CHAPTER 166
QUALITY IMPROVEMENT INITIATIVE GRANTS
441—166.1(249A) Definitions.
“Eligible entities” means nursing facilities, state agencies, nursing facility advocacy groups, and other nursing facility stakeholder groups.
“Nursing facility” means a Medicaid-enrolled facility that is defined in 441—81.1(249A) as “facility.”
“Quality improvement initiative” or “initiative” means an innovative project that prevents noncompliance or promotes compliance with state or federal requirements for nursing facilities and that directly or indirectly benefits nursing facility residents by enhancing their quality of life or quality of care.
[ARC 9402B, IAB 3/9/11, effective 4/1/11]
441—166.2(249A) Availability of grants. At the beginning of each calendar year, the department shall set aside an annual amount from the civil money penalty fund established pursuant to Iowa Code section 249A.19 to be awarded in the form of grants to eligible entities for approved quality improvement initiatives. At no time shall the grant set-aside cause the civil money penalty fund to drop below $1 million.
	166.2(1) In any calendar year in which sufficient funds are available in the civil money penalty fund to support quality improvement initiative grants, the department shall issue a notice for applications for grants.
	166.2(2) There is no entitlement to any funds available for grants awarded pursuant to this chapter. The department may award grants to the extent funds are available and, within its discretion, to the extent that applications are approved.
[ARC 9402B, IAB 3/9/11, effective 4/1/11]
441—166.3(249A) Requirements for applicants. Eligible entities wishing to apply for quality improvement initiative grants must meet the following requirements:
	166.3(1) Eligible entities may submit an application on behalf of a specific facility, on behalf of a group of facilities, or on behalf of a stakeholder group. However, grant funds awarded shall be distributed to one distinct entity that shall be contractually responsible for the funds.
	166.3(2) The applicant must demonstrate the capacity to carry out the initiative for which the grant is requested.
	166.3(3) At the time of the application, a facility applicant must not have:
	a. 	Any pending enforcement actions that could result in the closure of the facility;
	b. 	Any outstanding sanctions by the Iowa Medicaid enterprise or the Centers for Medicare and Medicaid Services; or
	c. 	Any outstanding or unresolved Class I violations.
	166.3(4) An applicant previously awarded a quality improvement initiative grant that failed to achieve that initiative’s intended goals or outcomes shall be ineligible to apply for a period of five years following that grant award. However, a grant may be considered if the applicant’s inability to complete the initiative was due to circumstances beyond the applicant’s control.
	166.3(5) An applicant may receive a maximum of two grants within a five-year period.
[ARC 9402B, IAB 3/9/11, effective 4/1/11]
441—166.4(249A) Requirements for initiatives. Grants are available only for quality improvement initiatives that are outside the scope of normal operations for the nursing facility or other applicant. Grants cannot be used as replacement funding for goods or services that the applicant already offers.
	166.4(1) The applicant must be able to identify:
	a. 	Areas in need of improvement, including staff education or training needs not available through current corporate or facility contract employment; and
	b. 	Efficient uses of the quality improvement initiative grant to improve the quality of life or quality of care of nursing facility residents.
	166.4(2) Grants may be awarded for:
	a. 	Short-term quality improvement initiatives (three years or less), and
	b. 	Initiatives with a longer term that involve collaborative efforts of state government and various stakeholders.
	166.4(3) The applicant shall not submit a request for or receive a grant for the same type of initiative previously awarded a grant.
	166.4(4) Except for a one-time initiative, grant awards shall be restricted to initiatives that will be self-sustaining once implemented. Costs to maintain the initiative may be considered allowable costs on the nursing facility’s financial and statistical report, subject to 441—subrule 81.10(1) and rule 441—81.6(249A).
	166.4(5) Quality improvement initiative grants are not available for the following:
	a. 	General operations or administrative salaries.
	b. 	Capital improvements, construction projects or other activities that would increase square footage or result in an increase in the assessed value of any property.
	c. 	Facility maintenance activities intended to meet the minimum standards for nursing facilities set forth in 481—Chapter 61.
	d. 	Goods or services for which the applicant or others are already obligated to pay.
	e. 	Vendor payments and payroll obligations for a facility’s normal operations or for fulfillment of state or federal requirements.
	f. 	Costs related to travel, bonuses or other direct employee benefits.
	g. 	Costs that are not specifically outlined in the applicant’s grant application or are already included in the facility’s cost report.
	h. 	Projects, programs, goods or services that are unrelated to improving the quality of life or quality of care of nursing facility residents.
