¥ ‘ 7 REVIEW RESPONSIBILITIES Under the triennial review system which has been initiated, each Regional Meidcal Program generally will be reviewed by the National Advisory Council only once during each three year period. The triennial review serves to "accredit" the Region as an organization and to set a general level of support for the three year period. Thus, except in specified-tases, the Director, RMPS will make awards for second and third (02 and 03) year support without further Council action, but will provide the Council with a summary of such awards. In general, individual Regional Medical Programs will assume responsibility both for technical review and for the selection of projects and activities within the overall Council-approved general level of support, while the Director, RMPS, will be responsible for monitori: the Regions and bringing to the Council's attention any substantive failure of the Region to meet requirements, or cases where substantial deviations occur from the approved application. It is the purpose of these guidelines to set forth how these various responsibilities will be implemented. -: The First Year's Award Subsequent to Council action, the RMP will be notified of the proposed general level of support and asked to submit revised budgets for those projects and activities which the RMP selects for funding. The RMP also will submit a Single, consolidated expenditure report showing any unexpended balance for the current grant year. The following year's award will be negotiated on the basis of the revised budgets submitted by the RMP and the award will be reduced by the amount of any unexpended balance. The Developmental Component Operational Regional Medical Programs have the option of requesting a Developmental Component of up to 10% of the annual direct cost funding level for the preceeding year. The purpose of the Developmental Component is to permit a Regional Medical Program to support relevant activities without undue delay as opportunities arise. 2 A Regional Medical Program may apply on its anniversary date for a Develop- © ental Component in any year. No Developmental Component will be approved unless it is specifically requested by an RMP and recommended formally by the Council. Developmental Components will be awarded only to the most out standing RMPs. Approval of a Developmental Component means that the Council and the Director, RMPS, have delegated authority to the individual RMP to fund core activ- ities and projects without prior notice, review or approval by either RMPS or the Council up to the amount approved for the Developmental Component. Thus, projects and activities initiated and funded under the Developmental Component of an award can and generally will include those which never before have been submitted to RMPS for review. Regional Medical Programs, however, will be responsible for notify ope 3 each activity funded within the Developmental Component. | Approval of a Developmental Component does not necessarily mean that S additional funds will be awarded. Projects ‘and core activities, however, may be funded under an approved Developmental Component up to the 10% limit within the "amount awarded. Continuations A Regional Medical Program at any time may select projects for funding from among those described in its approved triennial or 02 or 03 year application. RMPs not approved for a Developmental Component may-include in their applications fo second and third year support new projects not previously submitted. Such projects also may be included in second and third year applications from Regions which have fully utilized previously awarded Developmental Component funds. Continuation applications for the 02 and 03 years ordinarily will be approved by the Director. Changes in Projects and Activities Minor changes in specific projects or activities will be approved by the D Director, RMPS. Examples of such changes include; a. Changes in geographic scope (The project will serve Model City area A instead of Model City Area B, or the boundaries of the area to be served ar enlarged or modified in some way.) b. Changes in sponsor or affiliate (Hospital "ig substituted for Hospital "y™ at the project sponsor, or one or more affiliates is added to or subtracted from a group of cooperating institutions). c. Personnel changes (Changes in the Project Director or staff). d. Target ee (Nurses to nurses and PTs; Spanish speaking to Spanish speaking and Indians; Blacks to Puerto Ricans, etc.) e. Budget changes (Minor expansion, $50,000 or less, or reduction of project budgets or switching local funds fgQ Project A t@ Project B, or activating projects by transfer of funds from less productive projects or activities. The Council approves a general level of support for a three year period for the Region within which the RMP selects projects and activities. Where a Develop- mental Component has been approved by the Council, the RMP, on its own initiative, is permitted to-fund any project consonant with law, regulations and policies up to the full amount of the Developmental Component. If a Developmental Component has not been requested and approved, the RMP ispestricted to selecting projects from among those which have been submitted to and approved by RMPS in a triennial, 02 or 03 year application. New projects may be included by Regions in second and third year continuation applications provided the Council-recommended level of support is not exceeded. Since the Council's review and recommendation applies to approval for a given RMP as an organization rather than as a specific set of project and activities, the details of changes in individual projects or in the spectrum of projects and activities, ordinarily will be handled by the Director. SUMMARY OF LEVELS OF REVIEW Y less of Applications Reviewed By _ pplication Council Review Conmittee Director ” TRIENNIAL All All All CONTINUATION Only if; None, except at All, partic- a. New or increased Develop. Comp. is requested : b. Supplementary funds are requested. ec. Council requests review d. Director, RMPS Coun- cil to review. (e.g. where RMP fails or appears to fail to meet requirements.) Director's request ularly for such items as; a. Geographic changes b. Changes in target groups ce Personnel changes d. Changes in. sponsors or affiliates e. Budget changes f+ New initiative ational structure will be referred to Council at any time they occur. (e.g. mergers, dissol- utions ,etc.) % _ . Major changes in organiz- a PROPOSED RESPONSIBILITIES OF THE NATIONAL ADVISORY COUNCIL UNDER THE TRIENNIAL REVIEW SYSTEM A complete application will be submitted annually by each Regional Medical Program in accordance with a schedule of anniversary dates announced by RMPS. Under the Triennial Review System, Regional Medical Programs will ordinarily be recommended for funding by the National Advisory Council every three years. Awards will be made annually within the general level of support recommended by the Council for the year in question. In addition to recommending the general level of support, Council actions on individual applications may include advice to the appTicant Regional Medical Program, or specific conditions for the grant. - Each triennial application will be reviewed by assigned RMPS staff, a site visit team and the RMPS Review Committee prior | to review by the National Advisory Council. The Director, RMPS, will make awards for second and third (02 and 03) year support without further Council action except in the following cases: a. Supplementary funds are requested in addition to the general level of support recommended for the year in question. b. A new or increased developmental component is requested. c. The applicant has failed in a material respect to meet the require- ments of the Program or applicable laws, regulations or formally promulgated policies of the Department, HSMHA or RMPS. d. The Council has asked to see the application. e. The Director wishes to bring the application to the attention of the Council. The Council will be provided with a summary of staff actions regarding the funding of second or third (02 and 03) year support previously recommended by the Council. The summary will include the following for each Region: . a. The amount previously recommended by Council for funding. and the amount awarded. b. A list of projects or activities supported during the most recent grant year, identifying those which have been completed and those which have been supported through a developmental component. c. a 2 “~ A summary of the Region's response to any advice specified by the Council or limitations or conditions of the award. A summary of any outstanding accomplishments. A summary of any outstanding problems. Annual reports from the Regional Advisory Group and from RMPS Staff. (These will be made available as requested by the Council.)