IOWA DEPARTMENT OF PUBLIC HEALTH EMERGENCY MEDICAL SERVICES (EMS) SYSTEM DEVELOPMENT GRANT

Transcription

1 IOWA DEPARTMENT OF PUBLIC HEALTH EMERGENCY MEDICAL SERVICES (EMS) SYSTEM DEVELOPMENT GRANT APPLICATION INSTRUCTIONS AND APPLICATION FORMS FOR CONTRACT YEAR OF: SEPTEMBER 1, 2013 TO JUNE 30, 2014 Application Due Date: By 4:00 PM (local Iowa time) on August 15, 2013 Applications that are not RECEIVED by 4:00 PM on August 15, 2013, will not be eligible for funding for the period of September 1, 2013, through June 30, 2014.

2 INTRODUCTION The Iowa Code and Iowa Administrative Code sections regarding the Iowa Department of Public Health (DEPARTMENT) EMS System Development Grants require the DEPARTMENT to contract with county boards of supervisors or county boards of health (CONTRACTOR) for this program. ELIGIBLE APPLICANTS County boards of supervisors and county boards of health are eligible to apply for EMS system development funding at the regional, county, and local level for the period of September 1, 2013 through June 30, Only one application per each of Iowa s 99 counties, by either the county board of supervisors or county board of health, will be accepted. Funding Sources For the program period September 1, 2013 to June 30, 2014 the EMS System Development Grants contracts will be funded from state general funds. The issuance of this application in no way constitutes a commitment by IDPH to award a contract. Actual total awards and individual contract funding levels may vary from that listed or funding may be withdrawn completely, depending on availability of funding. Projected Funding Applicants may apply for up to the minimum dollar amount allocated per county for the total 10 month contract period. IDPH anticipates a minimum of $500,000 to be available for approximately ninety-nine (99) awards. Appendix 2: EMS System Development Grants Projected Funding by County of this application packet shows the funds that are projected to be available for each county if all 99 counties are funded. If fewer than 99 counties are funded, the unobligated funds will be redistributed to the counties that receive a contract. APPLICATION PROCESS Technical Requirements: These instructions prescribe the format, content, and submission criteria for this application. A. Application documents must be submitted in a single zipped file (preferred) or single PDF file format, no larger than 20 MB, and ed to applications@idph.iowa.gov per the instructions outlined below. Shortcuts or links to proposal documents will not be accepted and shall result in document rejection, which may result in rejection of the proposal. B. Applications must be typewritten and follow the format delineated herein. Aspect Requirement Format Length Font size Documents must be created in MS Office Word or Excel. MS Office format is the minimum product accepted. Not applicable. Proposal must be in a minimum of 12 point font. A smaller font may be used only for tables, figures or maps.

3 Margins Spacing Header or Footer and Pagination Signatures on Cover Page Minority Impact Statement Proposal content Required forms contain preset margins which may not be changed. May be single or double-spaced. Insert a header or footer that identifies the applicant name and page number. All pages are to be sequentially numbered (1, 2, 3 ) inclusive of all documents at the bottom or top of each page. The cover page (Attachment A) must be complete and contain at a minimum; electronic signature by an individual authorized to obligate the applicant agency, and key personnel of applicant agency along with their contact information. The minority impact statement (Attachment B) must be complete and contain an electronic signature by an individual authorized by the applicant agency. Failure to adhere to prescribed instructions, technical requirements, format, or application content may result in disqualification (rejection) of the application. C. Do not submit promotional materials. Promotional materials or items other than required by this application will not be considered during the review process. D. Any information or materials submitted separately from the application will not be considered in the review process. APPLICATION CONTENT Cover Page: Complete the required form (Attachment A) following these instructions: Applicant Information County Board of Supervisors or County Board of Health Name - Provide the legal name of the applicant entity. This must be the entity associated with the Federal Identification (ID) number per the Internal Revenue Service (IRS). Insert the agency s Federal Tax Identification Number per the Internal Revenue Service (IRS). Provide the Board s mailing address, city, state, and zip code. Provide the Board s telephone number. Provide the Board s FAX number. Provide an address for the Board. Provide the Board Chairperson s name. Total Dollar Amount Requested Indicate the total amount of grant funds requested, not to exceed the amount indicated for the county in Appendix 2: EMS System Development Grants Projected Funding by County Key Personnel Contact Information Program Administrator - Provide the name, telephone number, and address for the person who will have overall responsibility for administering the program(s) in which the grant funds the Board is applying for will be utilized. 1

