FLORIDA DEPARTMENT OF HEALTH BUREAU OF TOBACCO PREVENTION PROGRAM REQUEST FOR APPLICATIONS FOR GRANT OPPORTUNITY DOH FA

Transcription

1 FLORIDA DEPARTMENT OF HEALTH BUREAU OF TOBACCO PREVENTION PROGRAM REQUEST FOR APPLICATIONS FOR GRANT OPPORTUNITY DOH FA Florida Acute Care Hospitals of 400 Beds or Less Tobacco Cessation and Counseling Services This Grant Opportunity is not subject to Section (3) F.S. 1

2 TABLE OF CONTENTS Cover Page...1 Table of Contents...2 Timeline INTRODUCTION Statement of Purpose Available Funding Qualified Applicants Term Definitions Notice and Disclaimer PROGRAM OVERVIEW Background Major Program Goals Scope of Service Programmatic Authority Client General Description Task List Task Limits Description of Application Components Professional Qualifications Equipment Invoicing and Payment of Invoice Program Outcomes (Performance Measures) Provider Unique Activities Financial Specifications Evaluation of Applications Awards SUBMISSION OF APPLICATION Application Deadline Instructions For Submitting Application Instructions For Formatting Application SPECIAL CONDITIONS Cost of Preparation Renewal Unauthorized Aliens Minority Participation

3 ATTACHMENTS The following attachments are provided for your information. Attachments II through III apply if and only if you are awarded a grant. No specific action is required during this application process. ATTACHMENT I - ATTACHMENT II - ATTACHMENT III - REVIEWER QUESTIONS FINANCIAL AND COMPLIANCE AUDIT STANDARD CONTRACT 3

4 Florida Acute Care Hospitals of 400 Beds or Less Tobacco Cessation and Counseling Services DOH FA TIMELINE Schedule DUE DATE INFORMATION RFA Announced December 15, 2009 Posted electronically via: Purchasing/grants_funding.htm Vendor Bid System: Submission of Written Questions ( all questions) December 18, 2009 Submit to: Florida Department of Health Responses to Questions Placed December 23, 2009 Posted electronically via: Purchasing/grants_funding.htm Vendor Bid System: Applications Due January 2, 2010 Applications must be submitted electronically through Evaluation of Grant Applications January 7, 2010 Review and Evaluation of Grant Applications Begins Anticipated Announcement of Grant Awards Anticipated Grant Start Date January 11, 2010 January 22, 2010 Posted electronically via: Purchasing/grants_funding.htm Vendor Bid System: It is the applicants responsibility to regularly check the website for updates. 4

5 SECTION INTRODUCTION 1.1 Statement of Purpose This Request for Applications (RFA) seeks applications from Florida Acute Care Hospitals of 400 Beds or Less to become a smoke free or tobacco free campus, to provide or develop the capacity within their organization to conduct and sustain tobacco cessation counseling, to conduct tobacco cessation counseling and classes on the hospital site for their patients, employees and family members, and to add tobacco use information as part of employee orientation. 1.2 Available Funding The Florida Department of Health (Department), Bureau of Tobacco Prevention Program (Program) has up to $1,200, for Tobacco Cessation grants. It is estimated that one to 16 awards will be granted depending on the availability of funding. 1.3 Qualified Applicants Entities eligible to submit applications must be Florida Acute Care Hospitals of 400 beds or less. To be eligible to receive a grant, all corporations, limited liability companies or partnerships and their sub-contractors, seeking to do business with the State, shall be registered with the Florida Department of State in accordance with the provisions of Chapter 607, 608, 617 and 620, F.S. All applications shall be subject to the following: (1) The application must describe all proposed activities. (2) Funds may be used for staff positions, fringe benefits, travel, local advertising, printed materials, and educational materials to support tobacco cessation and counseling classes... (3) The Department reserves the right to reject any and all applications. (4) The applications shall include budget for year 1 (January 22, 2010 to June 30, 2010). Budgets may be increased by up to 5 percent for year 2 and by another 5 percent for year 3 based on annualized costs for year 1. The year 2 and year 3 budgets will be established during the annual grant renewal process. All funding availability will be subject to annual Legislative appropriation and that determination is final. 1.4 Term The term of the contract resulting from this RFA shall be no longer than three years. It is anticipated the term of the grant will be from January 22, 2010, through June 30, The Department may renew these grants through existing contracts for an additional two years based on availability of funds and satisfactory performance. 1.5 Definitions Acute Care Hospitals Florida licensed active hospitals that provide acute care and have 400 or less beds. Area Health Education Centers (AHEC) -- Five university-based medical school AHEC programs that develop and administer programs designed for health professional training, recruitment, and retention activities. The AHEC program offices subcontract with AHEC service area offices to provide AHEC services in specified service areas throughout the state. AHEC Service Area Office -- An AHEC office located in the service area of an AHEC Program office, and which is subcontracted with the program office to provide AHEC services in health professional training, recruitment, retention, and other activities such as special projects. There are 10 AHEC service area offices affiliated with Florida s five medical school based AHEC Program offices. CDC- Centers for Disease Control and Prevention. 5

