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1.A. Overview
In the current environment, health
centers have been challenged to
compete in a rapidly evolving health
care marketplace. Two of the most
pressing challenges faced by health
centers are (1) the significant
barriers in accessing capital for
developing or operating managed
care networks and plans or practice
management networks and (2) the
difficulty experienced in obtaining
financing from commercial lenders
and others at reasonable rates.
Health centers recognize the challenges
and opportunities that are occurring
in the health care environment and
are aggressively moving to form
managed care networks and plans
or practice management networks.
While many of these centers are
demonstrating varying degrees of
success in operating within a dynamic
health care system, those health
centers that do not participate
in a network or plan, or that participate
in one that cannot effectively compete
for the Medicaid market, will likely
experience a severely diminished
revenue stream and a high risk of
failure.
1.B. Program Description
Section 330(d)(1) of the Public
Health Services Act under subsections
(c)(1)(B) and (c)(C)(1) of the Act,
as amended, authorizes the Secretary
to guarantee up to 90 percent of
the principle and interest on loans
made by non-Federal lenders to health
centers as defined and funded under
section 330 of the Public Health
Service Act, to finance the costs
of developing and operating practice
management networks or managed care
networks or plans ("network or plans").
The Health Care Safety Net Amendments
of 2002 (Public Law 107-251) includes
legislative changes that enhance
the Program. These changes include:
- Increases the maximum guarantee
percentages from 85 to up to 90
percent;
- Allows for refinancing as an
eligible use of guaranteed loan
proceeds;
- Expands the eligibility for
the managed care loan guarantees
to include practice management
networks; and
- Loan guarantees may be made
directly to networks or plans
that are at least majority controlled
or majority owned (as applicable)
by section 330 funded health centers.
1.C. Program Structure
and Operation
The Loan Guarantee Program guarantees
loans secured from non-Federal lenders
and is not to be considered a direct
loan or grant. This Program is generally
expected to operate as follows:
the applicant for a loan guarantee
under this Program will borrow funds
secured from a non-Federal lender
and guaranteed up to 90 percent
by the Bureau of Primary Health
Care (BPHC) to (1) develop a network
or plan, and/or (2) operate a network
or plan already in place. To be
eligible for a loan guarantee under
this Program, the network or plan
must be owned or controlled by health
centers (see Eligible Applicants
and Definitions sections below).
Under this Program, a network or
plan may receive only one loan guarantee,
except that upon showing of good
cause the BPHC may make additional
loan guarantees.
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2.A. Application
Process Summary
In addition to applying for a guarantee
through the Program, the applicant
must also apply for a loan from
a non-Federal lender. The application
process for the Loan Guarantee Program
includes a two-part process:
- A pre-application process intended
to assess eligibility, exchange
information on the loan guarantee
program, and discourage submission
of final applications containing
proposals for which there is little
or no chance of success; and
- An application process designed
to review proposals and assist
applicants in approaching lenders.
Upon completion of a desk review
of the application materials,
the BPHC will arrange for site
visits. A panel of reviewers will
review applications that are complete
and have been determined to be
eligible.
During the pre-application, applicants
will outline their interests in
applying for a loan guarantee. Eligibility
for the program will be determined
and information exchanged around
the application process; roles and
responsibilities of the guarantor,
borrower, and lender coordinator;
health center participation in the
guarantee; and timeline for completion
of the application process and loan
closing. It is anticipated that
the total review and response time
on the Bureau's part for the pre-application
process will not exceed two months
(assuming all information requested
by the Bureau is complete).
Applications will consist of the
following: identification of the
organization applying for a loan
guarantee; organizational information
such as Articles of Incorporation,
By-laws, organizational charts,
etc. (refer to Attachment A for
additional information); and a current
business plan (refer to Attachment
B for additional information). A
site visit will be conducted within
60 days of submission of a completed
application package. It is anticipated
that the total review and response
time on the Bureau's part for the
application process will not exceed
four months (assuming all information
requested is complete).
