Affordable Care Act Capital Development Immediate Facility Improvements Grant Program

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Award Administration Information

  1. Award Notices

Each applicant will receive written notification of the outcome of the objective review process, including a summary of the expert committee’s assessment of the application’s merits and weaknesses, and whether the application was selected for funding. Applicants who are selected for funding may be required to respond in a satisfactory manner to Conditions placed on their application before funding can proceed. Letters of notification do not provide authorization to begin performance.

The Notice of Award sets forth the amount of funds granted, the terms and conditions of the award, the effective date of the award, the budget period for which initial support will be given, the non-Federal share to be provided (if applicable), and the total project period for which support is contemplated. Signed by the Grants Management Officer, it is sent to the applicant’s Authorized Organization Representative, and reflects the only authorizing document. It will be sent prior to the start date of May 1, 2012.
Administrative and National Policy Requirements
Successful applicants must comply with the administrative requirements outlined in 45 CFR Part 74 Uniform Administrative Requirements for Awards and Subawards to Institutions of Higher Education, Hospitals, Other Nonprofit Organizations, and Commercial Organizations or 45 CFR Part 92 Uniform Administrative Requirements For Grants And Cooperative Agreements to State, Local, and Tribal Governments, as appropriate.
HRSA grant and cooperative agreement awards are subject to the requirements of the HHS Grants Policy Statement (HHS GPS) that are applicable based on recipient type and purpose of award. This includes, as applicable, any requirements in Parts I and II of the HHS GPS that apply to the award. The HHS GPS is available at The general terms and conditions in the HHS GPS will apply as indicated unless there are statutory, regulatory, or award-specific requirements to the contrary (as specified in the Notice of Award).
Successful applicants will be required to follow the Federal construction requirements cited in this funding opportunity announcement and on the Notice of Award before proceeding with the CD-IFI project. The BPHC will provide guidance pertaining to monitoring and surveillance on federally-assisted projects to ensure that the design, bidding documents, and construction comply with Federal requirements. Additional information is available on the BPHC website at
Accessible Design Requirements

On September 15, 2010, the United States Department of Justice (DOJ) published revised Americans with Disabilities Act (ADA) regulations in the Federal Register that update and amend some of the provisions in the original 1991 ADA regulations. These changes include revised accessibility standards, called the 2010 Standards for Accessible Design (2010 Standards), which establish minimum criteria for accessibility in design and construction.

The Architectural Barriers Act of 1968, as amended, the Federal Property Management Regulations 101-19.6 (41 CFR 101-19.6), and the Uniform Federal Accessibility Standards issued by the General Services Administration (41 CFR 101-19.6, Appendix C) set forth requirements to make facilities designed, built, altered, or leased with Federal funds accessible to, and usable by, the physically handicapped and include minimum design standards. In addition, The Americans with Disabilities Act, 42 U.S.C. 12101 et seq., ( and Architectural Barriers Act Accessibility Requirements are available online at

Federal Interest

Real Property

The Federal Government retains a reversionary interest in real property constructed, acquired, or improved with Federal funds. The Federal interest is based on the total allowable project costs (Federal), excluding movable equipment and supplies, as a percent of the value of the property after completion of the project. In addition:

  • For alteration and renovation (A&R) projects, Federal interest exists for the useful life attributable to the A&R funded under this grant. Each CD-IFI A&R project having a total allowable project cost (Federal and non-Federal) of more than $500,000, excluding movable equipment with a unit cost of $5,000 or more and other items with a useful life of more than one year and a unit cost less than $5,000, is required to file a Notice of Federal Interest (NFI) against the property title. The level of Federal interest declines with physical depreciation or replacement of the alteration/renovation made to the asset.

