Request for Proposals
Emerging Professions Integration Grant Program
Working to advance the Minnesota Accountable Health Model
Grant Opportunity - Round Three
April 13, 2015
Table of Contents
Overview ......................................................................................................................................... 3
State Innovation Model (SIM) ..................................................................................................... 3
Background ..................................................................................................................................... 6
Why Emerging Professions?........................................................................................................ 6
Community Health Worker ......................................................................................................... 7
Community Paramedic................................................................................................................ 8
Dental Therapist.......................................................................................................................... 9
Goals and Outcomes..................................................................................................................... 10
Eligible Applicants ......................................................................................................................... 12
Available Funding and Estimated Awards .................................................................................... 13
Grant Timeline .............................................................................................................................. 13
Application Instructions................................................................................................................ 14
Required Application Documents................................................................................................. 15
Proposal Review Process .............................................................................................................. 17
Contact Information...................................................................................................................... 17
Appendix A.................................................................................................................................... 18
Proposal Cover Form................................................................................................................. 18
Appendix B .................................................................................................................................... 19
Budget Instructions and Forms ................................................................................................. 19
Form B1: Budget Summary ....................................................................................................... 20
Form B2: Contractor’s Budget Template - Cost Year 1................................................ 21
Form B3: Budget Justification Narrative - Cost Year 1 ................................................ 24
Appendix C .................................................................................................................................... 27
Due Diligence Review Form ...................................................................................................... 28
Minnesota Emerging Professions Integration Grant Program
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Overview
The Minnesota Department of Health (MDH) requests proposals for the Minnesota Emerging
Professions Integration Grant Program with the goal of integrating emerging professions into
the workforce, including models of accountable care. The grant program has three funding
cycles. This request for proposals (RFP) is the third and final round of grant funding for the
Minnesota Emerging Professions Integration Grant Program. Grant funds are focused on three
emerging professions: community health workers, community paramedics and dental
therapists/ advanced dental therapists. Funds may be used to support professional salary
and fringe benefits during the grant period, in order to facilitate the integration of emerging
professions into care delivery models.
The emerging professional must be a new hire or an existing employee moving into a new role,
and have the appropriate training and credentials in one of the three above mentioned
emerging professions.
Priority will be given to emerging professions practitioners who will work in, or closely
partner/coordinate care with, behavioral health, long-term care, local public health, and/or
social services settings, and organizations that are participating in, or preparing to participate
in, an Accountable Care Organization or similar health care delivery model that provides
accountable care (including, but not limited to, the Medicare Shared Savings Program, the
Medicare Pioneer ACO Program, or the Medicaid Integrated Health Partnerships program).
As health reform continues to change towards deeper coordination of services, better sharing
of information, and more accountability for the care delivered, this grant opportunity intends to
explore new relationships and team-based approaches using the work of emerging professions
as a tool for employers seeking this change. Emerging professions can act as a bridge between
clinical or programmatic goals and broader outcomes such as population-based health
initiatives. MDH is especially interested in how integrating emerging professions into a team
environment changes the work and capacity of others on the team and seeks to evaluate this.
For example, by bringing on a community health worker, what changes occur in the output of
others on the team, and is the quality of care affected?
State Innovation Model (SIM)
The Minnesota Emerging Professions Integration Grant Program is part of the Minnesota
Accountable Health Model being implemented through the State Innovation Model (SIM) grant.
The Minnesota Accountable Health Model (MAHM) is a State Innovation Model (SIM) testing
grant awarded by the Center for Medicare & Medicaid Innovation (http://innovations.cms.gov)
Minnesota Emerging Professions Integration Grant Program
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to the Minnesota Department of Human Services (DHS) and Minnesota Department of Health
(MDH) in 2013. The purpose of the SIM-Minnesota project is to provide Minnesotans with
better value in health care through integrated, accountable care using innovative payment and
care delivery models that are responsive to local health needs. The funds will be used to help
providers and communities work together to create healthier futures for Minnesotans, and
drive health care reform in the state.
The vision of the Minnesota Accountable Health Model is as follows:
• Every patient receives coordinated, patient-centered primary care.
• Providers are held accountable for the care provided to Medicaid enrollees and other
populations, based on quality, patient experience and cost performance measures.
• Financial incentives are fully aligned across payers and the interests of patients, through
payment arrangements that reward providers for keeping patients healthy and
improving quality of care.
• Provider organizations effectively and sustainably partner with community
organizations, engage consumers and take responsibility for a population’s health
through Accountable Communities for Health that integrate medical care,
mental/chemical health, community health, public health, social services, schools and
long-term supports and services.
The Minnesota Accountable Health Model will test whether increasing the percentage of
Medicaid enrollees and other populations in accountable care payment arrangements will
improve the health of communities and lower costs of health care delivery. To accomplish this,
the state will expand the Integrated Health Partnerships (IHP) demonstration, formerly called
the Health Care Delivery Systems (HCDS) demonstration, administered by the Department of
Human Services.
(http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionS
electionMethod=LatestReleased&dDocName=dhs16_161441)
The expanded focus will be on the development of integrated service delivery models and use
of coordinated care methods to integrate health care, behavioral health, long-term and postacute care, local public health and social services centered on patient needs.
