Memo
Date:
May 9, 2016
To:
Administrators, Graduate Medical Education and Training Programs,
Other Healthcare Providers
From:
Yende Anderson
Coordinator, IMG Assistance Program
Primary Care and Financial Assistance Programs
Office of Rural Health & Primary Care
Phone: 651-201-5988
Email:
yende.anderson@state.mn.us
Subject:
2016 Request for Proposals
Clinical Preparation Grant Program
Minnesota graduate medical education and training programs and other health care providers are
invited to apply for grant funding to support clinical preparation to assist immigrant international medial
graduates to prepare for medical residency. Application materials will be posted on the Office of Rural
Health & Primary Care (ORHPC) website on May 9, 2016. Attached is the program’s Grant Application
and Guidelines. Applications are due Month June 24, 2016. The website address for application forms
and instructions is: www.health.state.mn.us/divs/orhpc/funding/index.html.
Eligible projects must provide clinical preparation for Immigrant International Medical Graduates (IIMGs)
who has resided in Minnesota for at least two years, is certified by the Educational Commission for
Foreign Medical Graduates (ECFMG) and is committed to providing primary care for at least five years in
a rural or underserved area in Minnesota post residency. Preference will be given program sites in rural
or underserved areas of the state.
Questions about the grant application or the grant program can be directly to Yende Anderson at
yende.anderson@state.mn.us or 651-201-5988.
International Medical Graduate Clinical Preparation Grant Program
Grant Application Guidelines
Minnesota Department of Health (MDH)
Office of Rural Health & Primary Care
The purpose of this memo is to help you prepare an application for funds to provide hand on clinical
experience through the International Medical Graduate Clinical Preparation Grant Program. This
document has three sections:
I.
II.
III.
IV.
Funding source and background for the program.
Instructions on the preparation of the application.
Checklist to be used while preparing the application
Description of the criteria to be used during the review process
Section I –Program Description
BACKGROUND
Minnesota Statutes Section 144.1911 authorizes the Commissioner of Health to award grants to
support clinical preparation for Minnesota immigrant international medical graduates (IIMGs). A
Minnesota IIMG is defined as an international medical graduate who:
 was born outside the United States,
 now resides permanently in the United States as a citizen or Lawful Permanent Resident,
 has resided in Minnesota for at least 2 years, and
 did not enter the United States on a J1 or similar nonimmigrant visa following acceptance into a
United States medical residency or fellowship program.
The grant program supports clinical preparation for Minnesota IIMGs who are certified by the
Educational Commission for Foreign Medical Graduates (ECFMG) and who agree to practice post
residency in rural or underserved areas of the state. Funds will be awarded after a competitive review
process.
PROGRAM SUMMARY
A.
Eligible Applicants
Eligible applicants are programs and sponsors of clinical medical education or healthcare providers that
fulfill all of the following criteria:
1. Are located in Minnesota,
2. Have a history of providing clinical medical education or clinical preparation, and
3. Are willing to provide clinical preparation in primary care, including exposure to ambulatory and
inpatient medicine in one or more of the following specialties: family medicine, internal medicine,
obstetrics, pediatrics, psychiatry and rural medicine.
B.
Grant Program Requirements
Program Requirements
Programs may implement their own curriculum. However curricula must include exposure to various
circumstances and experience that would enable all trainees, upon program completion, to be able to:
 Understand and describe the United States health care system;
 Understand and describe assessment, evaluation and feedback norms in US medical education;
 Gather information, formulate differential diagnoses, and propose plans for initial evaluation
and management of patients with common presentations;
 Manage follow-up visits with patients having one or more common chronic diseases;
 Develop evidence-based health promotion/disease prevention plans for patients of any age or
gender;
 Demonstrate competency in advance elicitation of history, communication, physical
examination, and critical thinking skills;
 Demonstrate knowledge of local and national ethical and legal guidelines governing patient
confidentiality with specific attention to
o Written documentation
o Verbal communication with the patient’s family members;
 Communicate effectively with patients and patient’s family members; including how to:
o Utilize lay terms appropriate to the patient’s level of education and explain scientific
jargon,
o Recognize and mange denial and grief,
o Communicate abnormal results and “bad news” to patients in a sensitive manner,
o Discuss end of life issues with patient and family members with attention to the
patient’s wishes and needs,
o Provide concise daily updates for patients and families regarding hospital course and
rationale for on-going or new treatment plans;
 Clearly summarize the patient’s reason for admission and rationale for clinical plan;
 Assess suicidality in a depressed or psychotic patient;
 Be able to initiate a conversation with a patient about advance directives;
 Demonstrate the ability to clearly and concisely present oral and written summaries of patients
to members of the healthcare team with attention to the inclusion of relevant information and
synthesis of clinical information; and
 Demonstrate an understanding of cultural sensitivities and patient wishes with regards to
healthcare and incorporate this knowledge into discussions with the patient.
