(1) These rules establish a procedure for awarding grants to carry out the purposes of the Montana Community Health Center Support Act.

(1) "Advisory group" means the nine member group appointed as provided in 50-4-810, MCA.

(2) "Applicant" means the entity applying for the grant. An entity applying for a grant will be expected to apply for federal grants supporting Public Health Service Act (PHSA) (2007) Section 330 grantees when available.

(3) "Bureau of Primary Health Care (BPHC)" means the bureau within the Health Resources and Services Administration (HRSA) of the United States Department of Health and Human Services that oversees the determination of Community Health Center (CHC ) status and makes a recommendation regarding federally qualified health center (FQHC) and FQHC look-alike status. A health care center that wants Section 330 grant money from the PHA must apply to the BPHC as provided in 42 CFR 51c (2007).

(4) "Capital Expenditure Application" means an application for a one-time capital expenditure to an existing federally qualified health center to expand services by increasing medical, dental, or mental health capacity by purchasing equipment or renovating clinic facilities.

(5) "Centers for Medicare and Medicaid Services (CMS)" is the division of the United States Department of Health and Human Services that confers FQHC and FQHC look-alike status and implements FQHC reimbursement policy.

(6) "Community health center (CHC)" means a health care center that meets the requirements of 42 USC 254b (2007) and 42 CFR 51c (2007), and is receiving federal Section 330 grant money under the PHSA.

(7) "Comprehensive primary health care services" means:

(a) basic health services which, for the purposes of this subchapter, shall consist of:

(i) health services related to family medicine, internal medicine, pediatrics, obstetrics, or gynecology that are furnished by physicians and where appropriate, physician assistants, nurse practitioners, and nurse midwives;

(ii) diagnostic laboratory and radiologic services;

(iii) preventive health services, including:

(A) prenatal and perinatal services;

(B) appropriate cancer screening;

(C) well-child services;

(D) immunizations against vaccine-preventable diseases;

(E) screenings for elevated blood lead levels, communicable diseases, and cholesterol;

(F) pediatric eye, ear, and dental screenings to determine the need for vision and hearing correction and dental care;

(G) voluntary family planning services;

(H) preventive dental services;

(iv) emergency medical services; and

(v) pharmaceutical services as may be appropriate for particular centers;

(b) referrals to providers of medical services (including specialty referral when medically indicated) and other health-related services (including substance abuse and mental health services);

(c) patient case management services (including counseling, referral, and follow-up services) and other services designed to assist health center patients in establishing eligibility for and gaining access to federal, state, and local programs that provide or financially support the provision of medical, social, housing, educational, or other related services;

(d) services that enable individuals to use the services of the health center (including outreach and transportation services and, if a substantial number of the individuals in the population served by a center are of limited English-speaking ability, the services of appropriate personnel fluent in the language spoken by a predominant number of such individuals); and

(e) education of patients and the general population served by the health center regarding the availability and proper use of health services.

(8) "Department" means the Montana Department of Public Health and Human Services.

(9) "Department committee" means employees of the department and other persons appointed by the department director to participate in the screening and grant awards determination in this rule.

(10) "Expanded Medical Capacity Application" means an application to expand the medical services offered by existing federally qualified health centers or other facilities that have received federally qualified health center look-alike status.

(11) "Federally qualified health center" means a facility that meets the definition of 42 USC 1396d(I)(2)(B) (2007). A FQHC is entitled to receive enhanced Medicaid and Medicare reimbursement. Federally qualified community health centers, federally qualified health center look-alikes, and certain tribal and urban Indian entities are FQHCs.

(12) "FQHC look-alike" means a FQHC that has been determined by the United States Department of Health and Human Services to meet the requirements to be a Section 330 grantee but has not received Section 330 grants. A FQHC look-alike is entitled to receive enhanced Medicaid and Medicare reimbursement.

(13) "Medically underserved area or population (MUA/MUP)" means an area or population designated by the Secretary of the United States Department of Health and Human Services as having a shortage of primary health services. Designation information may be obtained from the primary care office within the United States Department of Health and Human Services.

(14) "New Access Points Application" means an application to create and support a health center which will serve a significant portion of a population located in a medically underserved area (MUA), or designated as a medically underserved population (MUP). Successful applicants will be expected to apply for federally qualified health center look-alike status and federal community health center grants at the first available opportunity.

(15) "New Satellite Access Application" means an application by an existing 330 grant funded federally qualified health center to establish a new access point to serve a new patient population that is outside the approved scope of project.

(16) "Public Health Service Act (PHSA)" means the federal Public Health Service Act codified at 42 USC 201, et seq. (2007).

