The Department of Health and Human Services is the Federal government's principal agency for protecting the health of all Americans and providing essential human services, especially to those who are least able to help themselves.
|Recipient||Amount||Start Date||End Date|
|Health, Pennsylvania Department Of||$ 7,000,000||   ||2019-10-21||2022-10-20|
|Health, Pennsylvania Department Of||$ 7,498,228||   ||2017-04-21||2019-10-20|
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|$ 0||   |
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Uses and Use Restrictions
? Model Oversight: provide oversight, approve global budgets and transformation plans.
Advise on and approve changes to operational and payment mechanisms ? Global Budget Administration: Set the precise methodology to set the global budgets for each participating rural hospital, with contributions from all payers participating in the model.
? Data Analytics: perform ongoing reporting and analysis in support of Model financial targets, population health outcomes and quality metrics.
Provide stakeholders with regular reports to inform decision-making.
Securely collect and store data from payers and providers.
Clean data for performance reporting and budget calculation.
? Technical Assistance: provide strategic and operational technical assistance to support care delivery transformation.
Convene hospitals to share best practices on care management and implementation. ? Quality Assurance: provide an annual assessment of compliance with transformation plan and global budget targets.
Recommend corrective action plans where needed.
Contract with an independent outcome evaluation group to provide board and CEO with rigorous evaluation of Model?s progress against population health, quality of care, and cost targets.
Engage stakeholders through an advisory panel for input on program policy and outcomes.
? Not pay for any community services (e.g., housing, food, violence intervention programs, and transportation) ? Not provide individuals with services that are already funded through any other source, including but not limited to Medicare, Medicaid, and CHIP. ? Not match any federal funds ? Not provide services, equipment, or supports that are the legal responsibility of another party under Federal, State, or Tribal law (e.g., vocational rehabilitation or education services) or under any civil rights laws.
Such legal responsibilities include, but are not limited to, modifications of a workplace or other reasonable accommodations that are a specific obligation of the employer or other party. ? To cover the costs to provide direct health care services to individuals.
To match any other Federal funds. ? To provide services, equipment, or supports that are the legal responsibility of another party under Federal or State law (e.g., vocational rehabilitation or education services) or under any civil rights laws.
Such legal responsibilities include, but are not limited to, modifications of a workplace or other reasonable accommodations that are a specific obligation of the employer or other party. ? To supplant existing State, local, or private funding of infrastructure or services, such as staff salaries, etc. ? To be used by local entities to satisfy State matching requirements. ? Award dollars cannot be used for specific components, devices, equipment, or personnel that are not integrated into the entire service delivery model proposal. ? To provide goods or services not allocable to the approved project.
? To be used by local entities to satisfy state matching requirements.
? To pay for construction. ? To pay for capital expenditures for improvements to land, buildings, or equipment which materially increase their value or useful life as a direct cost, except with the prior written approval of the Federal awarding agency. ? To pay for the cost of independent research and development, including their proportionate share of indirect costs (unallowable in accordance with 45 CFR 75.476). ? To use as profit to any award recipient even if the award recipient is a commercial organization, (unallowable in accordance with 45 CFR 75.216(b)), except for grants awarded under the Small Business Innovative Research (SBIR) and Small Business Technology Transfer Research (STTR) programs (15 U.S.C.
Profit is any amount in excess of allowable direct and indirect costs. ? To expend funds related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or Executive order proposed or pending before the Congress or any state government, state legislature or local legislature or legislative body.
This single source funding opportunity provides Pennsylvania with the necessary start-up funding for the Model and is open to Pennsylvania?s Department of Health and later the Rural Health Redesign Center.
First, the Pennsylvania Department of Health is uniquely positioned as the initial applicant under this funding opportunity to meet the objectives of this funding opportunity based on its existing knowledge of the Model, its regulatory authority over healthcare in Pennsylvania, and its capacity to administer the Pennsylvania Rural Health Model including operationalizing the Rural Health Redesign Center, and its existing partnerships and collaborations with Pennsylvania providers.
? Knowledge of the Model: The Pennsylvania Department of Health is intimately familiar with the objectives of the Model.