2.B. Eligible Applicants
Eligible applicants for a loan
guarantee under this Program fall
into one of the categories listed
below:
This determination of eligibility
is consistent with the requirements
as set forth in the statute: the
health centers legally are obligated
for the loan and the loan guarantee.
Legally, each health center participating
in the separately incorporated network
or plan will be a co-applicant for
its allocated share of the loan,
so that the health center(s) will
be severally but not jointly liable.
Under the Health Centers Consolidation
Act of 1996, health centers may
not be required by BPHC to pledge
as security any asset that is, or
may be, needed by the health center
to provide health services. In other
words, the health center is only
at risk for its equity share in
a for-profit network or plan, or
its proportionate share of the assets
in a non-profit network or plan.
Each health center that is an organizational
member or collaborator in the separately
incorporated network or plan must
obtain formal written authorization
from its Board for the purposes
of applying for its share of the
loan and loan guarantee, as well
as making loan payments. Documentation
of this authorization must be submitted
along with the application.
2.C. Definitions
For the purposes of the Loan Guarantee
Program, the following definitions
are used.
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The term "loan" shall, in this
document, mean arrangements
such as a letter or line of
credit, a guarantee of reserve
requirements or other similar
obligation, as well as the advancement
of funds. Thus, a loan guarantee
to an applicant as defined herein
may secure the issuance of a
letter or a line of credit,
any obligation to post or maintain
reserves, or the advancement
of funds.
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The term "loan guarantee" shall,
in this document, mean any guarantee
with respect to the partial
payment of the principal (up
to 90 percent of the loan principal)
on a loan as defined herein
by a non-Federal lender to an
applicant.
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The term "loan guarantee commitment"
shall, in this document, mean
a binding agreement by a Federal
agency to make a loan guarantee
when the applicant, the lender,
and any other party to the guarantee
agreement fulfill the specified
conditions.
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The term "health center" is
defined as an organization funded
under section 330 of the Public
Health Service Act, and includes
Community Health Center, Migrant
Health Center, Health Care for
the Homeless, Public Housing
Primary Care and School-Based
Health Center.
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The term "network" shall, in
this document, mean a group
of section 330 funded health
centers, that has: organized
into a single contracting unit
and demonstrated administrative
capacity and the ability to
manage risk contracts. Networks,
for the purposes of this Program,
include managed care networks,
practice management networks,
and comprehensive networks.
(i) Managed care network: a group
of safety net providers participating
in or developing an organization
to negotiate managed care contracts
on behalf of the participating providers.
(ii) Practice management network:
a group of safety net providers
organized horizontally to improve
access to care, improve quality
of care, and achieve cost efficiencies
through redesigned practices to
integrate services and optimize
patient outcomes.
(iii) Comprehensive networks combine
managed care and practice management
purposes in the same network.
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The term "plan" shall, in this
document, mean a group of providers,
including section 330 funded
health centers, that has organized
an entity recognized by the
State in which it operates as
a licensed health insuring organization,
or licensed to function like
a health insuring organization
for the Medicaid and/or Medicare
programs, and is authorized
to receive a contract from the
State or Federal government
under such program(s).
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The term "owned and controlled
by health center(s) For additional
information, please refer to
PIN 97-27, "Affiliation Agreements
of Community and Migrant Health
Centers."" shall, in this document,
mean that the section 330 funded
health center or health centers
in the network or plan collectively
have the authority to appoint
a minimum of 51 percent of the
network or plan's board members.
In addition:
(i) Relative to for-profit networks
and plans, the health center(s)
in the network or plan must hold
a minimum of 51 percent of the equity
in the network or plan, and have
the right to a minimum of 51 percent
of any distribution of profits;
and,
(ii) Relative to non-profit networks
and plans, subject to State law
and applicable tax laws, the health
center(s) in the network or plan
must have a right to a minimum of
51 percent of any distribution of
excess revenues. Further, if the
non-profit corporation is a membership
corporation, the health center(s)
must have a minimum of 51 percent
of the membership.
