Title 10 — Subtitle 45. Maryland Community Health Resources Commission
Chapter 01. Purpose and Definitions
Regulation .01 Purpose.LinkCopy Citation
A.
The purpose of the Commission is, through community health resources, to:
(1)
Increase access to health care services;
(2)
Redirect nonemergency emergency room use to community health resources;
(3)
Develop coordinated, integrated systems of community-based care; and
(4)
Assist patients in establishing a medical home with a community health resource.
B.
A key objective of the Commission is to reduce health disparities in the State.
Regulation .02 Definitions.LinkCopy Citation
A.
In this subtitle, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“Applicant” means a person that submits to the Commission, within the time period specified by the Commission:
(a)
A letter of intent to submit a grant application under this subtitle; or
(b)
A grant application under this subtitle.
(2)
“Application” means a document:
(a)
Prepared by an applicant in response to the Commission's call for proposals; and
(b)
That includes the elements specified in COMAR 10.45.06.03.
(3)
“Call for proposals” means a document issued by the Commission that:
(a)
Invites members of the public to develop and submit proposals for projects and programs for which grant funding under this subtitle is sought;
(b)
Specifies the required content of a grant application and proposal; and
(c)
Identifies selection criteria and funding priorities to be applied by the Commission in determining which proposals will be funded.
(4)
“Commission” means the Maryland Community Health Resources Commission.
(5)
“Commissioner” means a member of the Commission.
(6)
“Community health center” means a community-based health center that serves underserved populations and is grant-funded under §330(e) of the Public Health Service Act.
(7)
“Community health resource” means a person determined by the Commission to satisfy the criteria set forth in COMAR 10.45.05.02, .03, or .04.
(8)
“Department” means the Maryland Department of Health.
(9)
“Developmental Disabilities Administration (DDA) licensee” has the meaning stated in COMAR 10.22.01.01B(36).
(10)
“Federal poverty guidelines” means the poverty measure that is:
(a)
Issued annually in the Federal Register by the U. S. Department of Health and Human Services; and
(b)
Used to determine eligibility for government programs.
(11)
“Federally qualified health center” has the meaning stated in Health-General Article, §24-1301(b), Annotated Code of Maryland.
(12)
“Federally qualified health center 'look-alike'” means a community-based health center that:
(a)
Is authorized under §1905(l)(2)(B)(iii) of the Social Security Act; and
(b)
Meets the eligibility requirements for a grant under §330 of the Public Health Service Act (42 U.S.C. 254b), but is not a grantee.
(13)
“Fiscal year (FY)” has the meaning stated in COMAR 10.09.62.01B.
(14)
“Health care program for the homeless” means a community-based health center that:
(a)
Serves homeless adults and children; and
(b)
Is grant-funded under §330(h) of the Public Health Service Act (42 U.S.C. 254b(h)).
(15)
“Health center controlled operating network” means an entity funded or otherwise charged by the federal Health Resources and Services Administration (HRSA) to develop, operate, or enhance safety net provider networks so as to:
(a)
Improve health care access for the medically underserved;
(b)
Develop and operate safety net provider networks; and
(c)
Increase health centers' efficiency, revenue, and overall productivity.
(16)
“Historic Maryland primary care provider” means a person that provided primary care services through the Maryland PrimaryCare Program.
(17)
“Local health department” has the meaning stated in COMAR 10.09.40.01.
(18)
“Local nonprofit and community-owned health care program” means a collaboration of local public or private nonprofit health care programs, or both, to provide or coordinate free or reduced-cost health care services for low-income or uninsured individuals, such as:
(a)
County community action agencies established under the Economic Opportunity Act of 1964;
(b)
Partnerships of public or private nonprofit health care providers or programs providing case management or other care coordination services;
(c)
Private nonprofit programs that provide administrative, support, and coordination services to facilitate the provision of primary and specialty care services by volunteer practitioners; and
(d)
Community outreach programs sponsored by a local health department.
(19)
“Maryland PrimaryCare Program” means the State-funded initiative, governed by COMAR 10.51.01 — .11, providing office-based primary care to qualifying low-income adults.
(20)
“Migrant health center” means a community-based health center that:
(a)
Is grant-funded under §330(g) of the Public Health Service Act (42 U.S.C. 254b(g)); and
(b)
Serves migratory and seasonal farm workers and their families in the State.
(21)
“Outpatient mental health clinic” has the meaning stated in COMAR 10.21.17.02.
(22)
“Person” has the meaning stated in Health-General Article, §1-101(h), Annotated Code of Maryland.
(23)
“Practitioner” has the meaning stated in COMAR 10.09.62.01B.
(24)
“Presiding officer” means:
(a)
The chair of the Commission; or
(b)
In the chair's absence, the chair's designee.
(25)
“Primary care program for a public housing project” means a community-based health center that:
(a)
Provides comprehensive primary care services to public housing residents; and
(b)
Is grant-funded under §330(i) of the Public Health Service Act (42 U.S.C. 254b(i)).
(26)
“Provider” has the same meaning as “health care provider”, as stated in Health-General Article, §19-132, Annotated Code of Maryland.
(27)
“School-based health center” means a provider located on school grounds that the Secretary has designated a school-based health center as specified in COMAR 10.09.68.02.
(28)
“Secretary” means the Secretary of Health.
(29)
“State” means the State of Maryland.
(30)
“Substance abuse treatment provider” means a provider of substance abuse treatment services that is:
(a)
Located in the State; and
(b)
Certified in accordance with Health-General Article, §8-404, Annotated Code of Maryland.
(31)
“Teaching clinic” means a provider in the State that is staffed in part by practitioners participating in accredited clinical training programs for health professionals, including, but not limited to:
(a)
Physicians;
(b)
Nurses; and
(c)
Dentists.
