Frequently Asked Questions

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Live Q&A; Session

On September 18, 2008, Qualis Health held a teleconference for potential Regional Coordinating Center applicants offering them the opportunity to inquire about all facets of the Initiative.

A taped recording of the session is available for download here.

Project Overview

Who is coordinating the Initiative?
The Safety Net Medical Home Initiative is coordinated by Qualis Health. The Initiative is sponsored by The Commonwealth Fund, and the MacColl Institute for Healthcare Innovation is a key partner. Together, these three organizations are referred to as the “Project Team.”

When will the project actually start?
Finalists will be selected on December 12, 2008, and grantees will be announced on February 20, 2009. Activities for Regional Coordinating Centers and partner clinics are scheduled for late March / early April 2009.

What is the application timeline?
The timeline is as follows:

Letter of intent requested by: September 30, 2026
Applications due: November 3, 2025
Finalists announced: December 12, 2025
Site visits to RCC finalists and selected partner clinics: January 12-30, 2009
Grantees announced: February 20, 2026

Who is the project contact?
Questions about the RFP or application process should be sent to [email protected]. The project contact is:

Kathryn E. Phillips, MPH
Project Manager, Safety Net Medical Home Initiative
Qualis Health
10700 Meridian Ave N, Suite 100
PO Box 33400
Toll-free Phone: 1-800-949-7536 ext. 2007
E-mail: [email protected]

Application Requirements and Process

There appears to be an inconsistency in the page limit for the proposal: pg. 27 states that 25 pages are allowed; pg. 28 states that 20 are allowed. Please clarify.
The page limit for the proposal narrative is 25 pages. This page limit does not include the budget worksheet or budget justification, staffing requirements, or other required attachments (e.g., letters from partner clinics).

What is your definition of an annual report? Is it an audit or something else?
Ideally, we would like the published annual report that is distributed to members. If no report is published for public presentation, a formal annual progress report to the Board, complete with results of an annual financial audit, would suffice. Another alternative would be the clinic’s progress report on the business plan and clinic work plan that are submitted as part of the annual HRSA grant application packet.

Do partner clinics need to submit their annual reports as a part of the application process?
No. Annual reports will be requested from the partner clinics of RCCs that are selected as finalists. RCC applicants do not need to submit partner clinics’ annual reports as a part of their standard application.

Will partner clinics be required to submit a financial audit or any other financial documents?
Financial documents will be required in preparation for site visits for RCC/partner clinics selected as finalists. RCC applicants do not need to submit financial documents as a part of their standard application.

What kind of detail is needed in the letter of intent (LOI)?
Only contact information is required. Please include the name, telephone number and e-mail address for a contact person at the RCC organization. Also include the physical address of the RCC applicant and the organization’s website address.

Eligibility

What types of organizations are eligible for this initiative?
Any entity with a relationship with a group of safety net medical practices is eligible to apply as a Regional Coordinating Center (RCC). Examples of possible RCCs include, but are not limited to:

Area Health Education Centers
Community clinic consortia
Community hospitals with outpatient services
Management Services Organizations
Medicaid managed care plans
Multi-site community health center (CHC) corporations
Professional affiliations of safety net providers/practices
Public health departments
Public hospitals
Regional healthcare alliances
State Medicaid Agencies
State Primary Care Associations

Do partner clinics need to be federally-qualified health centers (FQHCs) or rural or urban health centers?
No, the only requirements are that partner clinics a) provide comprehensive primary care services and b) be part of the safety net system. To be considered part of the “safety net,” a medical practice must:

Organize and deliver a significant level of healthcare and other related services to the uninsured, Medicaid and other low-income populations.
Either by legal mandate or explicitly adopted mission, maintain an ‘open door,’ offering access to services for patients regardless of their ability to pay.

Are academic medical centers eligible to apply as Regional Coordinating Centers?
Yes.

Are public hospitals eligible to apply as Regional Coordinating Centers?
Yes.

Can consulting firms serve as Regional Coordinating Centers?
In most circumstances, no, because they are not set-up to support the long-term sustainability of projects.

Are there limits on practice/clinic size?
There are no restrictions on practice size.

