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Per 42 CFR 137.167 and 137.168, a self-governance tribe must apply the cost principles of the applicable OMB Circular, except as modified by: (a) section 106(k) of the Act (25 U.S.C. 450j-1), (b) other provisions of law, or (c) any exemptions to applicable OMB circulars subsequently granted by the OMB. No other audit or accounting standards shall be required by the Secretary. OMB Circular No. A-87 applies to this program. Preapplication Coordination: Preapplication coordination is not applicable. Environmental impact information is not required for this program. This program is excluded from coverage under E.O. 12372. Application Procedures: OMB Circular No. A-102 applies to this program. OMB Circular No. A-110 applies to this program. None. Award Procedure: Compacts/funding agreements are awarded to those Indian tribes or organizations who have completed negotiations with IHS. Deadlines: Contact the headquarters or regional office, as appropriate, for application deadlines. Range of Approval/Disapproval Time: From 60 to 90 days. Grants are approved or disapproved within 90 days of receipt of grant applications by the Indian Health Service, Division of Grants Operations. Appeals: See 42 CFR 137.410 through 137.445, for regulations governing ompacts/funding agreement decisions. Renewals: Per 42 CFR 137.35, upon approval and execution of a self-governance compact, the compact remains in effect for so long as permitted by Federal law or until determined by mutual written agreement or retrocession or reassumption of all PSFAs. Per 42 CFR 137.55, a funding agreement shall have the term mutually agreed to by the parties. Absent notification from an Indian tribe that it is withdrawing or retroceding the operation of one or more PSFAs identified in the funding agreement, the funding agreement shall remain in full force and effect until a subsequent funding agreement is executed. Per 42 CFR 137.35, upon approval and execution of a self-governance compact, the compact remains in effect for so long as permitted by Federal law or until determined by mutual written agreement or retrocession or reassumption of all PSFAs. Per 42 CFR 137.55, a funding agreement shall have the term mutually agreed to by the parties. Absent notification from an Indian tribe that it is withdrawing or retroceding the operation of one or more PSFAs identified in the funding agreement, the funding agreement shall remain in full force and effect until a subsequent funding agreement is executed. Formula and Matching Requirements: This program has no statutory formula. This program has no matching requirements. This program does not have MOE requirements. Length and Time Phasing of Assistance: Per 42 CFR 137.76, when a funding agreement requires an annual transfer of funding to be made at the beginning of a fiscal year, or requires semi-annual or other periodic transfers of funding to be made commencing at the beginning of a fiscal year, the first such transfer shall be made not later than 10 days after the apportionment of such funds by the OMB to the Department, unless the funding agreement provides otherwise. Per 42 CFR 137.77, the Secretary must transfer any funds that were not paid in the initial lump sum payment within 10 days after distribution methodologies and other decisions regarding payment of those funds have been made by the IHS. Method of awarding/releasing assistance: quarterly. Reports: Program reports are not applicable. Grantee will be required to submit, quarterly PMS 272 Federal Cash Transaction Reports to the Division Of Payment Management Branch. Depending on services provided, progress and financial reports will be required either quarterly or semi-annually with final performance and financial status reports due 90 after the end of the project
period. A SF269 Financial Status Report will be due to the Division of Grants Management Operations 90 after the end of each budget period. IHS grants are monitored by the Division of Grants Operations for financial compliance and by the IHS Program Staff for programmatic compliance. Audits: In accordance with the provisions of OMB Circular No. A-133 (Revised, June 27, 2003), "Audits of States, Local Governments, and Non-Profit Organizations," nonfederal entities that expend financial assistance of $500,000 or more in Federal awards will have a single or a program-specific audit conducted for that year. Nonfederal entities that expend less than $500,000 a year in Federal awards are exempt from Federal audit requirements for that year, except as noted in Circular No. A-133. Per 42 CFR 137.165, under the provisions of section 