The NFI requires HRSA’s Associate Administrator of the Office of Federal Assistance Management to provide prior written approval in order for the property owner to mortgage, sell, transfer, or use the property for a purpose inconsistent with the grant award. A notarized NFI must be filed against the property deed prior to construction in the appropriate public records office of the jurisdiction in which the property is located and once filed, a copy must be provided to the appropriate HRSA Grants Management Specialist. (See Appendix B for a sample NFI.)

Applicants not required to file a NFI (i.e., projects less than $500,000), acknowledge with the receipt of the Notice of Award that the Federal interest exists irrespective of the filing of a NFI. Adequate documentation must be maintained by the award recipient to track and protect the Federal interest. Such documentation includes communications between the lessor and the lessee related to protecting such interest, in accordance with the standard award terms and conditions. This documentation must be available for subsequent review by HRSA.
The NFI requires HRSA’s Associate Administrator of the Office of Federal Assistance Management to provide prior written approval in order for the property owner to mortgage, sell, transfer, or use the property for a purpose inconsistent with the grant award. A notarized NFI must be filed against the property deed prior to construction in the appropriate public records office of the jurisdiction in which the property is located and once filed, a copy must be provided to the appropriate HRSA Grants Management Specialist. (See Appendix B for a sample NFI.)

Applicants must provide a detailed equipment list, including non-expendable item with a useful life of more than one year and a unit cost of $5,000 or more (or equal to the applicant’s capitalization threshold), and items with a useful life of more than one year and a unit cost of less than $5,000, to identify items to be purchased with the CD-IFI project. Please note that equipment must be maintained, tracked, and disposed of in accordance with 45 CFR Parts 74.34, 74.35, 92.32, or 92.33 (as appropriate).

Leasehold Improvements

While leasehold improvements are allowed under the CD-IFI funding opportunity, please note:

  1. Lessors must agree in writing to the proposed A&R projects, and acknowledge Federal interest in the project, and file a Notice of Federal Interest if required.

  2. The lessor must agree to include in the lease agreement clauses that indicate the continued rights of the recipient/Federal Government in the event that the lessor of record changes.

  3. HRSA will determine if the term of the lease is long enough for the full value of the grant-supported improvements to benefit the grant activity. HRSA will take into account the purpose and duration of the grant, the expected life of the facility, and the use of the facility for grant-supported purposes.

  4. The lease agreement must provide the applicant reasonable control2.

  5. Funds may not be used to pay lease costs.

  6. Funds for a leased property cannot address needs that are part of the terms of the lease (i.e., the responsibility of the lessor).

  7. If funds address improvements that would impact terms of the lease (e.g., double paned windows) applicants must have written evidence of negotiated offset in the rent.

All other improvements that comply with the requirements of this funding opportunity are allowable.

For A&R projects proposed in leased facilities, the applicant must provide evidence that the lease includes the following language, whether as a provision of a new lease or an amendment to an existing lease, agreed to by both the recipient and lessor:
(a) the recipient agrees not to sublease, assign, or otherwise transfer the leased property, or use the property for a non-grant-related purpose(s) without the written approval from HRSA (at any time during the term of the lease, whether or not grant support has ended);

(b) the lessor will inform HRSA of any default by the recipient under the lease;

(c) HRSA shall have 60 days from the date of receipt of the lessor’s notice of default in which to attempt to eliminate the default, and that the lessor will delay exercising remedies until the end of the 60-day period;

(d) HRSA may intervene to ensure that the default is eliminated by the recipient or another recipient named by HRSA

(e) the lessor shall accept payment of money or performance of any other obligation by the HRSA’s designee, for the recipient, as if such payment of money or performance had been made by the recipient;

(f) in the event that the recipient defaults, the grant is terminated, or the recipient vacates the leasehold before the end of the lease term, HRSA shall have the right to designate a replacement for the recipient for the balance of the lease term, subject to approval by the lessor, which will not be withheld except for good reason; and

(g) the lease and any amendment to it shall be recorded in the land records of the jurisdiction where the property is situated.
In addition, the lessor must agree to file an NFI against the property title in the local jurisdiction before the project begins (if the proposed net project cost, less movable equipment, is greater than $500,000).
Sustainable Design