(32)
“Wellmobile” means a mobile health clinic in the Governor's Wellmobile Program, established under the Health-General Article, §§13-1301 — 13-1303, Annotated Code of Maryland, within the University of Maryland School of Nursing, that:
(a)
Delivers primary and preventive health care services to geographically underserved communities and uninsured individuals in the State; and
(b)
Provides principal training sites for the University of Maryland School of Nursing to expand student learning opportunities.
Chapter 02. Officers and Staff
Regulation .01 Commission Chair.LinkCopy Citation
A.
The chair is appointed by the Governor.
B.
Duties. The chair shall:
(1)
Except as provided in §B(6)(b) of this regulation, convene and preside over the meetings of the Commission;
(2)
Call meetings of the Commission as necessary to accomplish the Commission's purpose;
(3)
Appoint the Commission's vice chair;
(4)
Appoint the chairs of the Commission's standing and ad hoc committees;
(5)
Appoint the members of the Commission's committees; and
(6)
At meetings of the Commission, either:
(a)
Serve as the presiding officer; or
(b)
Designate the vice chair or other commissioner to preside over any Commission meeting the chair is unable to attend.
Regulation .02 Commissioners.LinkCopy Citation
The Commission consists of 11 members, appointed by the Governor, with the advice and consent of the Senate, in accordance with Health-General Article, §19-2103, Annotated Code of Maryland.
Regulation .03 Executive Director and Staff.LinkCopy Citation
A.
Executive Director. The Executive Director of the Commission:
(1)
Is the chief administrative officer of the Commission;
(2)
Is appointed by the Commission with the approval of the Governor;
(3)
Serves at the pleasure of the Commission; and
(4)
Shall, under the direction of the Commission, perform any duty or function that the Commission requires, consistent with Health-General Article, §§19-2101 — 2201, Annotated Code of Maryland, and this subtitle.
B.
Staff.
(1)
The Commission may employ a staff in accordance with the State budget.
(2)
The Commission, in consultation with the Secretary, shall determine appropriate job classifications and grades for all staff.
Chapter 03. Committees
Regulation .01 Standing Committees.LinkCopy Citation
A.
The four standing committees of the Commission are:
(1)
The Committee on Capital and Operational Funding;
(2)
The Committee on Hospital and Community Health Resources Relations;
(3)
The Committee on School-Based Community Health Clinic Center Expansion; and
(4)
The Committee on Data Information Systems.
B.
Committee Appointment. The chair shall appoint commissioners to serve on the standing committees annually, at the first regularly scheduled Commission meeting of each fiscal year.
C.
Vacancies. The chair may appoint commissioners to fill vacancies on the committees at any time.
Regulation .02 Ad Hoc Committees.LinkCopy Citation
A.
The Commission may establish one or more ad hoc committees to assist in performing duties of the Commission.
B.
An ad hoc committee established pursuant to §A of this regulation shall:
(1)
Limit its activities to the purpose for which it was formed; and
(2)
Be dissolved when the purpose for which it was formed has been satisfied or abandoned by the Commission.
Chapter 04. Meetings
Regulation .01 Meetings; Procedure.LinkCopy Citation
A.
Meetings of the Commission and meetings of the standing committees specified in COMAR 10.45.03.01 shall be governed in accordance with:
(1)
Maryland's Open Meetings Act; and
(2)
Commonly accepted rules of parliamentary procedure as determined by the chair.
B.
Quorum.
(1)
A majority of the full authorized membership of the Commission is a quorum.
(2)
A quorum need not be present in order for the Commission to hold a meeting.
(3)
If less than a quorum is present at any meeting, the presiding officer shall defer matters submitted for a vote until a quorum is present.
C.
Voting.
(1)
Each commissioner shall be entitled to one vote on each matter submitted to a vote at the meeting.
(2)
Voting shall be in person or by proxy.
(3)
The Commission may not act on any matter unless at least six members in attendance concur.
D.
Minutes. The Commission shall ensure that minutes of its public meetings are:
(1)
Recorded;
(2)
Presented to the Commission for approval; and
(3)
Made available for public inspection at the offices of the Commission during ordinary business hours.
Regulation .02 Frequency of Meetings.LinkCopy Citation
A.
Subject to §B of this regulation, public meetings of the Commission may be held for any authorized purpose, at a time and location determined by the Commission.
B.
The Commission shall meet at least six times per year.
Chapter 05. Community Health Resources
Regulation .01 Qualification as Community Health Resource.LinkCopy Citation
A.
To qualify as a community health resource, a person shall demonstrate that the person meets the criteria set forth in Regulation .02, .03, or .04 of this chapter.
B.
Regardless of the community health resource category for which an applicant submits evidence of qualification, the Commission may determine that the applicant meets the criteria to qualify as a community health resource under either Regulation 02, .03, or .04 of this chapter.
Regulation .02 Qualification under Health-General Article, §19-2101(c)(1), Annotated Code of Maryland — Primary Health Care Services.LinkCopy Citation
A.
Criteria. To qualify as a community health resource pursuant to this regulation and Health-General Article, §19-2101(c)(1), Annotated Code of Maryland, a person shall demonstrate that the person:
(1)
Is a nonprofit or for-profit health care center or program;
(2)
Provides primary health care services:
(a)
In accordance with a sliding scale fee schedule payment policy that is consistent with the guidelines set forth in Regulation .05 of this chapter;
(b)
Without regard to an individual's ability to pay; and
(c)
Primarily to Maryland residents from service sites located within the State; and
(3)
Provides medical care to address a patient's general health needs, including:
(a)
Promotion and maintenance of the patient's health;
(b)
Treatment of illness;
(c)
Prevention of disease;
(d)
Maintenance of the patient's health records; and
(e)
Making referrals for medically necessary and appropriate specialty care services.