To achieve the vision of shared cost and coordinated care, the Minnesota Accountable Health
Model includes key investments in five Drivers that are necessary for accountable care models
to be successful
(http://www.dhs.state.mn.us/main/groups/sim/documents/pub/dhs16_182962.pdf).
Minnesota Emerging Professions Integration Grant Program
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• Driver 1 is Health Information Technology/Health Information Exchange: Providers
have the ability to exchange clinical data for treatment, care coordination and quality
improvement.
• Driver 2 is Data Analytics: Providers have analytic tools to manage cost/risk and
improve quality.
• Driver 3 is Practice Transformation: Expanded numbers of patients are served by teambased integrated/coordinated care.
• Driver 4 is Accountable Communities for Health (ACH): Provider organizations partner
with communities and engage consumers, to identify health and cost goals, and take on
accountability for population health.
• Driver 5 is Accountable Care Organization (ACO) Alignment: ACO performance
measurement, competencies and payment methodologies are standardized, and focus
on complex populations.
The activities contained in this RFP, focusing on integrating emerging professions into the care
delivery team, are linked to Driver 3.
Through the Minnesota Accountable Health Model, Minnesota is working to achieve the vision
of the Triple Aim: improved consumer experience of care, improved population health, and
lower per capita health care costs. The Minnesota Accountable Health Model: Continuum of
Accountability Matrix
(http://www.dhs.state.mn.us/main/idcplg?
IdcService=GET_FILE&RevisionSelectionMethod=LatestReleased&Rendition=Primary&allowInte
rrupt=1&noSaveAs=1&dDocName=dhs16_188556) is designed to illustrate the basic
capabilities, relationships and functions that organizations or partnerships should have in place
to achieve the long-term vision of the Minnesota Accountable Health Model. It will help the
state to identify criteria and priorities for investment, and to lay out developmental milestones
that indicate organizations or partnerships are making progress towards the vision.
In addition, the Minnesota Accountable Health Model: Continuum of Accountability Matrix
Assessment Tool (http://www.health.state.mn.us/e-health/mahmassessmenttool.docx) is an
interactive tool that allows organizations to determine their location on the matrix continuum.
MDH and DHS will use this tool to better understand SIM-Minnesota participants and their
status in achieving the goals of the Minnesota Accountable Health Model, what SIM supports
are needed to achieve the goals, and how we may be able to provide additional tools or
resources. This tool will be used to help us develop targets and goals for participating
organizations, and to assess their progress.
In the Assessment Tool, the terms ‘organization’ and ‘provider’ are meant to include a broad
range of health and health care providers and support services providers that may or may not
Minnesota Emerging Professions Integration Grant Program
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formally be part of an existing ACO, but that are moving towards greater accountability for
quality, cost of care and health of the populations they serve. Many types of organizations,
including not only providers of medical care but also organizations that operate in the
behavioral health, social services, local public health, long term care/post-acute care settings,
community organizations, and other public/private sector partners that provide supportive
services to individuals and families, can all have a role in convening, leading or participating in
these models.
For more information on the SIM grant, the Minnesota Accountable Health Model and other
health reform activities visit the State Innovation Model Grant website
(http://www.mn.gov/sim).
Background
The goal of the Minnesota Emerging Professions Integration Grant Program is to foster the
integration of emerging professions into the workforce in roles that support the broad goals of
the Minnesota Affordable Health Model (MAHM) related to providing coordinated care, across
settings, for complex patients, populations and models of accountable care. The background
information provides an overview of the emerging professions that are targeted in round two:
community health workers, community paramedics and dental therapists/advanced dental
therapists.
Why Emerging Professions?
Minnesota has an ongoing program to track and analyze the state’s health care workforce,
centered in the MDH’s Office of Rural Health and Primary Care (ORHPC). As part of this ongoing
work, MDH conducts regular workforce surveys covering a wide range of licensed professions,
works with stakeholders around the state to identify, synthesize, and as appropriate respond to
emerging workforce concerns, and serves as the lead content experts for discussions on current
and future healthcare workforce needs and strategies to resolve potential shortages. Through
these and other activities, Minnesota has previously identified a current and growing shortage
of primary care and related providers that will, if not addressed, present challenges to
accomplishing the state’s health reform goals.
MDH continues both its statewide workforce monitoring and its state investments in health
professions education, loan forgiveness and other workforce development strategies. In
addition, through this federal State Innovation Model (SIM) Program, MDH will advance the
development of and monitor the impact of three emerging professions: the Community Health
Worker (CHW); the Community Paramedic (CP); and Dental Therapy – which includes the
Minnesota Emerging Professions Integration Grant Program
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Dental Therapist (DT) and the Advanced Dental Therapist (ADT). MDH has been involved in the
conception and development of these occupations, in large part because of their potential to
contribute to the spread of team care models and the roll out of Health Care Homes and other
emerging models of care delivery.
Emerging professions have the potential to work for a wide range of organizations and in a wide
range of settings. For example, a medical clinic may hire a community health worker to partner
with local public health and extend a range of services to an underserved community. A
hospital may hire a community paramedic and partner with long-term care organizations to
provide services through transitions of care. A dental clinic may hire a dental therapist and
work across sectors to expand services to behavioral health patients. These examples, and
similar scenarios, display how emerging professions may be integrated into the workforce in
ways that align with the overall goals of the SIM grant.
