FTS-BPHC

Moderator: Ms. Beth Tchinski
May 8, 2009
1:30 pm CT

Coordinator: Welcome and thank you for standing by. All participants will be on listen only until the question and answer session of today’s conference.

I would also like to remind you that the conference is being recorded. If you have any objections, you may disconnect at this time.

I would like to turn the call over to our speaker, Mr. Jim Macrae. Sir you may begin.

Jim Macrae: Great. Thank you very much. Good afternoon, good morning to everybody. I hope you all are having a nice Friday. It is actually beautiful here on the East coast at least in the Washington D.C. area. And it feels so good to see the sun. We have not seen it I think for the last seven or eight days so it is actually beautiful here.

We are very pleased that you are able to join us today to talk about the last major component with respect to the Capital Improvement Program which we wanted to go over with you all.

Today’s call is focused on the equipment aspect of this opportunity. And we are going to spend some time talking to you about what are the eligible costs, what are the particular things that folks can purchase, then walk you through how to actually submit the application and then finally open it up for questions that we think or that you may have with respect to this.

Again, just for your information, the slides for today’s call are up on our Web site. We also have up on our Web site a set of frequently asked questions. We encourage you to take a look at those. We do plan to update those if not every day at least every couple of days with questions that you all are sending in and thank you very much for all of the questions you have submitted so far.

In addition, there are a number of resources that are available up on that Web site so you can take advantage of those resources.

In particular, one of the big questions that has come up is with respect to calculating the job information and we do not have it up there yet, but it will be up there shortly in terms of how to calculate both around the construction aspect as well as the health center aspect in terms of the number of jobs.

Just some rules of thumb as you go about attempting to project estimates on both of those categories.

Just again for your information, these applications are due June 2. We are doing everything in our power to make it as easy as possible. We really do feel like we have made some significant attempts and I really do want to thank the staff again for all of their work to make the application electronic.

We really tried to just get at the core pieces that we had to do both from a requirement standpoint as well as from a funding standpoint.

So hopefully as you begin your projects, this will be very straightforward in terms of how to apply.

The last thing I will add before I turn it over to our first speaker is just to say that this opportunity is for immediate and pressing capital needs. This really is intended to go for projects that can be completed within two years.

Again, there will be an opportunity for a larger construction/renovation opportunity later this summer for the larger capital projects., with respect that construction, repair, renovation. But this is the opportunity with respect to in particular equipment to staff all of your sites or equip all of your sites, as well as to do an EHR or an IT project.

So just encourage you to take advantage of these resources, but again, focus on those things that can be accomplished in a two year period, and we will do the most to impact your operations ultimately to improve the care for your patients and ultimately to make an impact within your community.

We really are excited about this opportunity. This does not happen very often if ever. And we are privileged to be a part of it and really are looking forward to working with you to make this a success. So thank you very much.

With that, I will turn it over to Marie Legaspi to walk you through the major aspects with equipment. And again if you have it, please either you print it out or for those of you who are looking on the computer, we are going to go through the slides.

But for those who do not have access to a computer, please note that you can get access to the five after the call and we will attempt as best we can to walk you through it even if you do not have the slides with you.

So Marie, all yours.

Marie Legaspi: Okay. Thank you Jim. We included the first six slides in this presentation for your reference. Many of you are likely aware the general parameters of the CIP given this is our fourth call. However, before we delve into the IT and equipment and HIT projects, I do want to reiterate that what was mentioned in Wednesday’s call and we are going to be starting with slide 7.

And that is that any equipment that will be utilized at the site at which an alteration, repair, renovation or construction project is occurring should be included as part of that project, as well as any fixed equipment that requires installation. It should be proposed in an alteration, repair renovation project.

And for today’s call, on slide 8, we will be focusing on the following project types - IT, equipment and HIT. Certified EHR purchases were discussed on Thursday’s call, but we will just touch upon it here over the next three slides just to reiterate what was discussed.

So these project types, they may be proposed to be either a site specific, multi site or organization wide. So once you are in EHB you will have those options.

And also before we move on a little bit, we have received a number of questions about the purchase of modular units or trailer, whether those were allowable under - with CIP funds. And we do have an FAQ online, however just based on the number of questions we had, we needed to update it.

And so for the purposes of the CIP, a trailer is a portable vehicle built on a chassis designed to be hauled from one site to another by car or truck, whereas a modular unit is a prefabricated portable unit designed to be moved to a site and assembled on a foundation.

Now for IT equipment purchases for CIP, grantees may propose to purchase a trailer since it qualifies as equipment due to its portability. And modular units should be categorized as a new construction project and may be added as a site.

Now in terms of going onto the - what is allowable under each of the different types of CIP projects on slide 9, this will show how IT and equipment is defined.

This list here just highlights some of the examples of what would be included in an IT or equipment only purchase. Other examples that are not listed here include labs, dental and x-ray equipment. Excuse me.

And on slide 10, for HIT purchases this topic was touched upon during Thursday’s call, but I would like to refer you to those slides from yesterday’s call as well as our online resources for additional information. And we have a URL at the bottom of slide 10 for that.

But for HIT only purchases, those would include tele-health related equipment, hardware and integrated technologies, as well as any enhancement necessary to interface between HIT and EHR and other electronic systems.

And in terms of certified EHR only purchases, again this was discussed at length yesterday. But for the purposes of the context of our call today, if you please refer to the three green asterisks that are next to the infrastructure clinical facility cost, data infrastructure cost and implantation staffing, unless these types of costs are bundled within a certified EHR project, they should be proposed as an IT equipment project.

Now moving onto equipment and project sites, only for IT equipment projects, grantees may (prose) that one of the following four options for sites at which the project will occur. For example, at a site that is currently in the grantee’s approved scope of project or at a new mobile site only for the purpose of the mobile unit or at a site (previously) added as part of a recently submitted but not yet approved change in scope, or at a site via those added through an ARR or construction CIP project.

It is a little confusing now, but hopefully one of things that we do plan to post online is a graphic that will help grantees just understand what options are going to be available for picking a site.

Now I would like to address a few proponents of the CIP application as they pertain to equipment projects. The first is for project timeline, I would just like to remind folks that CIP funds must be obligated within a two year budget period.

And for item number 8 on a project cover page, we recommend grantees indicate the start and end dates for the following milestones. So for planning, project development, procurement, project completion, you will have a narrative box in EHB to provide us with this narrative information.

And specifically for the purpose of mobile units, we ask that you please provide an estimated date that the site will be operational.

And the second component I would like to highlight is the 424 budget. Again we are using the SF 424C in pages 19 through 22 of the CIP guidance, we included a chart that highlighted some of the allowable and unallowable costs.

Now I would like to bring your attention to line 10. So in line 10 we ask that you list all equipment costs with costs of $5000 or greater. And for line 11 is where you would list all of the non-expendable supplies with costs less than $5000.

We have also had a few questions around the fixed equipment if it is not part of a construction contract that we have in line 9. And basically, if you do have fixed equipment that is part of a construction contract, you will list that equipment in line 10 based upon these rules.

If they are $5000 or greater they would on line 10 or in line 11 if they are nonexpendable supplies with costs of less than $5000.

Again, as we mentioned earlier this week, we do hope to have several examples of a budget justification posted online. So we appreciate your patience as we work to get that clarification for you.

Now in terms of slide 15 regarding the equipment list, any equipment including nonexpendable supplies that are less than $5000 to be purchased with CIP funds should be listed and specific to the project. And basically within every project, you will need to complete an equipment list as applicable.

For the equipment list, if we proceed to page - to slide 16, you will be required to select an equipment type when adding equipment. For the purposes of CIP, we will use the following as examples.

So for clinical what we are looking for are like x-ray machines, CAT scanners, dental exam chairs. For non-clinical, these would include office furnishings, elevators, telephones, mobile vans, laptops. And one thing that we would like to point out here are those laptops to be categorized as non-clinical would be those that are not supporting an existing or new HIT or EHR.

And finally the last equipment type would be HIT or EHR. And that would include any equipment supporting a new or existing HIT or certified EHR system.

So for example, if you are going to be purchasing laptops and it is part of an existing certified EHR system, then those costs should be categorized as HIT or EHR for the purpose of the equipment list.

