WSR 98-24-107

PROPOSED RULES

DEPARTMENT OF HEALTH

[Filed December 2, 1998, 9:00 a.m.]



Original Notice.

Preproposal statement of inquiry was filed as WSR 98-18-071.

Title of Rule: Health systems resources, chapter 246-560 WAC.

Purpose: To combine two grant programs that are authorized by legislature into one grant program. These programs provide financial and technical assistance to health care facilities and recruitment and retention efforts of providers in rural and urban underserved areas.

Statutory Authority for Adoption: RCW 70.175.010 - [70.175.]090 and 70.185.030 - [70.185.]080.

Statute Being Implemented: Chapters 70.175 and 70.185 RCW.

Summary: Proposed rule specifies how the department may act on requests for funding of grant moneys to eligible communities.

Reasons Supporting Proposal: Rules will help local communities prepare a successful application and identify those interested parties that may not meet eligibility criteria. Refines the application process of two separate grant processes into one.

Name of Agency Personnel Responsible for Drafting: Kelly Shaw, Alice James, 2725 West Harrison Avenue, Suite 500, 705-6770; Implementation: Kelly Shaw, Alice James, Kris Sparks, 2725 West Harrison Avenue, Suite 500, 705-6770; and Enforcement: Not applicable, optional program, entities do not have to apply for funds.

Name of Proponent: Department of Health, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: This rule will combine the rural health system development grant program, which provided financial and technical assistance to rural communities and the community based recruitment and retention grant program, which provided financial and technical assistance to increase the availability of health care providers in rural and urban underserved areas of the state into one grant program, allowing one application and review process.

The purpose of the rule is to combine two like grant programs both legislatively authorized into one grant program.

The anticipated effect is to eliminate confusion among applicants. The proposed rule outlines eligibility criteria, contents of a required letter of interest, application content, and proposal review. Complying with the provisions of the proposed rule will aid local communities to prepare a successful application, and identify those interested parties that may not meet eligibility criteria.

Proposal Changes the Following Existing Rules: It combines the community based recruitment and retention program with the rural health systems development program into a new program called health systems resources. It clarifies eligibility for the program. It provides one application form and review process.

A small business economic impact statement has been prepared under chapter 19.85 RCW.



Small Business Economic Impact Statement

Determine Whether an SBEIS is Necessary: An SBEIS is necessary because the average costs to a business, $1,865 exceeds the threshold costs for affected businesses listed below.

The businesses that will be affected by this rule include the following:



sic code business threshold
801 Offices and Clinics of Doctors of Medicine $240
802 Offices and Clinics of Doctors of Dentists $170
803 Offices and Clinics of Doctors of Osteopathy $ 50
804 Offices and Clinics of Other Health Practitioners $110
805 Nursing and Personal Care Facilities $ 50
806 Hospitals $ 50
880 Home Health Care Service $ 50
809 Health and Allied Services $ 53
822 Colleges, Universities, Professional Schools, Junior Colleges $ 50
824 Vocational Schools $ 71
829 Schools and Educational Services $ 96
832 Individual and Family Social Services $ 50
833 Job Training and Vocational Rehabilitative Services $ 50
836 Residential Care $ 50
839 Social Services, not elsewhere classified $ 50

Determine the Size Distribution of Affected Businesses: Businesses affected by the proposed rule amendments will vary in size from smaller clinics with a few employees to hospitals with more than fifty employees.

Compare the Small Businesses Cost of Compliance with That of the 10% Largest Businesses: The economic impact statement identifies the costs of compliance for a small business at $1,150, and the costs for a large business at $2,540. The costs for small businesses to apply for a grant are less than one-half of the costs for a large business.

Decisions on Mitigation: The use of the letter of interest (LOI) process mitigates costs. The LOI is meant to weed out those applicants less likely to succeed in the full application, thereby not expending the additional costs of the full application. The requirements for application content were reviewed to determine if certain elements could be eliminated or minimized. The proposed rules require the minimum documentation necessary to enable the Department of Health to make fiscally responsible decisions. Requiring less information or documentation in the application will severely restrict our ability to make sound decisions in determining grant awards.

The total funds available are not adequate to fund all proposed projects, therefore, decisions need to be made to determine those most likely to succeed and have the greatest impact. Without adequate information, this would be impossible and may leave the department in a legally vulnerable position of having to defend our decisions.