(i) The network or plan acting
as the agent for one or more section
330 funded health centers, or
(ii) A section 330 funded health
center acting on behalf of itself
or on behalf of itself and as the
agent of other health centers.
Regardless of which eligibility
category the applicant falls under,
the network or plan must be owned
and controlled by health center(s)
(as defined above). The applicant
applying for the loan guarantee
under this Program must also apply
for a loan through a non-Federal
lender.
2.D. Pre-Application
Guidelines
Pre-applications will be accepted
and reviewed on an on-going basis.
BPHC requires that a completed pre-application
package be submitted prior to the
submission of an application package
to be considered for a loan guarantee
under this Program.
Pre-applications should provide
the following:
- Identification of the applicant
for a loan guarantee through
the Program, including:
- Brief overview of the proposed
use of guaranteed loan proceeds
and date funds will be required.
During the pre-application process,
the BPHC confirms the eligibility
of the potential applicant. Further,
the BPHC uses this opportunity to
conduct educational sessions with
interested applicants around the
following:
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Application process
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Role of lender coordinator
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Health center participation
in guarantee
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Estimated timeline for completion
and loan closing and
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Fees associated with the application
process.
BPHC, in its sole discretion, may
determine that a pre-applicant is
not ready to submit an application
and refer the pre-applicants deemed
appropriate for further assistance
to designated Federal staff and/or
contractors for advice on application
preparation and submission. Based
on the assessment of the pre-application
and considering the advice of the
designated parties, if any, the
BPHC will provide a written recommendation
within 30 days addressing whether
the pre-applicant should apply at
that time. A favorable Federal response
to a pre-application means only
that BPHC will consider a formal
application from the applicant but
in no way should be construed that
the applicant will ultimately receive
a BPHC loan guarantee.
2.E. Application
Guidelines
Application requirements are set
forth in Attachment A. BPHC staff
will conduct or oversee the application
review based upon information supplied
in the pre-application and application.
As part of the application process,
BPHC strongly advises that applicants
submit an application as set forth
in Attachment A prior to approaching
potential lenders for a loan. Attachment
A includes an index of items that
are to be submitted as part of the
application package; a completed
application is one that includes
all the items requested in this
portion of the guidance.
The submission of a completed application
allows the BPHC to assess the completeness
and readiness of applicants. Upon
this assessment, the BPHC will notify
applicants that they can begin approaching
lenders to secure the necessary
loan documents and preliminary proposals.
Again, a favorable Federal response
means only that BPHC will consider
the formal application, but in no
way should be construed that the
applicant will ultimately receive
a BPHC loan guarantee.
In the event of a favorable response
by the BPHC, the applicant should
begin approaching lenders for financing
options. Once an applicant has secured
a reasonable loan offer, the applicant
MUST submit a preliminary proposal,
i.e., a "Letter of Commitment" from
the potential lender, as well as
loan documents (loan agreement,
etc.) to complete the application
package and subsequently be considered
for a loan guarantee. The preliminary
proposal contains the financial
terms and conditions from a non-Federal
lender regarding willingness to
provide financing if a guarantee
is granted. The following information
must be included in the lender's
commitment letter:
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Interest rate, and whether
the interest rate is fixed or
variable;
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Term of loan;
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Amortization of loan;
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Payment schedule and structure
(frequency of payment, level
of payment, level principal,
interest only period, etc.);
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Loan-to-value requirements
(and whether an appraisal will
be required);
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Equity requirements;
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Collateral requirements; and,
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Covenants.
To participate in this Program,
lenders shall not currently be disbarred/suspended
from participation in a Government
contract or delinquent in a Government
debt. Further, for those lenders
not regulated by a Federal financial
institutions regulatory agency,
financial and capital requirements,
including minimum net worth requirements
based on business volume, will be
evaluated.