Moving onto the environmental review, all applications will need to include completed environmental information and documentation checklists. However, HRSA does not anticipate requiring an environmental assessment for IT equipment or HIT projects.

However, in the event that some of the equipment does include any hazardous materials, HRSA will make the determination of it is required - if an environmental assessment would be required for any CIP projects following a review of the environment information and documentation checklist.

If we can move onto slide 18 around additional considerations, again I know that you have seen this a lot already this week, but we would like to emphasize that no cost incurred or obligated prior to February 17 are allowed, as well as any costs incurred between February 17 and the date of issuance of the Notice of Grant Award for the CIP funds.

HRSA encourages Grantees to implement sustainable green design practices for all projects. And for equipment we encourage Grantees to review page 13 of the guidance for energy and other standard considerations for procurement of equipment.

And lastly equipment must be maintained, tracked and disposed of in accordance with 45 CFR Part 74 and 92.

Slide 19, you have also seen this many times before, but the CIP projects must be distinct standalone projects. Again as I mentioned earlier, mobile units are allowed as IT equipment projects whereas permanently affixed modular units would be considered construction projects.

And for the purposes of mobile van purchases only, if the CIP project will result in a new service the grantee should consider its capacity to maintain that service and must request as the services part of the separate changes go for (class).

Now slide 20 serves as a reminder for grantees on standard procurement principles and budgeting issues. Again, just because of any contract that will be used with this funding, grantees will need to make sure that they follow the standard procurement principles that apply to all HHS grants.

And finally on slide 21, this just serves to remind you what you will be reporting on a quarterly basis. And that will include the number of health center jobs created and retained. For example in the completion status as well as reporting actual versus projected budget on the uses of CIT grant funds.

And with that, I am going to turn it over to my colleague in OQD.

Suma Nair: Okay. I will quickly walk you through how to add a project in the system for IT equipment or HIT. And again, we have gone through a lot of this so I will try to move through it quickly and really point you toward those things that are specific to an IT, HIT or equipment only project.

Remember the overall architecture for this is there is a general application or proposal that can have multiple projects that you are proposing. I would be remiss if I did not mention, over and over again, that when you are working the system, remember to save and continue because you get locked out after 30 minutes if you have not been active in the system. So save frequently so you do not lose any of your work.

And finally again, only the authorizing official can submit your application. So as you have done all of the components for your various projects you are proposing, the authorizing official is the one who gets out at the proposal level and submits the entire application once it is complete.

That being said, the first slides here are around adding a project just shows you where we are overall in the project. You have the proposal cover sheet and you see a list of project. So the next slide, slide 23, shows you how from the pull down box you can pull down and select IT equipment only purchases. And again, this can be over a single site or multiple sites.

Moving then to the project status page, as we have talked about before, this lists all of the items that are necessary to complete for this project. And it helps you as you are screening the application to make sure all of the aspects of this particular project are done so that you can then submit.

And again, the elements that will go through as a part of this project are the basic cover page, the impact associated with this project, the equipment that you are proposing, the standard budget information, some site information and then the EID checklist.

Let us move onto the next slide then, slide 30 - 25 sorry. You see the project cover page there - again the standard information, site information, project management, contact information, need implantation and timeline, the same elements.

There is nothing here particular to an IT, HIT or equipment only project, it is just the standard elements.

As we move into the next component of the project is the project impact, the next slide. And here is where you have to propose what impact this project is going to have or the purchase of equipment IT or HIT will have.

You will see immediately under the direct impacts, there is a proposal for total square footage improved or increased. We are anticipating with the purchase of any equipment, IT equipment or HIT equipment, you are not going to necessarily be increasing or improving any square footage, so for most of you this will just be left blank.

Although you note that there is an asterisk and you cannot leave it blank because it is a required element, so again, since we are leveraging the (over R) system architecture, just go ahead and put zero for that. And similarly the fields right underneath that around impact on the EHR and number of providers and number of patients impacted, you may also identify zero for those if that is appropriate.

If you look below for the projected STEs and you see that number 2 row - title number 2 is construction related STEs, again probably with your equipment, IT or HIT related projects, you are going to have zero in those fields as well.

Moving ahead to the next element where you had the opportunity to propose the equipment that you are adding for this project, as Marie mentioned you can have clinical, nonclinical, HIT or EHR. You select one of those, put down the description, the price, the quantity and the like.

Next is into the project budget. And again this is a standard project budget page. As you put in the total costs and the allowable costs, the last column there around total allowable costs will automatically populate by virtue of doing the math there and the totals will automatically populate.

And again, if you remember, you know, now that we are at the fourth call and if you do your projects in this order, you will notice the budget summary information, there is the second table there shows you exactly where you are, visa vie this project and the projected amount to the various projects you have and your overall maximum eligible at that amount.

So it is kind of your checkbook debit account to keep you on track in terms of your budgeting.

Moving forward to the next slide funding sources, again if you are leveraging any other funds, you can reflect those here. The budget justification, as with the other projects, this is an opportunity to upload your budget justification into a Word document and you upload and attach.

Next moving onto the sites, so as you propose a project, you have to align it with one site, multiple sites or throughout your organization. And this - in the site section is where you have that opportunity.

Again with this, you can add a new site. And we had mentioned with these projects, you are really adding these sites through your alteration renovation repair project or through your construction project.

You have an opportunity with an equipment only purchase to add a new site by virtue of, as Marie mentioned, if you are purchasing a mobile unit, a mobile van, you can use the Add a New Site functionality here to propose that and that then becomes a site.

You can also pick a site from your existing scope. And again, not reflected on the slide but we mentioned we updated the functionality based upon your feedback. You can also pick a site from all of those pending change in scope requests.

The next slide just shows you once you click on Select From Your Scope it shows you the multiple sites. And you can remember if you want to choose multiple sites, you have to click on each radial button to access each one of those sites and have the equipment be related to those.

Now I am not going to go through - there is a couple other things that kind of following the system architecture that it will prompt you to do. As you remember, there is a site checklist. So if you propose a new site, you are going to have to fill it in.

So if you propose a mobile van, you are going to have to go through the site checklist. However, if you have not, you may still get that screen. You will see the note that this is not required, so please go down to the bottom of that screen and just hit save and continue and move forward.

There is also this section about other requirements. There are no other requirements with IT equipment and HIT related projects, so you will just go with the (stayed) and continue.

There is also no requirements for schematic drawings. You will be prompted to it because it is a part of the application. Just go down to the bottom and go into Save and Continue.

You must however, as Marie mentioned, do the environment and documentation checklist. So please go ahead. That is the next slide. Download the attachment, fill it out, upload it, attach it, and then go to Save and Continue.

And that brings us to the end of the nuances associated with the system for the IT equipment or HIT projects. And our last five that we have is of course the Help resources that are available there to support you.

Marie Legaspi: Okay. And the last two slides are just going to highlight some of the technical assistance resources that have been mentioned within our guidance and online. And the last slide 34, just highlights and reminds - serves as a reminder in terms of who you can contact for additional information.

And with that I guess we will open it up for questions.

Jim Macrae: That would be great. Let us take some questions.

Coordinator: Thank you. At this time we are ready for the question and answer session. If you would like to ask a question, please press star 1. You will be prompted to record your first and last name. To withdraw your question, press star 2.

Once again to ask a question, please press star 1. One moment.

Our first question comes from Gina Lombardi. Your line is open.

Gina Lombardi: Hi. I am hoping for some clarification because we are a little confused about how many projects we have right now. We know that we are doing alteration and renovation at two sites and that will be two separate projects. We are also looking at electronic health records. And we know that that would be a third project.

We are anticipating upgrading our practice management system too, and do not know whether we need to add that as a separate fourth IT project included under our alteration and renovation projects or if we wind up going to an electronic health record system that comes bundled with a practice management system if that would be part of our EHR project.

Can you help us untangle that?

Jim Macrae: Yes. I was going to say I think you are right. It is a little confusing. I think, you know, this may be one where you want to send the question into us just because for example are the two sites that you are renovating, are those your only two sites?

Gina Lombardi: Yes.

Jim Macrae: If those are your only two sites, then you could include that within the repair and renovation projects. If it is within your EHR, you know, the practice management piece, you could include that within the EHR.