506(c) of the Act 25 U.S.C. 458aaa5(c), Self-Governance Tribes must undertake annual audits pursuant to the Single Audit Act, 31 U.S.C. 7501 et seq. Per 42 CFR 137.166, exceptions are described in 31 U.S.C. 7502 of the Single Audit Act. Records: In accordance with 42 CFR - 137.175, Tribes are required to maintain records and provide Federal agency access to those records as provided in 137.177 137.176, except to the extent that a Self-Governance Tribe specifies otherwise in its compact or funding agreement, the records of the Self-Governance Tribe shall not be considered Federal records for purposes of chapter 5 of title 5, U.S.C. - 137.177, after 30 days advance written notice from the Secretary, the Self-Governance Tribe must provide the Secretary with reasonable access to such records to enable the Department to meet its minimum legal recordkeeping system requirements under sections 3101 through 3106 of title 44 U.S.C. 137.178, at the option of a Self-Governance Tribe, patient records may be stored at Federal Records Centers to the same extent and in the same manner as other Department patient records in accordance with section 105(o) of the Act 25 U.S.C. 450j(o). - 137.179, a Self-Governance Tribe may make agreements with the Federal Records Centers regarding disclosure and release of the patient records stored pursuant to 137.178. - 137.180, a Tribe must consider the potential application of Tribal, Federal and state law and regulations that may apply to requests for access to Tribal patient records, such as the provisions 42 CFR 184.108.40.206 pertaining to records regarding drug and/or alcohol treatment. Account Identification:
Obligations: (Salaries) FY 08 not reported.; FY 09 est not reported.; FY 10 est not reported. (Compacts/Funding Agreements) FY 08 $949,982,000; FY 09 $980,000,000; and FY 10 est $1,100,000,000. Range and Average of Financial Assistance: Range $85,000 to $64,200,000; Average $11,300,000. PROGRAM ACCOMPLISHMENTS: Fiscal Year 2008: In fiscal year 2008, there are 73 compact, 94 funding agreements covering tribally operated facilities which include 11 hospitals, 71 health centers, one school health centers, and 189 health stations/village clinics. Fiscal Year 2009: No Current Data Available Fiscal Year 2010: No Current Data Available REGULATIONS, GUIDELINES, AND LITERATURE: The Indian Self-Determination and Education Assistance Act, Public Law 93-638, as amended, authorizes compacts/funding agreements. According to section 515(c) of the Act 25 U.S.C. 458aaa-16(e), "unless expressly agreed to by the participating Indian tribe in the compact or funding agreement, the participating Indian tribe shall not be subject to any agency circular, policy, manual, guidance, or rule adopted by the Indian Health Service, except for the eligibility provisions of section 105(g) and regulations promulgated under section 517.42 CFR 137 applies to compacts/funding agreements. Regional or Local Office: None. Program Contact: Ms. Hankie Ortiz, Director, Office of Tribal Self-Governance, Indian Health Service, 801 Thompson Avenue, Suite 240, Rockville, MD 20852. Telephone: (301) 443-7821. For Grants Management Contact: Ms. Kimberly Pendleton; Senior Grants Management Officer, Division of Grants Operations, Indian Health Service; 801 Thompson Avenue, TMP, Suite 360; Rockville, Maryland 20852; Telephone: (301) 443-5204. Use the
same numbers for FTS.
for provision of services and for evaluation. Overall, not more than 40 percent of grant funds may be expended for equipment. Not more than 15 percent of grant finds may be expended for indirect costs. Grant funds may not be used for purchasing and installing telecommunications transmission equipment (e.g., microwave towers, satellite dishes, amplifiers, digital switching equipment or laying cable or telephone lines) or to acquire real property. Construction costs are allowable only for minor renovations related to the installation of equipment.
Important: For both Telehealth and Telehomecare Networks, the TNGP seeks to fund non-profit or public organizations with a demonstrable successful track record in implementing telehealth technology and with a network of partners in place and committed to the project as of the date of application. TNGP funds are intended to fund network expansion and/or to increase the breadth of services of existing successful telehealth networks. Start-up projects with no demonstrable telehealth experience and/or with prospective network partners not committed to the project will not be competitive. Applicants failing to submit verifiable information with respect to the commitment of network partners will not be funded.
