The TNGP has two provisions: Telehealth Networks (TNGP-TH) grants demonstrate how telehealth networks improve healthcare services in rural communities.

Telehomecare Networks (TNGP-THC) grants fund demonstration or pilot projects for telehomecare, services that may include, but are not limited

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to, case management by physicians, hospitals, medical clinics, home health agencies, or other health care providers who supervise the care of patients in their homes.

The TRCGP supports the establishment and development of Telehealth Resource Centers (TRC).

These centers assist health care organizations, health care networks, and health care providers in the implementation of cost-effective telehealth programs to serve rural and medically underserved areas and populations.

The TRCGP is designed to leverage the experience of mature programs that have a strong record of implementing telehealth services.

The LPGP supports State professional licensing boards to carry out programs under which licensing boards of various States cooperate to develop and implement State policies that will reduce statutory and regulatory barriers to telemedicine.

For the FY 2006 - FY 2008 funding cycle, the Telehealth programs are building upon the projects' demonstrated skill in evaluation, providing healthcare, and, as appropriate, in legal and regulatory issues and in the provision of technical assistance. TNGP grantees are developing evaluation designs to measure process and outcomes. Quantitative outcomes will measure the following areas: impact on quality of care; appropriateness of use of the technology; whether access was improved; whether clinical outcomes were improved; and, how the cost of service delivery was affected in terms of efficiency and effectiveness of care. The TRCGP and LPGP are newly funded programs for FY 2006 and FY 2007. As such, these grantees are presently building organizational capacity. The TRCGP grantees are developing an extensive array of tools to provide technical assistance, and they are formulating an evaluation design to measure their impact on supporting the activities of existing or developing telehealth networks in their regions to meet the health care needs of rural or other populations to be served, including the improvement of access to services and the quality of the services received by those populations. The LPGP grantees are developing programs under which licensing boards of various States will cooperate to develop and implement State policies that will reduce statutory and regulatory barriers to telemedicine. These grants will continue to focus on licensure issues for physicians and nurses. The funded projects are to build on the first year of efforts to develop national models for addressing barriers to adoption of the Nurse Licensure Compact and implement model agreements to expedite the licensure process and eliminate redundancies associated with applying for physician licenses in multiple jurisdictions. The TNGP has been funded in past cycles. For the last full 3-year cycle of funding 15 grants were awarded from FY 2003 - FY 2006. With approximately $3.75 million awarded to fund these 15 grants, the TNGP improved access to specialty services for residents of underserved rural communities. With a population of 3.8 million individuals who lived in these underserved communities, access to specialty care was provided for less than $1/person/year in TNGP program expenditures. Specialty services include mental health, diabetes, cardiology, dermatology, home health care and monitoring, pediatrics, radiology and many other specialties based on the needs of the particular community where the project is located. For further information on services and activities, see the OAT Grantee Directory at http://telehealth.hrsa.gov/. The TNGP has shown home care can improve efficiency by reducing nurse travel time, and individual grantees have reported savings in a variety of small scale studies across different applications. During the three year grant cycle FY 2003 - FY 2005, 7 grantees estimated that telehome care services saved over $77,000 in salary and travel costs associated with the reduced need for nurses to travel. In addition, several TNGP grantees have demonstrated in small scale studies the efficiency of their telehealth programs in producing tangible savings. The University of Tennessee recently reported a 56 percent decrease in emergency room (ER) visits per month for its telehealth diabetes program patients and a 38 percent decrease in spending on clinic visits per month for telehealth patients. The University of Arkansas has shown that by tracking patient outcomes through its TNGP grant, it has saved the Arkansas Medicaid Program over $14 million in emergency transports and medical costs by conducting telemedicine consults and assessments on high-risk obstetrics patients in rural areas. The Ohio Tele-mental Health Program reports that of the 709 telecommunication events recorded since the inception of the grant (clinicalconsultation,management,psychiatricservicesandeducation--48 of which were individual direct service encounters) have yielded a savings of $213,530 in saved mileage and saved staff "downtime." Individual programs have reported a significant impact of the TNGP program on the sustainability of services. Programs in Arkansas, Missouri, Kentucky, and Arizona report a significant impact on their obtaining ongoing state funding . For example, the program in Arkansas reports that its demonstrable success significantly contributed to obtaining Medicaid reimbursement for the telehealth services, and the provision of these services resulted in measurable savings. The Kentucky Telehealth Network program has documented the extensive leveraging of TNGP dollars (for every dollar invested through the HRSA telehealth programs, the program has been able to generate almost $7 dollars, primarily from the telehealth network sites themselves and the state.) Further, the TNGP is contributing to the ability of grantees to gain additional state and local support. The TNGP funded Kentucky Telehealth Network Program Kentucky has worked with the state legislature to create a statewide telehealth program, as has Missouri and Arizona. The University of Tennessee program reports that for every dollar provided by OAT grants, the program has been able to raise $2, in large part through service contracts with state and local organizations, such as the Tennessee Department of Children and Family Services, the Tennessee Department of Health, Shelby County government, and the like.