Evidence of a commitment from the
lender to fulfill the loan contingent
upon the issuance of the guarantee
must be included in the materials
to be submitted to the Bureau. Loan
documents are required prior to
receipt of a guarantee. The BPHC
has developed a standard set of
documentsboth loan and loan guarantee
documentsthat are to be used for
the Program (i.e., for network and
plan loan/loan guarantees). These
documents are available from the
Lender Coordinator and/or BPHC.
Upon receipt of a completed application,
the BPHC and its agents will engage
in a desk review of the materials
submitted by applicants. Included
in the BPHC's due diligence process
is a programmatic review and fiscal
(financial and business) review.
The due diligence review process
for this Program includes an examination
of the following: the network or
plan's overall business plan and
financial status; network/plan viability;
organizational capacity; effectiveness
in response to the marketplace;
needs assessment; and evidence of
assurance of repayment. Typically,
additional information is gained
through conference calls with the
BPHC, the applicant and other stakeholders
as appropriate. Once the BPHC is
confident that the applicant can
proceed, a site visit will be arranged.
See Evaluation Criteria section
below.
Once Bureau staff and/or the designated
Federal contractor(s) have conducted
the due diligence review and site
visit, and upon receipt of an approved
Letter of Commitment from a lender,
BPHC staff will determine whether
to submit the application to the
Loan Guarantee Review Committee
(the "Committee") for consideration.
The BPHC reserves the right, not
to submit an application to the
Committee.
It is anticipated that approximately
60 to 180 days will be needed to
adequately process an application
that has been deemed complete prior
to a Committee meeting, keeping
in mind that an acceptable Letter
of Commitment from a lender must
have been received by the BPHC.
It is anticipated that the Committee
will meet on a regular basis to
consider those applications determined
acceptable for final consideration
by the Committee, however, the schedule
will be adjusted to correspond to
the actual demand for the Program.
The Committee will make recommendations
for applicant denial or approval
to the BPHC Director.
2.F. Evaluation
Criteria for Applicants
In addition to meeting the eligibility
requirements as stated above and
the information requested for the
pre-application and application,
applicants will be evaluated against
the following criteria.
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Network/Plan Viability.
Evaluation of whether the network
or plan described in the application
has a financially viable and
feasible business plan, including
a review of:
- A forecast of the network
or plan's financial ability
to pursue and maintain equity;
- An analysis of the health
centers' and non-health center
collaborators' other contributions
to the network or plan; and,
- An appraisal of the adequacy
of projected revenue streams
to meet future operating expenses
(including debt service).
- Organizational Capacity.
Evaluation of the demonstrated
(or proposed, as applicable) capability
of the network or plan, i.e.,
- Qualifications and track
record of professional (e.g.,
administrative) staff and/or
management services organization;
- Information systems capacity;
- Medical management capabilities
(including qualifications
and track record of clinical
staff);
- Quality assurance programs;
- Membership growth and retention
plans; and,
- Overall viability of the
venture proposed.
- Appropriateness to the Marketplace.
- Evaluation of the extent
to which the applicant demonstrates
tangible, short-term, and
long-term benefits to its
collaborators and to the medically
underserved populations it
serves; and
- Extent to which the applicant
will strengthen or enhance
the presence of health centers
in the State and/or local
marketplace.
- Need for Loan Guarantee.
Demonstration that the loan would
not be available on reasonable
terms and conditions without the
guarantee.
- Assurance of Repayment.
Evaluation of the applicant's
means for assuring the loan will
be repaid within a specified time
frame, including whether the applicant
is offering reasonable security
(applicants are not required to
offer as security any asset that
is, or may be, needed by the health
center or centers involved to
provide health services). Repayment
will be structured in such a way
as to protect the financial interests
of the United States.
2.G. Submission
Instructions
Additional copies of this guidance
can be accessed by visiting the
HRSA Web site.