Since the application costs for a small business is already substantially less than the costs for large business, and the department needs adequate information upon which to make fiscally responsible decisions, no additional mitigation options were considered.

How the Agency Involved Small Businesses in the Development of the Rule: The drafts of the proposed rule amendments were sent to over seven hundred constituent groups and individuals with an interest in health systems resources. The mailing included rural hospitals, rural health clinics, community and migrant health centers, economic development councils, area agency on aging offices, local health jurisdictions, community mental health centers, native American tribes, University of Washington, Area Health Education Center @ WSU Spokane, Western Washington Area Health Education Center, past grantees, and other individuals that have expressed an interest in this grant program.

Relatively few comments were received, but those received were reviewed and incorporated where applicable. A second mailing of the proposed rule amendments will accompany the announcement of the public hearing, which will be sent to the same distribution list indicated above. The public hearing will present the third opportunity for businesses and the public to comment on the rule.

List Industries Required to Comply with the Rule: Compliance with the rule is required only for businesses that decide to apply for a grant through the health systems resources program. Potential businesses that may be interested in applying for a grant include those listed above and include the following SIC Codes: 801, 802, 803, 804, 805, 806, 880, 809, 822, 824, 829, 832, 833, 836, and 839.



A copy of the statement may be obtained by writing to Office of Community and Rural Health, P.O. Box 47834, Olympia, WA 98504-7834, e-mail crhmail@doh.wa.gov, phone (360) 705-6770, fax (360) 664-9273.

Section 201, chapter 403, Laws of 1995, applies to this rule adoption. We determined that this rule might be considered a significant rule. The Department of Health is voluntarily providing an economic analysis, and economic impact statement, and a small business economic impact statement. Entities are not required to participate in this program. Residents in Washington state may substantially benefit from this program, and may be excluded from using the program based on the proposed WAC. Consequently we are treating this as a significant rule.

Hearing Location: 2725 N.W. Harrison Avenue, Suite 500, Olympia, WA 98504-7834, on January 7, 1999, at 9:30 a.m.

Assistance for Persons with Disabilities: Contact Lorraine Edwards by December 23, 1998, TDD (360) 664-0064, or (360) 705-6770.

Submit Written Comments to: Fax (360) 664-9273 by January 5, 1999.

Date of Intended Adoption: January 7, 1999.

December 1, 1998

Kris Van Gorkom

Deputy Secretary

OTS-2065.6

AMENDATORY SECTION (Amending Order 186, filed 8/7/91, effective 9/7/91)



WAC 246-560-001  Purpose. (1) The purpose of these rules is to implement RCW 70.175.010((, 70.175.020, 70.175.030, 70.175.040, 70.175.050, 70.175.060, 70.175.070, 70.175.080, and)) through 70.175.090, and RCW 70.185.030 through 70.185.080. The Washington ((rural)) health systems ((project)) resources program includes rural health systems development and community-based recruitment and retention. The health systems resources program was established to provide financial and technical assistance to promote affordable access to health care services in rural ((areas)) and urban underserved populations of the state.

(2) The goals of the ((rural)) health systems ((project)) resources program are:

(a) ((To encourage innovative or established community-based approaches to improving rural health care delivery systems that may serve as models for other communities.)) To promote affordable access to health care services to residents in rural areas of Washington state.

(b) ((To help rural communities obtain needed technical assistance for local activities designed to:

(i) Identify a reasonable service delivery area in terms of geographic conditions, health care delivery patterns, and population characteristics;

(ii) Identify desired health outcomes and improvements in the health care system;

(iii) Identify and analyze deficiencies in the community's health care system;

(iv) Identify innovative steps the community may need to correct the deficiencies; and

(v) Initiate planned and positive actions to correct problems and make health care system improvements.

(c) To explore the use of outcome targets related to health status for rural health system development.

(d) To encourage the use of planning principles in the rural community health system decision making processes including:

(i) Community decisions regarding expected health outcomes and health care services produced;

(ii) Development of action plans; and

(iii) The regular, periodic updating of objectives.

(e) To identify public and private resources for:

(i) Providing technical assistance to rural communities; and

(ii) Facilitating community access to appropriate resources.)) To assure the availability of health care providers to:

(i) Residents of rural areas; and

(ii) Urban underserved populations.