B.
Submission Requirements. To demonstrate qualification as a community health resource under this regulation, a person shall submit, on or before the date and time specified by the Commission, the information and documentation that the person meets the criteria set forth in §A of this regulation, including:
(1)
A written statement that includes the applicant's name, the addresses of all its service locations, and a description of how the applicant meets the requirements of §A of this regulation;
(2)
A copy of the applicant's written procedures for consistent application of the applicant's policies concerning:
(a)
Uncompensated care;
(b)
Its sliding scale fee schedule, consistent with the requirements of Regulation .05 of this chapter; and
(c)
Provision of services regardless of a patient's ability to pay;
(3)
A list of services offered by the applicant;
(4)
A calculation of the proportion of patients served by the applicant who are Maryland residents;
(5)
An explanation of how the services offered by the applicant are provided, specifying practitioners' licensure categories, such as physician, nurse-practitioner, or other; and
(6)
Upon the Commission's request, any additional information the Commission requires to complete its determination.
C.
The Commission shall determine that a person does not qualify as a community health resource pursuant to this regulation if:
(1)
Unless COMAR 10.45.08.01G applies, the person does not submit to the Commission, on or before the date and time specified by the Commission, the documentation required by §B of this regulation;
(2)
The Commission requests additional information or materials pursuant to COMAR 10.45.08.01G, and:
(a)
The person does not submit the information or materials requested by the Commission within the time allowed; or
(b)
The additional information and material submitted by the person do not establish the person's qualification as a community health resource; or
(3)
The Commission determines that the person does not meet the qualification criteria specified in §A of this regulation.
Regulation .03 Qualification under Health-General Article, §19-2101(c)(2), Annotated Code of Maryland — Access Services.LinkCopy Citation
A.
To qualify as a community health resource pursuant to this regulation and Health-General Article, §19-2101(c)(2), Annotated Code of Maryland, a person shall demonstrate that the person:
(1)
Is a nonprofit or for-profit health care center or program;
(2)
Offers access services that:
(a)
Directly assist low-income, uninsured, or underinsured individuals to gain access to reduced-price clinical health care services; and
(b)
May include, but are not limited to:
(i)
Coordination of patients' health care;
(ii)
Case management services; and
(iii)
Transportation of patients to and from medical appointments; and
(3)
Offers access services, as described in §A(2) of this regulation:
(a)
Without regard to an individual's ability to pay;
(b)
In accordance with a sliding scale fee schedule that is consistent with the guidelines set forth in Regulation .05 of this chapter; and
(c)
Primarily to Maryland residents from service sites located within the State.
B.
Nonqualifying Services.
(1)
Services not directly assisting patients to access clinical health care services are not access services and do not establish a person's qualification as a community health resource pursuant to this regulation and Health-General Article, §19-2101(c)(2), Annotated Code of Maryland.
(2)
Examples of services that do not qualify as access services include, but are not limited to:
(a)
Transportation to health fairs or wellness lectures;
(b)
Mass mailings of health educational materials; or
(c)
Promotional activities sponsored by health care providers.
C.
To demonstrate qualification as a provider of access services, a person shall submit, on or before the date and time specified by the Commission, the information and documentation that the person meets the criteria set forth in §A of this regulation, including:
(1)
A written statement that includes the applicant's name, the addresses of all its service locations, and a description of how the applicant meets the requirements of §A of this regulation;
(2)
A copy of the applicant's written procedures for consistent application of the applicant's policies concerning its:
(a)
Sliding scale fee schedule; and
(b)
Provision of services regardless of a patient's ability to pay;
(3)
A list of services offered by the applicant;
(4)
A calculation of the proportion of patients served by the applicant who are Maryland residents; and
(5)
Upon the Commission's request, any additional information the Commission requires to complete its determination.
D.
The Commission shall determine that a person does not qualify as a community health resource under this regulation if:
(1)
Except when the Commission requests additional information or materials pursuant to COMAR 10.45.08.01G, the person does not submit to the Commission, on or before the date and time specified by the Commission, the documentation required by §C of this regulation;
(2)
The Commission requests additional information or materials pursuant to COMAR 10.45.08.01G, and:
(a)
The person does not submit the information or materials requested by the Commission within the time allowed; or
(b)
The additional information and material submitted by the person do not establish the person's qualification as a community health resource; or
(3)
The Commission determines that the person does not meet the qualification criteria specified in §A of this regulation.
Regulation .04 Qualification under Health-General Article, §19-2101(c)(2), Annotated Code of Maryland — Designee Services.LinkCopy Citation
A.
To qualify as a community health resource designated pursuant to this regulation and Health-General Article, §19-2101(c)(2), Annotated Code of Maryland, a person shall establish that the person meets the definition in COMAR 10.45.01.02 of a:
(1)
Federally qualified health center;
(2)
Federally qualified health center “look-alike”;
(3)
Community health center;
(4)
Migrant health center;
(5)
Health care program for the homeless;
(6)
Primary care program for a public housing project;
(7)
Local nonprofit and community-owned health care program;
(8)
School-based health center;
(9)
Teaching clinic;
(10)
Wellmobile;
(11)
Health-center controlled operating network;
(12)
Historic Maryland primary care provider;
(13)
Outpatient mental health clinic;
(14)
Local health department;
(15)
Substance abuse treatment provider; or
(16)
DDA licensee for FY 2012 and FY 2013.
B.
To demonstrate that a person is a community health resource under this regulation, the person shall submit, on or before the date and time specified by the Commission, documentation establishing that the person meets the definitional criteria specified in COMAR 10.45.01.02 for a community health resource listed in §A of this regulation.
C.