In addition, at the end of the training, trainees should be able to carry out the four General Milestone
(Professionalism, Interpersonal Communication Skills, Practice-based Learning and Improvement, and
Systems-based Practice) in the Next Accreditation System at a performance level of at least level 1,
preferably at a level 2. Pease see attached chart.
Funding Requirements
Grant funds may be used for:
1. Salary and fringe for faculty and preceptors related to providing clinical preparation for IIMGs;
2. Stipends for IIMG program participants;
3. Travel and lodging for IIMG program participants;
4. Training site improvements, fees, equipment, and supplies required for IIMG primary care
residents; and
5. Planning.
Grant funds may not be used to support administrative costs not directly related to clinical
preparation.
C.
Total Available Funding
Up to $300,000 is available per year. A program may apply for less than $300,000 and successful
applicants may be awarded less than requested.
D.
Distribution of Funding
Eligible clinical preparation programs may receive up to $ 300,000.
Due to the competitive nature of the grant, selected programs may not receive the full amount
requested.
Payments will be distributed quarterly, upon receipt of a progress report that includes certifying the
number of IIMGs in the program, an invoice, and an expenditure report.
The anticipated date of the contract is August 1, 2016 and the first available quarterly invoice may be
submitted November 1, 2016.
E.
Timeline
Application due to MDH:
Award Letter mailed:
Grant Agreements begin (est.):
June 24, 2016
Approximately July 15, 2016
August 1, 2016
Section II - Preparing the Application
The following outline and instructions should be used to prepare the grant application. While
additional documentation may be submitted, such material should be relevant to the specific scope of
the grant.
Required Forms and Documents
A.
Grant Application Form. (enclosed) Complete all items.
B.
Accounting System and Financial Capability Questionnaire. (enclosed) This form is required
from all applicants for funding over $50,000.
C.
Program Financial Statement
Applicants must include the most current financial statement of the program. This may be a
recent 990 form, an audit, a balance sheet, or an income statement that at least shows annual
revenue and expenses. Attached financial documentation must be specific to the residency
program, not documentation of a larger organization.
D.
Program Description (10 pages maximum). Write a summary of the proposed Clinical
Preparation program, including the following:
o Description of the program’s location, staff and faculty, administrative structure,
organizational partnerships, and budget. Please also describe any experience of
observerships, clinical preparation or other clinical training provided to medical students
or residents.
o Description of the program’s focus or emphasis while providing clinical
preparation/experience. IMG’s readiness is on a continuum; please describe the target
program participant and explain how the program will meet their needs. Please also
explain how they will be connected to other resources to meet needs that the program
may not address through the services it provides directly.
o Description of the program’s curriculum. An explanation of how these activities will help
the program participants demonstrate clinical readiness. An explanation of how
program activities will help the participants’ competitiveness in the residency
application process.
o Assessments of participants. Please explain how participants will be assessed and how
these assessments will inform programing. The expectation is that Grantee will monitor
and adjust program components depending on the performance of the program
participant.
o Description of experience with training or working with IIMGs. Plan for recruitment and
selection of IIMGs. Plan for collaboration with non-profits working with IIMGs.
o Statement of need for state grant funds. Applicants are encouraged to submit
information about their program costs, other funding sources and other information on
the need for state support.
E.
Grant Budget
A.
Grant Budget Form: required from all applicants. (enclosed)
B.