[Statutory Authority: Chapter 70.175 RCW. 91-16-108 (Order 186), 246-560-001, filed 8/7/91, effective 9/7/91.]



NEW SECTION



WAC 246-560-002  Implementation. The department may use the following methods to implement this chapter:

(1) Solicit and select projects as described in WAC 246-560-035 through 246-560-081.

(2) Offer, or contract for, services to carry out the purposes of this chapter.



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AMENDATORY SECTION (Amending Order 186, filed 8/7/91, effective 9/7/91)



WAC 246-560-010  Definitions. For the purpose of this chapter the following words and phrases have the following meanings unless the context clearly indicates otherwise.

(1) (("Advisory committee" means the rural health advisory committee or its successor, appointed by the secretary under RCW 70.175.030(3).

(2))) "Applicant" means any ((eligible entity)) interested party who has ((submitted)) been invited to submit an application proposing a ((rural)) health systems ((demonstration)) resources project.

(((3))) (2) "Application" means ((a)) an invited proposal for a ((rural)) health systems ((demonstration)) resources project.

(((4) "Assisted demonstration project" means a nonfunded application selected to receive specific technical assistance provided or supported by the department.

(5))) (3) "Basic health care services" means organized care modalities to prevent death, disability, and serious illness. The term includes, but is not limited to:

(a) Emergency services;

(b) Primary care physicians, physician assistants, nurse practitioners, and midwifery services;

(c) Short term inpatient care;

(d) Home health care;

(e) Community based care for chronic conditions;

(f) Dental care;

(g) Vision care;

(h) Hearing care;

(i) Hospice care;

(j) Mental health;

(k) Necessary support services; and

(l) Nutrition related services((; and

(m) Other "basic health services" specified and described in "A Report to the Legislature on Rural Health Care in the State of Washington" written by the Washington rural health care commission, January 1989)).

(((6))) (4) "Catchment area" means the Washington state geographic area where people ((who are likely to use the service live or are temporarily located)) live who are to receive the basic health care services addressed by the project.

(((7))) (5) "Community" means the resident individuals and organizations in a catchment area who may benefit from the basic health care services ((included in a demonstration)) addressed by the project.

(((8))) (6) "Community-based" means that the need is identified by a broad section of the community including providers, institutions in the area, and nonhealth care provider members of the community such as community members of health care boards, economic development council members, organized patient advocacy groups, and others who have an interest in the long-term viability of health care services in the catchment area.

(7) "Department" means the Washington state department of health.

(((9) "Demonstration project" means an application selected to participate in the project, including both funded and assisted demonstration projects.

(10) "Eligible entity" means any for-profit, not-for-profit, or governmental entity which is:

(a) Located in a rural catchment area;

(b) Acting on behalf of the population in a rural catchment area; or

(c) Acting on behalf of the population living in a catchment area, a significant portion of which is rural, and in which the target population is more than thirty minutes average travel time from the primary source of health care.

(11) "Financially vulnerable" means a health care facility falling below a reasonable level of performance.

(a) For hospitals the department uses the Financial Viability Index and/or the Financial Flexibility Index to measure performance.

(b) For health care facilities other than hospitals the department considers:

(i) Financial viability or the overall financial performance of the facility; and/or

(ii) Financial flexibility or the ability of the facility to obtain financing to meet its needs, however unexpected.

(12) "Funded demonstration project" means an application selected by the department to receive funds to support planning, organizing, and implementing activities.

(13))) (8) "Deliverable" means a document that results from project activities. The term includes, but is not limited to:

(a) A form;

(b) An agreement;

(c) A plan;

(d) Documentation of numbers served;

(e) A report; or

(f) Presentation material.

(9) "Health care delivery system" means services ((and)), personnel ((involved in providing health care to a population in a geographic area)), and how they are organized and financed.

(((14) "Health care facility" means any land, structure, system, machinery, equipment, or other real or personal property or appurtenances useful for or associated with delivery of inpatient or outpatient health care service or support for such care or any combination thereof which is operated or undertaken in connection with a hospital, rural health care facility, clinic, health maintenance organization, diagnostic or treatment center, extended care facility, or any facility providing or designed to provide therapeutic, convalescent, or preventive health care services.

(15) "Interested party" means any eligible entity interested in proposing a rural health system development project.

(16))) (10) "Interested party" means an eligible entity that has submitted a letter of interest for a health systems resources project.