6 Cessation Services -- Any evidence-based patient intervention that is aimed at treating and overcoming the physical and psychological aspects of tobacco use and addiction. Cessation Counselors -- Individuals who have been trained by an Area Health Education Center, American Lung Association, American Heart Association, American Cancer Society or other DOH approved entity as tobacco use cessation specialists who use approved curricula to deliver tobacco cessation services. Chronic Disease refers to illnesses that are prolonged, do not resolve spontaneously, and are rarely cured completely. Examples include, but are not limited to diabetes, asthma, cardiovascular disease and stroke, lung cancer and chronic lower respiratory disease (CLRD). Contract/Grant Manager A Department of Health employee who is specially trained in managing state contracts and serves as the primary contact with the grantee. Cultural Competence - Demonstrating sensitivity for clients heterogeneity, culture, history, context, and geography, and the relative importance of these components to different populations. Department The Florida Department of Health NRT -- Nicotine Replacement Therapy are those pharmaceutical products (available over the counter) designed and approved to assist patients receiving cessation services overcome their addiction to nicotine and include gums, patches, inhalers, lozenges, and sprays. Program The Department of Health, Bureau of Tobacco Prevention Program Tobacco-related Disparities Differences in patterns, prevention, and treatment of tobacco use. The risk, incidence, morbidity, mortality, and burden of tobacco-related illness that exist among specific population groups in the United States and related differences in capacity and infrastructure access to resources and environmental tobacco smoke exposure. Tobacco Prevention Educational information and programs that provide information on the dangers of tobacco use. 1.6 Notice and Disclaimer The Department may provide technical support and assistance to the grantee(s) within the resources of the Department to assist the grantee(s) in meeting the required deliverables. The support and assistance or lack thereof shall not relieve the grantee from the obligation to fully perform the contract requirements. Grant awards will be determined by the Department at its sole discretion based on the availability of funds. The Department reserves the right to offer grant awards for less than the amounts requested by applicants as it deems is in the best interest of the State of Florida and the Department. Additionally, the Department reserves the right to negotiate budgetary changes with applicants prior to the offer of a grant award. Applicants may decline the reduced or modified grant award and may request a commensurate modification or reduction in the scope of the work. If, during the grant funding period, the authorized funds are reduced or eliminated by the Florida Legislature, the Department may immediately reduce or terminate the grant award by written notice to the grantee. No such termination or reduction, however, shall apply to allowable costs already incurred by the grantee to the extent that funds are available for payment of such costs. 6

7 SECTION PROGRAM OVERVIEW 2.1 Background Tobacco addiction is among the leading preventable causes of morbidity and mortality in Florida and in the United States. Cigarette use, alone, results in an estimated 430,000 deaths each year in the US, including 28,700 deaths in Florida. The list of illnesses caused by tobacco use is long and contains many of the most common causes of death, including heart disease, stroke, many forms of cancer and lung, and vascular diseases. The tobacco industry spends close to $1 billion in Florida annually to market its products. Secondhand Smoke Exposure Tobacco free-policies protect people who may be involuntarily exposed to secondhand smoke and can also be effective in reducing tobacco consumption by smokers. People who breathe the smoke from other peoples cigarettes also suffer adverse health consequences related to their exposure to secondhand smoke. According to the U.S. Department of Health and Human Services Centers for Disease Control and Prevention (CDC), researchers have identified more than 4,000 chemicals in tobacco smoke, including more than 50 that cause cancer in humans and animals. The California Environmental Protection Agency estimates that secondhand smoke causes 26,100 to 69,600 deaths each year among adult non-smokers in the United States, including 3,400 deaths each year from lung cancer. Up to 300,000 children across the nation develop lower respiratory tract infections each year as a result of exposure to secondhand smoke, with 7,500 to 15,000 of these children hospitalized each year due to their infections. Exposure to secondhand smoke is a primary cause of asthma and acute asthmatic events among children. Tobacco smoke also has a direct impact on the health of the developing fetus. Women who smoke during pregnancy have a higher incidence of delivering low birth weight babies, a leading cause of infant death. Preventing Initiation Approximately 89 percent of smokers start before high school graduation. Approximately 75 percent of all youth who smoke have parents who smoke. Factors associated with tobacco use by youth include: low socioeconomic status; use and approval of tobacco use by peers or siblings; smoking by parents; accessibility; availability; and increased price of tobacco products. Cessation Research finds that 70 percent of adult smokers want to quit; smokers typically make many attempts before successfully quitting; 5 percent succeed in quitting in any given year; and 52 percent of persons who have ever smoked have successfully quit. 2.2 Major Program Goals The primary goals of the program are to reduce the prevalence of tobacco use among youth, adults, and pregnant women; reduce per capita tobacco consumption; reduce exposure to secondhand tobacco smoke and reduce tobacco-related disparities. Acute Care Hospitals are an important part of the community. The ability of hospitals to conduct tobacco counseling and cessation classes for their patients, employees and employee family members will greatly help those addicted to quit using tobacco products. The act of the Acute Care Hospital becoming a tobacco or smoke free campus will support the change in social norms about tobacco use and increase the health of Floridians. In support of providing a variety of methods of Floridians to stop using tobacco the Acute Care Hospitals will promote the Quitline, a toll free telephone cessation service and tobacco counseling and cessation services available through the Area Health Education Center (AHEC), American Lung Association, American Heart Association and American Cancer Society. This will provide a variety of opportunities for the individual and avoid duplication of effort. 2.3 Scope of Service This RFA seeks applications from Florida Acute Care Hospitals that have 400 beds or less to become a smoke free or tobacco free campus and to provide or develop the capacity within their organization to conduct and sustain tobacco cessation counseling and classes on the hospital site for their patients, employees and employee family members. 7