Pennsylvania?s Department of Health was a key member of the discussions between Pennsylvania and CMS during the development of the Model; the Pennsylvania?s Secretary of Health and staff dedicated significant time, energy, and resources over the past year in partnering with CMS to establish the Model?s financial, health outcomes, and rural hospital scale targets.
This existing familiarity and knowledge of the Model will help the Pennsylvania Department of Health to expediently deploy the start-up funding offered under this funding opportunity announcement and successfully operationalize the Rural Health Redesign Center. ? Authority and role in administering the Model: The Pennsylvania Department of Health is responsible for ensuring that changes in Pennsylvania?s health system improve the conditions and well-being of Pennsylvanians.
The Pennsylvania Department of Health has broad healthcare authority to administer the payments under the model and to improve the health of Pennsylvanians and control the rate of growth in healthcare costs.
Additionally, the Pennsylvania Department of Health is a signatory to the Pennsylvania Rural Health Model?s State Agreement and will be supporting the State in achieving its obligations under the State Agreement.
? Existing partnership and collaboration: The Pennsylvania Department of Health is located in Pennsylvania and has existing relationships and a history of collaboration with Pennsylvania providers, payers, and community-based resources that would benefit from this funding opportunity.
Pennsylvania?s Department of Health has also been working with these stakeholders for their input and participation throughout the development of the Model.
Second, the Rural Health Redesign Center as the second applicant, will also be uniquely positioned to meet the objectives of this funding opportunity.
Pennsylvania?s Department of Health will legislatively create the Rural Health Redesign Center as an independent entity with authority over the implementation of the Pennsylvania Rural Health Model.
The RHRC will approve hospital transformation plans, global budgets, exception adjustments and changes to operational and payment mechanisms associated with the Model as defined under the State Agreement.
The RHRC will also establish and build strong relationships with Pennsylvania rural hospitals as the rural hospitals implement the Model.
The RHRC will continue to strengthen these relationships as it implements the activities required under the Model.
Similar to Pennsylvania?s Department of Health, the RHRC will be uniquely positioned to support this Model as it will be legislatively created solely to provide implementation support for the Model.
CMS is committed to achieving better care for individuals, better health for populations, and reduced expenditures for Medicare, Medicaid, and CHIP. Through the Innovation Center, CMS strives towards these goals by testing innovative payment and service delivery models. CMS believes that states can be critical partners of the federal government and other health care payers to facilitate the design, implementation, and evaluation of community-centered health systems that can deliver significantly improved cost, quality, and population health performance results for all state residents, including Medicare, Medicaid, and CHIP beneficiaries. States have policy and regulatory authorities, as well as ongoing relationships with commercial healthcare payers, health plans, and providers that can accelerate delivery system reform. CMS has previously partnered with states to accelerate delivery system reform through initiatives such as the State Innovations Model (SIM) program. SIM provides state-based healthcare transformation efforts with funding to test the ability of states to utilize policy and regulatory levers to accelerate multi-payer health care transformation. Selected states have been working with state-based payers, including Medicaid and commercial payers, and providers to design and implement care delivery and payment reform. States participating in SIM were selected through two rounds of public Funding Opportunity Announcements released on August 23, 2012 (Round 1) and May 22, 2014 (Round 2). Additionally, CMS has released guidance to SIM state participants in which CMS indicated that in certain instances it will consider state proposals for Medicare?s alignment with state multi-payer payment and care delivery models. According to that guidance, CMS would assess such proposals with consideration of the following principles: 1) patient-centered, 2) accountable for total cost of care, 3) transformative, 4) broad-based, 5) feasible to implement, and 6) feasible to evaluate. Pennsylvania was one state that approached CMS with a desire for Medicare?s alignment with the state?s payment and care delivery model, and Pennsylvania submitted its