Memo Date: May 9, 2016 To: From: Administrators, Graduate Medical Education and Training Programs, Other Healthcare Providers Yende Anderson Coordinator, IMG Assistance Program Primary Care and Financial Assistance Programs Office of Rural Health & Primary Care Phone: 651-201-5988 Email: Subject: yende.anderson@state.mn.us 2016 Request for Proposals Clinical Preparation Grant Program Minnesota graduate medical education and training programs and other health care providers are invited to apply for grant funding to support clinical preparation to assist immigrant international medial graduates to prepare for medical residency. Application materials will be posted on the Office of Rural Health & Primary Care (ORHPC) website on May 9, 2016. Attached is the program s Grant Application and Guidelines. Applications are due Month June 24, 2016. The website address for application forms and instructions is: www.health.state.mn.us/divs/orhpc/funding/index.html. Eligible projects must provide clinical preparation for Immigrant International Medical Graduates (IIMGs) who has resided in Minnesota for at least two years, is certified by the Educational Commission for Foreign Medical Graduates (ECFMG) and is committed to providing primary care for at least five years in a rural or underserved area in Minnesota post residency. Preference will be given program sites in rural or underserved areas of the state. Questions about the grant application or the grant program can be directly to Yende Anderson at yende.anderson@state.mn.us or 651-201-5988.
International Medical Graduate Clinical Preparation Grant Program Grant Application Guidelines Minnesota Department of Health (MDH) Office of Rural Health & Primary Care The purpose of this memo is to help you prepare an application for funds to provide hand on clinical experience through the International Medical Graduate Clinical Preparation Grant Program. This document has three sections: I. Funding source and background for the program. II. Instructions on the preparation of the application. III. Checklist to be used while preparing the application IV. Description of the criteria to be used during the review process BACKGROUND Section I Program Description Minnesota Statutes Section 144.1911 authorizes the Commissioner of Health to award grants to support clinical preparation for Minnesota immigrant international medical graduates (IIMGs). A Minnesota IIMG is defined as an international medical graduate who: was born outside the United States, now resides permanently in the United States as a citizen or Lawful Permanent Resident, has resided in Minnesota for at least 2 years, and did not enter the United States on a J1 or similar nonimmigrant visa following acceptance into a United States medical residency or fellowship program. The grant program supports clinical preparation for Minnesota IIMGs who are certified by the Educational Commission for Foreign Medical Graduates (ECFMG) and who agree to practice post residency in rural or underserved areas of the state. Funds will be awarded after a competitive review process. PROGRAM SUMMARY A. Eligible Applicants Eligible applicants are programs and sponsors of clinical medical education or healthcare providers that fulfill all of the following criteria: 1. Are located in Minnesota, 2. Have a history of providing clinical medical education or clinical preparation, and 3. Are willing to provide clinical preparation in primary care, including exposure to ambulatory and inpatient medicine in one or more of the following specialties: family medicine, internal medicine, obstetrics, pediatrics, psychiatry and rural medicine. B. Grant Program Requirements
Program Requirements Programs may implement their own curriculum. However curricula must include exposure to various circumstances and experience that would enable all trainees, upon program completion, to be able to: Understand and describe the United States health care system; Understand and describe assessment, evaluation and feedback norms in US medical education; Gather information, formulate differential diagnoses, and propose plans for initial evaluation and management of patients with common presentations; Manage follow-up visits with patients having one or more common chronic diseases; Develop evidence-based health promotion/disease prevention plans for patients of any age or gender; Demonstrate competency in advance elicitation of history, communication, physical examination, and critical thinking skills; Demonstrate knowledge of local and national ethical and legal guidelines governing patient confidentiality with specific attention to o Written documentation o Verbal communication with the patient s family members; Communicate effectively with patients and patient s family members; including how to: o Utilize lay terms appropriate to the patient s level of education and explain scientific jargon, o Recognize and mange denial and grief, o Communicate abnormal results and bad news to patients in a sensitive manner, o Discuss end of life issues with patient and family members with attention to the patient s wishes and needs, o Provide concise daily updates for patients and families regarding hospital course and rationale for on-going or new treatment plans; Clearly summarize the patient s reason for admission and rationale for clinical plan; Assess suicidality in a depressed or psychotic patient; Be able to initiate a conversation with a patient about advance directives; Demonstrate the ability to clearly and concisely present oral and written summaries of patients to members of the healthcare team with attention to the inclusion of relevant information and synthesis of clinical information; and Demonstrate an understanding of cultural sensitivities and patient wishes with regards to healthcare and incorporate this knowledge into discussions with the patient. In addition, at the end of the training, trainees should be able to carry out the four General Milestone (Professionalism, Interpersonal Communication Skills, Practice-based Learning and Improvement, and Systems-based Practice) in the Next Accreditation System at a performance level of at least level 1, preferably at a level 2. Pease see attached chart. Funding Requirements Grant funds may be used for: 1. Salary and fringe for faculty and preceptors related to providing clinical preparation for IIMGs; 2. Stipends for IIMG program participants; 3. Travel and lodging for IIMG program participants; 4. Training site improvements, fees, equipment, and supplies required for IIMG primary care residents; and 5. Planning.