Except as provided in §D of this regulation, a person listed in §A of this regulation qualifies as a community health resource without regard to the sliding scale fee schedule requirements specified in Regulation .05 of this chapter.
D.
The Commission shall determine that a person does not qualify as a community health resource under Regulation .04 of this chapter if:
(1)
Except when the Commission requests additional information or materials to aid in making a determination pursuant to COMAR 10.45.08.01G, the person does not submit to the Commission, on or before the date and time specified by the Commission, the documentation required by §B of this regulation;
(2)
The Commission requests additional information or materials pursuant to COMAR 10.45.08.01G, and:
(a)
The person does not submit the information or materials requested by the Commission within the time allowed; or
(b)
The additional information and material submitted by the person do not establish the person's qualification as a community health resource; or
(3)
The Commission determines that the person does not meet the definition, as specified in COMAR 10.45.01.02, of a provider category listed in §A of this regulation.
Regulation .05 Sliding Scale Fee Schedule Guidelines.LinkCopy Citation
A.
Applicability. The Commission shall apply the sliding scale fee schedule criteria set forth in §B of this regulation to determine whether:
(1)
An applicant meets the sliding scale fee schedule criterion to qualify as a community health resource under Regulation .02A(2) or .03A(3) of this chapter; and
(2)
An application submitted by a community health resource addresses the selection criterion specified in COMAR 10.45.07.01I.
B.
A community health resource shall offer primary health care services or access services to individuals whose annual family income is:
(1)
Below 100 percent of the federal poverty guidelines:
(a)
Free of charge; or
(b)
For no more than a nominal fee; or
(2)
At least 100 percent of the federal poverty guidelines but less than 200 percent of the federal poverty guidelines:
(a)
Free of charge; or
(b)
At a reduced price.
C.
A community health resource qualifying under Regulation .02 or .03 of this chapter may not require individuals with annual family income of less than 200 percent of the federal poverty guidelines to pay any charges for primary health care services or access services in addition to those specified in §B(1) or (2) of this regulation, as applicable.
D.
Notice and Documentation. At each of its care sites in the State, a community health resource qualifying under Regulation .02 or .03 of this chapter shall:
(1)
Provide notice to the public of its sliding scale fee schedule, including the display of a prominently posted sign indicating that free or reduced-price care is available; and
(2)
Collect documentation of income from individuals applying for reduced-price care pursuant to the community health resource's sliding scale fee schedule.
Chapter 06. Community Health Resource Grants
Regulation .01 Call for Proposals.LinkCopy Citation
Beginning in FY 2007, the Commission shall issue to the public, at least once per year, and as budgeted resources permit, a call for proposals, which may include:
A.
An explanation of the grants program;
B.
A statement of the Commission's authority to make grant awards pursuant to Health-General Article, §19-2201(e), Annotated Code of Maryland;
C.
An indication of whether the object of the solicitation is to award:
(1)
Operating grants to qualifying community health resources; or
(2)
Funding for development, support, and monitoring of a unified data information system among primary and specialty care providers, hospitals, and other providers of services to community health resource members;
D.
In addition to the statement under §C of this regulation, a specific indication of the types of programs the Commission expects to fund and the amount of grant funds to be awarded;
E.
Requirements relating to submission of community health resources qualifications, including a requirement that the materials necessary to establish an applicant's qualification as a community health resource pursuant to COMAR 10.45.05.02, .03, or .04 be submitted:
(1)
As part of an applicant's letter of intent, pursuant to COMAR 10.45.06.02; or
(2)
As part of an applicant's grant application, pursuant to COMAR 10.45.06.03;
F.
Requirements applicable to letters of intent, if required, and grant applications, including:
(1)
The content required for letters of intent under Regulation .02 of this chapter;
(2)
The content required for grant applications under Regulation .03 of this chapter;
(3)
Formatting guidelines; and
(4)
The date and time for submission, the address to which letters of intent or grant applications shall be directed, and a specification of acceptable means of transmission;
G.
Guidelines for preparing grant proposals, including requirements as to:
(1)
The content of the proposal, consistent with Regulation .04 of this chapter;
(2)
The proposal's structure and organization;
(3)
Questions to be addressed in the proposal; and
(4)
Formatting and page limit requirements;
H.
An explanation of how grantees may use grant funds, consistent with COMAR 10.45.08.04;
I.
Budget guidelines; and
J.
To guide the applicant's preparation of the evaluation plan required by Regulation .04G of this chapter, an explanation of program monitoring and evaluation requirements.
Regulation .02 Letter of Intent.LinkCopy Citation
A.
The Commission may require that, as a condition of submitting a grant application, a person first respond to the Commission's call for proposals by submitting a letter of intent to the address and by the date and time specified in the call for proposals.
B.
The Commission may, in its sole discretion, require that a letter of intent include information and documentation sufficient to establish a person's qualification as a community health resource as specified in COMAR 10.45.05.02, .03, or .04.
C.
If the Commission requires a letter of intent pursuant to §A of this regulation, an applicant shall include in the applicant's letter of intent, in addition to any content that may be required by the Commission pursuant to §B of this regulation:
(1)
An identification of the type of grant, of those specified in the call for proposals pursuant to Regulation .01C of this chapter, for which the applicant intends to apply;
(2)
A succinct description, no more than 250 words in length, of the proposed project;
(3)
The estimated cost of the project and its expected duration;
(4)
The name and location of the applicant;
(5)
The name, title, address, telephone number, and email address of the proposed project director; and
(6)
The name, affiliation, and email address of the applicant's contact person or persons.
Regulation .03 Application.LinkCopy Citation
A.
An application for a grant under this subtitle shall be submitted to the place and by the date and time specified in the call for proposals.
B.
