You can view your scope of project in the Approved Scope section of your H80 grant folder in EHBs.

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