8 Hospitals are encouraged to develop the ability to conduct tobacco cessation in-house by training appropriate staff to conduct tobacco cessation counseling and classes however, they may choose to partner with a health center, county health department, college, university, technical school, vocational school or Florida Area Health Education Centers to conduct tobacco cessation classes on site. 2.4 Programmatic Authority Article X, Section 27, Florida Constitution and Florida Statute , requires that the Florida Legislature annually fund a comprehensive, statewide tobacco education and control program using tobacco settlement money. The Constitution further requires that the tobacco program conform to the CDC Best Practices, as amended, in order to implement effective population-based interventions and strategies. A new version of the CDC Best Practices was released in October 2007 and is now the statutorily mandated guiding document for the Program. Conformation to the 2007 CDC Best Practices requires a programmatic paradigm shift from individualized tobacco prevention activities (individual counseling, classroom presentations etc.) to those that are community based and have the potential to change social norms about tobacco use, including policy change, health-care system changes, and changes in tobacco-industry influences county-wide. 2.5 Client General Description All patients, employees and their families are eligible for program services. 2.6 Task List The program requires that grantees: 1. Initiate services within 30 days of execution of the contract with the department. 2. Assess and report employee, family member and patient needs related to tobacco use. 3. Establish the availability of appropriate hospital staff to become tobacco cessation specialists that will sustain tobacco cessation activities after the grant period has ended. 4. Maintain data on the number of patients, employees, and employee family members that currently use tobacco, the number attending and completing tobacco cessation classes, the number that have successfully quit, and the number of patients, employees, and employee family members supplied with NRT. 5. Collaborate and cooperate with the program and any contracted evaluation vendors conducting project evaluation. 6. Promote the toll free Florida Quitline. 7. Implement and complete the activities outlined in Section 2.3, Scope of Service. 8. Partner with other hospitals, health centers, county health departments, Area Health Education Centers, American Lung Association, American Cancer Society, American Heart Association, etc., as necessary to provide tobacco cessation counseling and classes. 9. Provide tobacco prevention and cessation information as part of new employee orientation. 10. Implement a tobacco-free or smoke-free campus policy including the banning of e-cigarettes. 11. Attend meetings and trainings sponsored by the program. 12. Become a member of the local tobacco prevention council. 13. Develop internal policy to implement the clinical preventive guidelines for tobacco. 14. Incorporate the U.S. Department of Health and Human Services Treating Tobacco Use and Dependence Clinical Practice Guidelines into hospital training. 15. Provide information on tobacco use, cessation, as well as the link between tobacco and chronic disease on TVs in lobbies and patient rooms. 16. Provide insurance incentives to employees that become or remain tobacco free. 17. Screen all patients for tobacco use upon entry into the hospital. 18. Provide information on secondhand smoke. 19. Do not accept equipment, funding, or other items from tobacco companies. 20. Promote state and national tobacco prevention observances. 21. Display tobacco facts and cessation information in lobbies and waiting rooms. 8

9 2.7 Task Limits The grantee shall not perform any tasks related to the project other than those described in Section 2.6 without the written consent of the Department ( correspondence is appropriate). 2.8 Description of Application Components All applications must be consistent with recommendations for an effective tobacco cessation program using components contained in the CDC s 2007 Best Practices and Health Care Provider Reminder Systems, Provider Education, and Patient Education treatment guide. Provide tobacco use education to employees, employee family members and patients. All applicants should address the following: A. Background and Need The applicant shall describe the target population (e.g. characteristics of the population including education, income, health status, demographics, number and percent of smokers and/or tobacco users.) The applicant shall describe the need for tobacco cessation and counseling including strengths and challenges of tobacco cessation, and the attitudes and behaviors related to tobacco use and control within the hospital setting. The applicant shall describe populations groups disparately affected by tobacco use and how the populations will be reached. The applicant shall describe the process for assessing and recording smoking/tobacco use status. B. Organizational Experience The applicant must identify the organizational experience related to tobacco prevention and cessation activities. C. Organizational Capacity Describe the organization s capacity and ability to direct and perform the proposed activities. Identify the key staff that will be involved with the project operations and include staff qualifications, duties and experience delivering the proposed or similar activities for this project. Include an organizational chart that depicts the project staff and indicates how each member relates to each other. Delineate the level of staff needed for the administration of this project. D. Project Summary Provide an executive summary including a brief description of the project s core elements and plans. If a grant is awarded, this summary may be used by the Department in publications and on public web sites to describe this project. E. Work Plan The applicant shall complete a proposed work plan and timeline within the application that describes the activities that will be accomplished to achieve specific outcomes and sustain a tobacco cessation program past the grant period. 9