Grant Budget Justification Narrative
Applicants must attach a narrative describing the detail of the proposed grant budget, with
sufficient detail for each requested year of the grant. Also include detail of any non-state funds
that will be used to for this program during the grant period. For each of the cost items on the
budget form for which grant funds are requested, provide a rationale and details regarding how
the budgeted cost items were calculated, by year. Label this concise narrative “Budget
Justification” and follow the order of the budget form in your narrative.
o Personnel
For this line describe all salaries to be paid to faculty/preceptors and other
administrative staff using grant funds. Include a description of the proportion of
salary to be paid using grant funds for each individual.
o Fringe
For this line describe all fringe benefits to be paid to faculty, and/or preceptors
using grant funds. Include a description of the proportion of fringe to be paid
using grant funds for each individual.
o Stipend
Describe the amount of stipend to be paid to IIMG program participants.
o Travel and Lodging
Include a detailed description of the proposed travel and/or lodging outside the
home location of the participant for IIMG program participants as it relates to
the direct operation of the program. Provide the number of miles planned for
program activities as well as the rate of reimbursement per mile to be paid from
grant funds. For example, a rural health rotation
o Supplies
Include a description of any supplies necessary for the operation of the clinical
preparation program.
o Contracted Services
Include any grant funding to be used for consultant fees, or any costs associated
with training sites on this line.
o Equipment and Capital Improvements
Include any grant funding to be used to purchase equipment, or to make capital
improvements.
o Other Expenses
Whenever possible, include proposed expenditures in the categories listed
above. If it is necessary to include expenditures in this general category, include
a detailed description of the activities as they relate to the direct operation of
the program. If possible, include a separate line-item budget and budget
narrative.
Submission: Applications must be submitted Yende Anderson (yende.anderson@state.mn.us) by
email or US mail no later than 4:30 p.m., June 24, 2016.
If using US mail, please mail the documents to:
Yende Anderson
Minnesota Department of Health
Office of Rural Health & Primary Care
P.O. Box 64882
St. Paul, Minnesota 55164-0882
Courier Address:
Minnesota Department of Health
Office of Rural Health & Primary Care
85 East 7th Place, Suite 220
St. Paul, Minnesota 55101
Applications postmarked prior to this date but not received by MDH prior to the time deadline will
be considered late. Late applications will not be considered for review.
Questions regarding these grant application guidelines should be directed to Yende Anderson at
yende.anderson@state.mn.us or 651-201-5988 or 800-366-5424.
I.
Section III - Application Checklist
Required Forms:
o
Grant Application Form
o
Accounting System and Financial Questionnaire
o
Grant Budget Form
II.
Program Financial Statement
Attach financial documentation specific to the clinical preparation program.
III.
Program Description (10 pages max)
Attach a description of the program’s history, structure, emphasis and recent outcomes
IV.
Grant Budget Justification Narrative
Attach this narrative detailing the individual lines of the budget.
Grant awards will be announced by July 15, 2016 with an estimated contract start date of August 1,
2016. Invoices can be submitted quarterly, upon execution of the contract and once work is started.
Upon selection and announcement of grant recipients, all submitted application information and
documentation will become public data.
Section IV – Review Criteria
A. Review Process
After the submission deadline, MDH will review all submitted applications for eligibility and
completeness. Complete applications from eligible applicants will move forward to a review
committee process. Applications will be scored by a grant review committee, using the criteria
listed below. The review committee will also discuss other relevant factors. Review committee
recommendations will be transmitted to the Commissioner for final funding decisions and
subsequent contracting.
B. Review Criteria
All complete applications from eligible applicants will be scored on a 100-point scale. Below is a
breakdown of that scale, and the component of the application where the information must be
present
o 25 points: Program Description
Is the program description complete? Does the description adequately
explain the program’s administrative structure, organizational structure,
and budget? Are the needs of IIMGs effectively described? Does the
program as described meet those needs? Is the program’s explanation of
how the clinical preparation will help program participants demonstrate
readiness and competiveness sufficient?
o 25 points: Program Experience/ Collaboration
Does the program have experience working with IIMGs? Is the program
equipped to respond to the unique needs necessary to support a
successful clinical preparation for IIMGs? Does the program have a plan
for recruiting and selecting IIMGs? Does the program have an adequate
plan for collaborating with other programs or nonprofits?
o 25 points: Curriculum
Is the curriculum complete given the focus of the program?
o 25 points: Proposed budget and proposed use of funds
Is the proposed budget clear? Does the budget narrative give adequate
detail in how funds will be accounted for and spent? Is the budget
reasonable?