Community Health Worker
According to the American Public Health Association, a CHW is a frontline public health worker
who is a trusted member of and/or has an unusually close understanding of the community
served. This trusting relationship enables the CHW to serve as a liaison/link/intermediary
between health/social services and the community to facilitate access to services and improve
the quality and cultural competence of service delivery. A CHW also builds individual and
community capacity by increasing health knowledge and self-sufficiency through a range of
activities such as outreach, community education, informal counseling, social support and
advocacy. (http://www.apha.org/membergroups/sections/aphasections/chw)
According to Minnesota Statute 256B.0625, subdivision 49,
(https://www.revisor.mn.gov/statutes/?id=256B.0625) the state’s Medical Assistance (MA)
program covers care coordination and patient education services provided by a CHW if the
CHW has:
1. Received a certificate from the Minnesota State Colleges and Universities System
approved community health worker curriculum; or
2. At least five years of supervised experience with an enrolled physician, registered nurse,
advanced practice registered nurse, mental health professional as defined in section
245.462, subdivision 18, clauses (1) to (6), and section 245.4871, subdivision 27, clauses
(1) to (5), or dentist, or at least five years of supervised experience by a certified public
health nurse operating under the direct authority of an enrolled unit of government.
Community Health Workers must work under the supervision of a Medical Assistance-enrolled
physician, registered nurse, advanced practice registered nurse, mental health professional as
defined in section 245.462, subdivision 18, clauses (1) to (6), and section 245.4871, subdivision
Minnesota Emerging Professions Integration Grant Program
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27, clauses (1) to (5), or dentist, or work under the supervision of a certified public health nurse
operating under the direct authority of an enrolled unit of government. Care coordination and
patient education services covered under this subdivision include, but are not limited to,
services related to oral health and dental care.
Minnesota’s Medicaid program has covered CHW services since 2009. Covered services are
defined as “diagnosis-based health education” as ordered by the CHW’s supervising provider.
As defined above, many provider types may supervise CHWs, including physicians, dentists,
public health nurses and mental health professionals among others. The supervising provider is
responsible for developing the patient health curriculum with the CHW, ordering the service,
and billing Medicaid on the CHW’s behalf.
Community Paramedic
A 2012 Legislative Report from the Minnesota Department of Human Services describes how
the concept of the Community Paramedic (CP) grew from the traditional career ladder of
Emergency Medical Technicians (EMTs). Most EMTs begin with a basic curriculum in emergency
medicine and, over the course of a career, gain new skills and certifications through training.
The typical ladder begins as a certified First Responder, then an Emergency Medical Technician
– Basic (EMT-B), then an Emergency Medical Technician – Intermediate (EMT-I). Eventually,
EMTs can obtain a certification to become an Emergency Technician – Paramedic (EMT-P). The
Community Paramedic certification offers career Paramedics a new level of training and a new
way to contribute their skills. (http://mnemscp.org/wp-content/uploads/2012/03/CommunityParamedics-Legislative-Report.pdf)
According to Minnesota Statute 256B.0625, subdivision 60
(https://www.revisor.leg.state.mn.us/laws/?id=169&doctype=Chapter&year=2012&type=0#la
ws.0.1.0) Medical Assistance covers services provided by community paramedics who are
certified under section 144E.28, subdivision 9, when the services are provided in accordance
with this subdivision to an eligible recipient.
Payment for services provided by a CP under this subdivision must be a part of a care plan
ordered by a primary health care provider in consultation with the medial director of an
ambulance service and must be billed by an eligible provider enrolled in medical assistance that
employs or contracts with the community paramedic. The care plan must ensure that the
services provided by a CP are coordinated with other community health providers and local
public health agencies and that CP services do not duplicate services already provided to the
patient, including home health and waiver services. Community Paramedic services are to
include health assessment, chronic disease monitoring and education, medication compliance,
immunizations and vaccinations, laboratory specimen collection, hospital discharge follow-up
care, and minor medical procedures approved by the ambulance medical director. Services
Minnesota Emerging Professions Integration Grant Program
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provided by a CP to an eligible recipient who is also receiving care coordination services must
be in consultation with the providers of the recipient’s care coordination services.
Community Paramedic services have been covered by Minnesota’s Medicaid program since
2012, and Minnesota is the first state to cover this newly developed profession. Community
Paramedics work under the direct supervision of the Medical Director of an ambulance service,
who is responsible for coordinating CP services with the patient’s primary care provider.
Dental Therapist
Dental Therapists (DT) and Advanced Dental Therapists (ADT) in Minnesota practice as part of a
dental team to provide educational, clinical and therapeutic services. Minnesota law defines
specific educational, examination and practice requirements for licensed dental therapists and
advanced dental therapists. One distinctive provision is that, according to Minnesota Statute
150A.105, Subdivision 2 and 3,
(https://www.revisor.mn.gov/statutes/?id=150A.105#stat.150A.105), a DT or ADT is limited to
primarily practicing in settings that serve low-income, uninsured, and underserved patients or
in a dental health professional shortage area. A DT or ADT must enter into a written
collaborative management agreement with a Minnesota-licensed dentist. A collaborating
dentist is limited to entering into a collaborative agreement with no more than five DTs or ADTs
at any one time. Collaboration agreement specifications for dental therapists
(http://www.dentalboard.state.mn.us/Portals/3/Licensing/Dental%20Therapist/DT%20%20CMA%20Approved%20Sept%2024%202010.pdf) and advanced dental therapists
(http://www.dentalboard.state.mn.us/Portals/3/Licensing/Dental%20Therapist/ADTCMA%2012-4-10approved.pdf) are available from the Minnesota Board of Dentistry.
