The State Offices of Rural Health Grant The State Offices of Rural Health Grant

Keith J. Midberry, MHSAKeith J. Midberry, MHSA

Department of Health & Human ServicesDepartment of Health & Human ServicesHealth Resources and Services AdministrationHealth Resources and Services Administration

Office of Rural Health PolicyOffice of Rural Health Policy

SORH OrientationSORH OrientationRockville, MDRockville, MD

September 10, 2014September 10, 2014

SORH Grant ProgramSORH Grant Program

Authorized by Public Health Service ActAuthorized by Public Health Service Act Funded since 1991Funded since 1991 FY 14 is 24FY 14 is 24thth year! year! Primary goal -to assist States in strengthening rural Primary goal -to assist States in strengthening rural

health care delivery systems by creating a health care delivery systems by creating a focal pointfocal point for rural health in each Statefor rural health in each State

Provides institutional framework to link rural Provides institutional framework to link rural communities with State / Federal resources.communities with State / Federal resources.

State Offices of Rural HealthState Offices of Rural Health

Single grantee in each of 50 StatesSingle grantee in each of 50 States Flexibility in deciding where to locate SORH Flexibility in deciding where to locate SORH

36 in State Health Departments / Agencies36 in State Health Departments / Agencies 11 in institutes of higher learning11 in institutes of higher learning 3 are not-for-profit organizations3 are not-for-profit organizations

Many SORH Directors are also Directors of Many SORH Directors are also Directors of State Primary Care Organization (PCOState Primary Care Organization (PCO))

Three Core Functions of SORHThree Core Functions of SORH

Defined in authorizing legislation Defined in authorizing legislation

1. Establish and maintain clearinghouse for 1. Establish and maintain clearinghouse for collecting / disseminating information on: collecting / disseminating information on: Rural health care issues;Rural health care issues; Research findings related to rural health; andResearch findings related to rural health; and Innovative approaches to the delivery of care Innovative approaches to the delivery of care

in rural areas (best practices).in rural areas (best practices).

Three Core Functions of SORHThree Core Functions of SORH

2. 2. Coordinate activities within state to avoid Coordinate activities within state to avoid duplication of effort and activities. duplication of effort and activities.

3. Identify Federal, State and NGO 3. Identify Federal, State and NGO programs and resources and provide programs and resources and provide technical assistance regarding application technical assistance regarding application and participation. and participation.

SORH FundingSORH Funding Federal-State PartnershipFederal-State Partnership 3:1 State matching funds required 3:1 State matching funds required FY14 is 24th year of the SORH program!FY14 is 24th year of the SORH program!

– First appropriation in FY 91 was $1.6M First appropriation in FY 91 was $1.6M – FY14 appropriation ~ $10M FY14 appropriation ~ $10M

Awarded ~$8.6M in FY 14, 45 States received Awarded ~$8.6M in FY 14, 45 States received $172,950 (~5% less than FY 12 award $180K)$172,950 (~5% less than FY 12 award $180K)

Others: $168K (1), $163K (2), $158K (1) & Others: $168K (1), $163K (2), $158K (1) & $153K (1)$153K (1)

11 states had off-set of FY 12 un-obligated 11 states had off-set of FY 12 un-obligated funds totaling $159K ($208K prior year) funds totaling $159K ($208K prior year)

SORH    

FY Approp. $M Cumulative $M

91 1.6 1.6

92 2 3.6

93 2.5 6.1

94 2.8 8.9

95 2.8 11.7

96 2.8 14.5

97 2.8 17.3

98 2.8 20.1

99 2.7 22.8

2000 2.7 25.5

2001 3.8 29.3

2002 7 36.3

2003 8.4 44.7

2004 8.4 53.1

2005 8.3 61.4

2006 8.2 69.6

2007 8.2 77.9

2008 7.9 85.9

2009 9.2 95.1

2010 10 105.1

2011 10 115.1

2012 10 124.9

2013 9.5 134.4

2014 9.5 143.9 

State - Matching FundsState - Matching Funds

$3 State match for every $1 of Federal funds $3 State match for every $1 of Federal funds requested requested - Leveraged ~ $4025M to date- Leveraged ~ $4025M to date

Covered by Title 45 CFR Covered by Title 45 CFR - Part 74 for nonprofits and university- Part 74 for nonprofits and university based models based models- Part 72 for State governments / agencies- Part 72 for State governments / agencies

Budget and Budget Justification must Budget and Budget Justification must includeinclude use use of State matching fundsof State matching funds

Grant LimitationsGrant Limitations

May May notnot be used for: be used for: providing health care servicesproviding health care services purchasing medical equipment, vehicles or purchasing medical equipment, vehicles or

communications equipmentcommunications equipment to purchase or improve real propertyto purchase or improve real property conduct activity regarding a certificate of needconduct activity regarding a certificate of need lobbying purposeslobbying purposes

Grant Limitations (cont.)Grant Limitations (cont.)