10 F. Budget and Narrative The applicant shall include a line item budget for a period starting January 22, 2010 through June 30, 2010 on the budget form provided with the application. All proposed costs for the project activities described in this RFA are required to be presented in a line-item budget format with a budget narrative that supports, justifies, and clarifies the various line items. The costs shall include but are not limited to: personnel salaries, fringe benefits, travel, consumable office supplies, and indirect costs. The use of food and promotional items is limited to no more than 2.5 percent of the total amount of the grant. Indirect costs are limited to no more than 7.5 percent of the total amount of the grant. G. Letters of Support The applicant shall submit at least three letters of support from partnership members or board members outlining their role and commitment to assist in the implementation of the proposed project and proposed work plan. Each letter is limited to one page. 2.9 Professional Qualifications The applicant will be responsible for the staff affiliated with the project, ensuring they have the education, experience and training necessary to successfully carry out duties required in the RFA. The applicant shall maintain an administrative organizational structure and support staff sufficient to discharge its contractual responsibilities. In the event the Program determines that the grantee s staffing levels do not conform to those promised in the application, the Program shall advise the applicant in writing and provide a timeframe to remedy the identified staffing deficiencies. The applicant shall replace any employee whose continued presence would be detrimental to the success of the project with an employee of equal or superior qualifications. The Program contract manager will exercise exclusive judgment in this matter. Any changes in personnel must be approved by the contract manager. Prior to any changes of the proposed individuals, the grantee shall notify and obtain written approval from the Program s contract manager of the proposed substitution. Written justification should include documentation of the circumstances requiring the changes. All changes must be equal or superior qualifications. Any substitutions shall be made only after agreement by the Program s contract manager Equipment The applicant will be responsible for supplying, at its own expense, all equipment necessary to perform under this RFA, including, but not limited to computers, telephones, copiers, scanner, fax machines, maintenance and office space Invoicing and Payment of Invoice All grants resulting from this RFA will be fixed fee/fixed price. The Department shall pay the grantee as follows, based upon the receipt of acceptable deliverables: The invoices will be submitted quarterly. The first invoice will be submitted as assigned by the contract manager. These invoices shall be submitted on the lead organization s letterhead. All deliverables required for payment including the invoice shall be submitted in electronic format. Failure to provide deliverables during the reporting period may lead to a deduction in payment. The Program s contract manager will review the invoices and deliverables within ten business days of receipt, in conformity with the provisions of Section II B of the Standard Contract. The Program reserves the right to ask for additional materials or details to ensure conformity with the provisions of the contract. It also reserves 10

11 the right to take additional, time to review larger, more complex documents submitted by the Grantee, including, but not limited to required annual work plan and quarterly progress reports. Advanced payments are authorized pursuant to approval of the Chief Financial Office as provided in Section (16)(B) F.S. Instructions for advance payment requests will be incorporated in the contract. Requests for advance payments will be considered on a case-by-case basis Program Outcomes (Performance Measures) The applicant must submit reports to the Program on a quarterly basis. The Program will provide the report formats: 1. Quarterly Progress Reports: Quarterly reports shall describe all progress made or challenges encountered with the proposed work. The quarterly progress report serves as the official report and must include updates on the following areas: Certification and/or copy of smoke-free or tobacco-free campus policy. Name of individual(s) certified to conduct tobacco cessation classes or if sub-contracted, the names individual(s) and their certification. Plan for collecting needs assessment of patients, employees and family members of employees. Documentation of tobacco cessation classes held. Documentation of the number of individuals completing classes Document of the number of individuals requesting NRT. Documentation protocol for assessing employees, employee family members, and patient smoking behaviors. Integration of cessation services for patients, employees, and employee family members. 2. Quarterly Financial Summary Report: A report of grant authorized expenditures. This report will be evaluated against the original budget submission. 3. Quarterly Invoices: Invoices for reimbursement of expenses must be submitted electronically on a quarterly basis Provider Unique Activities The applicant is solely and uniquely responsible for the satisfactory performance of the tasks described in Section 2.6. By execution of the resulting contract, the grantee recognizes its singular responsibility for the tasks, and deliverables described therein, warrants that it has fully informed itself of all relevant factors affecting accomplishment of the tasks, and deliverables, and agrees to be fully accountable for the performance thereof Financial Specifications The Department will provide payment to the successful grantee for approved and allowable costs that are reflected in the proposed budget. Limitations on Use of Funds: The use of food and promotional items is limited to no more than 2.5 percent of the total amount of the grant. Indirect costs are limited to no more than 7.5 percent of the total amount of the grant. The applicant is prohibited from accepting any funding, contribution, gift or any other support from any tobacco company, or using tobacco company training programs, or tobacco company developed cessation programs. 11