GRANT APPLICATION FORM
International Medical Graduate Clinical Preparation Grant Program
Minnesota Department of Health
Office of Rural Health and Primary Care
1. Applicant Organization (with which grant contract is to be executed)
Legal Name____________________________________________________________________________________________________________
Address_______________________________________________________________________________________________________________
Phone__(_______)_______________________________________________________________________________________________________
Federal ID Number _________________________________________ State Tax ID Number __________________________________________
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------2. Director of Applicant Organization
3. Fiscal Management Officer of Applicant Organization
Name/Title_________________________________________________Name/Title__________________________________________________
Address___________________________________________________ Address_____________________________________________________
Phone (_______)___________________________________
Phone (_______)____________________________________________
E-mail_____________________________________________________E-mail______________________________________________________
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------4. Operating Organization (if different from number 1)
Name/Title_____________________________________________________________________________________________________________
Address_______________________________________________________________________________________________________________
Phone___(_______)_______________________________________
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------5. Contact Person for Operating Organization (if different from number 2)
Name/Title_____________________________________________________________________________________________________________
Address________________________________________________________________________________________________________________
Phone____(_______)_____________________________________________________________________________________________________
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------6. Contact Person for Further Information on Application (if different from number 5)
Name/Title_____________________________________________________________________________________________________________
Address_______________________________________________________________________________________________________________
Phone_____(_______)___________________________________________________________________________________________________
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------7. Amount Requested_____________________________________________________________________________________________________
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
8. I certify that the information contained herein is true and accurate to the best of my knowledge and that I submit this application on behalf of the
applicant organization.
Signature
Title
Date
ACCOUNTING SYSTEM AND FINANCIAL CAPABILITY QUESTIONNAIRE
This is the standard form to be used in order to determine the financial capacity of grant applicants. The creation and implementation of
this form is in response to the best practices stated in the Office of Legislative Auditor’s report “State Grants to Nonprofit Organizations,”
January 2007.
No applicants will be excluded from receiving funding based solely on the answers to these questions.
SECTION A: APPLICANT INFORMATION
2.Employer
Identification Number
1. Organization Name and Address
3.Number of Employees
Full Time:
Part Time:
4. When did the applicant receive its 501(c)3 status? (MM/DD/YYYY)?
5. Is the applicant affiliated with or managed by any other organizations (Ex.
regional or national offices)?
YES
NO If “Yes,” provide details:
6a. Total revenue in most recent accounting
period (organization’s 12 month fiscal year).
5b. Does the applicant receive management or financial assistance from any
other organizations?
YES
NO If “Yes,” provide details:
6b. How many different funding sources does
the total revenue come from?
7. Does the applicant have written policies and procedures for the following business processes?
a. Accounting
Yes
No
Not Sure If yes please attach a copy of the table of contents
b. Purchasing
Yes
No
Not Sure If yes please attach a copy of the table of contents
c. Payroll
Yes
No
Not Sure If yes please attach a copy of the table of contents
SECTION B: ACCOUNTING SYSTEM
1.Has a Federal or State Agency issued an official opinion regarding the adequacy of the applicants accounting system for the
collection, identification and allocation of costs for grants
Yes
No
Note: If a financial review occurred within the past three years, omit Questions 2 – 6 of this Section and 1-3 of Section C.
a. If yes, provide the name and address of the reviewing agency:
b. Attach a copy of the latest review and any
subsequent documents.
2. Which of the following best describes the accounting system?
Manual
Automated
3. Does the accounting system identify the deposits and expenditures of program funds for
each and every grant separately?
4. If the applicant has multiple programs within a grant, does the accounting system record
the expenditures for each and every program separately by budget line items?
5. Are time studies conducted for an employee(s) who receives funding from multiple
sources?
6. Does the accounting system have a way to identify over spending of grant funds?
Combination
Yes
No
Not Sure
Yes
No
Not Sure
Not Applicable
Yes
No
Not Sure
No Multiple Sources
Yes
No
Not Sure
1. Is a separate bank account maintained for grant funds?
Yes
No
Not Sure
2. If grant funds are mixed with other funds, can the grants expenses be easily identified?
Yes
No
Not Sure
3. Are the officials of the organization bonded?
Yes
No
Not Sure
Yes
No
Not Sure
SECTION C: FUND CONTROL
SECTION D: FINANCIAL STATEMENTS
1. Did an independent certified public accountant (CPA) ever examine the organization’s
financial statements?
SECTION E: CERTIFICATION
I certify that the above information is complete and correct to the best of my knowledge.
1. Signature
2. Date
3. Title
11
/
/
Grant Budget Form
International Medical Graduate Clinical Grant Program
Minnesota Department of Health
Office of Rural Health and Primary Care
Categories
Grant funds
requested
Personnel:
Salaries
Fringe
Contracted services
Personnel Total
Stipend
Travel and Lodging
Supplies
Equipment and Capital
Improvements
Other
TOTAL
12
Non-grant
funds
contributed
Total