Grant funds may not be used to support administrative costs not directly related to clinical preparation. C. Total Available Funding Up to $300,000 is available per year. A program may apply for less than $300,000 and successful applicants may be awarded less than requested. D. Distribution of Funding Eligible clinical preparation programs may receive up to $ 300,000. Due to the competitive nature of the grant, selected programs may not receive the full amount requested. Payments will be distributed quarterly, upon receipt of a progress report that includes certifying the number of IIMGs in the program, an invoice, and an expenditure report. The anticipated date of the contract is August 1, 2016 and the first available quarterly invoice may be submitted November 1, 2016. E. Timeline Application due to MDH: June 24, 2016 Award Letter mailed: Approximately July 15, 2016 Grant Agreements begin (est.): August 1, 2016 Section II - Preparing the Application The following outline and instructions should be used to prepare the grant application. While additional documentation may be submitted, such material should be relevant to the specific scope of the grant. Required Forms and Documents A. Grant Application Form. (enclosed) Complete all items. B. Accounting System and Financial Capability Questionnaire. (enclosed) This form is required from all applicants for funding over $50,000. C. Program Financial Statement Applicants must include the most current financial statement of the program. This may be a recent 990 form, an audit, a balance sheet, or an income statement that at least shows annual revenue and expenses. Attached financial documentation must be specific to the residency program, not documentation of a larger organization.
D. Program Description (10 pages maximum). Write a summary of the proposed Clinical Preparation program, including the following: E. Grant Budget o Description of the program s location, staff and faculty, administrative structure, organizational partnerships, and budget. Please also describe any experience of observerships, clinical preparation or other clinical training provided to medical students or residents. o Description of the program s focus or emphasis while providing clinical preparation/experience. IMG s readiness is on a continuum; please describe the target program participant and explain how the program will meet their needs. Please also explain how they will be connected to other resources to meet needs that the program may not address through the services it provides directly. o Description of the program s curriculum. An explanation of how these activities will help the program participants demonstrate clinical readiness. An explanation of how program activities will help the participants competitiveness in the residency application process. o Assessments of participants. Please explain how participants will be assessed and how these assessments will inform programing. The expectation is that Grantee will monitor and adjust program components depending on the performance of the program participant. o Description of experience with training or working with IIMGs. Plan for recruitment and selection of IIMGs. Plan for collaboration with non-profits working with IIMGs. o Statement of need for state grant funds. Applicants are encouraged to submit information about their program costs, other funding sources and other information on the need for state support. A. Grant Budget Form: required from all applicants. (enclosed) B. Grant Budget Justification Narrative Applicants must attach a narrative describing the detail of the proposed grant budget, with sufficient detail for each requested year of the grant. Also include detail of any non-state funds that will be used to for this program during the grant period. For each of the cost items on the budget form for which grant funds are requested, provide a rationale and details regarding how the budgeted cost items were calculated, by year. Label this concise narrative Budget Justification and follow the order of the budget form in your narrative. o Personnel For this line describe all salaries to be paid to faculty/preceptors and other administrative staff using grant funds. Include a description of the proportion of salary to be paid using grant funds for each individual.