12 The applicant is prohibited from using any funds made available by this RFA for the purpose of lobbying pursuant to Section , F.S. and Section , F.S. Section (1) (f), F.S., defines Lobbying as influencing or attempting to influence legislative action or non-action through oral or written communication or an attempt to obtain the goodwill of a member or employee of the legislature. In addition, Section , F.S., prohibits the use of state funds for the purpose of lobbying the Legislature, the judicial branch or a state agency. Funds cannot be used to purchase Nicotine Replacement Therapy (patches, lozenges, and gum). DOH will provide NRT free as long as funding is available. If a grantee is state agency or entity, the applicant must comply with all other applicable state and federal laws, rules, policies and procedures Evaluation of Applications Upon receipt, applications will be reviewed for compliance with the requirements in this RFA. Applications that are not complete, or that do not conform to or address the criteria of the program will be considered nonresponsive and not accepted. Applications will be scored by DOH professionals knowledgeable of tobacco prevention efforts. All reviewers will have expertise in tobacco prevention and public health and an understanding of the unique health problems and issues related to tobacco cessation activities. Each grant application will be independently evaluated and scored by three reviewers. The reviewer evaluation questionnaire is outlined in Attachment I. For each application, the point scores of all participating reviewers will be averaged to determine its overall merit rating. Applications will be rank ordered by overall merit score. The Department will give preference to the most meritorious of those applications as long as it meets all other requirements stated in the RFA. If no application meets the minimum merit score, none will be funded by the Department Awards The grantee(s) will enter into a contractual agreement with the Department as indicated in Section 1.4. The Department reserves the right to revise proposed plans and negotiate final funding prior to finalizing the grant. SECTION 3.0 SUBMISSION OF APPLICATION 3.1 Application Deadline All applications must be submitted by January 2, 2010 at 5:00 (EST). 3.2 Instructions for Submitting Application Only electronic applications received through the DOH system will be accepted for this RFA. Applicants should anticipate that the volume of online activity may increase as the application deadline approaches and this may slow upload times. Applicants are encouraged to submit online applications well in advance of the deadline to avoid any delays due to busy servers or other potential internet failures. Your date and time stamp of receipt is based on when the submission is complete, not when the process began. 12

13 No late applications will be accepted, under any circumstances, regardless of the reason(s) for a late submission. Applications uploaded after the date and hour designated are automatically disqualified and will not be considered. Do NOT send applications by U.S. Mail, Courier, overnight, or Hand-Delivery. To complete the application process: Applications must be developed and submitted to the DOH Grant Manager electronically as specified in the timeline 3.3 Instructions for Formatting Application The entire text of all documents should be combined into the electronic application and must be in an easily readable format. Pages should be single-spaced, numbered, with one-inch margins. The font size shall be 11 points, the type shall be Arial. All applications must be submitted electronically as specified in section 3.2. The maximum number of pages, excluding attachments, is 15. The file size of all uploaded files must not exceed 3 MB in total. Any attachments must be limited to those requested in the online application. Appended material may not be used to circumvent the page limit for the application. Materials submitted will become the property of the State of Florida. The state reserves the right to use any concepts or ideas contained in the application. SECTION 4.0 SPECIAL CONDITIONS 4.1 Cost of preparation Neither the Department of Health nor the state is liable for any costs incurred by an applicant in responding to this RFA. 4.2 Renewal The grant resulting from this RFA may be renewed for a period that shall not exceed the following two Department fiscal years (July 1, 2010 to June 30, 2011 and July 1, 2011 to June 30, 2012). The renewal shall be in writing and subject to the terms and conditions of the original grant. The renewal shall be contingent upon satisfactory performance evaluations by the Department and subject to the availability of funds. The renewal may not include any compensation for costs associated with the renewal. The renewal may be increased by up to 5 percent for year 2 and by another 5 percent for year 3 based on annualized costs for year 1. The year 2 and year 3 budgets will be established during the annual grant renewal process. All funding availability will be subject to annual Legislative appropriation and that determination is final. 4.3 Unauthorized Aliens NOTICE TO GRANTEE: The employment of unauthorized aliens by any grantee is considered a violation of section 274A (e) of the Immigration and Nationality Act. If the grantee knowingly employs unauthorized aliens, such violation shall be cause for unilateral cancellation of this grant. 13