No more than 10 percent of funds may be used No more than 10 percent of funds may be used for research purposesfor research purposes

Indirect charge allowed Indirect charge allowed onlyonly if SORH has if SORH has currentcurrent indirect rate approved by HHSindirect rate approved by HHS- Attach form or explain, usually a percent of - Attach form or explain, usually a percent of salaries / fringe or direct costs salaries / fringe or direct costs

- 15% cap no longer applies - 15% cap no longer applies

Required MeetingsRequired Meetings

State travel restrictions still impact some SORHsState travel restrictions still impact some SORHs ORHP recently sent letter signed by Associate ORHP recently sent letter signed by Associate

Administrator, will contact state if requestedAdministrator, will contact state if requested Three required meetings as condition of award: Three required meetings as condition of award:

1. NRHA Annual Meeting – Philadelphia, PA / April 2015 1. NRHA Annual Meeting – Philadelphia, PA / April 2015 2. SORH Regional Meetings - May thru Sep. 2015 2. SORH Regional Meetings - May thru Sep. 20153. NOSORH Annual meeting3. NOSORH Annual meeting - Omaha, NE / Oct. 21-23, 2014 - Omaha, NE / Oct. 21-23, 2014

SORH funds can be used for non-required meetings (i.e. SORH funds can be used for non-required meetings (i.e. NRHA Policy Institute *, CAH conference) NRHA Policy Institute *, CAH conference)

Travel estimates must be itemized in budgets! Travel estimates must be itemized in budgets!

Performance Measures Performance Measures FY 08 started collection of two “new” FY 08 started collection of two “new”

performance / GPRA measures:performance / GPRA measures:- Number of technical assistance- Number of technical assistance encountersencounters provided directly by SORH provided directly by SORH

- Number of unduplicated - Number of unduplicated clientsclients that that received TA directly by SORH received TA directly by SORH

- Provide examples- Provide examples - Submit - Submit directlydirectly into EHB / Performance into EHB / Performance

Information Measurement System (PIMS) Information Measurement System (PIMS) by August 30th by August 30th

PIMSPIMS FY 13 data submitted via EHB by August 30, 2013FY 13 data submitted via EHB by August 30, 2013 Some SORHs modified their collection instrumentSome SORHs modified their collection instrument Total TATotal TA increased increased from from 64,32164,321 to to 83,878 83,878 Total Unduplicated ClientsTotal Unduplicated Clients increased increased from from

27,25927,259 to to 28,07228,072 Ratio of TA to Client increased from ~Ratio of TA to Client increased from ~2.3:12.3:1 to to ~3:1~3:1 Confusion about Confusion about affiliatedaffiliated versus versus non-affiliatednon-affiliated clients clients

appears to have wanedappears to have waned After discussion with RL, input may still be revisedAfter discussion with RL, input may still be revised Collect same way during FY 13, watch trendCollect same way during FY 13, watch trend Will soon provide display of six year trend (FY 08 – 13)Will soon provide display of six year trend (FY 08 – 13) (Change to PIMS report FY 10, examples must match TA & (Change to PIMS report FY 10, examples must match TA &

Client totalClient total NOSORH collecting optional measures and NOSORH collecting optional measures and

offering TruServe reporting tool to SORHsoffering TruServe reporting tool to SORHs

SORH Unobligated Balance Issue

• Determined when Federal Financial Form submitted• Total UOB decreased from $1.1M in FY 10 (13%) to $642K (7%) in FY 11, to $XXXXK (X%) in FY 12.• Now have six year look back - FY 07 thru FY 12.• Five year total - $4.2M, average of ~10% per year.• 10 SORHs account for ~65% of total UOB.• 25 SORHs averaged less than $10K per year and of

those17 had less than $5K per year!• Only 4 SORHs have had no UOB during past five

years!• Your Project Officer can provide UOB history.• Program integrity requires UOB history be factor in

determining future awards.

What’s Next?What’s Next?

Unprecedented times!Unprecedented times! FY13 UOBs, up or down?FY13 UOBs, up or down? FY15 budget to be determined. FY15 budget to be determined. Emphasis program integrity / scrutiny travel & meetings.Emphasis program integrity / scrutiny travel & meetings. Re-authorization / Indirect cap / match?Re-authorization / Indirect cap / match? Apply lessons learned to FY 15 competing continuation, Apply lessons learned to FY 15 competing continuation,

draft FOA by fall 2015.draft FOA by fall 2015. Base awards, compete for balance?Base awards, compete for balance? Determine rurality, any ideas? Determine rurality, any ideas? NOSORH input valuable and desired!NOSORH input valuable and desired! See you in Omaha, NC – I hope!See you in Omaha, NC – I hope!

Contact InformationContact Information Office of Rural Health Policy Office of Rural Health Policy

http://ruralhealth.hrsa.gov http://ruralhealth.hrsa.gov (301) 443-0835(301) 443-0835

Keith J. Midberry, MHSAKeith J. Midberry, MHSASORH Program CoordinatorSORH Program Coordinator

kmidberry@hrsa.gov kmidberry@hrsa.gov (301) 443-2669(301) 443-2669