As specified in the call for proposals, an application for a grant under this subtitle may be required to include the following elements:
(1)
A transmittal letter:
(a)
Specifying:
(i)
The title of the proposal;
(ii)
The name of the applicant;
(iii)
The name of the project director; and
(iv)
A statement that the applicant agrees that submission of a proposal constitutes the applicant's acceptance of the terms of the grant program; and
(b)
Signed by an individual responsible for conducting the affairs of the applicant and legally authorized to execute contracts on behalf of the applicant;
(2)
A grant application cover sheet, on a form provided by the Commission and signed by:
(a)
The project director; and
(b)
An individual responsible for conducting the affairs of the applicant and legally authorized to execute contracts on behalf of the applicant;
(3)
A statement of the applicant's contractual obligations, assurances, and certifications on a form provided by the Commission and signed by an individual legally authorized to execute contracts on behalf of the applicant;
(4)
The applicant's proposal, which includes the elements specified in Regulation .04 of this chapter; and
(5)
Any other information or documentation the Commission may require.
Regulation .04 Proposal Guidelines.LinkCopy Citation
An applicant for a grant under this subtitle shall prepare and submit to the Commission a proposal that is consistent with the instructions and requirements specified in the call for proposals, which may include:
A.
Information about the applicant, including:
(1)
The applicant's mission, programs, and service area;
(2)
The applicant's organizational strengths and challenges;
(3)
The applicant's organizational structure, including:
(a)
An indication of the applicant's for-profit or nonprofit status; and
(b)
If applicable, a copy of the applicant's IRS determination letter indicating tax-exempt status under 26 U.S.C. §501(c)(3) and a statement signed by an authorized official of the organization that this ruling remains in full force and effect;
(4)
An identification of the applicant's provider type;
(5)
The applicant's governance structure, including a list of the applicant's officers and governing body; and
(6)
A description of the applicant's staffing pattern and a copy of its organizational chart;
B.
A project summary;
C.
A project description, including a specification of the payment policies proposed by the applicant;
D.
A description of the target population;
E.
A specification of the proposed service area of the project;
F.
A discussion of the expected benefits of the project's success;
G.
An evaluation plan; and
H.
A work plan.
Chapter 07. Selection Criteria and Funding Priorities
Regulation .01 Selection Criteria.LinkCopy Citation
The Commission's criteria for selecting community health resources grant proposals for funding under this subtitle are as follows:
A.
Prospects for success of the proposed project, based on:
(1)
Clear, feasible, and achievable goals and objectives;
(2)
Reasonableness of work plan and budget; and
(3)
Adequacy of:
(a)
The project team's skills, competencies, commitment, and capacity to carry out the proposed work; and
(b)
Organizational and community support;
B.
Potential impact of the proposed project, based on the likelihood of the project leading to:
(1)
Improved access to health care and health outcomes for the target population by expanding:
(a)
Existing services to make them available to a new population not previously served by the applicant; or
(b)
The types of services offered to the applicant's established population;
(2)
Expansion or replication within the community, in neighboring areas, or more broadly across the State; or
(3)
Both;
C.
Community need for the proposed project, based on the:
(1)
Clarity and reliability of the proposal's quantitative and geographic identification and definition of the target population;
(2)
Adequacy of the proposal's documentation of the target population's needs through qualitative and quantitative data such as demographics, insurance coverage rates, and service utilization statistics;
(3)
Depth of the applicant's understanding of the community to be served; and
(4)
Relevance of the proposed project to the community's identified needs;
D.
Sustainability of the proposed project, based on the likelihood that the project will continue to provide benefits to the target population and the community beyond the duration of the proposed grant;
E.
Active engagement in the project by key participants, including relevant stakeholders, appropriate agencies and organizations, and community partners, based on their:
(1)
Participation in the project's planning and implementation process;
(2)
Allocation of dedicated staff and other resources to the project; and
(3)
Contributions of facilities and equipment;
F.
Data collection in connection with the proposed project, based on the Commission's assessment of the project team's ability to:
(1)
Both at baseline and as the project proceeds, measure and report progress in achieving project goals and objectives through quantitative measures, such as the number, demographics, characteristics, and service utilization of the target population; and
(2)
Comply with the evaluation and monitoring requirements established by the Commission;
G.
Organizational commitment, based on the applicant's:
(1)
Commitment to improving access to care for the target population; and
(2)
Ability to demonstrate that the proposed project will significantly contribute to this goal;
H.
Financial viability and accountability, based on the:
(1)
Applicant's financial soundness;
(2)
Adequacy of the applicant's financial management systems; and
(3)
Applicant's capacity to manage grant funds; and
I.
The extent to which the applicant demonstrates use of a sliding scale fee schedule effectively to increase access to care for low-income uninsured and underinsured individuals in Maryland.
Regulation .02 Funding Priorities.LinkCopy Citation
In selecting community health resources proposals to be funded under this subtitle, the Commission shall:
A.
Consider geographic balance; and
B.
Give priority to community health resources that:
(1)
In addition to normal business hours, operate during evening and weekend hours;
(2)
Have partnered with a hospital to establish a reverse referral program at the hospital;
(3)
Reduce the use of the hospital emergency department for nonemergency services;
(4)
Assist patients in establishing a medical home with a community health resource;
(5)
Coordinate and integrate the delivery of primary and specialty care services;
(6)
Promote the integration of mental and somatic health with federally qualified health centers or other somatic care providers;
(7)
Fund medication management or therapy services for uninsured individuals:
(a)
Whose income is up to 200 percent of the federal poverty guidelines;
(b)
Who meet medical necessity criteria; and
(c)
Who are ineligible for the public mental health system;
(8)
Provide a clinical home for individuals who access hospital emergency departments for mental health services, substance abuse services, or both; and
(9)
Support the implementation of evidence-based clinical practices.
