CAH Subcontract Program Application Items

These are the items needed to complete and submit an application to the North Dakota Critical Access Hospital (CAH) Subcontract Program.

CAH Financial/Operational Improvement Area of Choice Application Components

For full consideration, all areas must be completed. Empty spaces could be considered nonresponsive.

CAH Contact Information
Hospital name, county, address, phone, contact person, email

Select your facility’s desired activity to improve finance and/or operations
Only one activity may be selected. Depending on which activity is selected, additional information specific to the activity is required.

• Coding and Billing Chart Audit
  • Date of facility's last coding and billing audit
  • Known or suspected number of coding errors from last audit
  • Known or suspected number of missing documentation errors from last audit
• Chargemaster Review
  • Date of facility's last chargemaster review
  • Percentage of claim denied
  • Clean claims rate
• Chargemaster Scrub
  • Date of facility's last chargemaster scrub
  • Known or suspected number of incorrect code errors from last audit
  • Known or suspected number of incomplete codes from last audit
• 340B External Audit
  • Date of facility's last 340B external audit
  • Known or suspected number of duplicate accounts from last external audit
• Revenue Cycle Management
  • Date of facility's last revenue cycle management improvement effort
  • Number of registration errors as a percent of total registrations
  • Percent of point-of-sale collections
• Service Line Assessment
  • Date of facility's last assessment for the proposed service line
  • Average daily census for service line
  • Patient utilization of service line
• Other (please list current statistics)
  • Date of facility's last work related to the proposed activity
  • Other metrics that will be considered

Budget & Budget Narrative – New Process
Enter your project budget and line item details to include information on how the line items are determined and/or calculated to assist the reviewers in understanding the proposed budget. All budgets should be based on current vendor quotes. Please note the new budget and budget narrative online format compared to previous years. Separate budget and budget narrative documents are no longer required to be uploaded.

Project Management
Name, title, and email of the individual responsible for management and oversight of this project. Name, title, and email of hospital official authorized to enter into contract.

CHNA Implementation Activity Application Components

The objective is to support new collaborative population health improvement programming and activities that address a significant need identified by the hospital's most recent CHNA; assess determinants of health based on data review, encourage collaboration between CAH, local public health units, and other community organizations and stakeholders; and promote community engagement and healthy behaviors. These projects may be written on behalf of a CAH or CAH-owned Rural Health Clinic.

Reporting Requirements

12-month post measure reporting will include, but is not limited to:

• Goals and objectives of the project.
• Description and number of activities or programs implemented as a result of CHNA implementation funding for collaborative population health improvement activities.
• Describe interventions the target population received.
• Number of individuals in the target population served by these activities or programs.
• Description of collaborative partnerships developed through the CHNA Implementation Activity. List all community partners and describe roles of all partners involved in the project.

Application Components

For full consideration, all areas must be completed. Empty spaces could be considered nonresponsive.

• CAH Contact Information
  Hospital name, county, address, phone
• Budget & Budget Narrative – New Process
  Enter your project budget and line item details to include information on how the line items are determined and/or calculated to assist the reviewers in understanding the proposed budget. All budgets should be based on current vendor quotes. There are two text boxes for budgets:
  • Line item Budget: In-Kind or Other Contributions. List items, the amounts, and a brief description of those items that will be covered by in-kind or other contributions.
  • Line item Budget: SORH requested funding. List items, the amounts, and a brief description of those items that will be covered by SORH funding.
  Please note the new budget and budget narrative online format compared to previous years. Separate budget and budget narrative documents are no longer required to be uploaded.
• Project Description
  
  • Which CHNA-related need(s) are you seeking to address with this funding application?
  • Explain in detail the proposed activity or program, include the goals, action steps, and specific project deliverables. Make sure they are time sensitive and measurable. Include a timeline with specific dates. All project activities must be completed by June 30, 2025. If your project completion date is flexible, please note this. If you prefer to upload a workplan, you may do so.
  • State the total dollar amount of funding requested ($5,000 maximum).
  • Does this project involve a CAH, RHC, or both?
  • Describe the cohort and collaborative partnerships involved, including information detailing specific project roles and responsibilities of each partner identified.
  • Will hospital/RHC personnel be involved in carrying out the proposed activity or program? If yes, explain which personnel will be involved and what each individual’s role will be.
  • Define the anticipated impact the proposed activity or program will have on the community.
  • State the duration of the proposed activity or program? Is it a continuing program or of limited duration?
  • Explain how the activity or program will be measured for effectiveness.
• Project Management
  Name, title, and email of the individual responsible for management and oversight of this project. Name, title, and email of hospital official authorized to enter into contract.