June 28, Applicant Conference June 28, :00pm - 4:00pm HEAL NY Phase 2: Capital Restructuring Initiatives Request for Grant Applications

June 28, David Wollner - DOH, Director of OHSM Neil Benjamin - DOH, Div. of Health Facility Planning, and Moderator Christopher Delker - DHFP - Evaluation Co-Chair Robert Schmidt - DHFP, HEAL Implementation Unit Dennis Kling - DOH Div. Of Health Care Financing and Evaluation Co-Chair Robert Veino - DOH, Div. Of Legal Affairs Lora Lefebvre - DASNY - Portfolio Management Debbie Paden - DASNY – Counsel’s Office Conference Panelists

June 28, The HEAL NY Program (Section 2818 of PHL) Up to $1 billion available through appropriations and bond proceeds through DoH and DASNY -To support restructuring plans in regional areas –To support Health Information Technology projects on a regional level HEAL Phase 1 $52.9 million -Health Information Technology (HIT) projects

June 28, HEAL NY - Phase 2 Provide grants to assist projects that will achieve closure, downsizing or physical reconfiguration of hospitals and nursing homes Support capital restructuring plans in regional areas that result in improved quality, stability and efficiency of health care services

June 28, Objectives Improve quality, stability and efficiency of regional health care systems delivery Right-size through closure, consolidation and/or conversion of providers, programs and beds Eliminate duplication of services within communities, including reducing hospital and nursing home beds

June 28, Objectives Promote the development of services in the community at the appropriate level and cost Ensure against mortgage defaults or calls on mortgage insurance Reduce the rate of increase in health care spending

June 28, HEAL NY Phase 2 Funding Up to $269.4 million - Capital Appropriations to DOH -$74.4 million - Capital bonding authority through DASNY - $195.0 million Projects require at least a 50% match of non- state funds. If financially distressed – at least a 30% match

June 28, Grant Funding Sources DASNY Bond Proceeds -State supported debt: Grant funds must be used for “capital work or purpose” per State Finance Law -If tax-exempt bonds: must also be consistent with Federal Tax Law Capital Appropriations and Matching Funds can be for broader capital purposes, such as -Net closure costs (12 month period) -Debt retirement -Building security/insurance

June 28, Approximate Regional Allocation of Funds Including Regional, Rural and Small Category Awards Northern - $20.0 million Western - $22.6 million Hudson Valley – $31.5 million Long Island - $39.1 million Central - $42.5 million New York City - $113.7 million

June 28, Select Category and Region Select One Category: –Rural Projects –Small Projects –Regional Awards Select One Region: –New York City –Long Island –Hudson Valley –Northern –Central –Western

June 28, Grant Categories Applicants must select one category in which to compete: Rural Projects Category (see RGA attachments 3 & 4) -Up to $20 million in total grants -Grant request cannot exceed $1.5 million (50% match) or $2.1 million (30% match) Small Projects Category -Up to $10 million in total grants -Grant request cannot exceed $500,000 (50% match) or $700,000 (30% match)

June 28, Grant Categories Applicants must select one category in which to compete: Regional Awards Category 6 geographic regions within New York -Grant request cannot exceed $37.5 million (50% match) or $52.5 million (30% match) -Total dollar value of Grant awards in a region will be reduced by the dollar value of Small and Rural projects awarded in that region.

June 28, Eligible Applicants Article 28 Hospital or Nursing Home Active Member of Article 28 Corporations Multi-provider applications allowed Must designate Lead Applicant responsible for all administration of grant funds

June 28, Examples - Capital Restructuring Projects Close or downsize hospitals or nursing homes to take beds out of service in particular geographic regions Consolidate hospitals, or nursing homes, completely or partially Continued….

June 28, Examples - Capital Restructuring Projects (continued) Convert challenged, but needed hospitals, to levels of care more consistent with community needs Convert under-utilized hospitals, or portions thereof, to downsized or non- inpatient services Continued….

June 28, Examples - Capital Restructuring Projects (continued) Decertify unneeded nursing home beds and, where appropriate, convert vacant space for use as enhanced common living areas or provide long term care, such Assisted Living Programs and Adult Day Health Care Programs Manage long and short term capital debt obligations in a manner that will further the overall health system restructuring goals of HEAL NY and the Commission on Health Care Facilities in the Twenty-first Century

June 28, Part One: Technical Application Executive Summary –Briefly describe the overall project –How it meets HEAL NY Capital Restructuring Initiative objectives and requirements (RGA Sections 1.2 and 1.3) –How Eligible Applicant(s) meet eligibility criteria (1.4)

June 28, Part One: Technical Application Project Description Overview Project Outcomes Project Timeline Project Team Project Monitoring Plan

June 28, Regulatory Requirements Receipt of grant funds and execution of a GDA conditioned on Eligible Applicant meeting all regulatory requirements CON requirements (10 NYCRR 710.1) SEQRA compliance Federal and State standards of care

June 28, Project Timeframes Term of GDA’s expected to begin on or about October 1, 2006 Projects timeframe - up to two years If solely closing a facility – 12 month project timeframe All reimbursable costs must be incurred within period of GDA