A collaborating dentist must be licensed and practicing in Minnesota. The collaborating dentist
shall accept responsibility for all services authorized and performed by the DT or ADT pursuant
to the management agreement. Any licensed dentist who permits a DT or ADT to perform a
dental service other than those authorized under this section or by the board, or any DT or ADT
who performs an unauthorized service, violates sections 150A.01 to 150A.12. Collaborative
management agreements must be signed and maintained by the collaborating dentist and the
DT or ADT. Agreements must be reviewed, updated and submitted to the board on an annual
basis. Minnesota Statute 150A.105, subdivision 4-8
https://www.revisor.mn.gov/statutes/?id=150A.105#stat.150A.105) provides further detail on
the scope of practice, dispensing authority, and use of dental assistants for DTs or ADTs.
Dental Therapists and Advanced Dental Therapists can significantly expand access to
underserved populations by expanding the reach of a supervising dentist through a
collaborative management agreement (in the case of DTs) or through independent practice (for
ADTs). These midlevel professionals have the potential not only to increase access generally,
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but also to reduce emergency visits for dental pain and infection. Minnesota Statute
150A.106, subdivisions 2 – 4 (https://www.revisor.mn.gov/statutes/?
id=150A.106#stat.150A.106) provides further detail on the scope of practice, practice
limitation and medications for advanced dental therapists.
Goals and Outcomes
The goal of the Minnesota Emerging Professions Integration Grant Program is to foster the
integration of emerging professions into the workforce in roles that support the broad goals of
the Minnesota Affordable Health Model (MAHM) related to providing coordinated care, across
settings, for complex patients, populations and models of accountable care. Grant funds from
round two are focused on three emerging professions: community health workers, community
paramedics and dental therapists/advanced dental therapists. Funds may be used to support
professional salary and fringe benefits during the grant period, in order to facilitate the
integration of emerging professions into care delivery models, including accountable care
organizations.
The Minnesota Emerging Professions Integration Grant Program has three main objectives to
reach the goal of integrating emerging professions into the workforce. First, MDH will provide
funds to support an employer who wants to include an emerging professional as a part of their
team. The grant-supported position will be a new position, or an existing position moving into a
new role, and will remain beyond the grant period. MDH recognizes that the grant award is not
sufficient to cover all salary and fringe costs for such a position, and applicants will need to fund
the difference through reimbursement for services or other sources. If the emerging
professional terminates his/her position during the grant period, funds may then be re-directed
to another candidate, with notification of and approval by the State.
Applicants may or may not have identified the grant-supported professional to hire at the time
of application. If the professional has been identified, the applicant may name him/her in the
application. If the professional has not been identified, MDH recommends that the applicant
begin the recruiting process as soon as possible. In that case, the applicant may include up to 30
days of recruitment time in the project work plan.
Second, MDH will provide resources and technical assistance to grantees to help them integrate
the emerging professional. MDH has an Emerging Professions Coordinator who will serve as the
grant manager and can provide support to grantees. This may include assistance in recruitment
of an emerging professions practitioner, facilitation of occasional meetings to monitor progress,
Minnesota Emerging Professions Integration Grant Program
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and assistance with components of the evaluation process during and at the completion of the
grant period.
Third, MDH will collect information from grantees to evaluate the level of success in emerging
profession integration. Grantees will participate in an evaluation that will include reporting at
the mid- and end-point of the grant period. Along with meeting the self-defined goals and
objectives required as a part of the application, grantees should expect to provide qualitative
feedback and quantitative data through a variety of evaluation activities, and to share tools or
resources they have developed as part of their funded project. Evaluation activities may include
key informant interviews, patient/client satisfaction surveys and data sharing. Grantees should
include evaluation participation in their work plan, particularly near the end of the project.
MDH expects that grantees will:
•
•
•
•
Hire an emerging professions practitioner full-time, for the duration of the grant
o Any costs in excess of the grant dollars available will be incurred by the grantee
Participate in activities required for monitoring grant progress
Fulfill reasonable requests for information and data related to evaluation of the grant
Share resources developed and lessons learned during the grant period
Grantees are also strongly encouraged to participate in other SIM activities, such as statewide
learning collaboratives or topic-specific learning communities, as appropriate for their funded
project and their organizational needs.
In combination, the goals, objectives and outcomes of the Minnesota Emerging Professions
Integration Grant Program will build a base of knowledge around emerging professions. MDH
will continuously update and share information with internal and external partners about the
progress of the program. Lessons learned from this grant program will also contribute to the
development of several toolkits, which will be broadly shared as they are completed.
Minnesota Emerging Professions Integration Grant Program
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Eligible Applicants
Eligible applicants for this RFP include any type of organization that has the capacity to employ
a community health worker, community paramedic, dental therapist or advanced dental
therapist. These emerging professions have the potential to work for a wide range of
organizations in a wide range of settings. Potential examples of eligible applicants may include
hospitals, clinics, ambulatory services, health care homes, emergency medical services, health
care providers, nonprofits, educational settings, mental health centers, dental offices, senior
centers, faith-based programs, nursing homes, local public health programs, group homes,
inpatient mental health facilities, and human services programs, including substance use
disorder treatment programs.