proposal to CMS on May 23, 2016. CMS reviewed Pennsylvania?s proposal and determined that it met the requirements necessary to explore in detail a potential Pennsylvania-specific model. CMS, the Governor of Pennsylvania and Pennsylvania?s Department of Health, will enter into a State Agreement on the Pennsylvania Rural Health Model. Under the Model, CMS will test the effect of deliberate care delivery transformation of rural acute care hospitals and critical access hospitals (CAHs) on quality and costs of care. The Model places these hospitals on all-payer, prospective global budgets for inpatient and outpatient services. As part of the State Agreement, Pennsylvania committed to legislatively creating the Rural Health Redesign Center (the ?RHRC?) to operate the Model. This funding opportunity offers $5M in start-up funding to the Pennsylvania Department of Health to operationalize the RHRC. The RHRC will be the central independent entity operating the Model and supporting hospitals through technical assistance, data analytics, monitoring, and evaluation. This funding opportunity also offers the RHRC (once operationalized by the Pennsylvania Department of Health) to apply for an additional $10 million to begin implementing activities under the Model. In return, Pennsylvania commits to achieving health outcomes, financial, and Rural Hospital scale (number of Rural Hospitals participating in the Model) targets ? both for Medicare and across all significant healthcare payers as defined in the State Agreement. CMS believes that model oversight, global budget administration, data analytics, technical assistance, and quality assurance will be necessary in order to implement the Model and achieve the financial, health outcomes, and rural hospital scale targets required under the Model. First, CMS will provide start-up funding to the Pennsylvania Department of Health for 12 months from the date of award. Then, CMS will provide the Rural Health Redesign Center, through a separate cooperative agreement award, with initial implementation funding for 36 months from the date of award. These cooperative agreement awards will support operationalizing the Rural Health Redesign Center and initial Model implementation efforts, and will better enable Pennsylvania to achieve the Model?s financial, health outcomes, and rural hospital scale targets as defined under the State Agreement.
Employer Identification Number: All applicants must have a valid Employer Identification Number (EIN) assigned by the Internal Revenue Service. Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS number): All applicants must have a Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number in order to apply. The DUNS number is a nine-digit identification number that uniquely identifies business entities. Obtaining a DUNS number is free. To obtain a DUNS number, access the following website: www.dunandbradstreet.com or call 1-866-705-5711. See Section IV, Application and Submission Information, for more information on obtaining a DUNS number. System for Award Management (SAM) All applicants must register in the System for Award Management (SAM)* database (https://www.sam.gov/portal/public/SAM/) in order to be able to submit an application at http://www.grants.gov. In order to register, applicants must provide their DUNS and EIN numbers. Each year, organizations and entities, registered to apply for Federal grants through Grants.gov must renew their registration with SAM. Each year organizations and entities must renew their registration with SAM. Failure to renew SAM registration prior to application submission will prevent an applicant from successfully applying via Grants.gov. Similarly, failure to maintain an active SAM registration during the application review process can prevent CMS from issuing your agency an award under this program. Applicants should begin the SAM registration process as soon as possible after the announcement is posted to ensure that it does not impair your ability to meet required submission deadlines. Applicants must successfully register with SAM prior to submitting an application or registering in the Federal Funding Accountability and Transparency Act Sub-award Reporting System (FSRS) as a prime awardee user; awardees may make sub-awards only to entities that have DUNS numbers. Organizations must report executive compensation as part of the registration profile at https://www.sam.gov/portal/public/SAM/ by the end of the month following the month in which this award is made, and annually thereafter (based on 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). 2 CFR 200, Subpart E - Cost Principles applies to this program.
Aplication and Award Process
Preapplication coordination is not applicable.
Environmental impact information is not required for this program.
This program is excluded from coverage under E.O.