4 Fiscal Director Provide the name, telephone number, and address for the person with overall responsibility and authority for financial management for this program. County EMS Association Lead - Provide the name, telephone number, and address for the person who represents the County s EMS Association. Other Key Personnel Provide the name, title, telephone number, and address for any other persons who will have a key role not listed above. EMS Services Represented Provide the EMS Service name and city of operation for all EMS Services that will be represented by this application. EMS Systems Standards Self-Assessment Indicate the county s status on completion and posting of the Iowa EMS Systems Self- Assessment by checking the appropriate statement. Conditions & Signature Type or print the name of the individual authorized to execute legal documents on behalf of the County s Board. Insert a signature of the individual authorized to execute legal documents on behalf of the County s Board to certify that the applicant is in agreement with the conditions listed and all information submitted within the application. Minority Impact Statement: Identifies the applicant s potential impact of the project s proposed programs or policies on minority groups. Complete the required form (Attachment B) following these instructions: Applicants must independently complete the Minority Impact Statement form by checking the box that most accurately reflects the proposed project programs or policies impact on minority persons. Describe the rationale or evidence for your choice in a brief narrative, as well as identifying the specific minority groups in which there is a positive or negative impact (if applicable) on the checklist. Insert an electronic signature of a person authorized to execute legal documents on behalf of the County s Board and return with the application. Workplan and Budget Form: The required workplan and budget form (Attachment C) should be completed based on whether the applicant has or does not have a completed Iowa EMS System Standards Self-Assessment posted in an IDPH SharePoint Service Contract site prior to July 1, Note: If your County EMS Association has previously completed an Iowa EMS System Standards Self-Assessment that has been posted to the County s EMS Association SharePoint grant site, a copy of the completed Self-Assessment will be uploaded to the applicant Board of Supervisors or Local Board of Health SharePoint site once a contract has been executed. Please contact Stephen Poole at Stephen.Poole@idph.iowa.gov for assistance with this upload. For applicant with a completed Iowa EMS System Standards Self-Assessment posted in an IDPH SharePoint Service Contract site before July 1, the applicant will create a workplan using the Iowa EMS Standards Workplan and Budget (Attachment C) listing planned steps or activities to be undertaken during the contract period of September 1, 2013 through June 30, 2014 to demonstrate the development, or enhancement, or implementation, of one (1) or more Standard(s) with a status other 2

5 than completed as listed in their posted Self-Assessment. Applicants will also document estimated expenses with justifications associated with each listed step or activity in the budget column. For applicant without a completed Iowa EMS System Standards Self-Assessment posted in an IDPH SharePoint Service Contract site before July 1, Utilizing the September, 2010 Iowa EMS System Standards document, posted on the Bureau of EMS website the applicant will create a workplan using the Iowa EMS Standards Workplan and Budget (Attachment C) listing planned steps or activities to demonstrate the development, or enhancement, or implementation, or sustainment of identified System Standards within this contract period. Applicants will select, at a minimum, one (1) of the five identified Standards listed below: Iowa EMS System Standard 1.06 System Administration: Advanced Life Support (ALS) o Minimum Standard: The EMS system shall have a provision for ALS care. Iowa EMS System Standard 2.01 Staffing: Assessment of Needs o Minimum Standard: The EMS system shall, at least annually, assess and provide for staffing and training needs. Iowa EMS System Standard 4.03 Response and Transportation: Contingency Response/Mutual Aid o Minimum Standard: The EMS system shall have contingency plans and assure the development of mutual aid agreements to provide for emergent and non-emergent response during increased system volume. Iowa EMS System Standard 4.05 Response & Transportation: Air Medical Services o Minimum Standard: The EMS system shall have a process for identifying specialty air-medical transport services and shall develop policies and procedures regarding: Requesting of air-medical service Determination of patient destination Orientation of pilots and medical flight crews to the EMS system Addressing and resolving formal complaints Iowa EMS System Standard 6.01 System Evaluation: Continuous Quality Improvement Program o Minimum Standard: The EMS system shall establish an EMS CQI program to evaluate the response to emergency medical incidents and the care provided to specific patients. The program shall address the total EMS system, including all prehospital provider agencies and hospitals. It shall address compliance with policies, procedures and protocols and identification of preventable morbidity and mortality and document resolution of deficiencies found. Applicants will also document estimated expenses with justifications associated with each listed step or activity in the budget column. Use of Subcontractors: In the event of a funded proposal, proposed subcontracted services with a value of $2,000 or greater must be defined in a legal agreement, submitted to and approved by IDPH prior to signature by either party. Subcontracts must adhere to the provisions of Section 5 of the IDPH General Conditions effective January 1, 2013 Revised as posted on the IDPH Web page at under the Funding Opportunities link. Planned use of subcontractors by an applicant must be clearly explained in the proposal. This information must include: 1. The name and address of the subcontractor if known; 3