Are pediatric practices eligible to apply? Will proposals that target pediatric populations be less competitive?
Pediatric practices are eligible to apply as partner clinics; however, an RCC composed entirely of pediatric practices is not ideal, and would require sufficient explanation and justification. Also, a pediatric practice that is solely devoted to children with special healthcare needs would likely not be competitive because it is so specific and limited.

Does the project require that the target population include all age groups, or can it be limited to one group?
The RCC needs to reflect all age groups, but each partner clinic does not need to reflect all age groups. For example, in an RCC, you could have four pediatric practices and nine family practices (for a total of 13 practices).

Are nurse-managed clinics/health centers eligible?
Yes.

What do you mean by “comprehensive” primary care services?
To be eligible for participation, partner clinics must provide comprehensive primary care services, including preventive care and immunizations, ambulatory care and other common services. Clinics do not need to provide onsite mental health or dental care in order to be considered comprehensive. Minute clinics/retail clinics or mobile units are not eligible unless they provide the full continuum of primary care services.

Regional Coordinating Center (RCC) Structure

There is a wide variety of structures for RCC partnerships. If you have a specific question about a potential structure, please e-mail [email protected].

Each Regional Coordinating Center is expected to establish partnerships with 12 - 15 safety net clinics. Does this refer to the number of corporations or to free-standing sites of care?
The 12-15 clinic requirement refers to free-standing sites of care, either individual clinics or practices. Each physical location counts as one site.

How many organizations need to be a part of the Regional Coordinating Center’s collaborative in order for an application to be competitive?
To maximize the sustainability and spread of transformational efforts into the future, as well as optimize the policy engagement of participating entities, this initiative is seeking a mix of clinic affiliations. RCCs should apply with multiple corporate entities as clinic partners. For example, an RCC could apply with one FQHC with five satellite clinics (this would count as five clinics and one corporate entity); two independent community health centers, each with one site; a public health department clinic; and a community hospital that has four outpatient primary care clinics. In this scenario, the RCC applicant would be applying with 12 partner clinics (12 sites) and six corporate entities, including itself.

An RCC that applies with 12-15 clinics owned and operated by a single corporate entity will be considered only if the RCC applicant can demonstrate some or all of the following:

Significant penetration of clinics within a specific region
A large market share of Medicaid and/or uninsured individuals in the region
The potential to have a significant impact on policy

RCC applicants who apply with 1-3 corporate entities should include an explanation and justification in their proposal.

What geographic area constitutes a “region”?
A region can be as small as a city and as large as a state.

Can a region include two states?
A region can include two states only if the RCC applicant can demonstrate a history of the relevant organizations working together towards policy change. The states must also have enough similarities (for example, patient demographics or existing Medicaid policy) to make policy change relevant to both states involved in the collaborative.

Could the Regional Coordinating Center be a collaborative association of two or more organizations? Could there be two Medical Home Facilitators if the applicant is seeking to build collaboration between two PCMH programs?
Yes, so long as fiscal accountability and decision-making are clear.

Could a safety net clinic qualify as a Regional Coordinating Center?
Yes.

What do you mean by “market penetration” (as noted on p. 22 of the RFP)?
By market penetration we mean the proportion of patients served: 1) the proportion of patients in the region served by clinics in the RCC’s collaborative and 2) the proportion of patients in a specific area served by an individual partner clinic. If a percent cannot be easily estimated, please provide the total number of patients served. For example, you could say, “our collaborative of 13 clinics serves 175,000 patients across our state - 50% of all the people on Medicaid in our state.” You could also say, “clinic x has 2,000 patients. While this is a small clinic, it is the only clinic in a three-county radius, and provides care to over 90% of the uninsured in the community.”

Does the organization applying as the Regional Coordinating Center need to reside in the region served?
Not necessarily; however, the RCC must have strong relationships with local and regional stakeholders. The RCC must also be engaged in state health policy, and this may be difficult to accomplish if the organization resides in another state.

Use of Funds and Restrictions on Funding

Are there any restrictions on the use of project funds?
Yes. Funds may not be used for direct patient care, or for the development or maintenance of an electronic medical record (EMR) or other health information technology (HIT) application. Funds awarded under this grant program may be used for the following:

Salary support for a Medical Home Facilitator.
A stipend for a clinic quality improvement (QI) director or coach.
Meeting and travel expenses for partner clinics.
Learning collaboratives.
Other activities of the RCC and partner clinics.