For information regarding design practices for hospital and medical facilities, refer to the latest edition of the document “Guidelines for Design and Construction of Health Care Facilities.” Although not required, we strongly encourage organizations to use sustainable design principles when applicable to their projects in design, construction and practice. The specifics of Sustainable Design are discussed in Appendix A3 to the document’s Environment of Care section (1.2.3). The appendix references the U.S. Green Building Council’s LEED Green Building Rating System ( and the Green Guide for Health Care ( This document can be purchased from the American Institute of Architects (AIA) Order Department, PO Box 60, Williston, Vermont 05495-0060; (1-800-365-ARCH).

It is strongly recommended that grantees employ the following standards, where practicable, in the procurement of equipment.  Following these standards will mitigate many of the negative effects on human health and the environment from the proliferation, rapid obsolescence, low recycling rate, high energy consumption, and potential to contain hazardous materials, and increased liability from improper disposal.

  • Electronic Product Environmental Assessment Tool (EPEAT) - Silver Rated products,

  • When EPEAT registered products are not available, the following environmental criteria should be considered:

    • Energy Star features,

      • Computer Power Management – Enable CPU’s to go into power save mode after an appropriate time period (e.g., 15-60 minutes)

      • Monitor Power Management – Enable monitors to go into power save mode after an appropriate time period (e.g., 15-60 minutes)

      • Establishment of a four year or higher replacement cycle (refresh Rate) for desktop computers and laptops

      • Establishment of default setting to double sided printing for printers and print driver software.

    • Recycled content, reduced packaging

    • Reduced toxic constituents in the product and in the manufacturing process

    • Designed for recycle/reuse including upgradeability considerations

    • Vendor provided take-back service

    • Vendor demonstration of corporate environmental responsibility

Community Development Financial Institutions (CDFI) Fund

The mission of the U.S. Department of the Treasury’s CDFI Fund is to expand the capacity of financial institutions to provide credit, capital, and financial services to underserved populations and communities in the United States.  Through its various programs, the CDFI Fund enables locally-based organizations to further goals such as: economic development (job creation, business development, and commercial real estate development); affordable housing (housing development and homeownership); and community development financial services (provision of basic banking services to underserved communities and financial literacy training). 

HRSA recommends that applicants consider utilizing programs offered by participating CDFIs operating nationally or within your State.  For further information on the CDFI Fund, the programs it administers, and a listing of organizations in your community that have been certified as CDFIs, please visit
Environmental Review

The National Environmental Policy Act of 1969 (NEPA), 42 U.SC 4321 (P.L. 91-190, Sec. 2, Jan. 1, 1970, 83 Stat., 852), including Public Disclosure, Section 102 of NEPA, and EO 11514, requires Federal agencies to assess the environment impacts of major Federal actions, including construction projects supported in whole or in part through Federal contracts, grants, subsidies, loans, or other forms of funding assistance.

HRSA requires that applicants provide information on anticipated environmental impact as part of their applications. APPLICANTS MUST SUBMIT WITH THEIR APPLICATION an Environmental Information and Documentation (EID) Checklist for each project.
If the funded project has received a NEPA compliant environmental assessment at the Federal, State, or local level, a copy of the assessment must be sent to the BPHC Program Office at
If it has been determined by HRSA, after reviewing the project description and the EID, that the funded project may have a significant impact on the environment, HRSA will request that the grantee initiate and prepare an Environmental Assessment (EA). Based on the review of the draft EA, HRSA will determine if there is a Finding of No Significant Impact (FONSI) or additional review is required.
NEPA related reviews must be completed prior to commencing work outside of purchasing moveable equipment and supplies, engaging architectural and engineering services, or acquiring necessary licenses, permits and other approvals for the project.
For additional information regarding compliance with NEPA, please visit
Cultural Resource and Historic Preservation (HP) Section 106 Review

Successful grant applications for CD-IFI funds will be reviewed under the terms of section 106 of the National Historic Preservation Act (NHPA). Under section 106, prior to the expenditure of funds, an assessment must be made of the potential effects of undertakings on historic properties (which include any prehistoric or historic district, site, building, structure, or object), that are eligible for listing or are listed on the National Register of Historic Places (NRHP).