6 2. The scope of work to be performed by each subcontractor; 3. Subcontractor qualifications; and 4. The estimated dollar amount of each subcontract. Current individual employees of the State of Iowa may not act as subcontractors under this contract. The applicant is fully responsible for all work performed by subcontractors. No subcontract into which the applicant enters into with respect to performance under the contract will, in any way, relieve the applicant of any responsibility for performance of its duties. Completed Applications: Eligible applicants applying for funding from the EMS System Development Grant, for the period of September 1, 2013 to June 30, 2014, must complete and submit the following; Cover Page (Attachment A), Minority Impact Statement (Attachment B), and the Iowa EMS System Standards Workplan and Budget (Attachment C). All materials submitted as part of the application are public record. Completed applications must be received by 4:00 p.m. (local Iowa Time) on Thursday, August 15, 2013 by the IDPH SharePoint Service Contract Application Center in compliance with the following requirements: application documents as a single zipped file OR a single PDF, no larger than 20MB, to applications@idph.iowa.gov. The preferred submission is a single zipped file. The subject line of the must read EMS DEV. Do not include anything else in the subject line of the . The single zipped file or single PDF must be named EMS DEV (insert your agency name). Do not include additional information or text in the body of the as it will not be available to DEPARTMENT staff. An electronic notification of the receipt of the applicant s will be generated automatically by the IDPH SharePoint Service Contract Center. o This automated electronic notification will be sent only to the address where the submission originated. o If the notification of receipt is not received within 10 minutes of submitting the application it may indicate that the submission was not received by the IDPH SharePoint Service Contract Center. o Ensure that your local firewall and security settings will accept messages from the IDPH SharePoint Service Contract Center. Applications submitted to IDPH in any manner other than through the IDPH SharePoint Service Contract Application Center (e.g. electronic mail to any other address, faxed, hand-delivered, mailed or shipped or courier-service delivered versions) will be rejected, and not reviewed by IDPH. Any information submitted separately from the application will not be considered in the review process. IDPH will notify the applicant of the rejection. 4

7 The due date and time requirements (Thursday, August 15, 2013 by 4:00 p.m.) for receipt of the application by the IDPH SharePoint Service Contract Center are mandatory requirements and will not be subject to waiver as a minor deficiency. The date and time of submission of an application is automatically documented upon receipt by the IDPH SharePoint Service Contract Center. Applicants have the sole responsibility to ensure their application is received by the IDPH SharePoint Service Contract Center prior to the deadline. The application that is attached to the applicant s is automatically removed from the upon receipt by the server and is filed in the IDPH SharePoint Service Contract Application Center. The application is date and time stamped upon filing in the IDPH SharePoint Service Contract Application Center. The time that is automatically documented on the submitted and filed application within the IDPH SharePoint Service Contract Application Center is slightly delayed from the time the is received by the server, and is not the time that the applicant sent the . Although the delay is minimal, it may be increased when server traffic is high or other uncontrollable internet traffic circumstances, encryption issues, firewall issues, or server issues, etc. The date and time stamp by the IDPH SharePoint Service Contract Application Center shall serve as the official time of receipt of the application. It is the applicant s sole responsibility to submit ed applications in sufficient time so the application is received by the IDPH Service Contract Application Center prior to the stated due date and time. Applicants are strongly encouraged to submit ed applications as early as possible to allow sufficient time for any unforeseen issues to be resolved prior to the deadline, if they occur. Applications received by the IDPH SharePoint Service Contract Application Center after the stated due date and time will be rejected, not reviewed by the DEPARTMENT and a notice sent to the applicant. An electronic notification of receipt of the applicant s application within the IDPH SharePoint Service Contract Application Center will be generated automatically and ed to the sender of the ed application. If the electronic notification is not received within ten (10) minutes of the applicant s , please contact the SharePoint Helpdesk at to confirm delivery (available prior to 4 PM on Weekdays, excluding State Holidays). If an applicant s the application multiple times, only the last submission received by the IDPH SharePoint Service Contract Application Center prior to the stated due date and time will be accepted for review. Written Questions and Responses: Written questions related to this application must be submitted via to John McMullen at john.mcmullen@idph.iowa.gov no later than 4:00 p.m. local Iowa time on identified dates below. Questions must be submitted by electronic mail. If the question or comment pertains to a specific section of the application, the section and page must be referenced. Oral questions regarding the application will not be accepted. 5