93.211 TELEHEALTH NETWORK GRANTS Telehealth Network Grant Program (TNGP); Telehealth Resource Center Grant Program (TRCGP); and Licensure Portability Grant Program (LPGP) FEDERAL AGENCY: Health Resources and Services Administration, Department of Health and Human Services
Important: Projects selected for funding must provide clinical services for which performance measures can be developed. In addition, an applicant must provide evidence to show that it will be ready to begin to implement the project upon grant award.
The Telehealth Network Grant Program (TNGP) and the Telehealth Resource
Applicants must provide an evaluation design to measure quantitative outcomes, which should be measured in the following areas: impact on quality of care; appropriateness of use of the technology; whether access was improved; whether clinical outcomes were improved; and, how the cost of service delivery was affected in terms of efficiency and effectiveness of care. Of particular interest will be programs that can clearly measure the costs of their telehealth services and measure the impact of the telehealth program on : 1) improving access to health care services for residents of communities that did not have such services locally before the program; 2) hospitalization rates and emergency room visit rates per year for patients receiving disease management services for diabetes, congestive heart failure, stroke and other chronic diseases, as well as for patients receiving home care/home monitoring services; 3) controlling blood glucose levels in diabetic patients; 4) improving the efficiency of health care; and, 4) reducing medical errors, and other clear outcome measures.
Note: For FY 2009, the Agency is conducting a competition for the 3-year FY 2009 through FY 2011 project period.
The TNGP has two provisions: Telehealth Networks (TNGP-TH) grants demonstrate how telehealth networks improve healthcare services in rural communities. Telehomecare Networks (TNGP-THC) grants fund demonstration or pilot projects for telehomecare, services that may include, but are not limited to, case management by physicians, hospitals, medical clinics, home health agencies, or other health care providers who supervise the care of patients in their homes. The TRCGP supports the establishment and development of Telehealth Resource Centers (TRC). The Centers are to be an impartial, independent source of technical assistance to health care organizations, health care networks, and health care providers in the implementation of cost-effective telehealth programs to serve rural and medically underserved areas and populations. The program is designed for entities with a successful history of providing technical assistance in the field of telehealth/telemedicine, which enables them to give guidance to both new and existing programs in the development and implementation of an effective sustainable telehealth program. The TRCGP is designed to leverage the experience of mature programs that have a strong record of implementing telehealth services. The LPGP supports State professional licensing boards to carry out programs under which licensing boards of various States cooperate to develop and implement State policies that will reduce statutory and regulatory barriers to telemedicine.
TYPES OF ASSISTANCE: PROJECT GRANTS
TRCGP - Funds support the development of regional Telehealth Resource Centers (TRCs), which serve as a regional focus for supporting telehealth activities throughout their respective regions; and, one national Telehealth Resource Center focuses on legal and regulatory telehealth issues. Grant funds are used for salaries, equipment, operating, travel expenses, or other costs for: providing technical assistance, training and support; disseminating information and research findings related to telehealth services; promoting effective collaboration among telehealth resource centers and HRSA; conducting evaluations to determine the best utilization of telehealth technologies to meet health care needs; promoting the integration of the technologies used in clinical information systems with other telehealth technologies; fostering the use of telehealth technologies to effectively provide healthcare information and education for health care providers and consumers; and, implementing special projects that involve collaboration among TRCs to advance the field of telehealth. Grant funds are not used for: acquiring real property, equipment costs of more than 40% of total grant funds, for equipment or transmission costs not directly related to the grant purposes, to purchase or install general purpose voice telephone systems, construction costs, indirect costs exceeding 15% of total grant funds. LPGP - Grant funds are used for salaries, equipment, software development, operating, or other costs associated with developing legislative, administrative, and technical projects to address licensure barriers that hinder the practice of telemedicine across state lines. Grant funds may also be used for activities involving significant expansion of existing state agreements for cross-state recognition of professional licenses to other states.