Uses and Use Restrictions

TNGP - Funds support the use of telehealth (electronic information and telecommunications technologies to support and promote long-distance health care and ancillary services) in two ways: 1) Telehealth Networks, for improving access to health care services; provide a baseline of information for a systematic evaluation of telehealth systems; purchase or lease and install equipment; and to operate and evaluate the telehealth system.

2) Telehomecare Networks, for improving access to health services for patients in their homes and for evaluating the cost and effectiveness through provision of clinical care and remote monitoring of patients in their own homes using telehealth technologies.

Primary expenses for telehomecare shall be for personnel costs for provision of services and for evaluation.

Overall, not more than 40 percent of grant funds may be expended for equipment.

Not more than 15 percent of grant finds may be expended for indirect costs.

Grant funds may not be used for purchasing and installing telecommunications transmission equipment (e.g., microwave towers, satellite dishes, amplifiers, digital switching equipment or laying cable or telephone lines) or to acquire real property.

Construction costs are allowable only for minor renovations related to the installation of equipment.

Note: For FY 2009, the Agency is developing program guidance to facilitate a competition for the 3-year FY 2009 through FY 2011 project period.

The FY 2009 program guidance may include, under the TNGP provisions, a limited number of planning grants.) TRCGP - Funds support the development of regional Telehealth Resource Centers (TRCs), which serve as a regional focus for supporting telehealth activities throughout their respective regions; and, one national Telehealth Resource Center focuses on legal and regulatory telehealth issues.

Grant funds are used for salaries, equipment, operating, travel expenses, or other costs for: providing technical assistance, training and support; disseminating information and research findings related to telehealth services; promoting effective collaboration among telehealth resource centers and HRSA; conducting evaluations to determine the best utilization of telehealth technologies to meet health care needs; promoting the integration of the technologies used in clinical information systems with other telehealth technologies; fostering the use of telehealth technologies to effectively provide healthcare information and education for health care providers and consumers; and, implementing special projects that involve collaboration among TRCs to advance the field of telehealth.

Grant funds are not used for: acquiring real property, equipment costs of more than 40 percent of total grant funds, for equipment or transmission costs not directly related to the grant purposes, to purchase or install general purpose voice telephone systems, construction costs, indirect costs exceeding 15 percent of total grant funds.

LPGP - Grant funds are used for salaries, equipment, software development, operating, or other costs associated with developing legislative, administrative, and technical projects to address licensure barriers that hinder the practice of telemedicine across state lines.

Grant funds may also be used for activities involving significant expansion of existing state agreements for cross-state recognition of professional licenses to other states.

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Eligibility Requirements

Applicant Eligibility

TNGP - A grantee must be a nonprofit or public entity that will provide services through a telehealth network (TNGP-TH) to rural communities or through a telehomecare network (TNGP-THC) to patients in their homes located in either urban underserved or rural communities.

Telehomecare network grantees should have demonstrated experience in providing telehomecare services.

For both telehealth networks and telehomecare networks, proof of non-profit status is required.

Each entity participating in the network may be a nonprofit or for-profit entity.

Faith-based and community based organizations are eligible under the TNGP.

TRCGP - A grantee must be a public or private nonprofit organization.

Faith-based and community based organizations are eligible to apply.

Services may be provided to rural or urban communities.

LPGP - A grantee must be a State professional licensing board, or a national organization of professional licensing boards that provide services to state licensing boards.

Note: American Indian and/or Alaska Native Tribal Organizations are eligible provided those organizations meet the eligibility requirements above.