Chapter 08. Selection Process
Regulation .01 Letters of Intent — Commission Review.LinkCopy Citation
A.
The Commission may direct staff to review letters of intent and report to:
(1)
The Committee on Capital and Operational Funding;
(2)
The Commission; or
(3)
Both.
B.
If a letter of intent is submitted after the submission deadline specified in the call for proposals, the Commission shall:
(1)
Refuse delivery of the letter of intent; or
(2)
Return the letter of intent to the sender without review.
C.
The Commission shall review letters of intent properly submitted before the deadline specified in the call for proposals to:
(1)
Ensure that identifying information submitted by an applicant is complete; and
(2)
Determine the number and distribution of proposals likely to be submitted for each type of grant specified in the call for proposals.
D.
If, pursuant to COMAR 10.45.06.02B, the call for proposals requires an applicant to submit evidence of qualification as a community health resource with the applicant's letter of intent, the Commission shall determine, consistent with the criteria set forth in COMAR 10.45.05.02, .03, and .04, whether or not the applicant qualifies as a community health resource.
E.
The Commission shall notify an applicant determined to be a qualified community health resource:
(1)
Of the result of the Commission's review; and
(2)
That the applicant is eligible to submit a grant application in accordance with the requirements of the call for proposals.
F.
Except as provided in §G of this regulation, the Commission shall notify each unsuccessful applicant for qualification as a community health resource that the:
(1)
Commission has determined that the applicant does not qualify as a community health resource; and
(2)
Applicant is not eligible to submit a grant application in response to the call for proposals.
G.
If the Commission is unable to determine from its review of qualification materials submitted by the applicant whether or not the applicant qualifies as a community health resource, the Commission may:
(1)
Request that the applicant submit additional materials supporting the application for qualification as a community health resource;
(2)
Review the applicant's supplemental submission;
(3)
Determine whether or not the applicant qualifies as a community health resource; and
(4)
Provide notice of the Commission's decision to the applicant, in accordance with §E or F of this regulation, as appropriate.
Regulation .02 Application Review and Selection of Grantees.LinkCopy Citation
A.
If a grant application is submitted after the submission deadline specified in the call for proposals, the Commission shall:
(1)
Refuse delivery of the application; or
(2)
Return the application to the sender without review.
B.
The Commission shall review grant applications that were properly submitted prior to the deadline specified in the call for proposals in accordance with §C of this regulation.
C.
Review Procedures.
(1)
The Commission may direct staff to:
(a)
Initially review application materials;
(b)
Conduct negotiations with successful applicants regarding program specifications and grant conditions;
(c)
Report the results of staff's efforts performing the tasks assigned by the Commission pursuant to §C(1)(a) or (b) of this regulation to the:
(i)
Commission; or
(ii)
Committee on Capital and Operational Funding; or
(d)
Perform each of the tasks identified in §C(1)(a) — (c) of this regulation.
(2)
The Commission may consider, in connection with its evaluation of grant proposals:
(a)
Reports by:
(i)
The Committee on Capital and Operational Funding;
(ii)
Staff; or
(iii)
Both; and
(b)
Any application materials the Commission reviews directly.
(3)
The Commission shall consider, in connection with its evaluation of grant proposals, the degree to which a proposal:
(a)
Effectively responds to the call for proposals;
(b)
Meets the selection criteria specified in COMAR 10.45.07.01; and
(c)
Addresses the funding priorities specified in COMAR 10.45.07.02.
(4)
If the Commission determines that none of the proposals received has sufficient merit to justify award of a grant under this subtitle, the Commission shall notify all applicants of the decision not to award any grants in the present round of grant-making.
(5)
If the Commission determines, consistent with the criteria and priorities set forth in COMAR 10.45.07.01 and .02, that one or more of the proposals reviewed merits a grant award, the Commission shall:
(a)
To the extent adequate funding is available, select one or more applicant or applicants to receive funding pursuant to Regulation .03 of this chapter;
(b)
Notify all applicants with applications pending before the Commission of the Commission's decision; and
(c)
With respect to applicants selected pursuant to §C(5)(a) of this regulation, include with the notice required by §C(5)(b) of this regulation:
(i)
A specification of the amount or range of amounts the Commission expects to award to the grantee; and
(ii)
An explanation of the negotiation process described in Regulation .03 of this chapter.
Regulation .03 Negotiation and Award.LinkCopy Citation
A.
An applicant approved by the Commission for a grant award pursuant to Regulation .02 of this chapter shall, in collaboration with the Commission, develop grant specifications concerning:
(1)
Performance milestones;
(2)
Deliverables;
(3)
A grant disbursement schedule;
(4)
Monitoring and evaluation requirements;
(5)
Data requirements; and
(6)
The project's final budget.
B.
Upon its approval of grant specifications proposed by the applicant pursuant to §A of this regulation, the Commission shall perfect the grant award according to the terms of the successful proposal, as modified by the specifications negotiated pursuant to §A of this regulation and agreed to by the Commission and the grantee.
C.
In the event the Commission and an applicant selected pursuant to Regulation .02C(5) of this chapter are unable to agree on the specifications listed in §A of this regulation, either the Commission or the applicant may withdraw.
D.
In the event of a withdrawal from negotiations pursuant to §C of this regulation, the Commission may, in its sole discretion, make an additional selection or selections, pursuant to Regulation .02C(5)(a) of this chapter, from applicants who submitted high-scoring proposals that were not chosen in the Commission's original selection pursuant to Regulation .02C(5)(a) of this chapter.
Regulation .04 Use of Grant Funds.LinkCopy Citation
A.