But why don’t you just send us the question and we will get back to you with the specifics on that because it is a good question and it does get a little confusing the larger number of projects that you have. And I think our goal is to have you do the least number that you have to.

Gina Lombardi: We appreciate that. Also, will we then also be able to draw down funds on an as needed basis rather than in say 24 months?

Jim Macrae: (Ah).

Gina Lombardi: One twelve per month.

Jim Macrae: Yes. You basically you draw down as you spend it. The...

Gina Lombardi: To reimburse.

Jim Macrae: It is basically to reimburse expenses that you have. So no, you do not have with - draw down $112 every month. It is as expenses are incurred.

Gina Lombardi: Great. Thank you very much.

Jim Macrae: Sure.

Coordinator: Our next question, Doreen Gagnon, you may ask your question.

Doreen Gagnon: Hi. My question is pretty much similar to the one that just came up and it was about how to bundle my projects. And we have got 11 sites. And what I am confused is, I have got some that cover all my sites, like exam tables and computers and phone systems, and some that only cover three or four sites.

And I am wondering if I should bundle, do my all site stuff as one project and my three or four sites as separate ones. Plus, in the R&R, is that only for built in equipment or is that for all equipment at that site if you are doing R&R?

Jim Macrae: Well let me take the easy one first and then I am going to turn it over to the staff to answer the harder one. That is sort of the way I like to do things around here.

The easy one is that it includes all equipment in a renovation so it is not just fixed. So include all the equipment associated with that. That should be included in that project or is that not correct. Maybe I am wrong on that. That is correct? All right. Well let me give it to the harder ones. Marie do you want to try to take that one or...

Marie Legaspi: And I guess basically, you know, if - for your other ones, like you had mentioned purchasing just types of equipment by just what you mentioned, is it going to be an all equipment purchase then. It doesn’t matter which site they are at.

Doreen Gagnon: What is going to happen with the equipment is each site will need some exam tables. And for the phone system, that will be across all of our sites. For our security system, it is across all of our sites. So I am thinking in terms of those types of projects.

Marie Legaspi: I am guessing that you could do one IT project and we do allow for multi sites. And then so you will pick the sites which are impacted by what you are purchasing when you select a site. And then you will select the various equipment then. So you will just need to submit.

But again, I would just like to caution, if it is a new project that would require any significant repair or I mean renovation or installation, then that should be part of an ARR, an alteration, repair and renovation project.

Doreen Gagnon: Right. And what about if there is like an HR IT upgrade that is specific to the department, but impacts everybody. Would that - would I put that in as an all site project like an HR system and an upgraded financial management system?

Marie Legaspi: Yes.

Doreen Gagnon: Okay great. Oh man, that's just great. Thank you.

Marie Legaspi: You are welcome.

Coordinator: Our next question comes from Mike Hassing. Your line is open.

Man: (Implement at that).

Man: Then someone is (a shop).

Coordinator: Mike Hassing, your line is open.

Man: You might want to ask them.

Coordinator: (Larry Sanders), your line is open.

Please check your mute button.

(Janine Peterson), your line is open.

(Janine Peterson): Yes. I have two questions. On slide 13 where you have the about the milestone and you ask for a planning start and ending date, if the - can the planning start date be any time after the February 17 date?

Woman: Yes.

(Janine Peterson): Okay. And my second question has to do with indirect cost rates. If we have an indirect approved cost rate, can that be included in this project and how would we incorporate that based on the different projects?

Woman: Well your indirect cost rate is applied across all of your budget. So it does not matter whether it is on site A or site 50. It is still part of the total cost of the project.

(Janine Peterson): Okay. So...

Jim Macrae: So you would apply that for each project...

Woman: So you...

Jim Macrae: ...budget that you...

Woman: Yes.

Jim Macrae: ...submit to us.

Woman: So you would apply it across each project.

(Janine Peterson): All right. Thank you.

Woman: Yes.

Coordinator: Our next question (Dawn Wells), your line is open.

(Dawn Wells): I just have a question about bundling the different projects together. If we are considering an EMR system practice management dentrix and then possibly upgrading our current servers, would those be for - well I guess EMR would be a whole separate one. But would the other three be three separate HIT or IT projects?

Marie Legaspi: Well you will be - they will be all bundled as one. But then again, you know, when you get your equipment list you will need to just identify the equipment that is purchased under that.

(Dawn Wells): So but it will not be confusing as far as what equipment is going to be for the practice management, what is going to be for the dentrix, what is, you know, the servers?

Woman: Right. From our perspective, it sounds like all of those things are to support your EHR. Is that correct - the dentrix and the practice management?

(Dawn Wells): Well the dentrix is kind of a dental electronic health record system...

Woman: Right.

(Dawn Wells): ...so it will be interfaced with the EMR. And the practice management is interfaced with the EMR. But this dentrix - but it is my understanding that the practice management and the dentrix are not part of the EHR if they are an IT project. Is that correct?

Woman: The reason for those classifications is really if you were to do one of those without the EHR. I mean from our perspective, the fact that you could bundle them with the EHR and complete the checklist, then Appendix 5 is what is helpful to us. So those are bundled projects under EHR.

(Dawn Wells): Oh okay. So EMR, practice management, dentrix is all bundled under EHR. And then if we upgrade our current servers, that would be a separate IT project.

Jim Macrae: Unless it is part of your EHR that you would like to submit.

(Dawn Wells): Oh okay. All right. Thank you.

Jim Macrae: And we know this is a little confusing and, you know, if folks have particular questions you can definitely call into us. I think the good news is we are not going to preclude anybody. We just try to create these categories to make it. What we thought was the easiest it may not have turned out to be the easiest in terms of being able to report to us and ultimately be able to report back out.

But if you have specific questions, you can definitely send those in and we will help you work through, you know, which bucket or how can I bundle this in the best way.

Coordinator: Our next question (Xavier) your line is open.

(Xavier): Yes good afternoon. My question is going to deal with the equipment. Aside from a mobile unit, are we able to purchase vehicles for our health centers? We are located in six different counties and it is about 4000 square miles. Would that be an allowable cost under these funds?

Marie Legaspi: Yes.

Woman: Reasonable?

Marie Legaspi: Yes, reasonable.

(Xavier): Yes, reasonable. Absolutely.

Woman: Eco friendly.

(Xavier): Yes. Thank you. That answers our question. Thank you very much.

Jim Macrae: You are welcome.

Coordinator: Susan Amberson, you may ask your question.

Susan Amberson: Hi. I had a question that related to signage. We have recently gone through a name change. And the question came up as to whether or not replacing the signage for a number of locations would be considered an alteration or if it would fall under the equipment category because it would be monument signage separate from the building and not - there would not be any other alterations going on at many of the sites?

Jim Macrae: We would consider that equipment...

Susan Amberson: Okay.

Jim Macrae: ...for this purpose, not a renovation.

Susan Amberson: Okay. And that would be an eligible equipment cost.

Jim Macrae: Yes.

Susan Amberson: Okay. And then if the building that that sign would be located at has a historic designation, would that -would we then just for the sign trigger the historic any kind of review in that historic building area?

Jim Macrae: Yes it would.

Susan Amberson: Okay. Great. Thank you so much.

Coordinator: Our next question (Sean) your line is open.

(Sean): Hi. Well first of all, we want to clarify that we have an RR project which includes a parking lot renovation, removing some buildings and, (you know), improving access, patient access to our building and our parking lot. And then we also have an electronic dental record and an IT equipment project that are together.

So I was told that I can put those all under an RR project, that I can - even though they are totally unrelated that I can put the IT equipment in with an RR project. Is that - I just want to verify that that I am doing that right.

Jim Macrae: Oh I was going to say only if it is - the equipment that you are purchasing is for just that renovated site. If you are renovating your entire site and it is that only site where you are putting the equipment, then yes you could bundle it. But if you are renovating one site and then providing equipment for multiple sites, you would need to put that into - as a separate project.

(Sean): Okay. All right. And then we wanted to know the detail in the equipment list, how much detail do you want in the description of the equipment?

Marie Legaspi: Um.

(Sean): Like can we say server or do we have to say a certain brand, a model number and right down to the brass...