USES AND USE RESTRICTIONS: TNGP - Funds support the use of telehealth (electronic information and telecommunications technologies to support and promote long-distance health care and ancillary services) in two ways: 1) Telehealth Networks, for improving access to health care services; provide a baseline of information for a systematic evaluation of telehealth systems; purchase or lease and install equipment; and to operate and evaluate the telehealth system. 2) Telehomecare Networks, for improving access to health services for patients in their homes and for evaluating the cost and effectiveness through provision of clinical care and remote monitoring of patients in their own homes using telehealth technologies. Primary expenses for telehomecare shall be for personnel costs
Preapplication Coordination: Preapplication coordination is required. Environmental impact information is not required for this program. This program is eligible for coverage under E.O. 12372, "Intergovernmental Review of Federal Programs." An applicant should consult the office or official designated as the single point of contact in his or her State for more information on the process the State requires to be followed in applying for assistance, if the State has selected the program for review. Application Procedures: OMB Circular No. A-102 applies to this program. OMB Circular No. A-110 applies to this program. HRSA requires all applicants to apply electronically through Grants.gov.
All qualified applications will be forwarded to an objective review committee. Based on the advice of the objective review committee, the HRSA program official with delegated authority is responsible for final selection and funding decisions.
Applicant Eligibility: TNGP - A grantee must be a nonprofit or public entity that will provide services through a telehealth network (TNGP-TH) to rural communities or through a telehomecare network (TNGP-THC) to patients in their homes located in either urban underserved or rural communities. Telehomecare network grantees should have demonstrated experience in providing telehomecare services. For both telehealth networks and telehomecare networks, proof of non-profit status is required. Each entity participating in the network may be a nonprofit or for-profit entity. Faith-based and community based organizations are eligible under the TNGP. TRCGP - A grantee must be a public or private nonprofit organization. Faith-based and community based organizations are eligible to apply. Services may be provided to rural or urban communities. LPGP - A grantee must be a State professional licensing board, or a national organization of professional licensing boards that provide services to state licensing boards. Note: American Indian and/or Alaska Native Tribal Organizations are eligible provided those organizations meet the eligibility requirements above. Beneficiary Eligibility: TNGP - Health care providers in rural areas, in medically underserved areas, in frontier communities, and for medically underserved populations. TNGP-TH grantees include in the network at least two (2) of the following entities (at least one (1) of which shall be a community-based health care provider: (a) community or migrant health centers or other federally qualified health centers; (b) health care providers, including pharmacists, in private practice; (c) entities operating clinics, including rural health clinics; (d) local health departments; (e) nonprofit hospitals, including community (critical) access hospitals; (f) other publicly funded health or social service agencies; (g) long-term care providers; (h) providers of health care services in the home; (i) providers of outpatient mental health services and entities operating outpatient mental health facilities; (j) local or regional emergency health care providers; (k) institutions of higher education; or (1) entities operating dental clinics. TNGP-THC grantees are experienced in providing telehealth services, have a substantial caseload, are targeted to patients with chronic illnesses and senior citizens, have a history of doing evaluations and monitoring telehomecare network performance in terms of quality, cost, and effectiveness or services. TRCGP - Health care providers in rural areas, in medically underserved areas, in frontier communities, and medically underserved populations. The regional telehealth resource centers must support the activities of existing or developing telehealth networks in their regions to meet the health care needs of rural or other populations to be served, including the improvement of access to services and the quality of the services received by those populations. Regional TRCs have expertise in at least four (4) of the following areas: Clinical Outpatient Specialty Care; Critical or Emergency Care; Residential telehealth (home care)/chronic disease management; Nursing Home/Inpatient Care; Distance Education and Training; Store-and-Forward; Teleradiology. Regional TRCs collaborate with other organizations to address any of the seven areas where they are not expert. The National TRC exhibits expertise in the following areas: Reimbursement (Medicare, Medicaid, private insurance); Licensure (legislative and regulatory issues); Privacy, security, and confidentiality legislation at federal and state levels; Food and Drug Administration regulation; Telecommunications legal and regulatory issues; and, Private credentialing and accreditation organizations and issues (e.g., Joint Commission on Accreditation of Health Care Organizations). Note: American Indian and/or Alaska Native Tribal Organizations are eligible beneficiaries provided those organizations meet the beneficiary requirements above. LPGP - State professional licensing boards to carry out programs under which licensing boards of various States cooperate to develop and implement State policies that will reduce statutory and regulatory barriers to telemedicine. NCC grants will continue to focus on licensure issues for physicians and nurses. The funded projects are to build on the first year of efforts to develop national models for addressing barriers to adoption of the Nurse Licensure Compact and implement model agreements to expedite the licensure process and eliminate redundancies associated with applying for physician licenses in multiple jurisdictions. Credentials/Documentation: Applicants should review the individual HRSA Guidance documents issued under this CFDA program for any required proof or certifications which must be submitted prior to or simultaneous with submission of an application package. OMB Circular No. A-87 applies to this program.