(17) "Section 330 grantee" means a CHC that meets the requirements of 42 USC 254b and 254c (2007) and has been awarded federal grant money under the PHSA.

(18) "Service Expansion Application" means an application to expand the medical, mental health, or dental services offered by existing federally qualified health centers or other facilities that have received federally qualified health center look-alike status.

(1) The advisory group appointed pursuant to 50-4-810, MCA, shall advise the department committee, in writing, of its recommendations for the priorities related to awarding state grant(s) from among the following goals:

(a) create and support new access points for comprehensive primary health care services by applicants that will be working toward FQHC status;

(b) create and support new access satellites in new locations for comprehensive primary health care services by existing CHCs;

(c) expand the medical capacity of existing FQHCs that are Section 330 grantees;

(d) expand the medical, mental health, or dental services offered by existing FQHCs that are Section 330 grantees; or

(e) award one time grants for FQHCs to purchase equipment or renovate clinic facilities.

(2) Final decision will be made by the department committee. If the department committee does not follow the recommendations of the advisory group it will provide its reasons for not doing so in writing to the advisory group.

(1) To be eligible for consideration for a state grant an applicant must submit a proposal and meet the requirements listed in (1)(a) through (f) and (2). The applicant for:

(a) "capital expenditure" must be an existing FQHC. Capital expenditure grants are for the purchase of equipment or renovation of clinic facilities. Capital expenditure applications must demonstrate that additional services will be made available and/or increase patient capacity per department guidelines for capital expenditure applications;

(b) "expanded medical capacity" must be able to meet the qualifications contained in the United States Department of Health and Human Services, Policy Information Notice (PIN) 2006-09 dated February 8, 2006;

(c) "new access points" must be able to meet the qualifications for new access points described in the United States Department of Health and Human Services, HRSA-08-077 dated September 28, 2007;

(d) "new satellite access sites" must be able to meet the qualifications for new access points described in the United States Department of Health and Human Services, HRSA-08-077 dated September 28, 2007;

(e) "service expansion" must be able to meet the qualifications for service expansion grants contained in the United States Department of Health and Human Services, Policy Information Notice (PIN) 2003-03 dated February 12, 2003; and

(f) "state grants" must also apply for FQHC look-alike status and/or 330 grants, where applicable.

(2) The applicant for new access points must be able to meet all the requirements of 42 CFR 51c (2007) and provide evidence that the following requirements of 42 CFR 51c (2007) will be met:

(a) The successful applicant must have a governing board with at least nine but not more than 25 members, a majority of whom are individuals served or who will be served by the health center and are representative of the health center's patient demographics. No more than one-half of the remaining members of the governing board may be individuals who derive more than ten percent of their annual income from the health care industry. The remaining members of the governing board shall be representative of the area which the center serves.

(b) The successful applicant must have a sliding schedule of fees that is linked to the patient's ability to pay for patients with incomes up to 200% of the federal poverty level.

(c) The successful applicant must serve a significant portion of a population located in a medically underserved area (MUA) or designated as a medically underserved population (MUP). If the area is not currently federally designated, in whole or in part, as a MUA or MUP, the applicant must provide documentation that the request has been submitted.

(d) The successful applicant must provide access to services in the targeted service area or population without discrimination.

(3) The applicant for new satellite access sites, service expansion, expanded medical capacity, or capital expenditure must meet the requirements of 42 CFR 51c (2007) and provide evidence that the following requirements of 42 CFR 51c (2007) have been met:

(a) The successful applicant must have, or intend to have, a governing board with at least nine but not more than 25 members, a majority of whom are individuals served, or will be served, by the health center and are representative of the health center's patient demographics. No more than one-half of the remaining members of the governing board may be individuals who derive more than ten percent of their annual income from the health care industry. The remaining members of the governing board shall be representative of the area which the center serves.

(b) The successful applicant must have a sliding schedule of fees that is linked to the patient's ability to pay for patients with incomes up to 200% of the federal poverty level.

(c) The successful applicant must serve a significant portion of a population located in a medically underserved area (MUA) or designated as a medically underserved population (MUP).

(d) The successful applicant must provide access to services in the targeted services area or population without discrimination.

(1) The department will solicit proposals and award grants whenever funding is appropriated by the Legislature. The Department of Administration's request for proposals (RFP) process will be utilized to solicit applications based on the priority among projects determined pursuant to ARM 37.109.105. The opportunity to make a proposal for a grant will also be posted on the department's web site. The RFP will include the application selection criteria established pursuant to ARM 37.109.111.

