Frontier Extended Stay Clinic (FESC) Cooperative Agreement Program

• Program Purpose
• How to Apply to the Program
• Program Overview
• Eligible Applicants
• Program Contact
• Reference Materials

Program Purpose

The purpose of the Frontier Extended Stay Clinic (FESC) Cooperative Agreement Program is to examine the effectiveness and appropriateness of a new type of provider, the FESC, in providing health care services in certain remote locations. Funds awarded under Category One/Model Development must be used for the support of activities related to the coordination of FESC efforts throughout a State including the development of FESC protocols, licensure and certification criteria and program evaluation. Funds awarded under Category Two/Model Feasibility must be used to educate eligible providers about FESCs and determine if a FESC model would be viable for those providers.

How to Apply to the Program

To apply for a Rural Health Network Development Planning Grant you must request the full application package from the HRSA Grants Application Center by calling, 1-877-477-2123 and asking for Program Announcement Code HRSA-04-092. Applications are due on July 2, 2004. The Program Guidance and application documents below are available for informational purposes.

A recording of the Technical Assistance call will be available until June 19th at 866-351-2775.

Program Overview

In remote, frontier areas of the country, weather and distance can prevent patients who experience severe injury or illness from obtaining immediate transport to an acute care hospital. For residents in some of those communities, providers offer observation services traditionally associated with acute care inpatient hospitals until the patient can be transferred or is no longer in need of transport. Provision of these services requires the staffing, equipment and quality assurance programs of an acute care hospital. However, extended stay services are not currently reimbursed by Medicare, Medicaid or other third-party payers. For several years, officials in the State of Alaska and several State Offices of Rural Health, Primary Care Offices and Primary Care Associations have explored the development of a new provider type, or other mechanism, that would enable reimbursement of these services through the FESC model.

The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) acknowledged the work of FESC supporters by authorizing the Centers for Medicare and Medicaid Services (CMS) to conduct a demonstration program in which FESCs would be treated as Medicare providers. Under MMA, FESCs are defined as clinics that are: 1) located in communities which are at least 75 miles away from the closest hospital or are inaccessible by public road and 2) designed to address the needs of patients who are unable to be transferred to an acute care facility because of adverse weather conditions or who need monitoring and observation for a limited period of time.

In a separate recognition of the extended care services provided by some frontier clinics, an additional demonstration program to be administered by the Health Resources and Services Administration (HRSA) was established by the Consolidated Appropriations Act of 2004. Funds available for this program are to be used to evaluate the effectiveness of the FESC model and will be awarded through cooperative agreements.

The Cooperative Agreements will be awarded for a one (1) year project period. Funds will be awarded under two categories. Category One/Model Development is for the development and support of FESC models by a consortium of rural providers. Category Two/Model Feasibility is for the examination and research of the feasibility of FESC models in a specific state or communities by eligible entities. One (1) award of approximately $1,250,000 will be made under Category One/Model Development. Five (5) awards of approximately $50,000 each will be made under Category Two/Model Feasibility.

The recipient of funds under Category One/Model Development will be responsible for carrying out activities with the following objectives:

1. Manage cooperative agreement among all providers and all associated activities;
2. Develop protocols for patient care that address quality concerns and ensure patient safety;
3. Establish a provider workgroup to address concerns of providers from potential FESC sites throughout the State;
4. Implement and test FESC protocols;
5. Program evaluation;
6. Additional activities that support the development of FESCs.

The recipients of funds under Category Two/Model Feasibility will be responsible for carrying out activities with the following objectives:

1. Identification of potential FESC sites throughout the State;
2. Education of providers and communities about FESCs;
3. Development of State-level FESC implementation plan;
4. Additional activities that support the development of FESC models.

Eligible Applicants

Funds awarded under the authority of Section 330A of the Public Health Service Act must be awarded to a rural public or rural non-profit private entity. Funds awarded under this authority also require the development of a consortium of at least three separately owned organizations that provide health care services. For-profit organizations may be members of consortiums, but they are not eligible to be applicants. The purpose of the consortium requirement is to encourage creative and lasting collaborative relationships among service providers in rural areas. Members of a consortium might include hospitals, public health agencies, primary care service providers, rural health clinics, emergency services providers, tribal health providers and community and migrant health centers. Faith-based organizations are eligible to apply as members of a consortium. At least one member of the consortium must be an operational clinic or hospital, currently providing primary care services and located at least 75 miles from the nearest hospital or critical access hospital or inaccessible by public road. The roles and responsibilities of each member organization must be clearly defined and each must contribute significantly to the goals of the project. The applicant must prepare the application in consultation with the appropriate State office of rural health or another appropriate State entity. A list of State Single Points of Contact is below.

The grantee organization must not have received a grant under this subsection (other than for planning activities) for the same or a similar project.

Applicants for funds under Category One/Model Development of this program must also submit evidence of the support of the agency of their State's government responsible for the licensure and certification of health care entities.

Prospective applicants are required to notify your State Office of Rural Health or other appropriate State government entity early in the application process to advise them of their intent to apply. The State Offices can often provide technical assistance to applicants.

Program Contact

For additional information contact:

Emily Jane Costich
Office of Rural Health Policy
5600 Fishers Lane, Rm 9A-55
Rockville, MD 20857
(301) 443-0502
ecostich@hrsa.gov