14 4.4 Minority Participation In keeping with the One Florida Initiative, the Department of Health encourages minority business participation in this RFA. Applicants are encouraged to contact the Office of Supplier Diversity at or visit their website at for information on becoming a certified minority or for names of existing certified minorities who may be available for subcontracting or supplier opportunities. 14

15 Attachment I Hospital Tobacco Cessation and Counseling Services Grant Reviewer Questionnaire and Weighting Factors Proposed Project (20%) 1) Potential Impact: Given the demographics and needs described by the applicant, is this project likely to help individuals quit using tobacco? (10%) 2) Cultural Relevance: Is the project likely to provide adequate reach and intensity to meet the needs of population groups disparately affected by tobacco use? (10%) 3) Comments on the Nature of the Proposed Project: Please identify the apparent strengths and weaknesses in the quality of the project proposed in this application. Work Plan (45%) 4) Approach: Are the conceptual framework, activities, methods, and analyses adequately developed, well integrated, well reasoned, and appropriate for the project? (25%) 5) Feasibility: Can the proposed work be accomplished by the applicant in the specified time frame, given their documented experience and expertise, past progress, requested and available resources, and organizational commitment? (20%) 6) Comments on the Work Plan: Please comment on the work plan and include explanation of any concerns. Organizational Capabilities (25%) 7) Organizational Fit: How well does the applicant explain how the cessation program will fit into the current activities of the hospital? (10%) 8) Partner Commitment: Has the applicant provided sufficient evidence of commitment of the CEO, board, etc. to provide the required support? (10%) 9) Key Personnel Qualifications: Do the individuals named as key to the project have sufficient skills and experience to perform the work proposed? (5%) (10) Comments on Organizational Capabilities: Please comment on the overall qualifications and/or perceived gaps in skills, experience, or capacity of the organization, its partners, and the named key personnel to carry out the project described. Budget (10%) 11) Justification: Has the applicant provided sufficient justification for the expenses that will be incurred with this project? (5%) 12) Reasonableness: Is the proposed budget reasonable and consistent with the proposed activities and intent of the project? (5%) 13) Explanation of concerns: Please explain any concerns regarding the budget for the proposed project. Overall 14) Overall Evaluation Comments: After considering your responses to the previous questions, briefly summarize the most important points of your critique, indicating the relative importance of the major strengths and weaknesses of the application. 15) Other Recommendations: Beyond the items already addressed, is there any additional advice you are willing to offer the applicant? 15

16 ATTACHMENT II FINANCIAL AND COMPLIANCE AUDIT The administration of resources awarded by the Department of Health to the provider may be subject to audits and/or monitoring by the Department of Health, as described in this section. MONITORING In addition to reviews of audits conducted in accordance with OMB Circular A-133, as revised, and Section , F.S., (see AUDITS below), monitoring procedures may include, but not be limited to, on-site visits by Department of Health staff, limited scope audits as defined by OMB Circular A-133, as revised, and/or other procedures. By entering into this agreement, the provider agrees to comply and cooperate with any monitoring procedures/processes deemed appropriate by the Department of Health. In the event the Department of Health determines that a limited scope audit of the provider is appropriate, the provider agrees to comply with any additional instructions provided by the Department of Health to the provider regarding such audit. The provider further agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the Chief Financial Officer (CFO) or Auditor General. AUDITS PART I: FEDERALLY FUNDED This part is applicable if the provider is a State or local government or a non-profit organization as defined in OMB Circular A-133, as revised. 1. In the event that the provider expends $500,000 or more in Federal awards during its fiscal year, the provider must have a single or program-specific audit conducted in accordance with the provisions of OMB Circular A-133, as revised. EXHIBIT 1 to this agreement indicates Federal resources awarded through the Department of Health by this agreement. In determining the Federal awards expended in its fiscal year, the provider shall consider all sources of Federal awards, including Federal resources received from the Department of Health. The determination of amounts of Federal awards expended should be in accordance with the guidelines established by OMB Circular A-133, as revised. An audit of the provider conducted by the Auditor General in accordance with the provisions of OMB Circular A-133, as revised, will meet the requirements of this part. 2. In connection with the audit requirements addressed in Part I, paragraph 1, the provider shall fulfill the requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A-133, as revised. 3. If the provider expends less than $500,000 in Federal awards in its fiscal year, an audit conducted in accordance with the provisions of OMB Circular A-133, as revised, is not required. In the event that the provider expends less than $500,000 in Federal awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of OMB Circular A-133, as revised, the cost of the audit must be paid from non-federal resources (i.e., the cost of such audit must be paid from provider resources obtained from other than Federal entities.) 4. An audit conducted in accordance with this part shall cover the entire organization for the organization s fiscal year. Compliance findings related to agreements with the Department of Health shall be based on the agreement s requirements, including any rules, regulations, or statutes referenced in the agreement. The financial statements shall disclose whether or not the matching requirement was met for each applicable agreement. All questioned costs and liabilities due to the Department of Health shall be fully disclosed in the audit report with reference to the Department of Health agreement involved. If not otherwise disclosed as required by Section.310(b)(2) of OMB Circular A-133, as revised, the schedule of expenditures of Federal awards shall identify expenditures by agreement number for each agreement with the Department of Health in effect during the audit period. Financial reporting packages required under this part must be submitted within the earlier of 30 days after receipt of the audit report or 9 months after the end of the provider s fiscal year end. 16