Beneficiary Eligibility

TNGP - Health care providers in rural areas, in medically underserved areas, in frontier communities, and for medically underserved populations. TNGP-TH grantees include in the network at least two (2) of the following entities (at least one (1) of which shall be a community-based health care provider: (a) community or migrant health centers or other federally qualified health centers; (b) health care providers, including pharmacists, in private practice; (c) entities operating clinics, including rural health clinics; (d) local health departments; (e) nonprofit hospitals, including community (critical) access hospitals; (f) other publicly funded health or social service agencies; (g) long-term care providers; (h) providers of health care services in the home; (i) providers of outpatient mental health services and entities operating outpatient mental health facilities; (j) local or regional emergency health care providers; (k) institutions of higher education; or (l) entities operating dental clinics. TNGP-THC grantees are experienced in providing telehealth services, have a substantial caseload, are targeted to patients with chronic illnesses and senior citizens, have a history of doing evaluations and monitoring telehomecare network performance in terms of quality, cost, and effectiveness or services. TRCGP - Health care providers in rural areas, in medically underserved areas, in frontier communities, and medically underserved populations. The regional telehealth resource centers must support the activities of existing or developing telehealth networks in their regions to meet the health care needs of rural or other populations to be served, including the improvement of access to services and the quality of the services received by those populations. Regional TRCs have expertise in at least four (4) of the following areas: Clinical Outpatient Specialty Care; Critical or Emergency Care; Residential telehealth (home care)/chronic disease management; Nursing Home/Inpatient Care; Distance Education and Training; Store-and-Forward; Teleradiology. Regional TRCs collaborate with other organizations to address any of the seven areas where they are not expert. The National TRC exhibits expertise in the following areas: Reimbursement (Medicare, Medicaid, private insurance); Licensure (legislative and regulatory issues); Privacy, security, and confidentiality legislation at federal and state levels; Food and Drug Administration regulation; Telecommunications legal and regulatory issues; and, Private credentialing and accreditation organizations and issues (e.g., Joint Commission on Accreditation of Health Care Organizations). Note: American Indian and/or Alaska Native Tribal Organizations are eligible beneficiaries provided those organizations meet the beneficiary requirements above. LPGP - State professional licensing boards to carry out programs under which licensing boards of various States cooperate to develop and implement State policies that will reduce statutory and regulatory barriers to telemedicine. NCC grants will continue to focus on licensure issues for physicians and nurses. The funded projects are to build on the first year of efforts to develop national models for addressing barriers to adoption of the Nurse Licensure Compact and implement model agreements to expedite the licensure process and eliminate redundancies associated with applying for physician licenses in multiple jurisdictions.

Credentials/Documentation

Applicants should review the individual HRSA Guidance documents issued under this CFDA program for any required proof or certifications which must be submitted prior to or simultaneous with submission of an application package.

Aplication and Award Process

Preapplication Coordination

This program is eligible for coverage under E.O.

12372, Intergovernmental Review of Federal Programs.

An applicant should consult the office of the official designated as the single point of contact in his or her State for more information on the process the State requires to be followed in applying for assistance, if the State has selected the program for review.

Application Procedures

Grant applications and required forms for this program can be obtained from Grants.gov. Please visit the Grants.gov Web site at www.grants.gov to both find and apply for all Federal grant opportunities. All qualified applications will be forwarded to an objective review committee which will make funding recommendations to the Associate Administrator for the Office of Health Information Technology. The Associate Administrator has the authority to make final selections for awards.

Award Procedures

For FY 2008, funding for the third and final year of the 3-year project period will be based upon an evaluation of the grantee's first and second year performance, the third year program design, and expenditure justifications. For FY 2009, funding will be based on selections made under a competitive review process. Final decisions are made by the Associate Administrator, Office of Health Information Technology, Health Resources and Services Administration, based on recommendations made by the Director, Office for the Advancement of Telehealth.

Deadlines

www.hrsa.gov .

Authorization

Section 330I, Public Health Service Act; Section 330L, Public Health Service Act, 42 U.S.C. 254c-18.

Range of Approval/Disapproval Time

From 4 to 5 months.

Appeals

None.

Renewals

Renewals have not been determined.

Assistance Considerations

Formula and Matching Requirements

There are no statutory formula or matching requirements for this program.