Marie Legaspi: No. We are just looking for general. And so we the - we - in terms of like if you are ordering several pieces of different kinds of equipment, but they generally fit in the same category, like you said servers, we do not need to know Server A and quantity three unit cost blah. And since you are ordering three different kinds of servers, if they can be generally classified as a server, you can provide us with that general classification and then also just provide us with an average unit price...

(Sean): Okay.

Marie Legaspi: ...just because we have gotten a lot of questions like well if we are ordering X number of equipment and there are different variations of that, you know, do we need to list all of it. And the answer is no, but we are just looking for general categorization of these equipment types.

(Sean): Okay. And one last question is because we are doing an electronic dental record but not an electronic health record, do we still have to do the EHR checklist?

Jim Macrae: No you do not. And that would be categorized as an HIT purchase.

(Sean): Okay. Yes. Okay. Just making sure.

Jim Macrae: No, no. That is a good question.

(Sean): Okay. Thank you.

Jim Macrae: Sure.

Coordinator: Our next question, Mike Lardiere your line is open.

Mike Lardiere: Yes hi, thanks. Getting some requests I need to clarify for some health centers around if they were just going to use a non-EHR HIT equipment or software and specifically around upgrading or purchasing Human Resources or Accounting software, where would that come under?

Marie Legaspi: Are you talking about in terms of where those costs should be categorized on the budget?

Mike Lardiere: Whether they would come under this IT category? Yes.

Marie Legaspi: Oh.

Jim Macrae: So which of the three different project would it be IT, HIT or EHR.

Mike Lardiere: Yes, I know it wasn’t EHR, and...

((Crosstalk))

Jim Macrae: It is IT.

Woman: Yes.

Mike Lardiere: Okay. So it would be covered and it is under IT. Okay. Thank you.

Jim Macrae: Yes.

Coordinator: Our next question Jacqueline Bell your line is open.

Jacqueline Bell: Thank you. We have been on the conference call here in our center all week long. And we really think it is a good thing. But there has been a little confusion as to will this (step) pay for architectural fees?

Some of the people that asked, the answer was yes. And then on the call yesterday or the day before, it was explained to someone that they cannot use the money for that purpose if they were depending upon another grant source.

But can we use this money for architectural purposes if we are not depending upon a grant source? Not that we may not apply for it, but we are not totally dependent upon that.

Woman: Hello.

Jim Macrae: It is a good question and it is a little bit confusing because I think there have been two different sets of questions related to this that have been asked. One has asked as part of the project that they would like to submit under CIP, can they have their architectural fees and expenses covered. The answer to that is yes.

The second question that we have heard is whether you are thinking about a project in the future that you would like to potentially get funded or would even like to get funded through the Facility Investment Program, the major capital that we are going to be putting out later.

If you have the funding secured and are going to be building this facility with other resources beyond ours, then yes you can cover the architectural fees as part of this.

However, if you are using these funds to support the development of a plan to then submit an application to us under the Facility Investment, those would not be eligible.

Jacqueline Bell: (For the major).

Jim Macrae: So I think in your case, if you have the resources secured and available, you could use it for that purpose. That is correct. We would just ask you as part of your project to share the entire project with us and how the CIP funds would go for this aspect of it, the architectural and engineering costs.

Jacqueline Bell: Okay. And I have just a quick second question. Also one of the calls this week, a lady asked a question that no construction had to be bidded. But she asked if the architectural services had to be bidded, and someone said no. is that correct?

Jim Macrae: That was incorrect. They actually do need to be bid like any other service under the health center. So yes, they would follow the general procurement rules under the grants for all health centers.

I think that was someone in our sister bureau that was not familiar with the health center program regulations and requirements. So we apologize for that.

Jacqueline Bell: All right. Thank you. That is all I have.

Coordinator: Our next question (Heather Pegas) your line is open.

(Heather Pegas): Hi there. I think I have some of the same untangling questions that the others did. So if you are doing EHR, any of the equipment that you are using in EHR also can be used for IT equipment, so therefore you are applying for that under EHR.

Jim Macrae: Yes. If you are purchasing in EHR, I think the general rule of thumb is...

(Heather Pegas): Uh-huh.

Jim Macrae: ...if you are doing an EHR and you would like to have any of the other equipment costs associated with it, put it all under the EHR.

(Heather Pegas): Very good. Okay. And I just want to clarify that if we put something under the “wrong” category, that request is not going to be discounted? I think I heard you say that. Like if we make a mistake in where we put what we are requesting, that application will not be tossed out.

Jim Macrae: No because we are afraid if we were held to the same standard we would have problems too, so...

(Heather Pegas): Okay. Very good. And just one last question I just want to clarify. If we are doing like computers, that type of equipment and also doing a separate x-ray project, those are two separate equipment projects.

Jim Macrae: No. You would actually put it under equipment and you would just specify that you are going to purchase the x-ray piece and then the other equipment. So you would just say one equipment project and just list out what the equipment is that you are going to be purchasing.

(Heather Pegas): Thank you very much. That answered my question.

Jim Macrae: You are welcome.

Coordinator: Our next question (Tom Wall) your line is open.

(Tom Wall): Thank you and good afternoon. I have a couple questions and I think they are fairly brief. One is general regarding the use of funds in the two year period. (It seems) yesterday or the day before I heard that funds had to be spent within the two year period, but one of the slides indicated that it had to be obligated. And I wanted to know if there is a difference between spent and obligated.

Jim Macrae: Yes there is. Obligated means that you are - I am going to not use the nontechnical term but you are on the hook to eventually pay the cost. So for example, obligated means that you signed a contract that says you will - you are committing to this project and you will eventually have to spend the funds or give the funds to that entity. But you must obligate the funds before the end of the two year period. You do not have to spend all the funds by the two year period.

(Tom Wall): Thank you.

Jim Macrae: If I am wrong - I am looking at our grant folks to tell me whether that is correct.

Woman: I just want to expand that a little.

Jim Macrae: Please.

Woman: You should be reasonable.

Jim Macrae: Yes.

Woman: If you wait till the last day to obligate your construction project, that is not the intent of...

Jim Macrae: It is a good point.

(Tom Wall): (Very good).

Woman: ...you should try to obligate your - I mean I would construct two years, I would put my goal at by the end of the first year I would have obligated the money even if I hadn’t dispersed all of it yet.

(Tom Wall): Okay.

Jim Macrae: yes.

Woman: So does that make sense?

(Tom Wall): Yes it does.

Woman: Okay.

(Tom Wall): Second question on slide number 28 line 13 contingency costs, do you have any guidance on calculating contingency costs?

Jim Macrae: That is a very good question. We have some resources out there. I think in particular, you know, some around EHR, some around construction. I do not remember if we put a specific in there. I think we did have one as an example, but literally it is just an example in terms of contingency costs.

You know, what we are asking I think in particular is something that is reasonable. You know, I do not think we have a per se figure unless Marie you know of...

Marie Legaspi: No. We can post something up on the FAQs.

(Tom Wall): Okay. And we do expect contingency costs for say all renovation projects to be the same for every organization. So if it is a 10 or 12%, would it be the same or would you expect it to vary from project to project or project type to project type.

Jim Macrae: It may vary depending on the project type. And that is why I do not think there is a per se rule of thumb. But we will try to get something out there to provide, you know, some reasonable ranges or ideas about how you might go about projecting that.

(Tom Wall): Okay.

((Crosstalk))

(Tom Wall): That is all I have. Well thank you very much.

Coordinator: Our next question (Ed Michael) your line is open.

(Ed Michael): Thank you. This is regarding dental equipment. We have 12 dental chairs and every year I am replacing a dental chair. But we have three different sites and we would like to replace an x-ray unit also. Do we have to put it down for each site or can we just put it under organization and make a listing of all our equipment needs?

Marie Legaspi: Well as long as you are only going to be doing - it is not going to require any alteration, repair or renovation, this can be one project type?

(Ed Michael): Right.

Marie Legaspi: So you can do IT and equipment across multiple sites.

(Ed Michael): Okay. Even though it is not the same site, right?

Marie Legaspi: That is correct. You can select multiple sites.

(Ed Michael): Okay. Thank you.

Jim Macrae: Sure.

Coordinator: Our next question, Barbara Mannino your line is open.

Barbara Mannino: Thank you. We have already purchased a certified electronic health record, but we need to expand our licenses. Do I need to put that in as an electron - as an EHR project or as an HIT project?