Priority will be given to emerging professions practitioners who will work in, or closely
partner/coordinate care with, behavioral health, long-term care, local public health, and/or
social services settings, and organizations that are participating in, or preparing to participate
in, an Accountable Care Organization (ACO) or similar health care delivery model that provides
accountable care (including, but not limited to, the Medicare Shared Savings Program, the
Medicare Pioneer ACO Program, or the Medicaid Integrated Health Partnerships program).
Eligible applicants may receive funding for only one round of the Minnesota Emerging
Professions Integration Grant Program. Applicants must include information about any other
grant funding associated with the work of an emerging professions practitioner to be funded by
this grant.
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Available Funding and Estimated Awards
This is the third and final round of Requests for Proposals that MDH will release under the
Minnesota Emerging Professions Integration Grant Program. Release dates and award amounts
are subject to change based on available funding.
1. Minnesota Emerging Professions Integration Grant Program – Round One
RFP Release Date: Monday, April 21, 2014
Grant Period: July, 2014 – June 30, 2015
Total Funding Available: $180,000
Estimated Number of Grant Awards: Two (2) grants for each emerging profession, for a
total of up to six (6) grants.
Maximum Award Amount: Each grant is up to $30,000.
Number of Grants Awarded: 5
2. Minnesota Emerging Professions Integration Grant Program – Round Two
RFP Release Date: Monday, July 28, 2014
Grant Period: December, 2014 – November, 2015
Total Funding Available: $120,000
Estimated Grant Awards: Up to four (4) grants available; each grant is up to
$30,000
Number of Grants Awarded: 4
3. Minnesota Emerging Professions Integration Grant Program – Round Three
RFP Release Date: April 13, 2015
Estimated Grant Period: September 1, 2015 – August 31, 2016
Total Funding Available: $150,000
Estimated Grant Awards: Up to five (5) grants available; one for each emerging
profession plus two others, each grant is up to $30, 000.
Grant Timeline
Below is the timeline for Round Three.
RFP posted:
RFP informational call:
Proposals due to MDH:
Estimated notice of awards:
Estimated Grant start date:
Grant end date:
April 13, 2015
April 22, 2015 from 10:00 a.m. to 11:00 a.m. CST
(Call-in Number: 1-888-742-5095, Passcode: 6353794742)
Friday, June 12, 2015 by 4:00 p.m. CST
July 17, 2015
September 1, 2015
One year from execution of the grant agreement
Minnesota Emerging Professions Integration Grant Program
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Application Instructions
This RFP and all of the required application documents are available on the MDH website
(http://www.health.state.mn.us/divs/orhpc/workforce/emerging/index.html). You can also
receive the documents by emailing Kay Herzfeld at [email protected] with “Application
Documents” as the subject line.
Applicants should only submit the documents listed in the “Required Application Documents”
section. Extraneous materials will be discarded and not passed on to reviewers.
Applicants must submit one unbound signed original and three unbound, copies of the
application. Application forms must be completed using word processing and spreadsheet
software. Narrative documents must be double-spaced with one-inch margins, and no longer
than the designated page limit. The font size on forms and narratives must be 12-point font.
All pages must be numbered sequentially with sections clearly marked. In addition to the
paper submission, please include an electronic version of the application on a USB drive.
Proposals must be received by 4:00 p.m., Friday, June 12, 2015, at the address below. Faxed or
emailed applications will not be accepted:
Minnesota Department of Health
Office of Rural Health and Primary Care
ATTN: Kay Herzfeld
Courier Address:
85 East 7th Place
Saint Paul, Minnesota 55101
Mailing Address:
P.O. Box 64882
Saint Paul, Minnesota 55164-0882
Out of fairness to the other applicants, late proposals will not be considered.
Minnesota Emerging Professions Integration Grant Program
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Required Application Documents
Proposals for the Minnesota Emerging Professions Integration Grant Program must include
the components outlined below. Proposals must not exceed 12 pages of double-spaced 12point font. The 12-page limit includes only items 2-4 below.
1. Proposal Cover Form (see Appendix A)
2. Project Summary (1-2 pages). Brief summary of the emerging professions integration
project including the hiring organization, areas/populations to be served, key partner
organizations, demonstrated financial need and goals.
3. Emerging Professions Integration Description (6-8 pages)
a. Brief description of the organization seeking to hire an emerging professional:
Community Health Worker, Community Paramedic, Dental Therapist or Advanced
Dental Therapist.
b. Identify the grant-supported professional, if known. Identify the professional’s
credentials, and whether the professional is a new hire or an existing employee
moving into a new role. If the emerging professional has yet to be identified, include
plans for recruitment.
c. Identify the supervisor who will be responsible for overseeing the work of the
emerging professions employee.
d. Describe the role of the grant-supported professional (goals/outcomes/objectives)
with respect to community health needs and health care services.
e. Describe how the emerging professions employee will be used to coordinate care
across other sectors – for example, behavioral health, long-term care, local public
health, and/or social services. Include, if relevant, a description of partner
organizations with which the organization or employee will be working.
f. Describe any existing or planned participation by the applicant organization in an
Accountable Care Organization (ACO) model or any similar shared-risk arrangement.
g. Describe plans to orient the emerging professions employee and include how their
work will be integrated into the workflow of the organization. Include plans for
position sustainability beyond the grant period. Describe how the work of the
emerging professions employee will impact the work of others in the organization.
h. Describe the specific goals that the organization will achieve through grant funding,
and how progress towards these goals will be measured. Examples could include
number or type of patients served, types of services (including care coordination)
provided, partnerships established, revenue, patient satisfaction, patient outcomes,
or other indicators.
i. Describe how the grant funding will be used to achieve the goals of accountable care
and the triple aim of improving quality and patient experience and reducing costs.