2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. Applications will be submitted electronically through GrantSolutions in response to the Funding Opportunity Announcement (FOA). Applications will be submitted electronically through GrantSolutions in response to the Funding Opportunity Announcement (FOA). Application Materials; Application materials will be available for download at http://www.grants.gov. Please note that HHS requires applications for all announcements to be submitted electronically through http://www.grants.gov. For assistance with http://www.grants.gov, contact email@example.com or 1-800-518-4726. At Grants.gov, applicants will be able to download a copy of the application packet, complete it off-line, and then upload and submit the application via the Grants.gov website. Specific instructions for applications submitted via http://www.grants.gov: ? You may access the electronic application for this project at http://www.grants.gov. You must search the downloadable application page by the CFDA number. ? At the http://www.grants.gov website, you will find information about submitting an application electronically through the site, including the hours of operation. HHS strongly recommends that you do not wait until the application due date to begin the application process through http://www.grants.gov because of the time needed to complete the required registration steps. ? The applicant must be registered in the System for Award Management (SAM) database in order to be able to submit the application. Applicants are encouraged to register early, and must have their DUNS and EIN/TIN numbers in order to do so. ? Authorized Organizational Representative: The Authorized Organizational Representative (AOR) who will officially submit an application on behalf of the organization must register with grants.gov for a username and password. AORs must complete a profile with Grants.gov using their organization?s DUNS Number to obtain their username and password at http://grants.gov/applicants/get_registered.jsp. AORs must wait one business day after successful registration in SAM before entering their profiles in Grants.gov. Applicants should complete this process as soon as possible after successful registration in SAM to ensure this step is completed in time to apply before application deadlines. ? When an AOR registers with Grants.gov to submit applications on behalf of an organization, that organization?s E-Biz POC will receive an email notification. The email address provided in the profile will be the email used to send the notification from Grants.gov to the E-Biz POC with the AOR copied on the correspondence. ? The E-Biz POC must then login to Grants.gov (using the organization?s DUNS number for the username and the special password called ?M-PIN?) and approve the AOR, thereby providing permission to submit applications. ? Any files uploaded or attached to the Grants.Gov application must be PDF file format and must contain a valid file format extension in the filename. Even though Grants.gov allows applicants to attach any file formats as part of their application, CMS restricts this practice and only accepts PDF file formats. Any file submitted as part of the Grants.gov application that is not in a PDF file format, or contains password protection, will not be accepted for processing and will be excluded from the application during the review process. In addition, the use of compressed file formats such as ZIP, RAR, or Adobe Portfolio will not be accepted. The application must be submitted in a file format that can easily be copied and read by reviewers. It is recommended that scanned copies not be submitted through Grants.gov unless the applicant confirms the clarity of the documents. Pages cannot be reduced in size, resulting in multiple pages on a single sheet, to avoid exceeding the page limitation. All documents that do not conform to the above specifications will be excluded from the application materials during the review process. ? After you electronically submit your application, you will receive an acknowledgement from Grants.gov that contains a Grants.gov tracking number. CMS will retrieve your application package from Grants.gov. Please note that applicants may incur a time delay before they receive acknowledgement that the application has been accepted by the Grants.gov system. Applicants should not wait until the application deadline to apply because notification by Grants.gov that the application is incomplete may not be received until close to or after the application deadline, eliminating the opportunity to correct errors and resubmit the application. Applications submitted after the deadline, as a result of errors on the part of the applicant, will not be accepted. ? After CMS retrieves your application package from Grants.gov, a return receipt will be emailed to the applicant contact. This will be in addition to the validation number provided by Grants.gov. Applications cannot be accepted through any email address. Full applications can only be accepted through http://www.grants.gov. Full applications cannot be received via paper mail, courier, or delivery service. All grant applications must be submitted electronically and be received through http://www.grants.gov by 3:00 pm Eastern Daylight Time on the applicable due date. Applications not successfully submitted to Grants.gov by the due date and time will not be eligible for review. All applications will receive an automatic time stamp upon submission and applicants will receive an email reply acknowledging the application?s receipt. Please be aware of the following: 1) Search for the application package in Grants.gov by entering the CFDA number. This number is shown on the cover page of this announcement. 2) If you experience technical challenges while submitting your application electronically, please contact Grants.gov Support directly at: www.grants.gov/customersupport or (800) 518-4726. Customer Support is available to address questions 24 hours a day, 7 days a week (except on Federal holidays). 