o Fringe For this line describe all fringe benefits to be paid to faculty, and/or preceptors using grant funds. Include a description of the proportion of fringe to be paid using grant funds for each individual. o Stipend Describe the amount of stipend to be paid to IIMG program participants. o Travel and Lodging Include a detailed description of the proposed travel and/or lodging outside the home location of the participant for IIMG program participants as it relates to the direct operation of the program. Provide the number of miles planned for program activities as well as the rate of reimbursement per mile to be paid from grant funds. For example, a rural health rotation o Supplies Include a description of any supplies necessary for the operation of the clinical preparation program. o Contracted Services Include any grant funding to be used for consultant fees, or any costs associated with training sites on this line. o Equipment and Capital Improvements Include any grant funding to be used to purchase equipment, or to make capital improvements. o Other Expenses Whenever possible, include proposed expenditures in the categories listed above. If it is necessary to include expenditures in this general category, include a detailed description of the activities as they relate to the direct operation of the program. If possible, include a separate line-item budget and budget narrative.
Submission: Applications must be submitted Yende Anderson (yende.anderson@state.mn.us) by email or US mail no later than 4:30 p.m., June 24, 2016. If using US mail, please mail the documents to: Yende Anderson Courier Address: Minnesota Department of Health Minnesota Department of Health Office of Rural Health & Primary Care Office of Rural Health & Primary Care P.O. Box 64882 85 East 7 th Place, Suite 220 St. Paul, Minnesota 55164-0882 St. Paul, Minnesota 55101 Applications postmarked prior to this date but not received by MDH prior to the time deadline will be considered late. Late applications will not be considered for review. Questions regarding these grant application guidelines should be directed to Yende Anderson at yende.anderson@state.mn.us or 651-201-5988 or 800-366-5424. Section III - Application Checklist I. Required Forms: o Grant Application Form o Accounting System and Financial Questionnaire o Grant Budget Form II. III. IV. Program Financial Statement Attach financial documentation specific to the clinical preparation program. Program Description (10 pages max) Attach a description of the program s history, structure, emphasis and recent outcomes Grant Budget Justification Narrative Attach this narrative detailing the individual lines of the budget. Grant awards will be announced by July 15, 2016 with an estimated contract start date of August 1, 2016. Invoices can be submitted quarterly, upon execution of the contract and once work is started. Upon selection and announcement of grant recipients, all submitted application information and documentation will become public data.
Section IV Review Criteria A. Review Process After the submission deadline, MDH will review all submitted applications for eligibility and completeness. Complete applications from eligible applicants will move forward to a review committee process. Applications will be scored by a grant review committee, using the criteria listed below. The review committee will also discuss other relevant factors. Review committee recommendations will be transmitted to the Commissioner for final funding decisions and subsequent contracting. B. Review Criteria All complete applications from eligible applicants will be scored on a 100-point scale. Below is a breakdown of that scale, and the component of the application where the information must be present o 25 points: Program Description Is the program description complete? Does the description adequately explain the program s administrative structure, organizational structure, and budget? Are the needs of IIMGs effectively described? Does the program as described meet those needs? Is the program s explanation of how the clinical preparation will help program participants demonstrate readiness and competiveness sufficient? o 25 points: Program Experience/ Collaboration Does the program have experience working with IIMGs? Is the program equipped to respond to the unique needs necessary to support a successful clinical preparation for IIMGs? Does the program have a plan for recruiting and selecting IIMGs? Does the program have an adequate plan for collaborating with other programs or nonprofits? o 25 points: Curriculum Is the curriculum complete given the focus of the program? o 25 points: Proposed budget and proposed use of funds Is the proposed budget clear? Does the budget narrative give adequate detail in how funds will be accounted for and spent? Is the budget reasonable?