A grantee under this subtitle may use grant funds for:
(1)
Salaries and employment benefits for project staff;
(2)
Subcontracting and consultant fees;
(3)
Data collection and analysis;
(4)
Project-related travel, conference calls, and meetings;
(5)
Office supplies, expenses, and other indirect costs as approved by the Commission; and
(6)
A limited amount of essential equipment and minor infrastructure improvements required by the project.
B.
Funds from operating grants awarded under this subtitle may not be used for:
(1)
The purchase or lease of major equipment;
(2)
Construction projects;
(3)
Support of clinical trials;
(4)
Medical devices or drugs that have not received approval from the appropriate federal agency; or
(5)
Lobbying or political activity.
C.
Funds may not be used in contravention of the Department's Standard Grant Agreement.
Regulation .05 Formula for Disbursing Grants.LinkCopy Citation
A.
The Commission shall disburse grant funds to grantees in accordance with the following formula:
(1)
Unless the Commission finds that special circumstances apply and the grant award so specifies, the Commission shall make an initial payment to a grantee of up to 20 percent of the total grant award;
(2)
The Commission shall make progress payments to a grantee in accordance with a schedule of milestones:
(a)
To which the Commission and the grantee have agreed; and
(b)
That provides that, by the time the grant period expires, the total disbursement of grant funds shall equal 100 percent of the amount awarded under this subtitle; and
(3)
Unless the Commission finds that special circumstances apply and the grant award so specifies, a single progress payment may not exceed 50 percent of the total funds awarded the grantee under this subtitle.
B.
If the grantee fails to achieve any milestone, or fails to abide by the terms of the grant, the Commission may cancel the grant and withhold any or all funds not yet disbursed.
C.
The Commission may:
(1)
By written agreement entered into with a grantee after the award of a grant under this subtitle, modify any milestone or schedule of milestones;
(2)
Conduct audits or otherwise inspect the records, premises, and operations of the grantee to determine whether grant funds are being administered:
(a)
In a financially responsible manner;
(b)
In accordance with the terms of the grant award; and
(c)
In accordance with the requirements of Regulation .04 of this chapter; and
(3)
Establish in the grant documents such other terms and conditions relating to grant funds as the Commission considers reasonable and necessary.
Chapter 09. Emergency Grant Funding
Regulation .01 Purpose and Limitations.LinkCopy Citation
A.
In addition to the Commission's statutory authority pursuant to Health-General Article, §19-2201(e), Annotated Code of Maryland, to award operating grants to qualifying community health resources, the Commission may award temporary emergency grants to an applicant that meets the criteria set forth in this chapter.
B.
Temporary emergency grants may be awarded by the Commission only if:
(1)
The community health resource has encountered an unforeseeable lapse or cessation in otherwise stable funding that threatens an essential service or program serving low-income, uninsured, or underinsured residents within the State; and
(2)
A temporary emergency grant can provide assistance sufficient to briefly sustain the service or program until stable funding is restored or alternative funding is secured.
C.
The amount of funding available for a temporary emergency grant may not exceed $250,000.
D.
Temporary emergency funding obtained by a successful applicant shall make the applicant ineligible to apply for emergency funds for a 3-year period following the date of award of the temporary emergency grant.
Regulation .02 Letter of Request.LinkCopy Citation
A.
An applicant for temporary emergency funding shall submit to the Commission a letter of request outlining the need for temporary emergency funding.
B.
A letter of request shall include the following elements:
(1)
Information and documentation sufficient to establish the applicant's qualification as a community health resource as specified in COMAR 10.45.05.02, .03, or .04;
(2)
A brief description of the applicant's mission, programs, and service area;
(3)
The name, address, and location of the applicant, including the:
(a)
Name, title, address, telephone number, and email address of the director; and
(b)
Name and email address of the applicant's contact person;
(4)
The signature of an individual responsible for conducting the affairs of the applicant and legally authorized to execute contracts on the applicant's behalf;
(5)
A brief account of the organizational and financial structure of the applicant, including the applicant's:
(a)
For-profit or not-for-profit status; and
(b)
Financial stability over the 3-year period prior to the date of application; and
(6)
The nature of the program or service whose existence or funding is threatened, including:
(a)
The significance of the program or service to its target group and to the geographic area in which it operates;
(b)
The customary and usual amount of funds needed to provide the service or operate the program on a monthly, quarterly, or annual basis;
(c)
The normal or usual funding source or sources for the program or service;
(d)
The number and area of residence of low income, underinsured, or uninsured persons served by the program or service on a monthly, quarterly, or annual basis;
(e)
A concise explanation of why the temporary emergency for which funding is sought could not have been anticipated;
(f)
A concise account of any and all emergency funding requests by the applicant over the past 3 years and the results of those requests;
(g)
The specific amount of funding requested and the amount of time over which the funding will be expended;
(h)
A list of all other potential sources of funding, both internal and external, that have been approached by the applicant for this temporary emergency and their responses;
(i)
A clear explanation of how the requested funds will enable the applicant to stabilize the threatened service or program; and
(j)
Any other information that the Commission may require on the emergency grant application form.
Regulation .03 Selection Process.LinkCopy Citation
A.
Letters of Request — Commission Review. The Commission may direct staff to review a letter of request and report to:
(1)
The Committee on Capital and Operational Funding (Committee);
(2)
The Commission; or
(3)
Both.
B.
Temporary emergency funding requests shall be reviewed on a timely basis as follows:
(1)
Temporary emergency funding requests submitted from the 1st through 15th of any month shall be preliminarily reviewed by staff prior to the end of the month and forwarded to the Commission, the Committee, or both, within 10 days; or
(2)
Temporary emergency funding requests submitted from the 16th through the last day of the month shall be preliminarily reviewed by staff prior to the 15th of the succeeding month and forwarded to the Commission, the Committee, or both, within 10 days.