Woman: EHR.

Jim Macrae: We would prefer it under the EHR.

Barbara Mannino: Okay. Thank you.

Jim Macrae: Thank you.

Coordinator: Our next question (Jason Ferrara) your line is open.

(Jason Ferrara): My question is just regarding two individual projects themselves. We are receiving a lot of requests for proposals that include training bundled into the projects. Is that something that is allowed?

Jim Macrae: Yes it is.

(Jason Ferrara): Okay. Thank you.

Jim Macrae: Sure.

Coordinator: Our next question (Patrice Taylor) your line is open.

(Patrice Taylor): Yes. I see here where, well okay, we can purchase the mobile unit and it has to be operational within 60 days. So then do we go in - do we have to go in and enter the new mobile unit as a site then?

Jim Macrae: Just say a little bit more. In terms of when you purchase a mobile unit...

(Patrice Taylor): Um-hmm.

Jim Macrae: ...we do expect within 60 days of the purchase that it will be operational, but not within 60 days within the notice of grant award. So I just wanted to make sure that was clear.

But then the second part of your question was...

(Patrice Taylor): Yes. Then do we go in and enter the new mobile as like a site. Would that be considered like a new site?

Woman: Yes.

((Crosstalk))

Jim Macrae: Yes.

Marie Legaspi: Yes.

Jim Macrae: And can they do it as part of their application?

Marie Legaspi: Yes, yes.

Woman: Yes, as an equipment purchase.

Jim Macrae: As an equipment purchase. If you could maybe just walk through that just real quick.

Marie Legaspi: Yes. If you can look at, let us see, slide 12. Those are the various circumstances that you can - various options for you to pick a site for your mobile unit. So you can look over slide 12 and there are your options there for the site.

(Patrice Taylor): Okay.

Marie Legaspi: Yes, it is - you can add it under the CIP.

Woman: And just remember, all mobile - all mobile units that are equipped to provide care, dental or medical, are considered sites under your scope of projects.

(Patrice Taylor): Okay. And then I just have one more quick one. You said construction and architectural stuff has to be bid. What about renovation type things?

Jim Macrae: Yes.

Marie Legaspi: Sure.

(Patrice Taylor): Okay so that has to be bid too.

Woman: Everything has to be bid in accordance with the HHS administrative requirements requiring bidding of contracts goods and services. I encourage you to review all of the 45 CFR Part 74 in terms of how this applies to these efforts and your health center’s grant in general.

(Patrice Taylor): Okay, thank...

Jim Macrae: And I think we said we would try to find the specific citations just to give people sort of - I think somebody was mentioning it was 300 pages or something. So we will try to identify those specific places where it is located. But we will just highlight some.

That does not mean you shouldn’t at your leisure, maybe at night when you have problems falling asleep read all the guidance. But no seriously, we will get you the references to that specific because that really is a key piece of work not just for this particular project but actually for all health center work.

And it is a key piece in terms of Federal grant rules, OMB requirements, and we would just encourage you to review that and if you haven’t been doing it, please do so now and into the future. But we will try to get you the specific citations so you can have that.

(Patrice Taylor): Okay thank you.

Jim Macrae: Sure.

Coordinator: Our next question (Audrey Carver) you may ask your question.

(Audrey Carver): Thank you. Hi. I am calling for clarification on project type. We are not going to put in an EHR, but we are looking to put in a practice management system, as well as to build the infrastructure to support that system, and other applications such as accounting, HR, (Ron White) etcetera throughout the network. So I am not clear if the projects are IT equipment or HIT or both.

Jim Macrae: IT.

(Audrey Carver): All of them are IT. The purchase of the practice management and the building of the infrastructure to run the existing applications with the computers, the servers is all going to go under IT equipment.

Jim Macrae: That is correct.

(Audrey Carver): Thank you so much.

Jim Macrae: Yes.

(Audrey Carver): Bye.

Coordinator: Our next question (Debra Reynolds) your line is open.

(Debra Reynolds): Hi. Thank you. I am just looking for clarification. We are part of a collaborative project to - of ten other clinics to implement an EHR. It is on a staggered schedule. And so our clinics are not scheduled until the end of 2009.

So with regard to the planning project time and implementation, I am unclear when to say we - I mean should we stay we started because we essentially started five years ago either in the planning and the review phase and going out and finding the product.

Hello?

Jim Macrae: No it is a good question. We are...

(Debra Reynolds): So I mean, so we are beyond readiness but we have not purchased - and we have purchased some equipment but not the electronic health record part. We have upgraded our servers and things like that. So I am sort of right in between. We can demonstrate readiness and we have already done all that.

We have already gone through the choosing of a certified system and - so we have already done our due diligence and we are kind of - we are kind of the special people in the middle.

Jim Macrae: No, and did you - you mentioned a network. Did you do that through a HRSA funded network or...

(Debra Reynolds): Yes. Yes it was. We are the Redwood Community Health Coalition.

Woman: Oh.

(Debra Reynolds): And we are ten clinics in the four county area in the Bay area. So, but we - of course the health line has not purchased our part of the EHR equipment and that is what we would use this grant for.

Woman: As long as you are - you are not supplanting funds that have already been given to the...

((Crosstalk))

(Debra Reynolds): No we are not.

Woman: Then that would be allowable. Just work with your network to make sure...

(Debra Reynolds): Okay.

Woman: ...funds are allocated clearly.

(Debra Reynolds): Right. Okay. So but with regard to planning project timelines, do I just pick up where we would use this specific pot of money or...

Woman: Yes.

(Debra Reynolds): ...or the project in totality.

Woman: Just specific pot.

(Debra Reynolds): Okay thank you. Thank you so much.

Jim Macrae: Okay. And I think within your application you could reference that you have done this as part of your description of what you are proposing to do. I think that would be helpful just for the reviewers to know up front.

(Debra Reynolds): Okay. Okay great.

Jim Macrae: Sure.

(Debra Reynolds): Thank you so much.

Jim Macrae: Yes.

Coordinator: Our next question (Amy Duggan) you may ask your question.

(Amy Duggan): We were wondering if physical therapy equipment and optometry equipment are allowable if those are services that are included in our scope?

Jim Macrae: Yes they are.

(Amy Duggan): Okay thank you.

Jim Macrae: Sure.

Coordinator: Our next question (Mary Jean) your line is open.

(Mary Jean): Yes. I have two questions. One is on the bottom of slide 20, you talk about the obligation beyond 25% of the approved budget. And I did not understand what you meant there.

Jim Macrae: Yes. Basically when you propose a project to us, if after you receive the award you need to make some change in terms of that project, the basic grant threshold is that if any change in scope that is $250,000 or greater than 25% whichever is less, you need to come in with a formal change in scope request to us.

(Mary Jean): Okay that is fine. Now I understand. I just did not understand that to be a change in scope.

Jim Macrae: Right. That...

(Mary Jean): Second question actually goes back to the EHR sort of network thing because we also are part of a network acquiring EHR services. Funds have been raised separately for the purchase of EHR system itself and some of the equipment.

We will be buying additional equipment, but there is also the training of our staff and the time that we will give up in clinic to train our staff on the EHR system. Is that an allowable expense? I mean it is not really operating because we are not delivering services.

We will be pulling people out of clinic to train them for the CHR which will happen sometime probably September.

Jim Macrae: We can pay for training. This may be one where we - this will probably need a little bit more information just to understand it because it - on the surface we would say yes, but I think we need a little more information.

(Mary Jean): Okay because we would not be, in this case, paying the trainer. We would be diverting our staff from operating activities. But we can certainly send in a question related to this.

Jim Macrae: Yes because some folks have asked actually can they bring another staff person on board to deal with some loss in terms of the training aspect. So we need to - we can work through this with you. This is actually one the Qs & As that we have got around how to you account for even jobs and that aspect. So why don’t you shoot an email to us and we will work with you on that.

(Mary Jean): Okay great. Thank you.

Jim Macrae: Our next question (Ron) your line is open. Please check your mute button.

(Ron): I am not sure if this is me.

Coordinator: Sir your line is open.

Jim Macrae: It is you.

(Ron): Yes great. I have an EHR related question. We have an EHR that we have implemented in our mental health operations of our FQHC. And that we are pretty clear on.