How will the Regional Coordinating Centers distribute funds to the partner clinics?
Each RCC will be able to distribute its funds at its own discretion. RCCs may use the funds internally, or they may opt to distribute the funds directly to the individual partner clinics.

Are the funding dollars primarily for the Medical Home Facilitator?
The project funding is meant, in part, to support the Medical Home Facilitator. If an RCC has in-kind time for that position, or funding from another source to support that position, then it may use the project funding for another position or purpose. If this is the case, the RCC applicant should clearly indicate how the grant money will be used and how these activities/personnel will support the goals of the Initiative.

Is there a cap on indirect costs?
Yes. The Commonwealth Fund stipulates that indirect costs cannot exceed 10% of total project funds. Indirect costs are those costs incurred for common or joint objectives, which cannot be readily identified but are necessary to the operations of the organization. Indirect expenses include space rental, furniture, equipment, heat, electricity, accounting services, library services and the like. For additional information on indirect expenses, please refer to The Commonwealth Fund’s application guidance.

Resources Provided

Will clinics be reimbursed by Qualis Health for project expenses?
All monies will be given directly to the RCCs. Qualis Health will not make any payments to the partner clinics, nor will it reimburse partner clinics for any expenses incurred. If you are a partner clinic, and have questions about costs and payments, please contact your RCC coordinator directly.

The sample recruiting letter for partner clinics states that there is an “opportunity to receive financial assistance for quality improvement projects.” Is this meant to reflect the use of the $500,000, in-kind resources from The Commonwealth Fund or resources the Regional Coordinating Center is expected to bring to the table?
The “financial assistance” mentioned on page 9 of the RFP and in the template letter for potential partner clinics, refers to the project funding itself ($500,000 over four years) from The Commonwealth Fund.

Can you describe and quantify the level of in-kind resources that will come from The Commonwealth Fund, Qualis Health and the MacColl Institute?
The Project Team will provide technical assistance, coaching and training materials. Qualis Health will also pay directly for travel (airfare, lodging and meals) for meetings that involve all four Regional Coordinating Centers, including the RCC Kick-Off Meeting and the two-day training session planned for year one.

To what degree is in-kind or additional financial support required?
In-kind or additional support is not required, but it is strongly encouraged (refer to page 19 of the RFP). In-kind/additional resources can include time, money or materials from any source. As noted on page 31 of the RFP, special consideration will be given to RCC applicants that have additional resources to support their work.

Technical Assistance Approach

The Project Team will provide RCCs and their partner clinics with technical assistance and coaching on a variety of topics such as enhanced access, coordination, population management and patient-centeredness. For more information on the change concepts for practice transformation, please refer to pages 4-7 of the RFP. In addition to technical assistance and coaching, the Project Team will assist RCCs with policy activation for needed payment reforms and will help link RCCs and their partner clinics with regional stakeholders. For examples of specific project activities, please refer to the RFP.

Have you identified faculty or topics for technical assistance and coaching?
The topic areas for technical assistance will directly follow the change concepts described on pages 4-7 of the RFP. These topics are:

Engaged leadership
Quality improvement strategy
Patient-centered interactions
Organized evidence-based care
Continuous and team-based healing relationships
Enhanced access
Empanelment
Care coordination

As noted in the RFP, these change concepts will be revised during the course of the Initiative. The faculty will be comprised of staff from Qualis Health and the MacColl Institute for Healthcare Innovation. Additional expertise will be brought in as needed.

What will the medical home performance improvement outcome(s) look like, given that participating clinics will be at variable stages of progress when beginning the Initiative? How does the training schedule or topics allow for clinics that are further along in the medical home transformation process?
Our technical assistance approach will be tailored to the readiness level of the participating clinics. The training and coaching sessions will be responsive to the aptitude and experience of the participants.

What is the role, if any, of local technical assistance and training consultants and teams?
If an RCC or partner clinic has existing local resources, they are encouraged to draw on them; however, local technical assistance (TA) is not required. RCCs are not expected to develop their own TA resources.

Who should attend the RCC Kick-Off Meeting and how will this meeting be paid for?
The Medical Home Facilitator and the Executive Sponsor for the RCC should attend the RCC Kick-Off Meeting. Airfare and lodging will be paid for directly by Qualis Health. All meals will be provided, but no reimbursements will be given for other incidentals (e.g., shuttles, airport parking, tips, etc).