Pre-applications, applications,
and requested attachments MUST be
typed single-spaced in standard
size black type (not to exceed 15
characters per inch) on only one
side of each 8 ½ x 11 page that
can be photocopied. Each page must
be numbered consecutively with conventional
border margins. Applicants must
submit the original (signature)
and two copies of the pre-application/application.
Pre-application and application
materials should be mailed to:
Bureau of Primary Health Care
ATTN: Managed Care Loan Guarantee Program
4350 East-West Highway
Bethesda, MD 20814
Applicants should address any questions
related to this guidance to Marie
M. Legaspi either by phone at (301)
594-4319 or by email at MLegaspi@hrsa.gov.
2.H. Working with
Others During Application Preparation
During development of applications
for the loan guarantee program,
applicants are encouraged to work
closely with the appropriate Primary
Care Association. Applicants are
also encouraged to take advantage
of relevant technical assistance
available through designated Federal
contractors and other BPHC/HRSA
supported assistance programs (i.e.,
the Managed Care Technical Assistance
Program).
Technical assistance specific to
a particular loan guarantee request
may be advised by BPHC in response
to a pre-application or application.
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3.A. Conventional
Guarantee
The Loan Guarantee is structured
as a conventional guarantee. The
conventional guarantee, also known
as a straight form of credit enhancement,
is structured such that when a lender
puts the guarantee demand to the
BPHC (i.e., in the event of a default),
the BPHC must pay the amount of
the guarantee demand, or the guarantee
amount, to the lender. The guarantee
amount paid by the BPHC to a participating
lender should equal the outstanding
principal balance of a loan multiplied
by the guarantee percentage (up
to 90 percent).
The section 330 funded health centers
and the network/plan are required
to be co-borrowers of the loan,
and the health centers will be required
to execute the loan documents. All
members of the network/plan (including
section 330 funded and non-330 funded
entities) will have liability for
repayment of any and all amounts
payable to the lender in connection
with the loan, and this liability
shall be with full recourse to the
network/plan and its assets. Each
health center's liability for repayment
of the loan shall be limited to
a percentage of the total loan that
is equal to the percentage of each
health center's ownership interest
in the network/plan. The guarantee
may be secured by other section
330 health center assets that are
not used to directly deliver health
care. The BPHC will evaluate network/plan
statutory or contractual limits/
requirements on pledging assets
(e.g., the Medicaid program).
3.B. Lender Coordinator
One of the major components of
the Program is the Lender Coordinator.
As a result of an open selection
process, the National Cooperative
Bank (NCB) was chosen as Lender
Coordinator for the Program. The
Lender Coordinator's key roles and
responsibilities include, but are
not limited to, the following:
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Establishing a pool large enough
to supply lending capital for
loans guaranteed by the Program
by soliciting other lending
institutions;
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Serving as a liaison between
Program staff, potential lenders
and borrowers;
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Reviewing all lenders under
the Program; and
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Assisting the BPHC in monitoring
loan performance.
3.C. Origination
Fee
The Bureau has the authority to
collect a loan origination fee equal
to one percent (1%) of the total
amount of the loan to be guaranteed
under this Program. The origination
fee consists of the commitment fee
and the loan-closing fee. Once a
network or plan is selected to receive
a loan guarantee, BPHC will issue
a letter stating the terms and conditions
of the loan guarantee commitment.
Should the applicant wish to proceed,
both the network or plan's executive
director and Board chair must sign
an acceptance letter. This letter
must then be submitted to BPHC along
with the commitment fee.
Due upon acceptance of the loan
guarantee commitment is 50 percent
of the origination fee (the commitment
fee), with the balance due at loan
closing (the closing fee). The commitment
fee is consideration for the issuance
of the loan guarantee commitment
by BPHC and the significant costs
BPHC has incurred and will incur
in preparation for the closing and
the financing. The commitment fee
is non-refundable, whether or not
the financing closes. The Bureau,
however, may waive the loan origination
fee for an applicant who demonstrates
they will be unable to meet the
conditions of the loan if the applicant
incurs the additional cost of the
fee.