(11) "Letter of interest" means a brief description of a ((proposal for a demonstration)) project as described in WAC 246-560-040.

(((17))) (12) "Letter of invitation" means a letter inviting an interested party who has submitted a letter of interest to submit an application.

(((18))) (13) "Local project administrator" means an individual or organization representing the applicant and authorized to enter into legal agreements on behalf of the applicant.

(((19))) (14) "Matching funds" means fifty percent of the total budget for recruitment and retention activities must be from a source other than this program. Matching funds may be in-kind contributions.

(15) "Metropolitan statistical area" or "MSA" means ((a metropolitan statistical)) an urban area defined and described by the United States Department of Census, Bureau of the Census, ((Statistical Abstract of United States: 1988, 108th edition, Washington, D.C., United States Government Printing Office, and displayed for the state of Washington)) and printed in the State of Washington 1997 Data Book, Office of Financial Management, Olympia, Washington((, 1988, including)). The boundaries of all metropolitan statistical areas are county boundaries. The urban counties include:

(a) Benton;

(b) Clark;

(c) Franklin;

(d) Island;

(e) King;

(((e))) (f) Kitsap;

(((f))) (g) Pierce;

(((g))) (h) Snohomish;

(((h))) (i) Spokane;

(((i))) (j) Thurston;

(((j))) (k) Whatcom; and

(((k))) (l) Yakima.

(((20) "Program" means the office of rural health, or its successor, within the Washington state department of health.

(21))) (16) "Outcome" means the anticipated result or impact of the project activities.

(17) "Project" means ((the Washington rural)) a health systems resources project ((as authorized under chapter 70.175 RCW)).

(((22))) (18) "Rural" means a geographical area outside the boundaries of metropolitan statistical areas (MSA's) or an area within an MSA but more than thirty minutes average travel time from ((an area of at least ten thousand population)) a city or town or contiguous cities or towns with a population of ten thousand or more.

(((23) "Secretary" means the secretary of the department of health or his or her designee.

(24))) (19) "Successful applicant" means an applicant whose project has been selected ((as a demonstration project)) for contracting.

(((25))) (20) "Urban underserved" means an area((s)) within a MSA that ((are)) is thirty minutes average travel time or less from a city or town or contiguous cities or towns with a population of ten thousand or more, that has unmet health care needs.

(21) "Workplan" means a written document, usually in matrix form, that shows the detail of what is needed to complete a project. The activities, timeline, party responsible, budget, evaluation plan, and measurable outcome is shown for each deliverable.



[Statutory Authority: Chapter 70.175 RCW. 91-16-108 (Order 186), 246-560-010, filed 8/7/91, effective 9/7/91.]



NEW SECTION



WAC 246-560-011   Activities. (1) Health systems development activities include:

(a) The planning, development, and/or implementation of the infrastructure needed to support a cost effective health care delivery system. Examples of infrastructure development include:

(i) Telemedicine and other communications systems;

(ii) Modeling of managed care systems;

(iii) Financial business systems;

(iv) Clinical and quality assurance systems;

(v) Development of cooperative agreements and referral arrangements between similar or dissimilar entities to ensure easy transition between care levels for patients and their families; and

(vi) Development of networks of providers and others, organized to share services, negotiate contracts and, plan new services or service delivery systems.

(b) The mobilization of community leaders to design, develop, and implement a project to maintain or improve the viability of the local health care delivery system. Examples of community mobilization include:

(i) Leaders from different governmental jurisdictions evaluate the health care delivery system or parts of the system, determine where changes are needed, and develop a workplan to affect the necessary changes;

(ii) Participants in the health care delivery system determine how to pool resources to eliminate service duplication or gaps, or, to focus on new identified priorities; and

(iii) Participants in the health care delivery system determine how to restructure the system, including the necessary legal, regulatory, fiscal, or practice actions that will accomplish the needed change.

(c) The planning, development, or implementation of a new basic health care service to meet an identified gap in the health care delivery system. Examples of new service development include:

(i) A service previously unavailable in the service area; and

(ii) A service previously unavailable to a portion of the population in the service area.

