Implementation Plan Instructions

Implementation Plan Instructions.docx

The Health Center Program Application Forms

Implementation Plan Instructions

OMB: 0915-0285

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Implementation Plan Instructions


Applicants are expected to demonstrate that they will be operational and compliant with Health Center Program requirements (see Appendix E) within 120 days of award. The Implementation Plan (as noted in the RESPONSE section of the Project Narrative) is the applicant’s opportunity to demonstrate this readiness to initiate the proposed project plan. Instructions for developing the Implementation Plan are provided below.


Applicants are expected to include the goals and action steps necessary to ensure that within 120 days of the Notice of Award, all proposed site(s) will:

  • Be open and operational.

  • Have appropriate staff and providers in place.

  • Deliver services (consistent with Forms 5A and 5C) to the proposed target population.

  • Be compliant with Health Center Program requirements.


The Implementation Plan must be specific to the proposed project and should include operational, administrative, governance, and program policy activities (e.g., EHR implementation, staffing, reimbursement enrollment, board composition, revising policies and procedures to be compliant) to be undertaken as appropriate. Applicants may choose any of the following from the below list of focus areas and goals, or may include other focus areas and goals as desired. Health centers may use the Health Center Program Site Visit Guide at http://bphc.hrsa.gov/programrequirements/centerguide.html to assess compliance with program requirements.


The Implementation Plan will be reviewed in conjunction with the Project Narrative, Program Specific Forms, and required attachments to evaluate the application. Action steps described in the Implementation Plan related to compliance with program requirements and becoming operational in 120 days should be consistent with those discussed in the Project Narrative and other parts of the application. If required services are provided by contract or referral, specify action steps and timeframes for the development of these formal arrangements.


For applicants proposing site(s) that are currently operational and compliant with Health Center Program requirements, the Implementation Plan should demonstrate compliance and highlight proposed changes in access to care, such as planned service expansion and outreach activities, new collaborations/partnerships, and any other changes that would occur within 120 days of the Notice of Award as a result of the funding. If activities related to compliance and operational readiness are not thoroughly documented (i.e., included in the Program Narrative and Implementation Plan and corroborated in Attachments or Forms, as appropriate), the review/scoring of the application may be negatively impacted.


Focus Area: Operational Service Delivery Program

A.1. Provision of Required & Additional Services (Form 5A)

A.2. Core Provider Staff Recruitment Plan

A.3. System for Professional Coverage for After Hours Care

A.4. Admitting Privileges


Focus Area: Functioning Key Management Staff/Systems/Arrangements

B.1. Appropriate Management Team Recruitment

B.2. Documented Contractual/Affiliation Agreements

B.3. Financial Management and Control Policies

B.4. Data Reporting System


Focus Area: Operational Site(s) within 120 Days

C.1. Physical Location Ready to Receive Patients (e.g., alteration/renovation complete)

C.2. Readiness to Serve the Target Population


Focus Area: Implementation of a Sliding Fee Discount Program (SFDP) and Billings and Collections System

D.1. Implementation of a Compliant Sliding Fee Scale

D.2. SFDP and Billing and Collections Policies and Procedures


Focus Area: Quality Improvement/Quality Assurance (QI/QA) Program

E.1. Leadership and Accountability

E.2. QI/QA Policies and Procedures

E.3. QI/QA Plan and Process to Evaluate Performance


Focus Area: Governing Board

F.1. Required Composition Recruitment

F.2. Required Authority & Functions

F.3. Conflict of Interest Policies and Procedures


Key Elements of the Project Work Plan


  1. Focus Area: Applicants may choose a focus area based on the list above or provide a different focus area based on the action steps necessary to achieve the required operational and compliance status.

  2. Goal: For each Focus Area, provide at least one goal. Goals should describe measureable results.

  3. Key Action Steps: Identify the action steps that must occur to accomplish each goal. For each goal, provide at least one action step. For each action step, identify at least one person/area responsible and time frame.

  4. Person/Area Responsible: Identify who will be responsible and accountable for carrying out each action step.

  5. Time Frame: Identify the expected time frame for carrying out each action step.

  6. Comments: Provide supplementary information as desired.


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleImplementation Plan Instructions
AuthorJoanne Galindo
File Modified0000-00-00
File Created2021-01-23

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