3.D. Use of Loan
Proceeds
Loan funds guaranteed under this
Program may be used for costs which
the Secretary determines are necessary
to enable a health center or centers
to develop, operate, and own networks
or plans. In general, loan proceeds
potentially may be used for any
capital needs of a developing or
operational network or plan, including
resources for providing health care
services, but specifically may not
be used for costs related to facility
construction, renovation, or modernization.
3.E. Standard
Documents
In administering the Program, the
BPHC will be using a set of standard
documents for network and plan loans
including:
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Guarantor Commitment Letter,
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Borrower's Agreement with Guarantor,
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Loan Agreement (with lender),
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Secretary's Certificate, and
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Status Report/Covenant Compliance
Worksheet.
It is expected that certain terms
and conditions will be unique for
each loan or financing transaction.
Those terms and conditions can be
negotiated while the general structure
of the Program and the documents
will be standard across all loans
guaranteed under the Program.
3.F. Legal Fees
Outside legal fees and costs incurred
in applying for a loan guarantee
through this Program will be paid
by the applicant, including filing
and recording fees, if any.
3.G. Loan Guarantee
Monitoring
This Program will include an on-going
review and monitoring function by
the Bureau after the loan and the
loan guarantee are made. Information
will be compiled on the borrower's
operational and loan data to be
reported to the BPHC on a regular
basis. It is anticipated that borrowers
under this Program will be required
to periodically file with the Bureau
a statement on the use of the loan
proceeds covered by the guarantee.
The use of funds should be consistent
with the information as set forth
in the application package. Any
material departure from the approved
application information must receive
prior Bureau approval.
Further, the BPHC will conduct
site visits to review borrower compliance
with the terms of the loan guarantee,
as well as to carry out programmatic
and financial monitoring. Applicants
are also reminded that all meetings
of the Boards and executive committees
of the networks/plans for which
loan guarantees are issued shall
be open to a representative of the
BPHC.
3.H. Step-in Rights
Another major component of the
Program is the ability of the BPHC
to exercise its step-in rights,
or any action(s) that may be necessary
to prevent a default on a loan guaranteed
through the Program, under such
terms as the BPHC shall prescribe.
Proposed step-in actions that the
BPHC may take include, but are not
limited to, the following:
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Access and review of all books
and records of the borrower's
business operations and/or the
financial condition of the borrower;
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Conduct diagnostic reviews
of all aspects of the borrower's
business operations through
its employees and authorized
representatives, and formulate
and cause the borrower to implement
any technical assistance recommendations
resulting from any such diagnostic
reviews;
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Recommend and cause the borrower
to implement changes in key
management of the borrower;
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Enter peaceably upon the borrowers
premises to effect and carry-out
any step-in rights; and
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Any other action required or
permitted to be taken to carry
out statutory and regulatory
mandates with respect to the
Program.
Upon receipt from the lender of
a default notice, the BPHC shall
have thirty (30) days to submit
to the lender an action plan that
describes in reasonable detail the
measures the BPHC intends to exercise
(including a description of the
allocation of resources, timeframe
and personnel involved), as well
as any proposed remedial action(s).
The BPHC agrees to consult with
the lender and to share with the
lender any relevant documents and
information obtained with respect
to the borrower during the preparation
and implementation of the action
plan, but the lender shall have
no right to approve the plan or
the BPHC's method of implementing
the plan.
3.J. Defaults
The Bureau will require the lender
to notify the Bureau in writing
prior to initiating any default
action on a delinquent loan under
this Program. The specific time
period to be required for this notification
will be addressed in the guarantee
agreement document.
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APPLICATION
GUIDELINES FOR THE LOAN GUARANTEE
PROGRAM
A. Applicant and
Contact Information
Legal
Name of Applicant: |
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Street
Address: |
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City: |
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State: |
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Zip
Code: |
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Chief
Executive Officer: |
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Telephone: |
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Contact
Name (if different): |
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Title: |
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Telephone: |
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Email: |
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Amount
of Financing: |
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Possible
use of loan proceeds: |
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B. Index of Requested
Items
The following index lists the documents
and references that must
be submitted as part of any loan
guarantee request. Please number
and submit each item consistent
with the numbers in the index below.