(2) Recruitment and retention activities may be funded, only to the extent that matching funds are provided. They include, but are not limited to:

(a) An assessment of community characteristics or assets, including school systems, housing, churches, recreational, social and cultural opportunities;

(b) An assessment of the community, physicians and other health care providers, community leaders and citizens about the need for new or replacement health care providers;

(c) A staff development plan;

(d) A recruitment plan;

(e) A recruitment and retention financial plan;

(f) A plan for providing a new practitioner with sufficient professional, intellectual and emotional support;

(g) A plan for call coverage to ensure adequate time off for personal and family pursuits;

(h) An assessment of office and hospital facilities, equipment and support personnel to determine if they are adequate to allow a new practitioner to practice in a high-quality manner; and

(i) A retention plan.



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NEW SECTION



WAC 246-560-025  Requests to receive information. Any interested party may be placed on the health systems resources mailing list maintained by the Department of Health, Office of Community and Rural Health, or its successor, P.O. Box 7834, Olympia, WA 98504-7834. Contacts on the mailing list will receive instructions for the next funding cycle.



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NEW SECTION



WAC 246-560-035  Eligibility. (1) An interested party, may be a for-profit, not-for-profit, or governmental entity which is:

(a) Proposing services benefiting the population in a rural catchment area; and/or

(b) Proposing services benefiting an urban underserved area and including recruitment and retention activities.

(2) The majority of basic health services addressed by the project must be provided to people living in Washington state.



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AMENDATORY SECTION (Amending Order 186, filed 8/7/91, effective 9/7/91)



WAC 246-560-040  Letters of interest. (((1) Any interested party proposing a demonstration project shall submit a letter of interest. The letter shall follow the schedule in WAC 246-560-030 and:)) An interested party must submit a letter of interest to be considered for a health systems resources project. The department may solicit letters of interest.

The letter of interest must:

(((a))) (1) Not exceed ((two)) three pages;

(((b))) (2) Include the applicant name and address;

(3) Briefly describe the catchment area and the community;

(((c))) (4) Identify the health systems resources program goal(s) addressed by the project;

(5) Identify the health care problem;

(((d))) (6) Briefly describe ((what will be done)) proposed activities and the anticipated outcome; ((and

(e))) (7) Identify key health care providers, business representatives, public officials, and community leaders to be involved in the project; and

(8) Indicate projected total project costs and the amount of state funding requested. If the project includes recruitment and retention activities, indicate the source or sources of matching funds.

(((2) The department may request combining activities proposed in separate letters of interest for inclusion in a single application to:

(a) Avoid duplication;

(b) Increase cooperation; or

(c) Strengthen the overall health system serving the catchment area.

(3) The department may request additional information to enable it to apply the letter of interest selection criteria in WAC 246-560-050.))



[Statutory Authority: Chapter 70.175 RCW. 91-16-108 (Order 186), 246-560-040, filed 8/7/91, effective 9/7/91.]



NEW SECTION



WAC 246-560-045  Letter of interest review and action. (1) Reviewers shall score letters of interest independently using a scoring system established by the department, which is incorporated by reference.

(2) Copies of the scoring system may be requested by writing to the Washington State Department of Health, Office of Community and Rural Health, P.O. Box 47834, Olympia, Washington 98504-7834.

(3) The director of the office of community and rural health shall make the final decision regarding letters of interest based on letter of interest scores and the best utilization of resources to promote the goals of the program.

(4) The department will send a written response to all interested parties who submit a letter of interest.

(5) The department may invite applications from some, none, or all of the interested parties who submit a letter of interest.

(a) The invitation will include:

(i) Application content outline;

(ii) Directions for completing applications; and

(iii) Any letter of interest review comments to be addressed in the application.

(b) The department may request combining activities proposed by different interested parties for inclusion in a single application to:

(i) Avoid duplication;

(ii) Increase cooperation; or

(iii) Strengthen the overall health care delivery system serving the catchment area.

(c) The department will set a due date for receipt of applications.