Minnesota Emerging Professions Integration Grant Program
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4. Target Population (1-2 pages)
a. Identify the target patient population and communities the emerging professions
employee will serve. Include details on how the emerging professions employee will
serve the needs of the population. If applicable, describe how this project meets the
needs of the community in rural and/or underserved areas. Priority will be given to
projects that focus on patients/clients who are transitioning between care settings
or from a care setting to home, who have multiple chronic conditions (including
behavioral health as well as physiological conditions), or who are receiving medical
and social services supports, or who are in need of primary prevention services.
b. Describe how this project may improve health outcomes of the community to be
served. Include a description of the emerging professional’s potential to impact
health disparities in the community or population being served. Describe how this
project aligns with local public health needs assessment, hospital community health
needs assessments, county gaps analysis survey for long-term care, and/or other
state or local health planning efforts specific to the community being served.
5. Work Plan
Describe the work plan to achieve all of the goals/objectives proposed in the project
description section. Include a timeline for the work plan. Include plans to participate in
evaluation activities.
6. Budget
Salary and fringe benefit costs are eligible grant expenses for integrating the emerging
professional. Attach a line-item budget as a separate document (see Appendix B for
Budget Form). If applicable, include matching funds and revenue projections of
Medicaid or other third-party billing for the emerging professional.
Budget Narrative
Provide information on how each of the line items shown in the budget were calculated.
For example, include hourly wage and salary dollars and fringe benefit calculations.
7. Include a completed copy of Assessment Tool Results from the Minnesota Accountable
Health Model: Continuum of Accountability Matrix Assessment Tool
(http://www.health.state.mn.us/e-health/mahmassessmenttool.docx). Note: This
Minnesota Accountable Health Model: Continuum of Accountability Matrix location
and/or specific assessment results will not be part of the criteria for grant award or
funding decisions. However, it is a requirement of all grantees that receive SIM funding,
and for purposes of this grant is being used primarily as a self-assessment tool.
8. Applicant must complete the Due Diligence Form (please see Appendix C).
9. Applicant must submit an internal financial statement, an IRS Form 990, or the most
recent certified financial audit.
Minnesota Emerging Professions Integration Grant Program
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Proposal Review Process
Grant proposals will be reviewed and evaluated by a panel familiar with the Minnesota
Accountable Health Model and the goals of integrating emerging professionals. The panel may
include staff from the Minnesota Department of Health, Minnesota Department of Human
Services, Advisory Task Force members and the community at large. The panel will recommend
selections to the Commissioners of Health and Human Services. In addition to panel
recommendations, the commissioners may also take into account other relevant factors in
making final awards.
The grant proposals will be scored on a 100-point scale as listed below.
Criteria
Maximum Points
Project Description
Target Population
Work Plan
Budget
30 points
30 points
30 points
10 points
Total
100 points
Contact Information
Questions about the Minnesota Emerging Professions Integration Grant Program and the
proposal process should be directed in writing to:
Kay Herzfeld
Office of Rural Health and Primary Care
Minnesota Department of Health
Email: [email protected]
Other personnel are NOT authorized to discuss this request for proposal with Responders, with
the exception of the RFP informational call, before the proposal submission deadline. Contact
regarding this RFP with any personnel not listed above could result in disqualification.
Minnesota Emerging Professions Integration Grant Program
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Appendix A
Proposal Cover Form
1. Please select the Emerging Profession that will be supported with this grant:
Community Health Worker
Community Paramedic
Dental Therapist/Advanced Dental Therapist
2. Lead Applicant Organization- organization that will serve as the fiscal agent for project.
Grant agreement will be executed with this organization
Legal Name
Federal Tax ID #
State Tax ID #
3. Total amount of state grant funds applied for: $
Total dollar value of match (cash or in-kind): $
4. Contact Person for Further Information on Proposal:
Name Title
Organization:
Address:
Phone
e-mail:
I certify that the information contained herein is true and accurate to the best of my knowledge,
and I have been authorized to submit this proposal on behalf of the applicant organizations listed
above.
Signature of Authorized Official
Title of Authorized Official
Minnesota Emerging Professions Integration Grant Program
Date
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Appendix B
Budget Instructions and Forms
The budget forms described below are required to be completed and are available on MDH
Office of Rural Health and Primary Care website
(http://www.health.state.mn.us/divs/orhpc/workforce/emerging/index.html).
• Form B1: Budget Summary -- This form provides reviewers with a quick overview of the
amount of funding requested broken down by salary and fringe, as well as other funding
sources including the applicant’s contribution.
• Form B2 and B3: Deliverable-Based Budget Forms -- SIM-MN and CMMI requires these
forms to be completed by all grant applicants. Instructions for completing these forms
are included on the form. Budget forms must be completed for each cost year; Cost
Year 1 (September 1, 2015 – December 31, 2015) and Cost Year 2 (January 1, 2016 –
August 31, 2016).
o Form B2: Contractors Budget Template
o Form B3: Budget Justification Narrative
A sample of these forms is available on the following pages. Fillable forms are available
on the Emerging Professions website listed above.