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Executive Summary: Please provide
a brief summary (not to exceed
two pages) of the application,
noting the network/plan's history,
current situation, market position,
opportunity, and specific application
of loan proceeds. Please refer
to Attachment B for guidance
on the required elements of
an executive summary.
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Business Plan: Applicants to
HRSA's Loan Guarantee Program
must submit a well-developed
business plan. Applicants may
use any format but must provide
all requested information in
a logical and easily understood
manner. Please refer to Attachment
B for guidance on the required
elements of a business plan
for the purposes of applying
for a health center loan guarantee.
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Copies of the network/plan's
Articles of Incorporation, Bylaws,
Licensure, etc.
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Listing of Board of Directors
for the network/plan, including
names, addresses, employer,
and position. Identify all board
officers.
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Organization chart to include
listing/identification of key
staff and resumes of management
team.
-
List of health center(s) that
are organizational members of
the network/plan. Include the
name of the Executive Director/Chief
Executive Officer, mailing address,
phone, fax, and email.
-
Listing or description of key
health center providers and
network delivery system(s).
-
A list and description of the
network/plan's current lines
of business (credentialing,
integrated IS, Medicaid, SCHIP,
commercial, etc.); for plans,provide
information reflecting the date
enrollment was initiated and
current enrollment.
-
A list and description (with
copies available on site or
at request of the reviewers
prior to the site visit)of any
agreements for management, claims,
or benefit administration services
(i.e., prescription drugs, behavioral
health, disease management),
indicating the date the contract
began, renewal dates and enrollment
covered.
-
Contacts with State Medicaid
and Insurance Departments (include
name, title, phone, and email),
as applicable and available.
-
Copies of most recent audited
financial statements and management
letters.
-
Provide financial projections
for a minimum of three years
from the date of the latest
submitted financial statement
or from the date of anticipated
start-up. Provide the assumptions
around the major revenue items
and for major administrative
and expense trends. Extend projections
to and just beyond a break-even
point.
-
Describe how the applicant
expects to repay the monies
borrowed under this loan guarantee
program. Give a possible repayment
schedule and timetable for the
proposed loan.
-
Letter of Commitment from Lender.
-
Additional background on organizational
and corporate relationships
(Exhibit 1).
-
Certification by authorized
official (Exhibit 2).
SUPPLEMENTAL INFORMATION
A. Information
on Business Organization and Corporate
Relationships
-
Are you corporately integrated
with (e.g., a subsidiary of)
any other organization?
If yes, please indicate name, address,
type of legal relationship, and
nature of integration.
-
Are you involved in any joint
ventures?
If yes, please indicate names,
addresses, and types of legal relationships.
B. Litigation
Are you aware of any litigation
pending against the network, plan,
or health center(s) that might materially
affect the ability to borrow funds
or to repay them?
Yes No
If yes, please attach an explanation.
C. Additional
Contacts
Legal
Counsel (Firm Name) |
|
Address |
|
|
|
Attorney's
Name |
|
Email |
|
Telephone |
|
Borrower's Accountant
(Contact Name)
|
|
Firm
Name |
|
Email |
|
Telephone |
|
CERTIFICATION
BY AN AUTHORIZED OFFICIAL OF THE HEALTH
CENTER
The undersigned hereby represents
and certifies to the best of his/her
knowledge and belief that the information
contained in this application and
exhibits or attachments hereto is
true and complete and accurately
describes the nature of the health
center and the proposed project,
and agrees to promptly inform the
Health Resources and Services Administration's
Bureau of Primary Health Care of
any relevant changes in the proposed/actual
project or the information contained
herein.