(2) The applicant's proposal will consist of a brief statement of the amount of the funds requested and how the applicant proposes to use such funds. The proposal must disclose if it is for capital expenditure, expanded medical capacity, new access points, new satellite access, or service expansion. The applicant should also include a description of need, impact on access, projected number of additional patients served and encounters, timelines for providing services and applying for federal grant and/or look-alike status.

(3) In addition the RFP may require that the application include:

(a) its most recent application to the Secretary of HHS for a grant under Section 330 of the Public Health Service Act, if such grant application has been or will be submitted;

(b) its most recent application to the Secretary of HHS requesting designation as a federally qualified health center "look-alike" if such application has been or will be submitted;

(c) its service expansion application which it has submitted or will submit to the Secretary of HHS;

(d) its expanded medical capacity application which it has submitted or will submit to the Secretary of HHS; or

(e) its capital expenditure application which it will submit to the department.

(4) The applicant may refer to the United States Department of Health and Human Services, HRSA-08-077 dated September 28, 2007; or the United States Department of Health and Human Services, Policy Information Notice (PIN) 2003-03 dated February 12, 2003; or the United States Department of Health and Human Services, Policy Information Notice (PIN) 2006-09 dated February 8, 2006; or department guidelines for capital expenditure applications; whichever is most appropriate for additional information.

(1) Proposals will be evaluated by the department committee using the priorities developed by the advisory group pursuant to ARM 37.109.105 and the criteria by category of application as located at the United States Department of Health and Human Services, HRSA-08-077 dated September 28, 2007; or the United States Department of Health and Human Services, Policy Information Notice (PIN) 2003-03 dated February 12, 2003; or the United States Department of Health and Human Services, Policy Information Notice (PIN) 2006-09 dated February 8, 2006, or department guidelines for capital expenditure applications.

(2) The advisory group may develop additional criteria related specifically to Montana and its unique circumstances. Criteria to be considered may include, but are not limited to: high need areas, impact, federal funding opportunities, readiness, collaborations, and cost per client served.

(3) All criteria shall be listed in the request for proposal. If the department committee does not follow the recommendations of the advisory group, it must comply with the requirements of 50-4-811, MCA.

(4) In the event that funding is available after the initial award process has been completed, the department shall have the option of making awards to the next highest rated applicant(s) without requiring a new RFP process.

(1) The department committee will conduct an initial screening of the proposals to determine if the applicants have complied with the requirements set forth in the request for proposal. The department committee may allow an applicant to correct omissions or errors in its proposal that are not material. When exercising this option, the department committee shall notify all other applicants of the corrections made.

(1) An objective grant review process will be performed by the department committee consistent with the criteria stated in ARM 37.109.111.

(2) The advisory group will have an opportunity to define its role in the evaluation process in accordance with Montana Department of Administration requirements regarding requests for proposals.

(1) Final grant awards determination, along with a prioritized listing arranged by highest score of applicants will be made by the department committee. The department committee shall advise the advisory group, in writing, of its determination of grant award(s) along with the prioritized listing of additional eligible applicants. If the department committee does not follow the recommendation(s) of the advisory group, the department committee will provide its reasons for not doing so in writing to the advisory committee.

(2) Successful applicants, also referred to as "grantees", that are to be awarded grants by the department will negotiate a contract with the department. Grant amounts will be awarded prior to the end of the state fiscal year.

(3) The contract will be administered by the Hospital and Clinic Services Bureau, Health Resources Division of the department.

(4) The contract may be terminated for nonperformance or underperformance on the part of the grantee. The department committee may make a determination of nonperformance or underperformance based on the grantee's demonstrated work toward accomplishing the objectives of their request for proposal. The grantee will be notified by the department committee of its determination of nonperformance or underperformance. The grantee will be afforded an opportunity to remedy the nonperformance or underperformance. The department committee may make a determination of continuing nonperformance or underperformance based on the grantee's demonstrated work toward accomplishing the objectives of their request for proposal. The grantee will have the right to seek all contractual and judicial remedies available if aggrieved by the determination of continuing nonperformance or underperformance of the department committee.

(5) Grant awards will not supplant already available funds and in-kind resources.

(6) Grant award monies will cease once federal monies are received by the successful applicant for the same purpose as this grant award.

(7) In the event of (4) or facility closure, the department reserves the right to recoup unused capital grants and/or assets purchased with the monies derived from this grant award.

(8) Benchmarks and other reporting tools may be used by the department to determine a grantee's performance.

(9) Grant awards amounts may be expended over a time period not to exceed one year beyond the end of the biennium the grant was awarded if the project requires it and if legislative funding permits it. After that time period has elapsed, an application must be submitted for continuation of state funding based upon compliance with grant requirements and meeting performance measures.