Minnesota Emerging Professions Integration Grant Program -- Round 3 RFP
April 13, 2015
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Form B1 - Budget Summary
Categories
Salary
Grant Funding
Requested
Funding from
Other Sources
Total
Fringe
TOTAL
Note: Include other funding sources and calculations, including revenue projections from
third-party billing.
Minnesota Emerging Professions Integration Grant Program
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Form B2: Contractor’s Budget Template - Cost Year 1
Applicant/Grantee:
Total Contract Period: September 1, 2015 – August 31, 2016
Budget Form Instructions for Grant Applicants:
1. Complete a separate budget for each grant year - Year 1 (2015) and Year 2 (2016).
2. Complete the cells shaded in blue only, as salary and fringe are the only eligible expenses for the Emerging Professions
Integration Grant Program.
3. Ignore cells shaded in gray, as they are not eligible expenses for this grant program (e.g. Consultant, Supplies, Travel,
and Other categories).
4. The amount paid for deliverables in section two is based on costs in section one.
Section One
A. SALARIES & WAGES: For each position, provide the following information: position title, hourly rate,
and number of hours allocated to the project.
In Form B3 Budget Justification Narrative, provide a brief position description for each position listed.
Title
Hourly Rate
Total Salaries and Wages:
Hours
Total
0
$
$
$
$
$
$
$
B. FRINGE: Provide information on the rate of fringe benefits calculated for the total salaries and wages for
positions listed in 1A.
Enter the fringe benefit rate as a % of the total salaries and wages in decimal format.
Total Fringe:
Minnesota Emerging Professions Integration Grant Program
$
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C. CONSULTANT COSTS: Provide the following information for consultants/contractors: name of contractor or
organization, hourly rate, number of hours, services to be provided.
In Form B3 provide a brief background about the contractor including how previous experience relates to the project. If
the contractor has not been selected, include a description of the availability of contractors for the services or product,
a description of the availability of contractors for the services or product, and the method that will be used for
choosing a contractor.
Hourly Rate
Hours
Total
$
Hourly rate and number of hours
Name:
Organization:
Services:
Total Consultant Costs:
$
D. EQUIPMENT: Equipment costs are not allowed.
Item
Unit
Cost/Unit
Total Equipment Costs:
Total Cost
$
E. SUPPLIES: List each item requested, the number needed, and cost per unit. Include expected costs for general
operating expenses such as office supplies, postage, photocopying, and printing.
Item
Total Supply Costs:
Unit
Cost/Unit
Total Cost
$
$
$
$
$
F. TRAVEL: Provide estimated travel costs below for in-state travel. Include travel costs for hotels, meals, and attending
meetings. Include the estimated number of miles planned for project activities and
the rate of reimbursement per mile.
Out of state travel is not an eligible expense. Travel costs are not to exceed rates established in the Commissioner's Plan
at http://www.mmd.admin.state.mn.us/commissionersplan.htm
Item
Total Cost
Total Travel Costs:
Minnesota Emerging Professions Integration Grant Program
$
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G. OTHER: If applicable, list items not included in previous budget categories below.
Include a detailed description of the proposed expenditures in Form B2 Budget Justification Narrative.
Item
Total
Total Other Costs:
$
GRAND PROJECT TOTAL
$
Section Two
DELIVERABLES: The amount paid for deliverables in Section 2 is based upon the total dollars requested in
Section 1. Budget deliverables are to cross reference the deliverables in the Goals and Outcomes section of the RFP.
Deliverable:
Avg by Hour
Estimated Hrs
Billable Amt
$
$
$
Avg by Hour
Estimated Hrs
Billable Amt
$
$
$
Avg by Hour
Estimated Hrs
Billable Amt
$
$
TOTAL
Deliverable
TOTAL
Deliverable:
TOTAL
Deliverable:
$
Avg by Hour
Estimated Hrs
Billable Amt
$
$
TOTAL
$
GRAND PROJECT TOTAL
$
Minnesota Emerging Professions Integration Grant Program
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Form B3: Budget Justification Narrative, Cost Year 1
The Budget Narrative provides additional information to justify costs in Form B2 Budget.
Instructions: Provide a narrative justification in the cells shaded in blue. The narrative justification must
include a description of the funds requested and how their use will support the proposal. Ignore the cells
shaded in gray, as they are not eligible expenses for this grant program.
A. Salaries and Wages
This should include all personnel whose work is tied to the proposal.
Narrative Justification (enter a brief description of the roles, responsibilities, and unique qualifications of
each position):
Minnesota Emerging Professions Integration Grant Program
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B. Fringe
Narrative Justification (provide information on the rate of fringe benefits calculated for salaries and
wages):
C. Consultant Costs
Narrative Justification (provide a brief background about the contractor including how previous experience
relates to the project. If the contractor has not been selected, include a description of the availability of
contractors for the services or product and the method that will be used for choosing a contractor):
D. Equipment Costs
NOTE: Equipment costs are not allowed.
E. Supplies
Describe costs related to each type of supply, either in Budget Form B1 or below.
