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Stacie (Harting) Marsh

About Stacie

Health Care Reform Legislation and Its Impact on Federal Grant Programs

Background

In the past sixteen months, two major legislative changes have grant seekers and writers closely monitoring Grants.gov (the federal government’s web portal for identifying and applying for grants) for changes and additions to the federal grant application calendar.

The first significant legislative change was in response to the economic crisis. The American Reinvestment and Recovery Act (ARRA) was enacted in February 2009 with the goals of creating new jobs, spurring economic growth, and providing transparency in federal spending. This financial aid package includes $288 billion in tax cuts, $224 billion in education and health care entitlement programs, $224 billion for federal contracts and grants, and extensive quarterly reporting requirements. In particular, new grant funding is prevalent in health care information technology, construction and repair of new roads and bridges, community development and rehabilitation, and renewable energy projects. (http://www.recovery.gov/About/Pages/The_Act.aspx)

Additionally, $500 million in ARRA funding was allocated to bolster and expand the health professions workforce. These funds include $200 million to strengthen the workforce in key areas through health professions training programs and $300 million to support programs for clinicians and students in the health professions.

The second legislative change was the enactment of the Patient Protection and Affordable Care Act (PPACA) on March 23, 2010. The PPACA, along with the Health Care and Education Reconciliation Act of 2010, mandated vast changes to the American health care system that will be phased in over the next four years. The law includes the expansion of Medicaid eligibility, the subsidization of insurance premiums, incentives for businesses to offer health care benefits, and a prohibition on pre-existing condition denials.

Impact on Federal Grant Programs

The dramatic ARRA financial aid package brought about countless new federal grant programs backed by billions of dollars. Many of these grant programs are one-time opportunities. For example, the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Labor announced $1 billion in federal grant opportunities in February 2010 for projects that encourage health care information technology and job training for careers in this discipline. The newly created Office of Adolescent Health announced $100 million in teenage pregnancy prevention grants. Additionally, the U. S. Department of Housing and Urban Development (HUD) has issued two rounds of funding for the Neighborhood Stabilization Program for assisting communities hit by the foreclosure and home abandonment crisis.

New and Revised Grant Opportunities through the PPACA

The Obama Administration’s more recent legislative victory, the Patient Protection and Affordable Care Act (PPACA) has also affected the federal grant making landscape. Public Law 111-148 (upon which the PPACA is based) was enacted March 23, 2010, in the midst of the annual grant solicitation season for many grant programs within HHS.

One of the most significant impacts has been within the Health Resources and Services Administration (HRSA), a division of HHS. This article will provide a case study on the recent impact of the PPACA has had upon recent HRSA grant opportunities. It is not intended to be a comprehensive overview of all federal agencies and grant programs affected by the recent legislation.

For example, following passage of the PPACA, grant seekers for HRSA’s Training in Primary Care Medicine and Dentistry (TPCMD) grant program – which includes six distinct grant solicitations – were forced to abandon their applications just days before the original deadline. TPCMD has traditionally supported academic administrative units, residency training, predoctoral training, faculty development training, physician assistant training, and general and pediatric dental residency training program areas. The PPACA reauthorized and amended the TPCMD programs in Title VII, Section 747 of the Public Health Service Act.

The revised Funding Opportunity Announcement (FOA), released several weeks later, made fairly significant changes to the program authority, including increased program areas and scope of activities, extended project period, modified funding priorities and preferences, separation of dental training programs from the traditional TPCMD program authority, and even changes to the application process.  Grant seekers were given only twenty-nine days to revise and submit their applications.  The PPACA also created a new program within the TPCMD grant authority, the Interdisciplinary and Interprofessional Joint Graduate Degree program.  Furthermore, additional reporting requirements were added for all programs within this grant authority.

The PPACA also affected a new HRSA grant program made possible by ARRA, the Equipment to Enhance Training for Health Professionals (known as the EETHP Equipment Initiative).  This initiative is comprised of twenty-one health professions training programs (those authorized under Titles III, VII and VIII of the Public Health Service Act).  Through this initiative, grant seekers have the unique opportunity to request federal funds for major equipment purchases for TPCMD programs.  However, grant seekers for this program also had to stop and shift course midway through the application process following the passage of PPACA, because HRSA posted a notice to applicants on its web site approximately two weeks before the original deadline informing them that the FOA would be reissued. In late April, applicants were given only three weeks to submit applications per the new guidelines.

Other grant programs within HRSA that have been newly created or modified by the PPACA include the following:

  • Patient Navigator Outreach and Chronic Disease Prevention Program (HRSA-10-209)
  • Area Health Education Centers (AHEC) Infrastructure Development Awards (HRSA-10-251)
  • Area Health Education Centers (AHEC) Point of Service Maintenance and Enhancement Awards (HRSA-10-252)
  • Grants to States for Loan Repayment (HRSA-10-066)
  • ARRA: Predoctoral (and Postdoctoral) Training in General, Pediatric, and Public Health Dentistry and Dental Hygiene (HRSA-10-262 and HRSA-10-261, respectively)

The PPACA also authorized five-year demonstration grants with which states could develop, implement and evaluate alternatives to current tort litigations (beginning in FY 2011) with preference given to proposals designed to enhance patient safety and improve access to liability insurance. New grant programs are also being developed to support evidence-based and community-based prevention and wellness programs, as well as grants for small employers for the establishment of wellness programs.

The authors also anticipate future grant programs related to the development of inter-disciplinary care teams in the primary care setting.

Conclusion

Regardless of their political persuasion, federal grant seekers can find both positive and negative implications of the major legislative changes in funding for health care grant programs over the past 16 months. While the last-minute changes in application processes and scope of grant programs may be frustrating for some, ultimately the Recovery Act and subsequent health care reform legislation (PPACA) has provided considerable new grant opportunities for a variety of health care disciplines, particularly health professions training programs that had been significantly underfunded.

Furthermore, although it has been widely reported that recent changes to the federal grant post-award processes have resulted in more extensive compliance guidelines, many of these regulations have been required for years. “Shovel-ready” projects, timely program and financial reports, and public awareness of spending are all ideal traits of federal grant applications and may be required for future grant recipients. However, this may well mean that there will be fewer no cost extensions granted, stricter adherence to reporting requirements, and easier access for public records request.

Furthermore, there are several new grant rules that may become federal golden rules. These include the following:
  1. Do not ask for money until you are ready to spend it.
  2. There is no such thing as a free lunch. Grantees will be required to provide extensive documentation of how their grant funds were allocated.
  3. A-133 guidelines will actually be required. (Note: These guidelines are known as the Single Audit – the process by which grantees prove they followed post-award processes correctly.)

So what is next? No one knows for certain what will come to pass. However, it is safe to assume that the best course of action is to stay informed through Grants.gov, as well as state and federal agency contacts.  In the ultra-competitive world of grant seeking, federal priorities are changing and so are the grant opportunities. Grant writers, who may be prone to the comforts of routine and rule-following, should strive to be flexible and use their keen eye for detail in a rapidly changing health care funding climate.

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