We have not implemented an EHR for our primary care part of the operations. And so we are wondering if that would be too distinct EHR projects.

Jim Macrae: The first one would actually be...

(Ron): We are adding a module to our fir - we are adding some additional capabilities to our first one, but we have not really started on that project for primary care.

Jim Macrae: Well the primary care one would definitely be an EHR. The mental health one I think we would treat that, since it is not certified as...

(Ron): Oh no it is. It absolutely is certified.

Jim Macrae: Well I think what we would say is that one probably should probably be an IT - HIT.

Marie Legaspi: If it is a certified EHR indeed by...

((Crosstalk))

(Ron): It absolutely is. It is a CTS certified program.

Marie Legaspi: Okay. If it is certified, then that would be an EHR as well. I think if you have two distinct separate EHRs that you are working with, then it would be proposed as...

(Ron): It may in fact be the same EHR and that is what we need to explore is whether the program that we have partially deployed for mental health will actually meet our primary care needs. So in terms of EHR readiness, on the mental health side we are much farther down the path. On the primary care side, we need to know whether that would be a separate project because we are at a different point and we need to determine whether or not the EHR we have deployed for mental health will meet our primary care needs.

Marie Legaspi: Since you are at two different degrees of readiness, I would say propose that as two separate EHR projects.

(Ron): Okay terrific. Thanks so much.

Jim Macrae: Let me - let us just reference that. Why don’t you submit it as - the medical part, do that as one EHR project and then for the mental health piece, I would include that as an HIT project at this point.

If it ends up that, you know, through your consultation and your work that you are going to roll it all into the one EHR project, then you can just submit it as one. But if you really are at different points, then it is unclear about how this might integrate, why don’t you do the medical part as an EHR and then the mental health aspect as an HIT project.

(Ron): Okay terrific. Thanks. (Bye).

Jim Macrae: Good question - complicated, but good question.

Coordinator: Our next question (Lisa Stevens) your line is open.

(Lisa Stevens): We have already purchased an electronic health record system, but we are looking to purchase an electronic dental record, which I understand would be categorized as an HIT purchase. My question is does the electronic dental record have to be CCHIT certified like the EHR?

Jim Macrae: Right now there is no certification for dental EHRs.

(Lisa Stevens): Okay.

Jim Macrae: So no it would not need to apply under that criteria.

(Lisa Stevens): Okay great. Thank you.

Jim Macrae: Yes.

Coordinator: (Lisa Carroll) you may ask your question.

(Lisa Carroll): Hi good afternoon. Just a quick clarification on something that was asked or stated earlier, I want to make sure that I understood that all equipment projects, whether they are a separate site, dental, medical equipment are all going to be one project. Correct?

Jim Macrae: Say that one more time because we were just - make sure we got it right.

(Lisa Carroll): Okay. We have several equipment purchases that we would like to make.

Jim Macrae: yes.

(Lisa Carroll): We have dental, medical equipment. We are just adding another site. We need to outfit that and also replace some of the equipment over here that we are moving over there. Is that all under one project or do I need to have separate project applications under equipment for those three?

Jim Macrae: Well if you are proposing a new site...

Woman: Hmm.

Jim Macrae: ...you can include equipment as part of that new site. But if it is equipment across all of your existing sites, you can do that as one project.

(Lisa Carroll): Okay.

Jim Macrae: So I guess the question is, the new site, if you are doing any construction or repair renovation, you can include the equipment. If you are just adding a new site, you could do it all under equipment.

Woman: Um-hmm.

Woman: Okay.

Jim Macrae: Is that right?

(Lisa Carroll): Okay. Thank you very much.

Coordinator: (Len Onyanis) you may ask your question.

(Len Onyanis): Yes good afternoon. We are planning on purchasing a new phone system for two of our approved sites. Is the support cost associated with the phone system is that an allowable cost under this program?

Hello?

Woman: I couldn’t quite hear you. Can you say what it is you want to propose again? I am sorry.

(Len Onyanis): Right. We are buying a new phone system. And as part of the phone system, we would be buying a support contract to main - if any - in case any equipment breaks or, you know, or I guess, yes, any equipment breaks or does not work we would, you know, we would be covered. Is the support part of that an allowable cost?

Woman: Absolutely.

Jim Macrae: Yes. And just - the only thing that I would reemphasize is that this is for two years. So after that period, you need to be able to pick that up with your own resources.

(Len Onyanis): Okay I understand. And then a follow up with - along the same lines, we are also going to be re-cabling our one building. We are going to be re-cabling it to support the phone system and we are also going to install new cabling in a new facility. Is network cabling also allowed?

Jim Macrae: It is. I think the question is, would it constitute major renovation or repair to your facility.

(Len Onyanis): In one site it would. In the new site it would. In the existing site I am not sure because we currently have an infrastructure. We are just adding new cabling to support this phone system because we - technically we have to.

Jim Macrae: Well if it will not constitute major renovation, then you can just include that as part of IT equipment. If it will constitute renovation, then you should include that as part of a renovation project.

(Len Onyanis): Okay. Okay. Thank you very much.

Jim Macrae: But the bottom line is it is allowable. Yes.

(Len Onyanis): Okay. Okay. Thank you.

Jim Macrae: Yes.

Coordinator: Our next question Gwen Williams your line is open.

Gwen Williams: Thank you. Do we know how much money is likely to be coming in the Facility Investment Program Grants or how many grants those are likely to be?

Jim Macrae: Generally speaking, we are anticipating anywhere between $500 and $525 million for the Facility Investment Program. We do not have per se the exact number, but we are estimating that around 100 projects may be supported with an average award size of between $5 and $6 million.

Gwen Williams: Thank you.

Jim Macrae: But as I have said to many folks on many previous calls, that is where we are right now. Nothing is final until the guidance comes out. And sometimes, as you all may have seen the email, we sometimes have to update after the guidance gets out that first time. But that is where we are right now.

Gwen Williams: Okay. Thanks much.

Jim Macrae: Sure.

Coordinator: Our next question Marta Silverberg your line is open.

Marta Silverberg: Yes. Hi. My question is you look at a slide 9 and 10, we do have a practice management system that needs upgrade in order to accommodate the UDS that we need to report. We are new - brand new funded. And but we use it - the all the servers are in Texas and we, you know, we do not have the servers here in our facility.

We subscribe to this company for our practice management. If that upgrade, based on the slides that say (License and Intellectual) Property Upgrades, would that fall into that category?

Jim Macrae: It would be an IT purchase.

Marta Silverberg: Yes. IT only purchase. That is what I wanted to make sure that that falls into that category.

Jim Macrae: No, no, absolutely.

Marta Silverberg: Okay. Thank you very much.

Jim Macrae: Sure.

Coordinator: Our next question (Shana Kline) your line is open.

(Shana Kline): Hi. I had a question in regards to what category we should be applying for what we are going to be asking for. We currently have an electronic practice management system and we are going to be starting the medical record piece of it in the next month.

And we currently have an ASP model so we are not purchasing the actual system, we just pay monthly for it. And I did not know if that would fall under the EHR piece or IT.

Jim Macrae: You should apply for that under the EHR.

(Shana Kline): Okay. All right. That was my only question.

Jim Macrae: Thanks.

(Shana Kline): All right.

Coordinator: Our next question (Victoria) your line is open.

(Victoria Derrick): Is that (Victoria Derrick)?

Coordinator: Yes. Your line is open.

(Victoria Derrick): Okay sorry. From the call I have understood that the equipment line we could allow us to purchase a vehicle. Is that correct?

Jim Macrae: Yes, within reason.

(Victoria Derrick): What is within reason?

Woman: You are not going to purchase anything that a reasonable person would not buy, meaning that it fits your needs. It is an economical vehicle. It is not a Cadillac or a BMW.

(Victoria Derrick): Right.

Woman: Who else could we - that we know somebody tried to use our grant funds for. It has to meet the test of reasonableness just like every other cost that you incur.

(Victoria Derrick): Right. So like a clinic van to transport patients within our very large service area would account - would be reasonable.

Jim Macrae: That would be reasonable, yes.

(Victoria Derrick): Okay.

Woman: The van that you - the type of van you purchase needs to be reasonable.