Name
of Authorizing Official |
|
Signature |
|
Title |
|
Date |
|
|
|
GUIDELINES
FOR BUSINESS PLAN FORMAT
In compiling the information for
the application, please note that
the following narrative items must
be submitted for the application
to be considered eligible and complete.
A. Executive Summary
In general, the executive summary
provides a snapshot of the organization
and the proposed use for the loan
proceeds. It provides a summary
of the application and the need
for the guaranteed proceeds. The
summary (not to exceed two pages)
should include
-
The network/plan's history,
-
Current situation, market position,
opportunity, and
-
Specific description of how
guaranteed proceeds will be
applied in support of the network/plan's
activities.
B. Business Plan
In general, business plans are
written for a variety of purposes
and can be directed at several different
audiences:
-
To carry out specific goals
of the organization's strategic
plan;
-
To provide the Board of Directors,
staff, and management with a
common road map;
-
To attract business partners;
and
-
To attract additional funding/financial
support.
The business plan should provide
the following information:
- A brief description of the network/plan's
history and operations, including:
- Organizational background
and mission
- Strategic direction
- Programs and services
- Review of operations
- A description of network/plan
structure, management, and governance,
including:
- Summary overview
- Leadership and vision of
the network/plan
- Staff experience and qualifications
(technical and professional
capabilities)
- Summary of key roles and
responsibilities
- Profile of network/plan
board of directors
- A description of the network/plan's
service delivery systems, including:
- Clinical leadership and
decision-making
- Care management, including
utilization management, quality
assurance
- Quality improvement activities
- Health center and provider
network overview
- Summary of agreements in
support of the network/plan's
service delivery system (disease
management, claims adjudication,
behavioral health, etc.)
- A description of network/plan
organizational membership, including:
- Profiles of network/plan
members (indicate if health
center)
- Aggregate summary of strengths
and weaknesses
- Relationship with other
networks/plans and safety
net providers
- A description and an analysis
of the market, including:
- Summary overview
- Market characteristics
- Competitive analysis
- Provider trends for managed
care
- Proposed marketing and outreach
activities
- A description of how funds will
be used
- A rationale and description
for loan guarantee
- Proposed application of
guaranteed funds
- A description of the network/plan's
financial operations
- Overview of financial condition
- Historical financial performance
and condition
- Projected financial performance
- Underlying assumptions
|
HEALTH
SERVICE DELIVERY ASSETS
"Health Services Delivery Assets"
shall mean:
-
Any asset subject to a Federal
reversionary interest prior
to receipt of a loan guaranteed
by the Health Resources and
Services Administration ("HRSA").
-
Any asset taken as security
by a Federal or non-Federal
lender or guarantor.
-
Any asset acquired subsequent
to receipt of a loan guaranteed
by HRSA that meets the definition
of a Health Service Delivery
Asset, as herein provided.
-
Any asset used in the scope
of any section 330 project (as
hereinafter defined).
-
Any asset used for the provision
of Health Services (as hereinafter
defined) outside the scope of
any section 330 project.
-
Any asset that is used in whole
or in part for, or is strategically
or operationally planned to
be used in whole or in part
for, the provision of health
services in and/or outside the
scope of any section 330 project.
-
Any revenue generated from
any asset when such asset is
used for, or is strategically
or operationally planned to
be used for, the provision of
health services in and/or outside
the scope of any section 330
project.
-
Any revenue (regardless of
its source) used for, or strategically
or operationally planned to
be used for, the provision of
health services in and/or outside
the scope of any section 330
project.
For purposes hereof, (i) the term
"health services" means any service
authorized under section 330 of the
Public Health Service Act, including
but not limited to any service the
network/plan is currently providing,
or any other service the network/plan
is providing or is strategically or
operationally planning to provide
that meets a common definition of
the term "health services"; and (ii)
the term "section 330 project" means
a project that is authorized by and
undertaken pursuant to section 330
of the Public Health Service Act,
to carry out specified health related
activities. |
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