C.
Staff Determinations.
(1)
Staff shall review a request for emergency funding to preliminarily ascertain that:
(a)
Sufficient information has been provided to determine a community health resource's status; and
(b)
Sufficient information has been provided concerning the threatened service or program for which funding is being requested.
(2)
Staff shall alert the applicant to perceived preliminary deficiencies, if any, in the submission and request supplementation as necessary.
(3)
Upon receipt of the information required as preliminarily determined by staff, the letter of request shall be forwarded to the Committee, the Commission, or both, at the discretion of the Commission chairperson.
Regulation .04 Selection Criteria for Temporary Emergency Funding.LinkCopy Citation
The Commission's criteria for awarding an emergency grant to a community health resource are as follows:
A.
The nature of the temporary emergency situation, including an evaluation of the applicant's inability to anticipate the emergency situation;
B.
The essential nature of the threatened program or service to the population served and as part of the provision of essential health care services to the relevant low-income population;
C.
The reasonable likelihood of resolution of the temporary emergency situation as a direct result of the requested emergency funds;
D.
The reasonable likelihood of the sustainability of the threatened program or service upon the cessation of temporary emergency funding; and
E.
The number of emergencies, as that term is described in Regulation .01B of this chapter, for which funding was sought by the applicant in the last 3 years, and the number of instances in which funding was obtained.
Regulation .05 Review by Committee on Capital and Operational Funding.LinkCopy Citation
A.
The Committee on Capital and Operational Funding shall review letters of request in a timely manner to:
(1)
Ensure that all information as to community health resource status specified in COMAR 10.45.05 has been provided and, if not, request that specific supplements be provided; and
(2)
Ensure that all information required in the letter of request under Regulation .02B of this chapter has been provided and, if not, request that specific supplements be provided.
B.
Following receipt of all necessary information, the Committee shall:
(1)
Make an initial determination as to whether the applicant qualifies as a community health resource pursuant to the criteria specified in COMAR 10.45.05;
(2)
Make an initial determination as to whether temporary emergency funds should be provided to the applicant;
(3)
Make an initial determination as to the amount of temporary emergency funds to be awarded to the applicant; and
(4)
Forward to the Commission for review:
(a)
The Committee's recommendation on each of the determinations required by §B(1) — (3) of this regulation;
(b)
The community health resource's letter of request; and
(c)
Any supplementary documents.
Regulation .06 Review by the Commission.LinkCopy Citation
A.
Upon receipt of a recommendation on a request for emergency funding from the Committee on Capital and Operational Funding, or on its own initiative, the Commission shall:
(1)
Determine whether all necessary information has been made available and, if not, request supplementary information; and
(2)
Determine whether the applicant qualifies as a community health resource pursuant to COMAR 10.45.05.
B.
If the Commission determines that the applicant is not a community health resource, the Commission shall notify the applicant that the applicant is not eligible to receive emergency funding from the Commission.
C.
If the Commission determines that the applicant is a community health resource, the Commission shall consider whether the applicant:
(1)
Has provided information documenting an unforeseeable temporary emergency situation threatening an essential service or program; and
(2)
Meets the selection criteria specified in Regulation .04 of this chapter.
D.
If the Commission determines, consistent with the criteria set forth in §A of this regulation, that the applicant's request does not meet the criteria for award of a temporary emergency grant under this subtitle, the Commission shall notify the applicant of the Commission's decision not to make temporary emergency funds available.
E.
If the Commission determines, consistent with the criteria set forth in §A of this regulation, that the applicant's request should receive funding, the Commission shall:
(1)
To the extent adequate funding is available, determine the:
(a)
Amount of emergency funds that will be offered to the applicant; and
(b)
Conditions under which funds will be made available;
(2)
Direct staff to conduct negotiations with the applicant regarding the specified grant conditions; and
(3)
Notify the successful applicant of the fact that temporary emergency funds will be made available conditioned on the applicant's acceptance of the terms of the emergency grant agreement.
Regulation .07 Negotiation and Award.LinkCopy Citation
A.
An applicant approved by the Commission for a temporary emergency grant pursuant to Regulation .06 of this chapter shall, in collaboration with the Commission, develop grant specifications concerning:
(1)
A grant disbursement schedule;
(2)
Monitoring and evaluation requirements;
(3)
Data requirements; and
(4)
The budget that will be impacted by the emergency grant funds.
B.
Upon the Commission's approval of grant specifications proposed by the applicant pursuant to §A of this regulation, the Commission shall perfect the temporary emergency grant award according to the terms of the successful letter of request, as modified by the specifications negotiated pursuant to §A of this regulation and agreed to by the Commission and the grantee.
C.
In the event the Commission and an applicant are unable to agree on the specifications listed in §A of this regulation, either the Commission or the applicant may withdraw.
Regulation .08 Use of Grant Funds.LinkCopy Citation
A.
A grantee under this chapter may use grant funds only for the purposes outlined in the applicant's letter of request unless a change in those conditions has been previously agreed to by the Commission and the applicant in writing.
B.
If a grantee fails to abide by the terms of a grant agreement, the Commission may cancel the grant and withhold any or all funds not yet disbursed.
C.
The Commission may:
(1)
By written agreement entered into with an emergency grantee after the award of an emergency grant under this subtitle, modify the terms of the grant agreement; and
(2)
Conduct audits or otherwise inspect the records, premises, and operations of the grantee to determine whether grant funds are being administered:
(a)
In a financially responsible manner; and
(b)
In accordance with the terms of the grant award.
D.
The successful grantee, based on being awarded an emergency grant from the Commission, shall sign an agreement not to seek emergency funding from the Commission for a period of 3 years following the date of notification of the grant award.