Length and Time Phasing of Assistance

Competitions are conducted every three years, with up to a 3-year project period. For projects awarded under a competition, grants are made annually each year for up to 3 years. Projects awarded in FY 2006 have a 3-year project period from FY 2006 through FY 2008 (subject to appropriations), and funding for FY 2008 reflects the third year of the 3-year period. A new competition will be conducted in FY 2009 for a 3-year project period, FY 2009 through FY 2011. Payments are made through an electronic transfer system or cash demand system.

Post Assistance Requirements

Reports

Annual progress and financial status reports are required 90 days from the end of the budget period, and the final performance report and final financial status report are due 90 days from the end of the project period.

Progress reports are to be submitted every six (6) months.

Audits

In accordance with the provisions of OMB Circular No. A-133 (Revised, June 27, 2003), Audits of States, Local Governments, and Non-Profit Organizations, nonfederal entities that expend financial assistance of $500,000 or more in Federal awards will have a single or a program-specific audit conducted for that year. Nonfederal entities that expend less than $500,000 a year in Federal awards are exempt from Federal audit requirements for that year, except as noted in Circular No. A-133.

Records

All records must be maintained until expiration of 3 years from the date of submission of the final expenditure report. If questions remain following the 3-uear period, such as those raised as a result of an audit or an on-going enforcement action, recipients must retain records until the matter is completely resolved.

Financial Information

Account Identification

75-0350-0-1-550.

Obigations

TNGP - (Grants) FY 07 $3,946,209; FY 08 $3,932,000; and FY 09 est $4,000,000. TRCGP - (Grants) FY 07 $1,800,000; FY 08 $1,800,000; and FY 09 est $1,800,000. LPGP - (Grants) FY 07 $773,000; FY 08 $700,000; and FY 09 est $700,000.

Range and Average of Financial Assistance

TNGP - In FY 06, the first year of the FY 2006-2008 award cycle, the financial assistance ranged from approximately $226,333 to $250,000. The average award was approximately $243,845. In FY 07, the second year of the FY 2006-2008 award cycle, the financial assistance ranged from approximately $205,360 to $270,000. The average award was approximately $246,638. Awards in FY 08 and FY 09 will range from $210,000 - $250,000. TRCGP - In FY 06, the first year of the FY 2006-2008 award cycle, for the Regional TRCs, the financial assistance ranged from approximately $250,000 to $310,000. The average award was approximately $297,884. The National TRC received $160,000. In FY 07, the second year of the FY 2006-2008 award cycle, for the Regional TRCs, the financial assistance was $325,000 for each of the five grantees. The National TRC received $175,000. Estimated awards for the Regional TRCs in FY 08 and FY 09 are $325,000 for each grantee. The National TRC will receive approximately $175,000. LPGP - In FY 06, the first year of the FY 2006-2008 award cycle, two grantees received $342,500 each. In FY 07, the second year of the FY 2006-2008 award cycle, the two grantees received $342,500 and $344,814. Estimated Awards in FY 08 and FY 09 are $350,000 for each grantee.

Regulations, Guidelines, and Literature

This program is subject to the provisions of 45 CFR Part 92 for State, local and tribal governments and 45 CFR Part 74 for institutions of higher education, hospitals, other nonprofit organizations and commercial organizations, as applicable.

Information Contacts

Regional or Local Office

Monica Cowan, Project Officer, Office for the Advancement of Telehealth, Office of Health Information Technology, 5600 Fishers Lane, Room 7C-26, Rockville, MD 20857. Telephone: (301) 443-0076.

Headquarters Office

Grants Management Office: Rick Goodman, Director, Division of Grants Management Operations, Health Resources and Services Administration, Department of Health and Human Services, 5600 Fishers Lane, Room 11A-16. Health Services Branch: (301) 443-2385; Research and Training Branch: (301) 443-3099; Government and Special Focus Branch: (301) 443-3288.

Criteria for Selecting Proposals

For FY 2008, non-competing continuation funding for Telehealth grantees will be based upon an evaluation of each of the grantee's first two years of performance, the third year program design, and expenditure justifications. For FY 2009, the Agency is developing program guidance to facilitate a competition for the 3-year FY 2009 through FY 2011 project period. (Note: The FY 2009 program guidance may include, under the TNGP provisions, a limited number of planning grants).