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AMENDATORY SECTION (Amending Order 186, filed 8/7/91, effective 9/7/91)



WAC 246-560-050  ((Letter of interest selection considerations.)) Criteria for inviting applications. ((The department shall consider the following factors to select interested parties to receive letters of invitation:

(1) The proposed demonstration project addresses the goals of the rural health system project specified under WAC 246-560-001;

(2) The proposed demonstration project is in an area where a financially vulnerable health care facility is present;

(3) The proposed demonstration project is in an area where a financially vulnerable health care facility is present and an adjoining community in the same catchment area has a competing facility;

(4) The proposed demonstration project addresses access to basic health care services in an area where access is severely limited;

(5) The proposed demonstration project addresses needed improvements in the delivery of basic health services, including preventive services;

(6) The proposed demonstration project contains well thought out approaches to problem solving likely to result in improvements persisting after the project period;

(7) The proposed demonstration project reflects a cooperative approach, which may involve several organizations, categories of health care providers, and communities;

(8) The proposed demonstration project is unique and serves as a model for other communities; and

(9) The extent to which the proposed demonstration project uses multiple funding sources.)) (1) The project addresses at least one of the goals of the health systems resources program, as described in WAC 246-560-001.

(2) The project addresses needed improvements in the delivery of basic health care services, including preventive services.

(3) The project reflects a cooperative approach, which may involve several organizations, categories of health care providers, or communities.

(4) The project can serve as a model for other communities.

(5) The project reflects priorities established for a particular funding cycle as set forth in the application materials.

(6) The project addresses access to basic health care services in an area where access is severely limited or inadequate; and

(7) If recruitment and retention of providers is identified as an outcome the application demonstrates:

(a) Recruitment and retention problems have been chronic; or

(b) The community is in need of primary care practitioners; or

(c) The community has unmet health care needs for specific target populations; and

(d) There is a fifty percent local funding match.



[Statutory Authority: Chapter 70.175 RCW. 91-16-108 (Order 186), 246-560-050, filed 8/7/91, effective 9/7/91.]



AMENDATORY SECTION (Amending Order 186, filed 8/7/91, effective 9/7/91)



WAC 246-560-060  ((Submission of)) Application((s)) content. ((Applicants shall submit applications on the form provided by the department. The application shall, at a minimum, follow the time schedule in WAC 246-560-030 and:

(1) Describe the problem including:

(a) The duration of the problem or deficiency; and

(b) The number of people affected;

(2) Describe the catchment area. When the proposal involves a service or services not currently provided, the applicant shall demonstrate to the satisfaction of the department:

(a) A reasonable service delivery area in the sense that geographic conditions, health care delivery patterns, other social and economic relationship patterns, and population characteristics make it a realistic market; and

(b) A reasonable use area from the perspective of the residents, in the sense that residents are likely to go to the proposed delivery site as a preferred source for the proposed service.

(3) Identify any special needs in the catchment area;

(4) Explain how the proposal addresses the goals identified in WAC 246-560-001 or why this proposal should be approved as a demonstration project if the goals are not addressed;

(5) Identify any model or models used in a proposed demonstration project;

(6) Describe the relationship between the proposed demonstration project and any current or previous programs designed in whole or in part to solve related health care problems in the catchment area;

(7) Identify key health care providers, business representatives, public officials, and community leaders involved in the project;

(8) Identify project goals, specific objectives, and procedures to assure results from the project consistent with the letter of interest;

(9) Specify the work program for achieving the objectives;

(10) Explain how the demonstration project will coordinzate and avoid unnecessary duplication of services and activities with existing health services, including public and private health care services in the catchment area;

(11) Identify the potential and steps required to financially sustain the activities initiated as a result of the project;

(12) Describe how the applicant will evaluate the demonstration project;

(13) Describe the decision-making process or processes for determining appropriate courses of action throughout the demonstration project;

(14) Provide the proposed budget for the project period indicating:

(a) The amount of state funds requested;

(b) The amount by source of other financial support; and

(c) The schedule of payments requested from the state;

(15) Identify whether the proposal may be considered for:

(a) Designation as a funded demonstration project only; or

(b) Identify the portions of the proposal to be considered as an assisted demonstration project;

(16) Provide letters of support and commitment to participate from key providers, local government officials, and business and community leaders.

(17) Discuss any issues raised by the department in the letter of invitation.)) (1) A completed face sheet.

(2) A description of the applicant and its capacity to manage and oversee the project.

(3) A description of the proposed project including:

(a) Health systems resources program goal(s) addressed; and

(b) Health systems resources program priority addressed.

(4) A statement of the problem, including:

(a) The duration of the problem or deficiency;

(b) The number of people affected;

(c) How the problem has been documented;

(d) The community involvement in identifying the problem; and

(e) Special needs of the population to be served.