HRSA has determined that the following activities constitute an undertaking under the NHPA: 1) all new construction and expansion projects (including demolition of existing buildings; 2) alteration/renovation/repair projects where exterior changes to the building façade or surroundings (such as grading, fencing, or additional parking) may be made (including roof, windows and parking lots), and 3) where interior renovations may be made to a building that is over fifty (50) years old, or is historically, architecturally, or culturally significant.
Under section 106, prior commencing work outside of purchasing moveable equipment and supplies, engaging architectural and engineering services, or acquiring necessary licenses, permits and other approvals for the project, an assessment must be made of the potential effects of undertakings on historic properties, and a notification/consultation must take place with all interested parties. Pursuant to the regulations at 36 CFR Part 800, HRSA determines the project’s effect on historic properties in consultation with the State Historic Preservation Officer (SHPO), Tribal Historic Preservation Officers (THPO), representatives of the local government, and other affected Indian tribes and interested parties.
For projects that require section 106 review, CD-IFI project funds may not be drawn down until HRSA receives documentation from the SHPO/THPO concurring whether the property:

  • is not historic; or

  • is historic, with the project causing no potential adverse effects; or

  • is historic and the project may cause adverse effects and provide a resolution to the adverse effects through a fully executed MOA finalized by all parties.

For additional information regarding compliance with section 106, please visit

Force Account Labor

If an applicant chooses to use its in-house personnel for in-house design work and/or in-house construction work in lieu of selecting a private firm, the grantee must obtain approval from BPHC prior to beginning the design phase. The grantee must show that it is more cost effective in comparison to outsourcing the work. The total cost for in-house personnel plus the fee for the architect and engineer must not exceed the prevailing architectural and engineering fee costs (usually 5 to 15 percent of the construction bid cost).
Detailed information regarding the format and content of the justification needed for an assessment of the proposal are available online at
Cultural and Linguistic Competence

HRSA is committed to ensuring access to quality health care for all. Quality care means access to services, information, materials delivered by competent providers in a manner that factors in the language needs, cultural richness, and diversity of populations served. Quality also means that, where appropriate, data collection instruments used should adhere to culturally competent and linguistically appropriate norms. For additional information and guidance, refer to the National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS) published by HHS and available online at Additional cultural competency and health literacy tools, resources and definitions are available online at and

Trafficking in Persons

Awards issued under this funding opportunity announcement are subject to the requirements of Section 106 (g) of the Trafficking Victims Protection Act of 2000, as amended (22 U.S.C. 7104). For the full text of the award term, go to If you are unable to access this link, please contact the Grants Management Specialist identified in this funding opportunity to obtain a copy of the Term.


Healthy People 2020 is a national initiative led by HHS that sets priorities for all HRSA programs.  The initiative has four overarching goals:  (1) attain high-quality, longer lives free of preventable disease, disability, injury, and premature death; (2) achieve health equity, eliminate disparities, and improve the health of all groups; (3) create social and physical environments that promote good health for all; and (4) promote quality of life, healthy development, and healthy behaviors across all life stages. The program consists of over 40 topic areas, containing measurable objectives.  HRSA has actively participated in the work groups of all the topic areas and is committed to the achievement of the Healthy People 2020 goals.  More information about Healthy People 2020 may be found online at

National HIV/AIDS Strategy (NHAS)