17 PART II: STATE FUNDED This part is applicable if the provider is a nonstate entity as defined by Section (2), Florida Statutes. 1. In the event that the provider expends a total amount of state financial assistance equal to or in excess of $500,000 in any fiscal year of such provider (for fiscal years ending September 30, 2004 or thereafter), the provider must have a State single or project-specific audit for such fiscal year in accordance with Section , Florida Statutes; applicable rules of the Department of Financial Services; and Chapters (local governmental entities) or (nonprofit and for-profit organizations), Rules of the Auditor General. EXHIBIT I to this agreement indicates state financial assistance awarded through the Department of Health by this agreement. In determining the state financial assistance expended in its fiscal year, the provider shall consider all sources of state financial assistance, including state financial assistance received from the Department of Health, other state agencies, and other nonstate entities. State financial assistance does not include Federal direct or pass-through awards and resources received by a nonstate entity for Federal program matching requirements. 2. In connection with the audit requirements addressed in Part II, paragraph 1; the provider shall ensure that the audit complies with the requirements of Section (8), Florida Statutes. This includes submission of a financial reporting package as defined by Section (2), Florida Statutes, and Chapter (local governmental entities) or (nonprofit and for-profit organizations), Rules of the Auditor General. 3. If the provider expends less than $500,000 in state financial assistance in its fiscal year (for fiscal years ending September 30, 2004 or thereafter), an audit conducted in accordance with the provisions of Section , Florida Statutes, is not required. In the event that the provider expends less than $500,000 in state financial assistance in its fiscal year and elects to have an audit conducted in accordance with the provisions of Section , Florida Statutes, the cost of the audit must be paid from the nonstate entity s resources (i.e., the cost of such an audit must be paid from the provider resources obtained from other than State entities). 4. An audit conducted in accordance with this part shall cover the entire organization for the organization s fiscal year. Compliance findings related to agreements with the Department of Health shall be based on the agreement s requirements, including any applicable rules, regulations, or statutes. The financial statements shall disclose whether or not the matching requirement was met for each applicable agreement. All questioned costs and liabilities due to the Department of Health shall be fully disclosed in the audit report with reference to the Department of Health agreement involved. If not otherwise disclosed as required by Rule 69I-5.003, Fla. Admin. Code, the schedule of expenditures of state financial assistance shall identify expenditures by agreement number for each agreement with the Department of Health in effect during the audit period. Financial reporting packages required under this part must be submitted within 45 days after delivery of the audit report, but no later than 12 months after the provider s fiscal year end for local governmental entities. Non-profit or for-profit organizations are required to be submitted within 45 days after delivery of the audit report, but no later than 9 months after the provider s fiscal year end. Notwithstanding the applicability of this portion, the Department of Health retains all right and obligation to monitor and oversee the performance of this agreement as outlined throughout this document and pursuant to law. PART III: REPORT SUBMISSION 1. Copies of reporting packages for audits conducted in accordance with OMB Circular A-133, as revised, and required by PART I of this agreement shall be submitted, when required by Section.320 (d), OMB Circular A-133, as revised, by or on behalf of the provider directly to each of the following: A. The Department of Health at each of the following addresses: Contract Administrative Monitoring Unit 4052 Bald Cypress Way, Bin B01 (HAFACM) Tallahassee, FL The contract manager for this agreement listed in the standard agreement. 17