3) Upon contacting Grants.gov, obtain a tracking number as proof of contact. The tracking number is helpful if there are technical issues that cannot be resolved. To be considered timely, applications must be received by the published deadline date. However, a general extension of a published application deadline that affects all State applicants or only those in a defined geographical area may be authorized by circumstances that affect the public at large, such as natural disasters (e.g., floods or hurricanes) or disruptions of electronic (e.g., application receipt services) or other services, such as a prolonged blackout. This statement does not apply to an individual entity having internet service problems. In order for there to be any consideration there must be an effect on the public at large. Grants.gov complies with Section 508 of the Rehabilitation Act of 1973. If an individual uses assistive technology and is unable to access any material on the site including forms contained with an application package, they can email the Grants.gov contact center at firstname.lastname@example.org or call 1-800-518-4726. Form of Application Submission The application must include all contents described below, in the order indicated, and conform to the following specifications: o Use 8.5? x 11? letter-size pages (one side only) with 1? margins (top, bottom, and sides). Other paper sizes will not be accepted. This is particularly important because it is often not possible to reproduce copies in a size other than 8.5? x 11?. o All pages of the project and budget narratives must be paginated in a single sequence. o Font size must be at least 12-point with an average of 14 characters per inch (CPI). o The Project Narrative must be double-spaced. o The Budget Narrative may be single-spaced and should follow the justifications and table formats provided in Appendix A, Guidance for Preparing a Budget Request and Narrative in Response to SF 424A. o Tables included within any portion of the application should have a font size of at least 12-point with a 14 CPI and may be single spaced. o The project abstract is restricted to a one-page summary which may be single-spaced. o The application may not exceed 45 pages. Although tables are counted towards the page limitation, the additional required documentation, including Standard Forms and Project Abstract is excluded from the page limitation The following standard forms are found in the Grants Application Package at www.grantsolutions.gov and must be completed with an electronic signature and submitted as part of the proposal: o Project abstract summary o SF-424: Official Application for Federal Assistance (see note below) o SF-424A: Budget Information Non-Construction o SF-424B: Assurances-Non-Construction Programs o SF-LLL: Disclosure of Lobbying Activities ? Project Site Location Form(s)
Applications will be forwarded to a review panel. The review panel will evaluate the proposal based on how well applicant addresses the evaluation criteria outlined in the FOA. Based on the advice of the review panel, the CMS selection official will approve the selected application and issue a Notice of Award. Successful applicant will receive a Notice of Award (NoA) signed and dated by the CMS Grants Management Officer that will set forth the amount of the award and other pertinent information. The award will also include standard Terms and Conditions. Applicant should be aware that special requirements could apply to cooperative agreement awards based on the particular circumstances of the effort to be supported and/or deficiencies identified by the review panel.
Contact the headquarters or regional office, as appropriate, for application deadlines.
Social Security Act, section 1115A.
Range of Approval/Disapproval Time
Anticipated Notice of Award dates are 60 days after application submission.
CMS reserves the right to approve or deny any or all proposals for funding. Note that section 1115A of the Social Security Act, which creates the Center for Medicare and Medicaid Innovation (CMMI). Section 1115A(d)(2) states that there is no administrative or judicial review of the selection of organizations, sites, or participants to test models.
Formula and Matching Requirements
This program has no statutory formula. Matching requirements are not applicable to this program. MOE requirements are not applicable to this program.
Length and Time Phasing of Assistance
The period of performance will be 12 months from the date of award for Pennsylvania Department of Health and 36 months from the date of award for the Rural Health Redesign Center. Method of awarding/releasing assistance: quarterly.
Post Assistance Requirements
The Grantee must submit quarterly progress reports as well as a final progress report.
CMS will provide a reporting template for all progress reports.
Each quarterly progress report must include the information outlined below.
A separate reporting template will be provided by CMS for the final progress report.
The purpose of the final progress report is to summarize the grantee?s progress throughout the entire project period to include overarching lessons learned, unanticipated challenges or successes, etc.
All reports must be submitted to www.grantsolutions.gov.
The minimum program progress narrative report elements ? are as follows: i. Program Name; ii. Project Director Name; iii. Reporting Period; iv. Data and Reporting Requirements (refer to Section I.6.b Data and Reporting Requirements for the required data elements); v. Additional Metrics Proposed by Applicant (if applicable); vi. Budget Status - include amounts for planned expenditure, actual expenditure, and deficit/surplus; vii. Project description - short summary; viii. Progress on Goals ? Status on goals that were previously projected to be completed in this reporting period, including explanation of and remediation plans for any goals not met; ix. Accomplishments ? Specific tasks that were accomplished during this reporting period; x. Projected Goals - Goals projected to be completed during the next reporting period; and xi. Issues - Issues that must be addressed for the project to be successful. Quarterly progress reports are due 30 days after the end of the quarterly period.
The final progress report is due 90 days after the end of the project period.