The National HIV/AIDS Strategy (NHAS) has three primary goals: 1) reducing the number of people who become infected with HIV, 2) increasing access to care and optimizing health outcomes for people living with HIV, and 3) reducing HIV-related health disparities.  The NHAS states that more must be done to ensure that new prevention methods are identified and that prevention resources are more strategically deployed.  Further, the NHAS recognizes the importance of early entrance into care for people living with HIV to protect their health and reduce their potential of transmitting the virus to others.  HIV disproportionately affects people who have less access to prevention, care and treatment services and, as a result, often have poorer health outcomes.  Therefore, the NHAS advocates adopting community-level approaches to identify people who are HIV-positive but do not know their status and reduce stigma and discrimination against people living with HIV.

To the extent possible, program activities should strive to support the three primary goals of the NHAS.  As encouraged by the NHAS, programs should seek opportunities to increase collaboration, efficiency, and innovation in the development of program activities to ensure success of the NHAS.  Programs providing direct services should comply with Federally-approved guidelines for HIV Prevention and Treatment (see as a reliable source for current guidelines). More information can also be found at
Smoke-Free Workplace

The Public Health Service strongly encourages all award recipients to provide a smoke-free workplace and to promote the non-use of all tobacco products. Further, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain facilities (or in some cases, any portion of a facility) in which regular or routine education, library, day care, health care or early childhood development services are provided to children.


The successful applicant under this guidance must comply with the following reporting and review activities.

  1. Audit Requirements

Comply with audit requirements of Office of Management and Budget (OMB) Circular A-133. Information on the scope, frequency, and other aspects of the audits can be found on the Internet at

  1. Payment Management Requirements

Submit a quarterly electronic Federal Financial Report (FFR) Cash Transaction Report via the Payment Management System.  The report identifies cash expenditures against the authorized funds for the grant or cooperative agreement. The FFR Cash Transaction Reports must be filed within 30 days of the end of each calendar quarter. Failure to submit the report may result in the inability to access award funds. Go to for additional information.
c. Status Reports
1) Federal Financial Report. The Federal Financial Report (SF-425) is required within 90 days of the end of each year of the two-year project period. The report is an accounting of expenditures under the project that year. Financial reports must be submitted electronically through EHB. More specific information will be included in the Notice of Award.
2) Submit a Progress Report(s). The awardee must submit a progress report to HRSA on a quarterly basis through the EHB, which may include the following:

  • Project completion status (percent complete)

  • Actual versus projected budget information—uses of CD-IFI grant funds

  • Project Implementation Certification

  • Bonding/Insurance Coverage Certification (as applicable)

  • Construction Schedule

  • Earned Value Management

Further information will be provided in the award notice.
3) Submit a Closeout Report. A closeout report is required within 90 days of the completion of the CD-IFI project period. The report will include the following items:

  • Photos of the completed project, including “before” photos

  • A certificate of substantial completion

  • A certificate of occupancy

  • A letter stating that the project was completed in accordance with previously certified contract documents and in accordance with all applicable Federal statutes and regulations.

Further information will be provided in the award notice.
4) Ad Hoc Submissions: Throughout the project period, HRSA may determine that a project required additional information to be submitted beyond the standard deliverables. This information may include, but is not limited to, the following:

  • Purchase orders

  • Contract documentation

  • Project implementation photos

  1. Transparency Act Reporting Requirements

New awards (“Type 1”) issued under this funding opportunity announcement are subject to the reporting requirements of the Federal Funding Accountability and Transparency Act (FFATA) of 2006 (Pub. L. 109–282), as amended by section 6202 of Public Law 110–252, and implemented by 2 CFR Part 170. Grant and cooperative agreement recipients must report information for each first-tier subaward of $25,000 or more in Federal funds and executive total compensation for the recipient’s and subrecipient’s five most highly compensated executives as outlined in Appendix A to 2 CFR Part 170 (FFATA details are available online at Competing continuation awardees, etc. may be subject to this requirement and will be so notified in the Notice of Award.

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