[ARC 9402B, IAB 3/9/11, effective 4/1/11]
441—166.5(249A) Applications. Eligible entities shall apply for quality improvement initiative grants using Form 470-4869, Grant Award Application. Applications may be accessed electronically through the Iowa Medicaid enterprise Web site, www.ime.state.ia.us/Providers.
	166.5(1) Grant applications must be received by the Iowa Medicaid enterprise between February 1 and April 30 of any calendar year in which grant funds are available. Grant applications submitted before or after this period shall not be considered.
	166.5(2) To be considered, each application must include, at a minimum, the following:
	a. 	A description of the initiative’s vision or goal. The application must identify how the grant will improve the quality of care or quality of life of nursing facility residents.
	b. 	The objectives or expected outcomes of the initiative.
	c. 	An implementation plan.
	d. 	An education plan. For initiatives intended to provide education or training to stakeholders, the applicant shall submit a plan for the development and execution of the training curriculum.
	e. 	A sustainability plan. The application shall describe how the initiative is a one-time initiative or will be self-sustaining once the grant implementation period has ended.
	f. 	A budget, with competitive quotes. Applicants must include three quotes for the cost of equipment, construction and labor for the quality improvement initiative. The quotes shall be from businesses that comply with federal, state and local laws as required for the health and safety of the residents of the nursing facility.
	g. 	A monitoring plan. The application shall describe how the applicant will monitor and evaluate ongoing progress toward meeting the initiative’s stated goals.
	h. 	The qualifications of professionals and other staff involved in the initiative.
[ARC 9402B, IAB 3/9/11, effective 4/1/11]
441—166.6(249A) Awarding of grants. Grants will be awarded beginning July 1 of each calendar year in which grant funds are available.
	166.6(1) A grant award review committee shall be appointed by the state Medicaid director. The committee shall review and evaluate all complete grant applications submitted within the required time frame.
	166.6(2) Applications shall be evaluated using the following criteria (indicated on Form 470-4869, Grant Award Application):
	a. 	Vision or goal: 5 points.
	b. 	Description of initiative: 20 points.
	c. 	Effect on quality of care or quality of life of residents: 20 points.
	d. 	Objectives and outcomes: 20 points.
	e. 	Implementation plan: 25 points.
	f. 	Education plan: 5 points.
	g. 	Sustainability: 5 points.
	166.6(3) Each grant application must score at least 85 points on the evaluation criteria for the application to be recommended to the department director for an award.
	166.6(4) The department shall comply with the Centers for Medicare and Medicaid Services (CMS) guidance on whether specific categories of civil money penalty use require federal approval. The department shall submit the project plan for each grant the department intends to award, along with any required documentation, to CMS to seek approval or denial of the proposed project.
[ARC 9402B, IAB 3/9/11, effective 4/1/11]
441—166.7(249A) Grant requirements. Grant awards are subject to the following general requirements.
	166.7(1) Contract. Grants for approved applications shall be awarded through a contract entered into by the department and the applicant. Grant funds shall be distributed to grantees in quarterly increments.
	166.7(2) Progress report. The grantee shall submit quarterly progress reports following the date of the award until completion of the initiative. A grantee that fails to submit a quarterly progress report shall forfeit any future grant award distributions.
	166.7(3) Final report. The grantee must submit a final report to the bureau of long term care of the Iowa Medicaid enterprise within 60 days of completion of the initiative.
	a. 	The report shall be submitted on Form 470-4950, Grant Award Final Report.
	b. 	The final report must provide evidence of successful completion of the quality improvement initiative and must address the following:
	(1)	The purpose of the grant,
	(2)	The expected outcomes of the initiative,
	(3)	The actual outcomes of the initiative,
	(4)	The number of residents who benefited from the initiative,
	(5)	The status of the action plan for sustainability if the initiative will continue beyond the grant funding.
[ARC 9402B, IAB 3/9/11, effective 4/1/11]
These rules are intended to implement Iowa Code section 249A.19.
[Filed Emergency After Notice ARC 9402B (Notice ARC 9157B, IAB 10/20/10), IAB 3/9/11, effective 4/1/11]