June 28, Allowed Grant Expenditure Types Restructuring, Reconfiguration, Debt Restructuring -Capital costs to reconfigure infrastructure -Equipment expense -Capital acquisition cost associated with downsizing Closure Costs Applications must include justification for all costs and whether applicant believes the expense to be a bondable capital expense (RGA Attachment 7)

June 28, Matching Funds Grants are considered for up to 50% of Projects total cost Projects that include one or more financially distressed entities with a significant role (see RGA section 1.8.3) – eligible for up to 70% grant Any proceeds from sale of assets as part of a restructuring must be applied to the Project cost and counted as matching funds

June 28, Matching Funds (continued) Matching funds from other sources – other than New York State grants (Applicant Funds, Program Income, Foundations, Loans) Applicant must provide written documentation of funding commitments; contingent commitments acceptable

June 28, Matching Funds Criteria Only direct costs. No indirect costs such as administrative Costs financed by program income during project Verifiable in-kind contributions

June 28, Matching Funds Criteria (continued) Donated services at fair market value or rental rate (Excludes Vendor discounting) All matching costs must be incurred within the period of the Grant Disbursement Agreement Project planning costs will NOT count toward match and are NOT reimbursable.

June 28, Part Two: Financial Application Executive Summary Project Budget -Certification of Financial Distress, if applicable -Project Budget Expenses and Justification Project Fund Sources - HEAL grant amount and matching funds Cost Effectiveness - Evidence of verifiable savings relative to Project cost Project Financial Viability – Feasibility Plan (balance sheet, income statement and cash flows – 3 years) Improvement to Financial Viability of Financially Distressed Entity continued

June 28, Part Two: Financial Application (continued) Eligible Applicant Financial Stability General Corporate Information - List of vendor contracts - List of grant applications applied for / awarded - Name and Certificate of Incorporation of Parent, Sibling, or Sub-Corp of Applicant - Copy of Applicant Form 990 or Attorney General Filing

June 28, Application Evaluation Process Joint Review and Award Process: DOH and DASNY Stage 1: Completeness of Application -Applications missing material elements eliminated from further review Stage 2 (a): Applicant Eligibility Review -Eligible Applicant is an Article 28 Hospital, Nursing Home or an active Member of an Article 28 Corporation (continued)

June 28, Application Evaluation Process (continued) Stage 2 (b) : Financial Eligibility Review -Project Eligibility (Allowable Expense) and Budget (Attachment 7) has 50% of Project funds from sources other than HEAL Grant (30% if qualifies as Financially Distressed (RGA Section 1.8.3) Stage 3: Application Scoring - Technical score (65%) - Financial score (35%)

June 28, Application Evaluation Criteria Reduction in excess health system cost or usage Project’s return on investment and cost effectiveness Public Health care need continues to be met and is improved Ability to meet regulatory requirements and timing

June 28, Application Evaluation Criteria (continued) Ability of Eligible Applicant to achieve Project goals Ability of Eligible Applicant to fund its share of Project Overall cost and reasonableness of Project Budget Responsiveness and completeness of Grant Application

June 28, Selection of Awards Factors - Minimum total score(s) are being considered - Demonstrable and verifiable savings of health care expenses preferred Rural and Small Projects in each Region selected first

June 28, Selection of Awards (continued) Grant awards may be less than amount requested due to limitations of funds and other factors DOH and DASNY reserve the right to reallocate funds among categories and regions to serve the best interest of the State.

June 28, Submitting the Application Applications must be received by 4:00 pm, July 31, 2006 in Room 1325 of Corning Tower Applications must be labeled: HEAL NY Phase 2: Capital Restructuring Initiatives RGA# Applications must not include any cost information in the technical application

June 28, Submitting the Application (continued) 2 complete original and signed copies, along with: 11 copies of the Technical Application and 6 copies of the Financial Application Use the Application Checklist for Completeness Applications should be submitted to: Fred Genier Director, Grants and Procurement Section New York State Department of Health Room 1325 Corning Tower Albany, New York

June 28, Certification for HEAL NY Grants  Applicant will make every effort to ensure that the project described in this application will be consistent with the goals and recommendations, when available, of the Commission on Health Care Facilities in the Twenty-First Century, as established pursuant to Section 31 of Part E of Chapter 63 of the Laws of  All contracts entered into by the Grantee in connection with the Project shall (A) provide that the work covered by such contract shall be deemed “public work” subject to and in accordance with Articles 8, 9 and 10 of the Labor Law; and (B) shall provide that the contractors performing work under such contract shall be deemed “state agencies” for the purposes of Article 15A of the Executive Law

June 28, Certification for HEAL NY Grants (continued)  If awarded a HEAL NY grant, the funds will be expensed solely for the project purposes described in this RGA and in the GDA and for no other purpose  I understand that in the event that the project funded with the proceeds of a HEAL NY grant ceases to meet one or more of the criteria set forth above, then DOH and/or the Dormitory Authority shall be authorized to seek recoupment of all HEAL NY grant funds paid to the Grantee and to withhold any grant funds not yet disbursed

June 28, Key Dates Any questions regarding the application process can be sent to: Questions Due: July 7, The Q&A document will be posted by July 14, 2006 on the DOH website at: h ttp:// Application Due: July 31, 2006 Term of GDA’s expected to begin: October 2006