Notification is made in writing by a Notice of Grant Award. Deadlines: Contact the headquarters or regional office, as appropriate, for application deadlines. Range of Approval/Disapproval Time: 2 months. Appeals: Not Applicable. Renewals: Renewals have not been determined. Formula and Matching Requirements: This program has no statutory formula. Matching requirements are not applicable to this program. MOE requirements are not applicable to this program. Length and Time Phasing of Assistance: Competitions are conducted every three years, with up to a 3-year project period. For projects awarded under a competition, grants are made annually each year for up to 3 years. For example, projects awarded in FY 2006 had a 3-year project period from FY 2006 through FY 2008. A new competition is being conducted in FY 2009 for a 3-year project period, FY 2009 through FY 2011 (subject to appropriations). Payments are made through an electronic transfer system or cash demand system. See the following for information on how assistance is awarded/released: Grantees drawdown funds, as necessary, from the Payment Management System (PMS). PMS is the centralized web based payment system for HHS awards. Reports: No program reports are required. No cash reports are required. Annual progress and financial status reports are required 90 days from the end of the budget period and the final performance report and final financial status report are due 90 days from the end of the project period. Progress reports are to be submitted every 6 months. No expenditure reports are required. No performance monitoring is required. Audits: In accordance with the provisions of OMB Circular No. A-133 (Revised, June 27, 2003), "Audits of States, Local Governments, and Non-Profit Organizations," nonfederal entities that expend financial assistance of $500,000 or more in Federal awards will have a single or a program-specific audit conducted for that year. Nonfederal entities that expend less than $500,000 a year in Federal awards are exempt from Federal audit requirements for that year, except as noted in Circular No. A-133. Records: Grantees are required to maintain grant accounting records for 3 years after the date they submit the FSR. If any litigation, claim, negotiation, audit, or other action involving the award has been started before the expiration of the 3-year period, the records shall be retained until completion of the action and
42% were able to achieve ideal glycemic control compared to a target of 21%.
resolution of all issues which arise from it, or until the end of the regular 3-year period, whichever is later. Account Identification:
Tele-homecare/monitoring. TNGP grantees have developed common metrics and data analysis strategies, based on data routinely collected through the OASIS system, which is a nationally recognized standardized data collection system of performance measures. The performance measures focus on the impact of these grants on the cost and effectiveness of the services provided. Data are being collected and aggregated from all programs, with a report of the findings available in FY 2010.
Obligations: (Project Grants) FY 08 $3,838,312; FY 09 est $4,165,000; FY 10 est $4,500,000 - These figures are for the TNGP. (Project Grants) FY 08 $309,196; FY 09 est $350,000; FY 10 est $350,000. (Project Grants) FY 08 $2,094,250; FY 09 est $2,175,000; FY 10 est $2,525,000 - These figures are for the TRCGP. Range and Average of Financial Assistance: TNGP - In FY 06, through FY 08, awards each year ranged from approximately $226,000 to $270,000, with an average award each year of approximately $240,000. Awards in FY 09 and FY 10 will range from $210,000 $245,000.