(Victoria Derrick): Okay. No, I understand that. No, I understand that.

Jim Macrae: And we are not - just so we are very clear - we are not saying against any particular brands, it is more the high end luxury - so that could be any manufacturer. It is not any particular brand.

(Victoria Derrick): Right.

Jim Macrae: It is whatever is reasonable in terms...

(Victoria Derrick): Yes.

Jim Macrae: ...of what you...

((Crosstalk))

(Victoria Derrick): Well I completely understand that. And can I ask a very silly question? Would we be allowed - would the CIP funds cover the insurance costs for a van for two years?

Jim Macrae: Yes they would.

(Victoria Derrick): Ooo.

Jim Macrae: But just realize that that cost is not ongoing.

(Victoria Derrick): No I understand that. Okay thank you very much.

Jim Macrae: Yes.

Coordinator: Our next question (Brenda Baumer) you may ask your question.

(Brenda Baumer): Good afternoon. We are - I am another one trying to get my projects sorted out here. We are proposing multiple projects. One is a renovation of existing space to expand our dental department and one is an equipment only project.

We would like to add a dental EMR. We already have a medical EMR. Should this be a standalone HIT project or should it be combined with the dental department renovation?

Jim Macrae: Actually you could combine with the dental piece, the dental aspect of that, the dental EHR. That would be considered part of the equipment for that.

Marie Legaspi: As long as it is at the same site.

(Brenda Baumer): Right. It would be at the same site. So it could be combined with the renovation of the dental department?

Jim Macrae: Yes.

(Brenda Baumer): Okay. Thank you very much.

Jim Macrae: Sure.

Coordinator: Our next question, (Joanna Griffin) your line is open.

Soyla Griffen: Hi. No. I am sorry. This is Soyla Griffen. I did - I have two questions. I know for certain that we cannot include any equipment cost that were purchased prior to February 17. But I heard you say or I heard somebody say that that cost between - costs after Feburary the 5th, 17th were not allowable for equipment. Did I hear you correctly or did my phone just have a little blip there?

Jim Macrae: Your phone may have had a little blip...

Soyla Griffen: Okay.

Jim Macrae: ...but let me just add to that blip. Basically they may be allowable. And so it depends. It needs to meet the requirements of the application guidance. It ultimately has to get approval. So we do not want anybody to, you know, start purchasing things right now until awards are made because that would be at your own risk.

But are costs that were incurred after February the 17th, 2009 potentially eligible? Yes. If they fit the basic requirements and they ultimately get approval from us.

Soyla Griffen: And I do have another question and I wanted to ask this the other day and I did not - was not - did not make it in time. But we have a building, our Admin building, and we have a courtyard in the middle of our building. And so what we want to do is enclose that and put a roof over it and a foundation and all.

So technically that is additional - I believe it is additional square footage, but would you consider that additional square footage since the surrounding building is already there?

Woman: Okay.

Woman: That would be a construction versus renovation question.

Jim Macrae: We would consider it construction because it is creating new square footage so yes, you are correct.

Soyla Griffen: Okay. But for this particular application, then that - I would just have to fill out a checklist though, the environmental checklist then correct for that?

Jim Macrae: Yes. There is actually two types of checklists. There is the one that is standard across.

Soyla Griffen: Right.

Jim Macrae: And then there is the one specifically for construction projects.

Soyla Griffen: Okay.

Jim Macrae: And in your case, you know, if you initially put it in as renovation, we would likely come back to you and ask you to fill it out anyway giving that it is covering and filling in space that previously had not served as usable space...

Soyla Griffen: Okay.

Jim Macrae: ...services. So.

Soyla Griffen: That makes sense to me. Thank you.

Woman: If I could...

Jim Macrae: Yes, go ahead.

Woman: ...add one element. If in that project you are adding all that new square feet to your building and as a consequence you will now be providing direct health services at that location?

Soyla Griffen: No. It is just - it is really to accommodate new Admin staff because we have been growing over the past year. So it is just to accommodate new Admin staff.

Woman: Okay great because otherwise you would have to add that site as a service delivery site...

((Crosstalk))

Woman: ...have a project but you can leave it as Admin only.

Soyla Griffen: Yes it is Admin only. Thank you.

Woman: Um-hmm.

Coordinator: Our next question (Toby Johnson) you may ask your question.

(Toby Johnson): Hi thank you. I have a question. We have - currently lease a data center facility where most of our equipment lives. Does that need to be added as a service delivery site - equipment only?

Woman: No.

Jim Macrae: No it does not.

(Toby Johnson): Thank you.

Coordinator: Our next question Tracy Rehm you may ask your question.

Tracy Rehm: Hi. I wanted to get clarification on incurred costs and exactly what that means. I can understand that it would be anything that was done and paid for before 2/17. But from an accounting standpoint, are we talking about an accrual basis so we had the work done before but we didn’t pay for it until after 2/17? Would that be eligible?

Jim Macrae: No it would not because you have created an obligation...

Tracy Rehm: Okay.

Jim Macrae: ...even though you have not sent the money, you still have created an obligation.

Tracy Rehm: Okay. And so it is really you incurred the costs after 2/17...

Woman: You obligate...

Tracy Rehm : ...and the work then gets done.

Woman: Okay.

Tracy Rehm: It is the same as obligating, but it is after.

Woman: You cannot pay - cover any costs that were obligated prior to 2/17.

Tracy Rehm: Okay.

Woman: I do not care when the bill comes in. If they were obligated and you signed a contract or you made a...

Tracy Rehm: The work was done.

Woman: ...purchase order...

Tracy Rehm: Um-hmm.

Woman: ...you cannot cover it with these funds.

Tracy Rehm: Okay great. Thank you.

Jim Macrae: Sure.

Coordinator: Our next question (Melissa) you may ask your question.

(Melissa): Yes. I actually have two questions. My first one is we are looking at purchasing some software that will assist us with reporting, but it will pull the information out of our EHR. So I was wondering if that was really an EHR project or if that is more of an HIT project?

Jim Macrae: We would say that that would be HIT since you are not purchasing an EHR at this - a system that will just pull information from that EHR...

(Melissa): Okay.

Jim Macrae: ...if that is correct. If it is actually to build something onto the EHR, then we would say submit it as an EHR project.

(Melissa): Okay great. My second I guess has to - it is another one of these architectural drawings. We are in the process - we are still in the planning stages. We started about four months ago and we are interviewing architects now to help us with site selection and planning the new building.

We have not secured any funding yet. So I just want to clarify if we are able to use these funds to help plan that building or not.

Jim Macrae: No, that would not be eligible unfortunately. What we, you know, this is the opportunity to complete projects within the two year timeframe. So if you have resources secured, it could be part of that cost, or if you have other resources, it could be part of a larger project.

But if it is just to plan something that is not secured yet no these would not go for that purchase.

(Melissa): Okay great. Thank you.

Jim Macrae: Sure.

Coordinator: (Judy McNaught) your line is open.

(Judy McNaught): Hi. I have a list of equipment that I want to buy with this funding. A group of it is to get ready for our EHR. The actual EHR is being bought by the network that we are dealing with.

Some of my equipment is for upgrading computers just in the - your basic Microsoft Office 2007. And then the third part is to buy Medicaider and the monthly fee that it costs us for Medicaider. Is that three different projects or is that one project that has three different types?

Jim Macrae: That was - we may need you to send that one in just so we fully understand it because I think you have raised a lot of different pieces and we just - why don’t - if you could send that into us then we will work with you because I, you know, like I said, our goal is to not have you apply multiple times if you do not have to. So...

(Judy McNaught): Right.

Jim Macrae: ...why don’t you send that into us and we will work with you to figure out where it fits the best.

(Judy McNaught): Okay great.

Coordinator: Our next question (Rick Boziek) your line is open.

(Rick Boziek): Hi. Two questions. First of all, the first one deals with line items. We are looking at acquiring an EHR system. The EHR will probably be made up of a couple servers that would be over $5000, but it would also be made up of a lot of small items or items that are under $5000. Should those be split out as equipment and as supplies and others based on it or is it the total cost?

Marie Legaspi: Um.

(Rick Boziek): For the EHR system.

Marie Legaspi: Yes. You will be splitting those equipment that are over $5000 on line 10 and anything that is - that has a useful life of more than a year but generally do not have an acquisition cost greater than $5000 would be listed in line 11.