Narrative Justification (enter a description of the supplies requested and how their purchase will support
the purpose and goals of this proposal):
F. Travel
Travel may include costs associated with travel for meetings and other items included in the deliverables.
Narrative Justification (describe the purpose and need of travel and how costs were determined for each
line item in the budget):
G. Other
Narrative Justification (explain the need for each item and how their use will support the purpose and goals
of this proposal. Break down costs into cost/unit: i.e. cost/meeting and explain the use of each item
requested):
Minnesota Emerging Professions Integration Grant Program
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F. Travel
Travel may include costs associated with travel for meetings and other items included in the deliverables.
Narrative Justification (describe the purpose and need of travel and how costs were determined for each
line item in the budget):
G. Other
Narrative Justification (explain the need for each item and how their use will support the purpose and goals
of this proposal. Break down costs into cost/unit: i.e. cost/meeting and explain the use of each item
requested):
Minnesota Emerging Professions Integration Grant Program
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Appendix C
Due Diligence Review Form
Purpose
The Minnesota Department of Health (MDH) must conduct due diligence reviews for non­
governmental organizations applying for grants, according to MDH Policy 240.
Definition
Due diligence refers to the process through which MDH researches an organization’s financial
and organizational health and capacity (MDH Policy 240). The due diligence process is not an
audit or a guarantee of an organization’s financial health or capacity. It is a review of
information provided by a non-governmental organization and other sources to make an
informed funding decision.
Restrictions
An organization with a medium or high risk due diligence score may still be able to receive
MDH funding. If MDH staff decides to grant funds to organizations with medium or high risk
scores, they must follow the conditions or restrictions in MDH Policy 241: Grants, Organizations
with Limited Fiscal Capacity.
Instructions
If the applicant is completing the form: Answer the following questions about your organization.
When finished, return the form with the Additional Documentation Requirements to the grant
manager as instructed.
If the grant manager is completing the form: Use the applicant’s responses and the Additional
Documentation Requirements to answer the questions. When finished, use the Due Diligence
Review Scoring Guide to determine the applicant’s risk level.
Minnesota Emerging Professions Integration Grant Program
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Due Diligence Review Form
Organization Information
1. How long has your organization been doing business?
2. Does your organization have a current 501(c) 3 status from the IRS?
Yes
Circle Yes or No.
3. How many employees does your organization have (both part time and full time)?
No
4. Has your organization done business under any other name(s) within
the last five years? Circle Yes or No. If yes, list name(s) used.
Yes
No
5. Is your organization affiliated with or managed by any other
organizations, such as a regional or national office? Circle Yes or No. If
yes, provide details.
Yes
No
6. Does your organization receive management or financial assistance
from any other organizations? Circle Yes or No. If yes, provide details.
Yes
No
7. What was your organization's total revenue in the most recent 12-month accounting period?
8. How many different funding sources does the total revenue come from?
9. Have you been a grantee of the Minnesota Department of Health within
the last five years? Circle Yes or No. If yes, from which division(s)?
Yes
No
10. Does your organization have written policies and procedures for
accounting processes? Circle Yes or No. If yes, please attach a copy of
the table of contents.
Yes
No
11. Does your organization have written policies and procedures for
purchasing processes? Circle Yes or No. If yes, please attach a copy of
the table of contents.
Yes
No
12. Does your organization have written policies and procedures for payroll
processes? Circle Yes or No. If yes, please attach a copy of the table of
contents.
Yes
No
13. Which of the following best describes your organization's
accounting system? Circle one response.
Manual
Automated
Both
14. Does the accounting system identify the deposits and
expenditures of program funds for each and every grant
separately? Circle one response.
Yes
No
Not sure
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15. If your organization has multiple programs within a grant,
does the accounting system record the expenditures for
each and every program separately by budget line items?
Circle one response.
Yes or Not
applicable
No
Not sure
16. Are time studies conducted for employees who receive
funding from multiple sources? Circle one response.
Yes or Not
applicable
No
Not sure
17. Does the accounting system have a way to identify overspending of grant funds? Circle one response.
Yes
No
Not sure
18. If grant funds are mixed with other funds, can the grant
expenses be easily identified? Circle one response.
Yes
No
Not sure
19. Are the officials of the organization bonded? Circle one
response.
Yes
No
Not sure
No
Not sure
Yes
No
23. Are there any current or pending lawsuits against the organization?
Circle Yes or No.
Yes
No
24. If yes, could there be an impact on the organization's financial position?
Circle one response.
25. Has the organization lost any funding due to accountability issues,
misuse, or fraud? Circle Yes or No. If yes, please describe the situation,
including when it occurred and whether issues have been corrected.
Yes
No or Not
applicable
No
20. Did an independent certified public accountant (CPA) ever
Yes
examine the organization's financial statements? Circle
one response.
21. Has any debt been incurred in the last six months? Circle Yes or No. If
yes, what was the reason for the new debt? What is the funding source
for paying back the new debt?
22. What is the current amount of unrestricted funds compared to total revenues?
Yes
Additional Documentation Requirements
• Non-governmental organization with annual income under $25,000: Submit your most recent
board-reviewed financial statement.
• Non-governmental organization with annual income between $25,000 and $750,000: Submit
your most recent IRS Form 990.
• Non-governmental organization with annual income over $750,000: Submit your most recent
certified financial audit.
Minnesota Emerging Professions Integration Grant Program
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