TRCGP - In FY 06, the first year of the FY 2006-2008 award cycle, for the Regional TRCs, the financial assistance ranged from approximately $250,000 to $310,000. The average award was approximately $310,000. The National TRC received $160,000. In FY 07, the second year of the FY 2006-2008 award cycle, for the Regional TRCs, the financial assistance was $325,000 for each of the five grantees. The National TRC received $175,000. In FY 08, the third year the Regional TRCs on average received $372,000. The National TRC received $218,750. Estimated awards for the Regional TRCs in FY 09 and FY10 are $325,000 for each grantee. The National TRC will receive approximately $200,000. LPGP - In FY 06, the first year of the FY 2006-2008 award cycle, two grantees received $342,500 each. In FY 07, the second year of the FY 2006-2008 award cycle, the two grantees received $342,500 and $344,814. In FY 08 one grantee was awarded $309,196 and for FY 09 one grantee will receive an estimated award of $350,000. PROGRAM ACCOMPLISHMENTS: Fiscal Year 2008: FY 2006 FY 2008. TNGP grantees are developing evaluation designs to measure process and outcomes. Quantitative outcomes will measure the following areas: impact on quality of care; appropriateness of use of the technology; whether access was improved; whether clinical outcomes were improved; and, how the cost of service delivery was affected in terms of efficiency and effectiveness of care.
The TRCGP and LPGP are newly funded programs for FY 2006 through FY 2008. As such, these grantees are presently building organizational capacity. During the first three years of this program. The TRCGP grantees provided individualized technical assistance to groups developing Telehealth services, created five detailed toolkits and specialized training materials, and facilitated technical assistance through regional webinars and teleconferences in the 24 states that they cover, including US-Affiliated Pacific Islands. Standard performance measures are under development to evaluate the performance of these grantees beginning in 2010. The LPGP grantees are developing programs under which licensing boards of various States will cooperate to develop and implement State policies that will reduce statutory and regulatory barriers to telemedicine. These grants will continue to focus on licensure issues for physicians and nurses. HRSA has been tracking performance of its Licensure Portability Grant Program (LPGP) grantees. In FY 2006, the Federation of State Medical Boards (FSMB) was awarded a three-year grant to reduce the legal and administrative barriers to states sharing licensure information. In its first year, FSMB established pilot projects in two regions of the country to develop and maintain a centralized interactive data management system. FSMB also compiled state profiles of the technical capabilities to electronically share licensure data for each of the 14 states in the pilot regions, and conducted a policy analysis of each to determine legislative and regulatory barriers to sharing data. A comprehensive policy review of the nine states that have specific telemedicine licenses/registration programs also has been completed.
In FY 2008, the FSMB expanded the focus of its activities, adopting two major objectives: (1) to increase the number of states adopting a common licensure application (a key step in reducing the barriers to licensure portability); and (2) to increase the number of states that participate in mutual recognition of each others licenses. Results from these activities will be available in January 2010.