18 B. The Federal Audit Clearinghouse designated in OMB Circular A-133, as revised (the number of copies required by Sections.320 (d)(1) and (2), OMB Circular A-133, as revised, should be submitted to the Federal Audit Clearinghouse), at the following address: Federal Audit Clearinghouse Bureau of the Census 1201 East 10 th Street Jeffersonville, IN C. Other Federal agencies and pass-through entities in accordance with Sections.320 (e) and (f), OMB Circular A-133, as revised. 2. Pursuant to Sections.320(f), OMB Circular A-133, as revised, the provider shall submit a copy of the reporting package described in Section.320(c), OMB Circular A-133, as revised, and any management letter issued by the auditor, to the Department of Health at each of the following addresses: Contract Administrative Monitoring Unit 4052 Bald Cypress Way, BIN B01 (HAFACM) Tallahassee, Florida The contract manager for this agreement listed in the standard agreement. 3. Additionally, copies of financial reporting packages required by Part II of this agreement shall be submitted by or on behalf of the provider directly to each of the following: A. The Department of Health at each of the following addresses: Contract Administrative Monitoring Unit 4052 Bald Cypress Way, BIN B01 (HAFACM) Tallahassee, FL The contract manager for this agreement listed in the standard agreement. B. The Auditor General s Office at the following address: Auditor General s Office Claude Pepper Building, Room West Madison Street Tallahassee, Florida Any reports, management letter, or other information required to be submitted to the Department of Health pursuant to this agreement shall be submitted timely in accordance with OMB Circular A-133, Florida Statutes, and Chapters (local governmental entities) or (nonprofit and for-profit organizations), Rules of the Auditor General, as applicable. 5. Providers, when submitting financial reporting packages to the Department of Health for audits done in accordance with OMB Circular A-133 or Chapters (local governmental entities) or (nonprofit and for-profit organizations), Rules of the Auditor General, should indicate the date that the reporting package was delivered to the provider in correspondence accompanying the reporting package. PART IV: RECORD RETENTION The provider shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of six years from the date the audit report is issued, and shall allow the Department of Health or its designee, the CFO or Auditor General access to such records upon request. The provider shall ensure that audit working papers are made available to the Department of Health, or its designee, CFO, or Auditor General upon request for a period of six years from the date the audit report is issued, unless extended in writing by the Department of Health. End of Text 18

19 EXHIBIT 1 1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF THE FOLLOWING: Federal Program 1 CFDA# Title $ N/A Federal Program 2 CFDA# Title $ N/A TOTAL FEDERAL AWARDS $ N/A _ COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO THIS AGREEMENT ARE AS FOLLOWS: 2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF THE FOLLOWING: Matching resources for federal program(s) CFDA# Title $ State financial assistance subject to Sec , F.S.: CSFA# Title $ TOTAL STATE FINANCIAL ASSISTANCE AWARDED PURSUANT TO SECTION , F.S. $ COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS AGREEMENT ARE AS FOLLOWS: State Funds and Matching Funds: 19

20 EXHIBIT 2 PART I: AUDIT RELATIONSHIP DETERMINATION Providers who receive state or federal resources may or may not be subject to the audit requirements of OMB Circular A-133, as revised, and/or Section , Fla. Stat. Providers who are determined to be recipients or subrecipients of federal awards and/or state financial assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I and/or Part II of Exhibit 1 are met. Providers who have been determined to be vendors are not subject to the audit requirements of OMB Circular A- 133, as revised, and/or Section , Fla. Stat. Regardless of whether the audit requirements are met, providers who have been determined to be recipients or subrecipients of Federal awards and/or state financial assistance, must comply with applicable programmatic and fiscal compliance requirements. In accordance with Sec. 210 of OMB Circular A-133 and/or Rule , FAC, provider has been determined to be: Vendor or exempt entity and not subject to OMB Circular A-133 and/or Section , F.S. Recipient/subrecipient subject to OMB Circular A-133 and/or Section , F.S. NOTE: If a provider is determined to be a recipient /subrecipient of federal and or state financial assistance and has been approved by the department to subcontract, they must comply with Section (7), F.S., and Rule 69I-.006(2), FAC [state financial assistance] and Section _.400 OMB Circular A-133 [federal awards]. PART II: FISCAL COMPLIANCE REQUIREMENTS FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive Federal awards or state matching funds on Federal awards and who are determined to be a subrecipient, must comply with the following fiscal laws, rules and regulations: STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW: OMB Circular A-87 Cost Principles* OMB Circular A-102 Administrative Requirements OMB Circular A-133 Audit Requirements Reference Guide for State Expenditures Other fiscal requirements set forth in program laws, rules and regulations NON-PROFIT ORGANIZATIONS MUST FOLLOW: OMB Circular A-122 Cost Principles* OMB Circular A-110 Administrative Requirements OMB Circular A-133 Audit Requirements Reference Guide for State Expenditures Other fiscal requirements set forth in program laws, rules and regulations EDUCATIONAL INSTITUTIONS (EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT) MUST FOLLOW: OMB Circular A-21 Cost Principles* OMB Circular A-110 Administrative Requirements OMB Circular A-133 Audit Requirements Reference Guide for State Expenditures Other fiscal requirements set forth in program laws, rules and regulations *Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the OMB Circular A-133 Compliance Supplement, Appendix 1. STATE FINANCIAL ASSISTANCE. Providers who receive state financial assistance and who are determined to be a recipient/subrecipient, must comply with the following fiscal laws, rules and regulations: Section , Fla. Stat. Chapter 69I-5, Fla. Admin. Code State Projects Compliance Supplement Reference Guide for State Expenditures Other fiscal requirements set forth in program laws, rules and regulations Additional audit guidance or copies of the referenced fiscal laws, rules and regulations may be obtained at by selecting Contract Administrative Monitoring in the drop-down box at the top of the Department s webpage. * Enumeration of laws, rules and regulations herein is not exhaustive nor exclusive. Fund recipients will be held to applicable legal requirements whether or not outlined herein. END OF TEXT 20