The Grantee must also agree to cooperate with any federal evaluation of the Model.
The Federal Financial Report (FFR or Standard Form 425) has replaced the SF-269, SF-269A, SF-272, and SF-272A financial reporting forms.
Recipient must utilize the FFR to report cash transaction data, expenditures, and any program income generated (if applicable for the program).
As detailed above, award recipient must agree to cooperate with any federal evaluation of the model and performance results and provide required quarterly and final reports in a form prescribed by CMS.
Reports will be submitted electronically.
These reports will include how cooperative agreement funds were used, describe project or model progress, and describe any barriers, delays, and measurable outcomes.
CMS will provide the format for project or model reporting and technical assistance necessary to complete required report forms.
Successful applicant must also agree to respond to requests that are necessary for the evaluation of the Model Design, pre-testing assistance, or Model Testing efforts and provide data on key elements of model performance and on results from the cooperative agreement activities.
As detailed above.
Successful applicants must submit reports to Federal Funding Report and meet Payment Management System reporting requirements.
Pennsylvania will submit to CMS quarterly reports on the financial targets and annual reports on the health outcomes and rural hospital participation and payer scale targets as stipulated outside of this cooperative agreement but in the Model?s State Agreement.
In accordance with the provisions of 2 CFR 200, Subpart F - Audit Requirements, non-Federal entities that expend financial assistance of $750,000 or more in Federal awards will have a single or a program-specific audit conducted for that year. Non-Federal entities that expend less than $750,000 a year in Federal awards are exempt from Federal audit requirements for that year, except as noted in 2 CFR 200.503.
Award recipient is required to maintain proper records ? including financial records, supporting documents, statistical records, and all other records pertinent to the program ? for the duration of the award, and retain these for a minimum of three years. If any litigation, claim, negotiation, audit, or other action involving the award has been started before the expiration of the three years, the records should be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular three year period, whichever is later.
75-0522-0-1-551 - For Section 3021 Model Programs.
(Cooperative Agreements) FY 16 $0; FY 17 est $10,000,000; and FY 18 est $7,000,000 - This will be a Cooperative Agreement for entirety of performance period. In 2017, up to $10M will be awarded to Pennsylvania Department of Health. In 2018, up to $7M will be awarded to the Rural Health Redesign Center. In 2019, up to $5M will be awarded to the Rural Health Redesign Center. Finally, in 2020 up to $3M will be awarded to the Rural Health Redesign Center.
Range and Average of Financial Assistance
In 2017, up to $10M will be awarded to Pennsylvania Department of Health. In 2018, up to $7M will be awarded to the Rural Health Redesign Center. In 2019, up to $5M will be awarded to the Rural Health Redesign Center. Finally, in 2020 up to $3M will be awarded to the Rural Health Redesign Center.
Regulations, Guidelines, and Literature
This solicitation is subject to the Health and Human Services Grants Policy Statement (HHS GPS) at http://www.hhs.gov/asfr/ogapa/aboutog/hhsgps107.pdf. 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. Standard and program specific terms of award will accompany the NoA. Applicant should be aware that special requirements could apply to cooperative agreement awards based on the particular circumstances of the effort to be supported and/or deficiencies identified in the application by the HHS review panel. The recently released HHS regulation (45 CFR Part 75) supersedes information on administrative requirements, cost principles, and audit requirements for grants and cooperative agreements included in the current HHS Grants Policy Statement where differences are identified.
Regional or Local Office
Theresa Dreyer 7500 Security Blvd., Baltimore, Maryland 21244 Email: Theresa.email@example.com Phone: 410-786-8984
Criteria for Selecting Proposals
The applicant must produce a detailed and fully developed proposal exemplifying the applicant?s readiness to participate in the Funding in Support of the Pennsylvania Rural Health Model. Each proposal must include the following core elements: Description of Need ? 20 points Statement of Project Goals ? 10 points Capacity to implement the project ? 30 points Implementation Plan ? 20 points Data Collection and Reporting Plan ? 10 points Budget and Budget Narrative ? 10 points.
Finnovation Lab, a Twin Cities-based program supported by the Bush Foundation, has graduated its inaugural class of social impact entrepreneurs from its fellowship program.