USACAboutCOVID-19 Telehealth Program
Supporting Information

Supporting Information

Evaluation Metrics

For the HCP that meets each criterion:

  • Round 1 Application Number (GRA00XXXX) for previous applicants or documentation demonstrating submission, e.g., an e-mailed confirmation
  • Full Site Name and Physical Address, including county information, for rural, low-income, Critical Access Hospital (CAH), and Tribal area providers and for “hardest hit” providers
  • Supporting documentation is needed for certain “Other” Tribal affiliations
  • Healthcare Provider Shortage Area (HPSA) ID or Score for HPSA providers
  • Federally-Qualified Health Center (FQHC) ID, Bureau of Primary Health Care Health Center Management Information System ID (BHCMISID), or Uniform Data System (UDS) number for FHQCs, FQHC Look-Alikes, and Disproportionate Share Hospitals

Purpose and Intent

  • Whether the applicant will treat COVID-19 patients directly
  • Whether the applicant will treat patients without COVID-19 symptoms

Funding Request

For all requested funding items:

  • Category
  • Description
  • Quantity, if applicable
  • Cost on applicable basis
    • One-Time
    • Monthly
    • Per Unit

Applicants must provide supporting cost documentation (e.g., an invoice or a vendor quote) for all eligible services and devices for which funding is requested.