GRANT APPLICATION FORM International Medical Graduate Clinical Preparation Grant Program Minnesota Department of Health Office of Rural Health and Primary Care 1. Applicant Organization (with which grant contract is to be executed) Legal Name Address Phone ( ) Federal ID Number State Tax ID Number ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 2. Director of Applicant Organization 3. Fiscal Management Officer of Applicant Organization Name/Title Name/Title Address Address Phone ( ) Phone ( ) E-mail E-mail ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 4. Operating Organization (if different from number 1) Name/Title Address Phone ( ) ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 5. Contact Person for Operating Organization (if different from number 2) Name/Title Address Phone ( ) ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 6. Contact Person for Further Information on Application (if different from number 5) Name/Title Address Phone ( ) --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 7. Amount Requested --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 8. I certify that the information contained herein is true and accurate to the best of my knowledge and that I submit this application on behalf of the applicant organization. Signature Title Date
ACCOUNTING SYSTEM AND FINANCIAL CAPABILITY QUESTIONNAIRE This is the standard form to be used in order to determine the financial capacity of grant applicants. The creation and implementation of this form is in response to the best practices stated in the Office of Legislative Auditor s report State Grants to Nonprofit Organizations, January 2007. No applicants will be excluded from receiving funding based solely on the answers to these questions. SECTION A: APPLICANT INFORMATION 1. Organization Name and Address 2.Employer Identification Number 3.Number of Employees Full Time: Part Time: 4. When did the applicant receive its 501(c)3 status? (MM/DD/YYYY)? 5. Is the applicant affiliated with or managed by any other organizations (Ex. regional or national offices)? YES NO If Yes, provide details: 6a. Total revenue in most recent accounting period (organization s 12 month fiscal year). 5b. Does the applicant receive management or financial assistance from any other organizations? YES NO If Yes, provide details: 6b. How many different funding sources does the total revenue come from? 7. Does the applicant have written policies and procedures for the following business processes? a. Accounting Yes No Not Sure If yes please attach a copy of the table of contents b. Purchasing Yes No Not Sure If yes please attach a copy of the table of contents c. Payroll Yes No Not Sure If yes please attach a copy of the table of contents SECTION B: ACCOUNTING SYSTEM 1.Has a Federal or State Agency issued an official opinion regarding the adequacy of the applicants accounting system for the collection, identification and allocation of costs for grants Yes No Note: If a financial review occurred within the past three years, omit Questions 2 6 of this Section and 1-3 of Section C. a. If yes, provide the name and address of the reviewing agency: b. Attach a copy of the latest review and any subsequent documents. 2. Which of the following best describes the accounting system? Manual Automated Combination 3. Does the accounting system identify the deposits and expenditures of program funds for each and every grant separately? Yes No Not Sure 4. If the applicant has multiple programs within a grant, does the accounting system record Yes No Not Sure the expenditures for each and every program separately by budget line items? Not Applicable 5. Are time studies conducted for an employee(s) who receives funding from multiple Yes No Not Sure sources? No Multiple Sources 6. Does the accounting system have a way to identify over spending of grant funds? Yes No Not Sure SECTION C: FUND CONTROL 1. Is a separate bank account maintained for grant funds? Yes No Not Sure 2. If grant funds are mixed with other funds, can the grants expenses be easily identified? Yes No Not Sure 3. Are the officials of the organization bonded? Yes No Not Sure SECTION D: FINANCIAL STATEMENTS 1. Did an independent certified public accountant (CPA) ever examine the organization s financial statements? Yes No Not Sure SECTION E: CERTIFICATION I certify that the above information is complete and correct to the best of my knowledge. 1. Signature 2. Date / / 3. Title 11
Grant Budget Form International Medical Graduate Clinical Grant Program Minnesota Department of Health Office of Rural Health and Primary Care Categories Grant funds requested Non-grant funds contributed Total Personnel: Salaries Fringe Contracted services Stipend Travel and Lodging Supplies Equipment and Capital Improvements Other Personnel Total TOTAL 12