16 grants were awarded from FY 2006 FY 2008, with approximately $4 million awarded each year, the TNGP improved access to specialty services for residents of underserved rural communities. With a population of 4.3 million individuals who lived in these underserved communities, access to specialty care was provided for less than $ 1/person/year in TNGP program expenditures. Specialty services include mental health, diabetes, cardiology, dermatology, home health care and monitoring, pediatrics, radiology and many other specialties based on the needs of the particular community where the project is located. (For further information on services and activities, see the OAT Grantee Directory at http://www.hrsa.gov/telehealth/publications.htm )
The National Council of State Boards of Nursing (NCSBN) was also awarded an LPGP grant to identify and implement enhancements to its current program for cross-state recognition of licenses for nurses - the Nurse Licensure Compact (NLC) - and to support states that are in the process of or considering adoption of the NLC. In the first year, NCSBN developed a cost analysis tool as a reference for States to address misconceptions regarding the cost of adopting the NLC. To date, 23 states have implemented a NLC. The NCSBN focused the third year of its grant on a detailed evaluation of the existing NLC and assessing areas for streamlining the compact to facilitate the adoption of it by more states. The final report from this grant will be made available in December 2009. Fiscal Year 2009: No Current Data Available Fiscal Year 2010: No Current Data Available REGULATIONS, GUIDELINES, AND LITERATURE: This program is subject to the provisions of 45 CFR Part 92 for State, local and tribal governments and 45 CFR Part 74 for institutions of higher education, hospitals, other nonprofit organizations and commercial organizations, as applicable. Regional or Local Office: See Regional Agency Offices. Monica Cowan, Project Officer, Office for the Advancement of Telehealth, Office of Health Information Technology, 5600 Fishers Lane, Room 7C-26, Rockville, MD 20857. Telephone: (301) 443-0076. Headquarters Office: Monica Cowan 5600 Fishers Lane, Room 7-C26, Rockville, Maryland 20857 Phone: (301) 443-0076 Website Address:
OAT had a program assessment in 2006. The program was cited for its success in expanding access to services in underserved rural communities. OAT developed annual performance measures and is tracking performance against benchmarks. In several instances, grantees exceeded the benchmarks, but there is much variation in the data and until a full set of data is available for the first three years of this effort (March 2010), the targets will not be revised. The 2006-2008 cohort of TNGP grantees provided a total number of 96 clinical services, across 690 sites in underserved rural communities for a total of 786 sites and services. When added to the baseline of 489 services, the TNGP has supported 1,275 sites and services in these communities since FY 2005. In FY 2007, 191 communities had access to Pediatric services and 159 communities had access to adult mental health services for which they otherwise would not have had access in the absence of the TNGP grants.
The program began in FY 2006 to collect data on a long-term measure to assess the programs impact on clinical outcomes in diabetic patients served by the grantees of the TNGP program, targeting control of hemoglobin A1C levels in patients. In FY 2006, 34% achieved ideal glycemic control, while in FY 2007,
funded projects are to build on the first year of efforts to develop national models for addressing barriers to adoption of the Nurse Licensure Compact and implement model agreements to expedite the licensure process and eliminate redundancies associated with applying for physician licenses in multiple jurisdictions. The grants are intended to result in an expansion of existing state agreements for cross-state recognition of professional licenses. Fiscal Year 2009: No Current Data Available Fiscal Year 2010: No Current Data Available CRITERIA FOR SELECTING PROPOSALS: For FY 2009, the Agency is conducting competitions for each of its programs for the FY 2009 through FY 2011 project period.
Not Applicable. EXAMPLES OF FUNDED PROJECTS: Fiscal Year 2008: The TNGP - University of Arkansas for Medical Sciences, Telehealth for Kids in Delta Schools (Telehealth KIDS), Little Rock, AR: The projects purpose is to work with local healthcare providers, facilities, parents and school staff to develop services and protocols that will complement and support local providers, strengthen existing referral patterns, and emphasize services that are currently unavailable in Lee County. The project will focus on children who currently have no doctor or who are currently unable to access available health care services due to poverty, lack of transportation, or complicating family issues. Specific needs identified by Lee County will target Asthma, Diabetes, Behavioral, and General Pediatric Health issues. The project links Whitten Elementary School and Lee High School into the existing network. Telehealth KIDS will use telehealth technology and Telehomecare monitoring to improve access and clinical outcomes, and overall health of Lee County Students. Telehealth KIDS will install interactive video systems. Desktop cameras will be purchased for behavioral consulting by health professionals. Interactive education units will be used at Lee County Health Unit and Lee High School. Telehomecare monitoring will be used for students suffering from asthma and diabetes. Home Health Monitors will be distributed to students homes. Lee County Schools are currently connected by T1 lines. The University of Arkansas for Medical Sciences competed and received funding in FY 2006 and FY 2007, and has been operational since 1995.
