Sample_Redacted_SSE_Redacted.pdf

Health Resources and Services Administration

HRSA 19-XXX

Objective Review Committee Final Summary Statement

SSccoorree::

Application Number:

Application Name:

State: l

Criterion 1: Need Strength:

The applicant organization clearly describes its proposed new service area and target population through illustrative maps and geographic descriptions of the area and demographic information representing the target group.

The application presents the health needs of the designated area with detail and data, citing underutilization and difficulty in providing health care to rural residents. The application identifies the importance of building relationships in the community.

Weakness:

The application does not provide clear documentation of the extent of the health care needs of the targeted special population of seasonal agricultural workers. For example, diabetes, asthma and hypertension are noted as their main health issues, but no specific data are documented to justify this conclusion.

The application does not provide thorough detail in regard to the targeted subpopulation of seasonal agricultural workers (i.e., occupational hazards; time in the service area; and cultural barriers).

Criterion 2: Response Strength:

The applicant organization clearly documents its existing experience providing health care to a similar target population in a geographic area other than that proposed.

The applicant organization clearly documents the availability of a 24-hour nurse hotline accessed with an 800 number for afterhours care, or use of an emergency center for patient medical emergencies.

The applicant organization clearly describes having a sliding fee discount program, and explains how the fee scale is applied based on patient income and resources available.

Section I

HRSA 19-XX

The applicant organization clearly documents the projected number of unduplicated patients to be served and the formula used to reach the projected number.

Weakness:

The operational plan does not clearly explain the roles of the staffs of the existing

Federally Qualified Health Center (FQHC) currently serving the proposed geographic area and the proposed administrative duties for the transition team.

Criterion 3: Collaboration Strength:

The applicant organization provides clear evidence, through signed Memoranda of Understanding with healthcare entities, of plans to provide emergency services, inpatient and outpatient hospital referrals, laboratory, radiology, and screening, obstetrics/gynecological and behavioral health services.

The attachments to the application clearly present documentation of collaboration efforts with other primary care providers in the service area. The application states that with the Notice of Award (NoA), the organization will reach out to other health centers in the service area to strengthen the continuity of care for the patients.

Weakness:

None

Criterion 4: Evaluative Measures Strength:

The applicant organization clearly describes clinical and financial performance measure goals, including numerators, denominators, baseline data and projections for the end of the grant period.

The applicant organization provides clear evidence it has in place a strong Quality Improvement/Quality Assurance (QI/QA) plan that addresses all required clinical priorities, risk management, and credentialing policies and procedures that include anonymous risk management strategies, and patient satisfaction surveys.

The applicant organization clearly discusses how the health record system will use health information technology to protect patient confidentiality, guard patient records, and readily collect and organize required data for reporting.

Weakness:

HRSA-

The application does not thoroughly describe the details of the quality improvement program that discusses grievance processes, patient safety, and adverse events.

Criterion 5: Resources/Capabilities Strength:

The applicant organization clearly describes its current experience in ensuring its providers are credentialed and have hospital admitting privileges, and indicates plans to continue this practice in the new service areas should the project be funded.

The applicant organization provides detailed evidence it has an organizational structure and a well-qualified management team in place that are appropriate for project implementation. Memoranda of Agreement are detailed and roles of subcontractors appropriate to the project purpose are explained.

The applicant organization provides clear evidence of an established accounting and control system, and Board-approved policies and procedures that meet Generally Accepted Accounting Principles (GAAP).

The applicant organization provides a clear description of its participation in federal benefits programs, citing involvement in the 340b Drug Pricing Program, Medicare, Medicare Children's Health Insurance Program, and National Health Service Corps.

The applicant organization provides clear evidence of having received quality awards from the Health Resources and Services Administration.

The applicant organization provides evidence in its Bylaws that financial systems in place are in compliance with terms and conditions required of Federally Qualified Health Centers.

The applicant organization clearly indicates that there are current on-going discussions about the use of telehealth technology for behavioral health services.

Weakness:

The application does not include a detailed resume for the Chief Operating Officer.

The application does not describe how payments from patients are requested pertinent to billing and collections.

The application does not clearly describe procedures are in place for insurance and billing.

For example, the application states, "The billing office has procedures in place to insure that unpaid claims are followed-up on in a timely manner." Those procedures are not detailed.

Criterion 6: Governance

HRSA

Strength:

The applicant organization clearly documents the governing board's oversight responsibilities. The organization's management structure is clearly depicted in an organization chart that reflects the organization's hierarchy placing the board in the lead.

The application concisely describes how the governing board effectively operates within the organization's structure to ensure that the board maintains authority and oversight of the project.

Weakness:

The application does not provide clear evidence that the governing board composition reflects the ethnicity served by the clinics per the requirements of its Bylaws.

Criterion 7: Support Requested Strength:

None

Weakness:

The personnel line item budget does not clearly align with the project narrative. The budget does not clearly delineate between staffing for existing clinic services provided. , and staffing for the proposed new sites.

The application does not clearly describe how the organization will respond to financial changes or challenges.

HRSA 19-xx

Priority Point question 1: Program Compliance Priority Met: No

Priority Point: 0 Priority point comment:

Not eligible.

Priority Point question 2: Patient Trend Priority Met: No Priority Point: 0 Priority point comment:

Not eligible.

Blank Page