(5) A description of the catchment area(s) to be served by the project. The catchment area(s) must be a reasonable service delivery area such that:

(a) Geographic conditions, health care delivery patterns, other social and economic relationship patterns, and population characteristics make it a reasonable market; or

(b) Residents are likely to go to the proposed catchment area as a preferred source for the proposed services.

(6) A description of any model(s) used in the proposed project.

(7) A description of the relationship between the proposed project and current or previous programs designed to solve related health care problems in the catchment area.

(8) A description of the other individuals and entities involved in the project and their relationship with the applicant to implement the project. A copy of an organizational chart for the proposed project, lists of roles and responsibilities, or other items that document the relationship between the applicant and the involved activities may be submitted with the application.

(9) A workplan for what is needed to accomplish the project. For all major activities, include a timeline, entity responsible, funds needed and source of funds, and measurable outcome(s).

(10) A description of the evaluation process including measurable outcomes.

(11) A description of the plan for dissemination of information about the project.

(12) A detailed budget and budget justification for the project period, including:

(a) The amount of state funds requested;

(b) The amount, by source, of other financial or in-kind support and evidence of cost participation by the applicant and other entities involved in the project; if the application includes recruitment and retention activities, amounts by source(s) of matching funds must be identified;

(c) The steps required to financially sustain the project activities after state support had ended.

(13) Letters of agreement, support, commitment and contribution from each entity identified as participating in the project.

(14) Any additional information requested by the department in the letter of invitation.



[Statutory Authority: Chapter 70.175 RCW. 91-16-108 (Order 186), 246-560-060, filed 8/7/91, effective 9/7/91.]



NEW SECTION



WAC 246-560-065  Application screening criteria. (1) The department will screen applications for the following criteria:

(a) Received in the Office of Community and Rural Health, P.O. Box 47834, Olympia, Washington 98504-7834; on or before the due date.

(b) One original application and two unbound copies provided, sufficiently legible to be copied. The department will determine legibility; and

(c) Application contains each of the items described in WAC 246-560-060.

(2) Applications that contain all screening criteria will be reviewed.

(3) If an application fails to contain any screening criterion, it will not be reviewed. The applicant will be notified in writing.



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NEW SECTION



WAC 246-560-075  Reviewer selection. The department may consider the input of individuals outside the department who have expertise with rural and underserved communities. Selected reviewers must sign a statement:

(1) Agreeing to refrain from discussion of letters of interest or applications outside of the review process; and

(2) Asserting that they do not have a conflict of interest. A conflict of interest includes a reviewer:

(a) Holding a position in an organization under review;

(b) Having a significant financial interest in the outcome of the review; or

(c) Participating in the development of the letter of interest or application under review.



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NEW SECTION



WAC 246-560-077  Application review, selection, and funding. (1) The department may, based on reviewer recommendations, funding limitations, or other considerations, offer funding to all, some or none of the applicants, and may offer to fund portions of projects.

(2) Reviewers shall score applications independently using a scoring system established by the department which is incorporated by reference.

(3) Copies of the scoring system may be requested by writing to the Washington State Department of Health, Office of Community and Rural Health, P.O. Box 47834, Olympia, Washington 98504-7834.

(4) The director of the office of community and rural health shall make the final decision regarding funding based on application scores, total funds available, and the best utilization of resources to promote the goals of the program.



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NEW SECTION



WAC 246-560-085  Appeal process. (1) The following departmental actions are subject to administrative appeal:

(a) A decision not to invite an application;

(b) A determination that an application does not meet initial screening criteria and will not be reviewed; or

(c) A decision not to fund all or any portion of a project.

(3) The appeal process is governed by the Administrative Procedure Act (chapter 34.05 RCW), chapter 246-10 WAC, and this chapter.

(4) To initiate an appeal, the applicant must file a written request for an adjudicative proceeding within twenty-eight days of receipt of the department's decision. The request shall be mailed, by a method showing proof of receipt, to the Adjudicative Clerk Office, P.O. Box 47879, 2413 Pacific Avenue, Olympia, Washington 98504-7879.

(5) The request must contain:

(a) A specific statement of the issue or issues and law involved;

(b) The grounds for contesting the department's decision; and

(c) A copy of the department's decision.



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Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.



REPEALER



The following section of the Washington Administrative Code is repealed:



WAC 246-560-070 Selection criteria for funded demonstration projects.