TNGP Applications will be funded based on the extent which documentation is provided in the following areas:
Expected outcomes include reduction of hospitalization and emergency room visits, measuring the impact of telehealth program on controlling blood glucose levels in diabetic patients, collecting data to measure clear outcomes, including improving access for individuals that otherwise would not have such access, productivity, efficiency, dollars saved and quality of services. The project is developing a detailed evaluation and data plan that addresses the required performance measures.
Need, the documented need for the project and the likely demand for the proposed services; Response, the extent to which project objectives, activities and benefits are consistent with the objectives of the grant program and the needs for the project;
Evaluative Measures, the extent to which the project measures success in meeting its goals and objectives; Impact, the level of local involvement in planning and implementing the project, level of commitment as evidenced by cost participation of applicant, other network members and/or other organizations, and long-term plans for sustainability; Resources/Capabilities, the ability of network members, including clinicians, to implement the project and the corresponding feasibility of the projects plan of activities; Support Requested, the reasonableness of the budget to proposed activities and anticipated outcomes/results; and, Technology/Integrating Administrative and Clinical Systems, the extent to which the applicant proposes to integrate administrative and clinical information systems and effectively deploy technology.
The TRCGP - The Great Plains Telehealth Resource and Assistance Center
The TNGP will seek to select projects that have demonstrated skill in evaluation. In addition, applicants must evidence a successful track record in providing telehealth services and to demonstrate how the proposed funds will expand services to new communities and/or populations. Applicants must provide an evaluation design to measure process and outcomes. Quantitative outcomes should be measured in the following areas: impact on quality of care; appropriateness of use of the technology; whether access was improved; whether clinical outcomes were improved; and, how the cost of service delivery was affected in terms of efficiency and effectiveness of care.
This Regional TRC will increase telehealth utilization among rural and frontier health care providers by breaking down both geographic and experiential barriers. This center will serve telehealth programs in this region and nationally by focusing on individualized coaching services; providing information, assistance and direction as requested and needed; an on-line toolbox; and a regional telehealth conference. Services provided include: general one-to-one assistance and direction in topics such as telehealth policies/procedures, licensure, scheduling, evaluation, research, and others; on-line resource toolbox; annual regional conference; identify key regional issues; in general, help rural facilities acquire the skills/expertise to implement telehealth programs.
Of particular interest will be programs that can clearly measure the costs of their telehealth services and measure the impact of the telehealth program on: 1) improving access to health care services for residents of communities that did not have such services locally before the program; 2) reducing hospitalization rates and emergency room visit rates per year for patients receiving disease management services for diabetes, congestive heart failure, stroke and other chronic diseases, as well as for patients receiving home care/home monitoring services; 3) controlling blood glucose levels in diabetic patients; 4) improving the efficiency of health care; and, 4) reducing medical errors, and other clear outcome measures. Also, of particular interest are networks that include Community Health Centers funded by the Health Resources and Services Administration (HRSA) in the network (i.e.,330 grantees).
The project outcomes are as follows: 1) To increase the knowledge of applications, practices and research findings relating to telehealth; 2) To increase the quality and quantity of standards-based information regarding the best utilization of telehealth technologies; 3) To increase the number of contacts initiated by providers; 4) To improve the skill level of key staff members to conceptualize, plan, implement and evaluate telehealth programs; and, 5) To increase the number of providers that utilize telehealth technology.
TRCGP TRC applicants will be assessed on their current activities and success in addressing the following areas:
The LPGP Two grantees are developing projects to support State professional licensing boards to carry out programs under which various States will cooperate to develop and implement State policies that will reduce statutory and regulatory barriers to telemedicine across state boundaries. The grantees are focusing on projects that will reduce impediments to the practice of telemedicine across state lines by physicians and nurses, respectively. The
Telecommunications, industry standards, and technology assessment;