8 The following dates are set forth for informational purposes. IDPH reserves the right to change them. Written Questions and Responses Dates Round 1 Questions Due Interim Responses Posted By: Tuesday, July 16, 2013 Friday, July 19, 2013 Round 2 Questions Due Interim Responses Posted By: Wednesday, July 24, 2013 Friday, August 2, 2013 Proposals Due Thursday, August 15, 2013 Post Notice of Intent to Award Friday, August 23, 2013 Review of Applications: IDPH staff will review each application for compliance with the mandatory requirements of application content, including technical requirements. Applications will be rejected and not reviewed by IDPH for the following reasons: If the application is received by the IDPH SharePoint Service Contract Application Center after the 4:00 p.m. Thursday, August 15, 2013 due date and time. If the application is submitted in any manner other than by to applications@idph.iowa.gov. If the application is not submitted as a single zipped file or a single PDF file. If the application does not include all required documents, information, and signatures. Notice of Intent to Award August 23, 2013: A Notice of Intent to Award the contract(s) will be posted on the IDPH Web page under Funding Opportunities link by 4:30 pm. Applicants are solely responsible for reviewing the Notice of Intent to Award to determine their award status. Contract Negotiations and Execution of the Contract: Following the posting of the Notice of Intent to Award, each successful applicant will retrieve a contract document through the IDPH SharePoint Service Contract system. The successful applicant has ten (10) working days from receipt in which to negotiate and sign a contract with IDPH. If contract has not been executed within 10 days IDPH reserves the right to cancel the award. IDPH may, at its sole discretion, extend the time period for negotiations of the contract. If an applicant chooses not to participate, or if a contract cannot be executed, the unobligated funds will be redistributed to the counties that receive a contract. There is no penalty if an eligible applicant applies and then decides after reviewing the proposed contract that it does not wish to participate in the program. Appeal of Award Decision: The posting of the Notice of Intent to Award on the IDPH Web page constitutes receipt of notification of the adverse decision per 641Iowa Administrative Code Chapter 176.8(1). Applicants may appeal the adverse decision only for a timely submitted application. The appeal shall be submitted in writing within ten business days of receipt of notification of the adverse decision. Appeals shall be submitted in writing, return receipt requested, to John McMullen, Contract Administrator, Division of Administration and Professional Licensure, Iowa Department of Public Health, Lucas State Office Building, Des Moines, Iowa Appeals must clearly and fully identify all issues being contested and demonstrate what procedures in the proposal were not followed. In the event of an appeal, the Department will continue working with the successful applicant pending the outcome of the appeal. 6

9 REQUIRED ACTIVITIES Grant recipients will be responsible for the administration of funds received in accordance with the most current version of 641 Iowa Administrative Code Chapter 140 (Appendix 1). Required activities for the contact period of September 1, 2013 through June 30, 2014 will be based on the applicant s approved workplan and budget. PERFORMANCE MEASURES A. Applicants who have a completed Iowa EMS System Standards Self-Assessment posted in an IDPH SharePoint Service Contract site prior to July 1, 2013 will be required to complete the following activities: Contractual Performance Measure: Recipients of the grant award must complete, at a minimum, 80% of the planned steps and activities submitted as part of their workplan for the contract period of September 1, 2013 through June 30, Failure to complete all of the listed steps and activities by the due date will result in the reduction of the recipient s total grant award by 5%. B. Applicants who do not have a completed Iowa EMS Systems Standards Self-Assessment posted in an IDPH SharePoint Service Contract site as of July 1, 2013 will be required to complete the following activities: Contractual Performance Measure 1: Recipients of the grant award must complete and submit the Iowa EMS System Standards Self- Assessment (as posted in their SharePoint service contract site by the Department) no later than Tuesday, December 31, An example of the Iowa EMS System Standards Self-Assessment can be viewed at Failure to submit the completed Self-Assessment by the due date will result in the reduction of the recipient s total grant award by 5%. Contractual Performance Measure 2: Recipients of the grant award must complete, at a minimum, 80% of the planned steps and activities submitted as part of their workplan for the contract period of September 1, 2013 through June 30, Failure to complete all of the listed steps and activities by the due date will result in the reduction of the recipient s total grant award by 5%. OTHER REQUIREMENTS The DEPARTMENT s contract general conditions effective January 1, 2013 revised January 10, 2013 will apply to the contract. These general conditions are posted on the IDPH Internet site under Funding Opportunities: Required Reports 7

10 Required reports shall be filed on forms and/or in the format approved by the DEPARTMENT and uploaded to the IDPH SharePoint Completed Reports folder. The CONTRACTOR shall file claims via SharePoint. The CONTRACTOR shall provide the documentation specified by the DEPARTMENT before the claim can be paid. Report Number of Date Due copies Claim Voucher 1 Electronic Within 45 days of month of expenditure First Progress Report 1 Electronic January 15, 2014 Final Progress Report 1 Electronic June 30, 2014 Claim vouchers and expenditure reports shall be filed via SharePoint. 8