Attachment 12: Operational Plan Instructions and Sample

New or competing supplement applicants must outline a plan, specific to the proposed project, with reasonable and time-framed activities necessary to assure that:

  1. Within 120 days of release of the Notice of Award (NoA), all proposed sites (as noted on Form 5B: Service Sites and described in the Project Narrative) must have the necessary staff and providers in place to begin operating and delivering services (as described on Form 5A: Services Provided and in the Project Narrative).
  2. Include plans to hire, contract, and/or establish formal written referral arrangements with all providers (consistent with Forms 2: Staffing Profile, 5A: Services Provided and 8: Health Center Agreements, and Attachment 7: Summary of Contracts and Agreements) and begin providing services at all sites for the stated number of hours (consistent with Form 5B: Service Sites) within 1 year of release of the NoA.

Table 1: Key Elements of the Operational Plan

Element Implementation
Focus Area Choose focus areas from the list below 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 measureable 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 time-frame 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 measureable 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 time-frame for carrying out each action step.
Comments
As desired, provide supplementary information.
Goal A1: Provision of Required and Additional Services (Form 5A: Services Provided and Project Narrative)
  1. Action Step
  2. Action Step
  1. Person Responsible
  2. Person Responsible
  1. Time-frame
  2. Time-frame
 

 

Date Last Reviewed:  May 2021