Who should attend the two-day training session and how will this meeting be paid for?
The Medical Home Facilitators and the Partner Clinic Teams should attend the two-day training session. Executive Sponsors do not need to attend the training session. A “Partner Clinic Team” should include the clinic’s Medical Director or other clinician champion, QI Director or other operations manager, and another support staff person designed by the clinic. In general, all “key staff” should attend the two-day training session.

For guidance on key staff, refer to pages 26-27 of the RFP. Airfare and lodging will be paid directly by Qualis Health for all participants. All meals will be provided, but no reimbursements will be given for other incidentals (e.g., shuttles, airport parking, etc). If reimbursements for incidentals are required, the RCC should build costs into their budget, and reimburse their partner clinics accordingly.

How will travel and meetings be paid for generally?
Qualis Health will pay for airfare and lodging (and provide meals) for meetings that include all four RCCs (for example, the RCC Kick-Off Meeting and the Clinic Training Session). Gatherings of partner clinics within one RCC must be paid for by that RCC using grant funds or in-kind/additional resources.

Policy Activation

If medical home components don’t work for a clinic given the current financial incentive environment (e.g., max packing a visit), can they delay implementation until financial incentives change?
Partner clinics are expected to implement the project activities regardless of their current financial incentive environment. During the application review, special consideration will be given to applicants that have demonstrated that they can implement the activities of the initiative early in the project period. Please refer to page 31 of the RFP for more information on “special considerations.”

Medical Home Facilitator and Executive Sponsor

The Medical Home Facilitator seems to have two very divergent roles, one of practice coach (involving a clinical background) and one of a liaison (more administrative/project management role). Can this be two separate people?
RCC applicants are welcome to propose whatever division of labor they feel is best suited to the needs of their collaborative.

The RFP indicates that RCC applicants must “ensure all QI activities are anchored with the Board of Directors.” What exactly does this mean? How would this be addressed by a clinic that is part of a larger system (e.g. mission clinic of a hospital)? How much “oversight” is required vs. knowledge about the overall QI program?
The partner clinics, and ideally the RCC, should be able to demonstrate Board commitment to QI structure and a QI work plan, integrated with the agency’s strategic plan. Board members should provide input into QI initiatives, and should receive regular progress reports on QI initiatives.

Is the Medical Home Facilitator viewed as the primary liaison to the Project Team?
Yes.

Is the Executive Sponsor seen as a leadership role that would be identified and recognized, but not directly funded through project funds?
Yes, the Executive Sponsor of the RCC should be identified in the RCC’s proposal, and in most cases, this person’s time will be represented as an in-kind contribution. The Executive Sponsor is expected to lead the policy activation efforts.

Can the Executive Sponsor be housed separately from the RCC if proper lines of authority and leadership are documented?
Yes.

Medical Home Self-Assessment Tool

Is the Medical Home Self-Assessment the only item that clinics submit directly to Qualis Health (online), while the rest of their materials need to be submitted as part of the RCC application?
Yes. To clarify, the RCC is responsible for collating information from the partner clinics and submitting one complete application. The Medical Home Self-Assessment is an online survey. Partner clinics can take this survey at any time during the application process. The survey data is automatically submitted to Qualis Health. The RCC applicant does not need to complete the survey unless it is counting itself as a partner clinic. Once the RCC has selected its partner clinics, the RCC coordinator or grant writer should e-mail [email protected] and request a link to the Medical Home Self-Assessment Tool. A unique link will be sent to the RCC, and each partner clinic should use that link.

How many clinics in a collaborative need to complete the Medical Home Self-Assessment survey?
At least 80% of partner clinics must complete a Medical Home Self-Assessment by the application deadline (November 3, 2025). For example:

If you are applying with 15 partner clinics, 12 of the clinics must complete an assessment.
If you are applying with 14 partner clinics, 11 of the clinics must complete an assessment.
If you are applying with 13 partner clinics, 10 of the clinics must complete an assessment.
If you are applying with 12 partner clinics, 9 of the clinics must complete an assessment.