(Rick Boziek): Okay thank you. And my second question is...

Marie Legaspi: For the same project.

(Rick Boziek): ...we are also looking at updating our IT system and we are going to buy equipment for it but we will also need somebody to - a contractor to set it up. The cost of the contract would go under - would that go under equipment or would we need to put in - put it in an alterations budget?

Jim Macrae: Generally it would go under equipment, the IT portion. But if it would entail major renovation to your facility, then it would be a renovation project and you could include the equipment as part of that.

(Rick Boziek): Okay. Thank you very much.

Jim Macrae: Sure.

Coordinator: Our next question (Alisha Majeska) you may ask your question.

(Alisha Majeska): Thank you. Good afternoon. We have viewed a number of demos air electronic health records. And during that process, we determined that it was best that we joined a network because we would not be able to support an air electronic health record on our own.

We have spoken to several networks and have made a decision. My question is do we still need to go through a bidding or (RSP) process?

Jim Macrae: Is this a HRSA funded network?

(Alisha Majeska): You know, I am not sure. I think that they have received HRSA funds in the past or HRSA grants.

Woman: I mean as far as I know, the network has already gone through the Federal procurement rules around, you know, needing to get a number of bidders.

(Alisha Majeska): Um-hmm.

Woman: And so, by going with that network, as far as I know, there is no additional procurement process required to networks. I mean, we will...

Jim Macrae: But...

Woman: ...we can definitely...

Jim Macrae: ...why don’t you...

Woman: ...do a follow up but...

Jim Macrae: I was going to say why don’t you send that question. That is a good question. And we will not only answer your specific one but we will put out a frequently asked question with respect to this because I think it involves a couple of different pieces in terms of how it is just looked at from the grant’s perspective in terms of 45 CFR, whether - if a network is done and you contract with them whether you have to then do it in terms of getting with that network as I understand. So we will get back to you on that one.

(Alisha Majeska): Okay great. So I should just email the question in?

Jim Macrae: Yes please.

(Alisha Majeska): All right, thank you.

Coordinator: Our next question (Susan Calson) you may ask your question.

(Susan Calson): Yes. I actually have two different questions. The first touches on something that was asked earlier. We have an existing certified EHR. And I wanted to know - I understand that we can use some of this funding for additional licenses. But can we also use it for additional training?

Jim Macrae: Yes, although that was one of the questions that was asked and we are going to put out specific guidance around that just to give people...

(Susan Calson): Okay.

Jim Macrae: ...a little more information on that (aspect).

(Susan Calson): Okay. My other questions is about the purchase of a mobile unit.

Jim Macrae: Yes.

(Susan Calson): And I understand that we apply for the change in site through this process. If we want to use our unit to go someplace outside of our existing service area, what do we have to do? How do we show need? What do we do through this application or is there another process?

Woman: You would do that through this process because essentially you have to complete a change in scope request...

(Susan Calson): Okay.

Woman: ...in order to add that. And so the discussion of your service area and the extension of your service area using this mobile unit...

(Susan Calson): Um-hmm.

Woman: ...I would encourage you to consider whether or not the expansion of your service area will be moving you into an area that is already serviced by another health center or potentially served by another health center...

(Susan Calson): Um-hmm.

Woman: ...and certainly reaching out to them...

(Susan Calson): Right.

Woman: ...and getting letters of support or other documentation from them and including that as part of your application will help to facilitate the process.

(Susan Calson): Okay. So we would include those letters of support with this application.

Woman: Yes please.

(Susan Calson): Okay. Thank you very much.

Jim Macrae: All right. I think we have time for probably two more questions.

Coordinator: Our next question (John Leary) your line is open. I am sorry, (Mike Leary).

(Mike Leary): Thank you. I apologize if this was already answered because I had to step out for a fire drill. But on slide 7 and some other places, there was reference to significant installations. And I am thinking in the context of particularly IT or HIT what does significant installation mean? Is there a dollar amount associated with the labor for installation or, you know, what is the rule of thumb around that?

Jim Macrae: We do not have per se a rule of thumb. What we have said generally to this question is that if there will be significant alterations to your facility or, you know, people being displaced for a significant period of time, meaning more than one day, those sort of things, that is considered a renovation.

But if it is simply, you know, running lines through the building or something like that that will take minimal amount of amount and minimal disruption, that is not considered an alteration or a renovation.

(Mike Leary): Okay. Then on - one question on mobile units, considering a van, mobile unit van, there is talk that there is - it has been noted that these would be new sites. Is a scope change request required to be approved before the funds could be released for that?

Jim Macrae: I think it depends on - well first of all, you can submit that and click on the Added New Site as part of the application.

((Crosstalk))

Jim Macrae: And then I think the question is sort of goes back to the person that just asked - if it is going outside of your current service area...

(Mike Leary): Okay.

Jim Macrae: ...then yes you would need to get approval to be able to provide services outside of your current service area. However if it is within your service area, it will just be addressed through the Add A Site function in this application.

(Mike Leary): Okay. And very quickly, what about affiliated centers or sub-grantees that are not - whose sites are not owned or controlled by the grantee, are they eligible for use of these funds?

Woman: As - the sub-recipients are not directly eligible for any funding to the extent that the grantee of record, the health center - that the grantee of record chooses to use of its funds at locations that are sub-recipient locations, the expectations that are - for any of the health center sites would apply.

So in terms of maintaining site control with leases, environmental assessment, all of the other factors would be necessary and required if the funds are going to be used to support a site that is one of the sub-recipient sites.

(Mike Leary): Thank you.

Jim Macrae: Okay. I think we have time for one last question.

Coordinator: Our last question comes from (Pat Dubois). You may ask your question.

(Pat Dubois): Hi. We are just still trying to sort through which project goes in which area. And I think I have gotten most of them straightened out. But we are looking to purchase a couple dental laboratories and some radiology equipment for one of our existing sites. Does that count as equipment only or do we have to put that under the ARR even if all - even if we are just asking for the equipment costs?

Marie Legaspi: But will those equipment be installed?

(Pat Dubois): Yes they will.

Marie Legaspi: Yes. So then that will need to be an alteration, repair and renovation project.

(Pat Dubois): Okay.

Marie Legaspi: And so unfortunately if you are going to be installing those equipment over different sites, unfortunately you will need to be submitting separate alteration, repair and renovation projects because those are site specific.

(Pat Dubois): Okay. No. It is all going - all the equipment is going in one site.

Marie Legaspi: Okay. So you will need to - you can include all of that...

(Pat Dubois): Okay.

Marie Legaspi: ...in one project.

(Pat Dubois): Okay. And just another quick question - what is the difference between the ARR and construction?

Marie Legaspi: Construction is if you are increasing your usable square footage.

(Pat Dubois): Okay. Okay. All right, that is what I needed. Thank you.

Jim Macrae: Thank you. And a big thanks to everybody for participating on today’s call, especially my colleagues around the table who very ably helped answer many of your questions.

If you did not have the opportunity to get your question asked today, please do not hesitate to send those in to bphcrecovery@hrsa.gov. In addition we would just encourage you again to go to our Web site where the guidance is available.

A set of frequently asked questions, as well as the slides from today’s presentation, as well as all the presentations from this week, we would definitely encourage you all to take a look at that because there is a lot of information available and hopefully we will answer most of if not hopefully all of your questions that you may have.

But please do not hesitate to contact us. That is what we are here for. In addition, at the end of this slide presentation, there were folks that you can contact with respect to program questions, folks you can contact with respect to grants questions, and then finally folks once you get into the actual application EHB portion of this that you can ask questions when you are submitting your application.

This is a very exciting time and very exciting opportunity for health centers. And we are committed to making sure that we are all successful and we look forward to continuing our dialogue and discussion and we look forward to those applications coming in June 2 or earlier. I would encourage folks earlier would be great, but we also understand that there is a lot to do between now and then.

So we wish you all the best and we wish you a great weekend as well as for people who are mothers, a Happy Mother’s Day, and for people who have mothers which I think is everybody, Happy Mother’s Day too.

So thanks everybody. Have a great weekend.

Coordinator: Mr. Macrae? Mr. Macrae? Ma’am? Is there anyone on line?

END