Attachment 12: Operational Plan Instructions and Sample

New and competing supplement applicants must upload a detailed operational plan. Outline the following for the proposed project:

  • Reasonable and time-framed activities. Show that within 120 days of release of the Notice of Award (NOA) all sites will have the staff and providers you need to begin operating and delivering services. Make sure that sites and services are consistent with Form 5B: Service Sites (PDF - 81 KB) and Form 5A: Services Provided (PDF - 62 KB).
  • Plans to hire, contract, and/or establish formal written referral arrangements with all providers. Show that you will be able to provide all services at all sites for the stated number of hours within one year of the NOA release.

    Make sure your plan is consistent with: 

Note: Attachment 12 will count towards the page limit.

If you apply for service areas with special medically underserved population funding, you must include additional information in the Operational Plan.

If you apply for:

Homeless Population (HP) funding: Describe your plan to ensure that the required primary health care services and substance use disorder services are available and accessible to individuals:

  • Who lack housing
  • Whose main residence during the night is a supervised public or private facility that provides temporary lodging
  • Who live in transitional housing
  • Who live in permanent supportive housing or other housing programs that target populations without homes
  • Who are children and youth at risk of homelessness, homeless veterans, and veterans at risk of homelessness

Residents of Public Housing (RPH) funding: Describe your plan to ensure that the required primary health care services are available and accessible to residents of public housing and individuals living in areas immediately accessible to public housing.

  • Public housing is low-income housing that is developed, owned, or assisted by a public housing agency, including mixed finance projects
  • Public housing does not include housing units that accept Section 8 housing vouchers but do not receive other support from a public housing agency

Migratory and Seasonal Agricultural Workers (MSAW) funding: Describe your plan to ensure that the required primary health care services are available and accessible to the following people in your service area:

  • Migratory and seasonal agricultural workers (MSAWs) whose main job has been in agriculture within the last 24 months, and who have a temporary home because of that job
  • MSAWs whose main job is in agriculture on a seasonal basis and who do not meet the definition of a migratory agricultural worker
  • People who no longer work in migratory or seasonal agriculture because of age or disability
  • Family members of everyone we described
     

Table 1: Key Elements of the Operational Plan

Element Implementation
Focus Area Choose focus areas from the list of Optional Focus Areas, or identify different focus areas necessary to achieve the required operational status.
Goal For each focus area, provide at least one goal. Goals should describe measurable results.
Key Action Steps Identify at least one action step that must occur to accomplish each goal.
Person/Area Responsible Identify who will be accountable for carrying out each action step.
Time-Frame Identify the expected timeframe for carrying out each action step.
Comments Provide supplementary information as desired.

Optional Focus Areas

Operational Service Delivery

A.1. Provision of Required & Additional Services (Form 5A: Services Provided and Project Narrative)
A.2. Professional Coverage for After Hours Care
A.3. Admitting Privileges
A.4. Readiness to Serve the Target Population

Functioning Key Management Staff/Systems/Arrangements

B.1. Documented Contractual/Affiliation Agreements/Subawards
B.2. Data Reporting System

Implementation of a Compliant Sliding Fee Discount Program and Billings and Collections System at Proposed Site(s)

C.1. Sliding Fee Discount Program
C.2. Billing and Collections System
C.3. Implementation of a Compliant Sliding Fee Scale

Integration of the Proposed Site(s) into the Quality Improvement/Quality Assurance (QI/QA) Program

D.1. Leadership and Accountability
D.2. QI/QA Plan and Process to Evaluate Performance

Governing Board

E.1. Recruitment of Members to Ensure Compliance with Board Composition and Expertise Requirements
E.2. Conflict of Interest Requirements
E.3. Strategic Planning

Sample Operational Plan

Focus Area: Operational Service Delivery

Goal
On separate rows, identify the goals for each focus area. Goals should describe measurable results.

Key Action Steps
Identify the action steps that must occur to accomplish each goal.

 Person/Area Responsible
Identify who will be responsible and accountable for carrying out each action step.		 Time-Frame
Identify the expected timeframe for carrying out each action step.		 Comments
As desired, provide supplementary information.

A1: Provision of Required and Additional Services (Form 5A: Services Provided and Project Narrative)

  1. Provide all required and additional services on Form 5A within 120 days
  1. Action Step
  2. Action Step
  1. Person Responsible
  2. Person Responsible
  1. Time-frame
  2. Time-frame
  
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