Can a Regional Coordinating Center applicant get a copy of the Medical Home Self-Assessment Tool before it finalizes its clinic partnerships?
Yes. If you would like a PDF copy of the Medical Home Self-Assessment Tool, please e-mail [email protected]. Please note that partner clinics must complete the actual assessment online. Paper copies will not be accepted.

Will the Regional Coordinating Center applicants have access to the completed Medical Home Self-Assessments?
Yes. Regardless of their selection status, RCC applicants will receive a summary of the data submitted by their partner clinics on the Medical Home Self-Assessment. RCC applicants will NOT have access to the data in real-time--they will be e-mailed summary results after the review period has ended (December 2008).

Health Information Technology (HIT) and Electronic Medical Records (EMR)

Do you have a specific requirement or vision for current HIT capacity? Will preference be given to clinics who already have an EMR?
An EMR is not required. Preference will be given to clinics that have systems to do the following (ideally, electronically):

Schedule appointments and monitor access to care.
Process encounter and claims data to identify clinic patients for follow-up and to ensure they have been seen.
Define their aggregate population.
Define at-risk subpopulations, as well as those in need of routine care.
Track care of individual patients and subpopulations, including referrals and abnormal lab/imaging results.
Provide individual care reminders.

Workload

What is the additional workload for providers and office staff associated with this project?
It is difficult to estimate the number of hours per week or year this initiative will require. Each partner clinic will be expected to have a Clinic Team, which will be responsible for implementing the practice transformation changes described on pages 4-7 of the RFP. Partner clinic staff will also be involved in project reporting and the external evaluation. The Medical Home Facilitator is the primary liaison with the Project Team, and will coordinate and streamline activities and reports to minimize the burden on clinic staff. For more information on project reporting requirements, see: What type of project reports will be required? For more information on the external evaluation, see: What is the extent of the evaluation process for the partner clinics?

Evaluation

What is the extent of the evaluation process for the clinics?
All partner clinics will be asked to fill out an organizational survey that includes the National Committee for Quality Assurance Physician Practice Connections Patient-Centered Medical Home Survey Tool (NCQA PPC-PCMH) both pre- and post-intervention. All partner clinics will also be asked to supply patient registry data on HEDIS/guideline-type clinical performance indicators on a yearly basis.

In half of the partner clinics, the Evaluation Team will collect information on patient experience pre- and post-PCMH intervention. When patients check out after their visit, clinics will disburse postcards describing the patient survey to adult patients and parents of pediatric patients who may then call the Evaluation Team to have the survey administered by telephone.

In a subset of clinics pre- and post-PCMH intervention, the Evaluation Team will perform qualitative phone interviews on the process of adoption and implementation of the PCMH standards with five diverse personnel, such as the CEO, Medical Director, physicians, nurses and administrative staff. In a few of the clinics selected for the qualitative interviews, the Evaluation Team will conduct a 1.5-day site visit for business case analyses of the PCMH intervention.

The Evaluation Team will perform qualitative interviews with center leaders, collect billing data to evaluate trends in revenues and costs, and provide a self-administered survey to estimate PCMH administrative costs, such as training sessions and regular PCMH activities (population management, data entry, team meetings, etc). The Evaluation Team will also conduct qualitative interviews of the RCC about the intervention.

The Evaluation Team and the Project Team will work together to streamline data collection tools as much as possible to reduce the burden on the clinic staff.

Project Reporting, Payments and Post-Award Information

What type of project reports will be required?
RCCs will be required to submit a quarterly invoice and a quarterly progress report with a description of project activities conducted during that quarter. A year-end financial report will be required within 90 days of the end of each grant year. RCCs will also be required to submit a non-competing continuation application each year. RCCs will be responsible for collating information from their partner clinics into these reports--partner clinics will not have to submit additional progress reports.

Will the contact be for one year at a time or all four years at once?
One year at a time, with a non-competing re-application required each year. The re-application process will allow RCCs to update their proposed activities and budget for the coming year.

How often will grant funds be distributed? Once per year or quarterly?
The payment cycle has not yet been finalized; however, it most likely will follow a three-payment format, such as 40% at the outset, 40% in six months and 20% at year end, after receipt of the required year-end reports.

Other Questions

Do you have a question that's not addressed above? E-mail your questions to [email protected]. You will receive a response within five days and the answer to your question will be posted on this site.