(a) The Department shall develop an application form, and make it available in electronic format accessible by the public.
(b) The apphcation period will be determined and announced by the Department.
(c) The Department will make a notification of grant award within sixty ( 60) days of the close of the designated application period or notify the applicant(s) in writing, as identified in Section 6 of these Rules.
(d) Prior to submission of the Primary Care Support Grant Program application to the Department, the applicant, following public notice and a hearing, must obtain approval by the Board of County Commissioners for the applicable county. An official copy of the meeting minutes obtained from the County Clerk of the applicable county or a signed letter granting board approval is required as part of the application. The meeting minutes must state that board approval was granted. Board approval caimot be more than six (6) months old at the time of application to the Program.
(e) Applicant must complete the approved application and submit it to the Department with the appropriate and required supporting documents.
(f) The application, among other documents and factors as outlined in these Rules and in the statute, will be used to determine if an applicant is awarded a grant and must: - (i) Include a narrative describing the scope of the project.
- (ii) Identify the location and physical address of the current or projected clinic as apphcable.
- (iii) Identify and document the availability of local matching funds in an amount no less than twenty-five percent (25%) of the total funding request. For example, a grant request of $ 400,000 must show $100,000 m local matching fiands.
- (A) Local matching funds may be in cash, in-kind, or both, and must be shown in the form of a contract, promissory note or other legally binding written agreement.
- (B) Local matching funds must be utilized proportionally to the grant funds as the project progresses. A timehne shall be developed to include within the Grant Award Agreement, setting forth the proportional use of the funds, which may differ with the requirements of different projects.
- (iv) Identify the itemized total cost of the intended project, the total grant amount requested, and the total local matching funds (cash or in-kind).
- (A) If local matching ftmds are in-kind, an appraisal of goods and services must be included with the application.
- (B) In the event there is disagreement in the value of in-ldnd match, the Department may pursue alternative means to determine the in-kind value. If there is a cost to determining this value, that cost will be billed to and paid for by the applicant. A considerable difference in value is cause for denial of a grant, and is within the discretion of the Department.
- (v) Identify how the applicant will provide services to individuals regardless of their ability to pay and provide care to Medicare, Medicaid, and CHIP eligible patients. The applicant must submit the charity care policy or sliding fee scale, or both, with its application.
- (vi) Provide an operating plan that integrates healthcare services within the entire service community to promote accessibility and quality of care as is required by this Act.
- (vii) If applicable, demonstrate how an existing clinic positively impacts access to care.
- (viii) If applicable, justify creation of a new chnic in the community identified.
- (ix) Identify how the applicant's proposal may reduce Emergency Room or similar type care usage.
- (x) Identify three (3) quality indicators of the appHcant's choice, as defined in Section 4 of these Rules.
- (xi) Identify a list of key performance indicators for the project, as defined in Section 4 of these Rules.
- (xii) Demonstrate how the applicant will meet reporting requirements to remain in compliance with the Program during the entire three (3) year grant term.
- (xiii) Identify the individual responsible for the entity, including the chairperson, CEO, board of directors, or equivalent if a public entity, or owner(s) if not a public entity. If awarded a grant under this Program, the entity must notify the Department of any changes to the ownership, organization or control of the entity. The Department shall review the change and determine what, if any, effect the change in ownership, organization or control may have on the Program and the funding. The Department retains the sole discretion to refuse to fund an organization that has changed ownership, organization or control after the initial application period, and ret ains tliS abi lit}' to request repayment of one hundred percent (100%) of Program funds should there be a change of ownership, organization or control.
- (xiv) Include a copy of the Board of County Commissioners' meeting minutes or a signed letter where approval was given to the entity to apply for this Program.