BHW HRSA-22-050 (T12) SOHW Final Updated.pdf

U.S. Department of Health and Human Services

Bureau of Health Workforce

Division of Medicine and Dentistry

Grants to States to Support Oral Health Workforce Activities

Funding Opportunity Number: HRSA-22-050

Funding Opportunity Type(s): Competing Continuation and New

Assistance Listings (AL/CFDA) Number: 93.236

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2022

Application Due Date: January 31, 2022 Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

HRSA will not approve deadline extensions for lack of registration.

Registration in all systems may take up to 1 month to complete.

Issuance Date: November 17, 2021

Thomas Vallin, MPH Project Officer, Division of Medicine and Dentistry Telephone: (301) 443-1307 Email: TVallin@hrsa.gov

See Section VII of this Notice of Funding Opportunity (NOFO) for a complete list of agency contacts.

Authority: 42 USC §256g (§340G of the Public Health Service (PHS) Act) mailto:TVallin@hrsa.gov

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508 Compliance Disclaimer

Note: Persons using assistive technology may not be able to fully access information in this file. For assistance, please email or call one of the HRSA staff above in Section VII.

Agency Contacts.

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2022 Grants to States to Support Oral Health Workforce Activities program. The purpose of this program is to support States in developing and implementing innovative programs to address the oral health workforce needs of designated Dental Health Professional Shortage Areas (Dental HPSAs).

Funding Opportunity Title: Grants to States to Support Oral Health Workforce Activities

Funding Opportunity Number: HRSA-22-050

Due Date for Applications: January 31, 2022

Anticipated Total Annual Available

FY 2022 Funding:

$12,800,000

Estimated Number and Type of Award(s): Up to 32 grant(s)

Estimated Annual Award Amount:

Up to $400,000 per award subject to the availability of appropriated funds

Cost Sharing/Match Required: Yes

Period of Performance: September 1, 2022 through August 31, 2026 (4 years)

Eligible Applicants: Governor-designated, State governmental entities. Only one application per State will be accepted.

See Section III.1 of this notice of funding opportunity (NOFO) for complete eligibility information.

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Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf, except where instructed in this NOFO to do otherwise.

Technical Assistance HRSA will hold a pre-application technical assistance (TA) webinar for applicants seeking funding through this opportunity. The webinar will provide an overview of pertinent information in the NOFO and an opportunity for applicants to ask questions.

Visit the HRSA Bureau of Health Workforce’s open opportunities website at https://www.hrsa.gov/grants/find-funding to learn more about the resources available for this funding opportunity.

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf https://www.hrsa.gov/grants/find-funding

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. Purpose

2. Background

II. AWARD INFORMATION

1. Type of Application and Award

2. Summary of Funding

III. ELIGIBILITY INFORMATION

1. Eligible Applicants

2. Cost Sharing/Matching

3. Other

IV. APPLICATION AND SUBMISSION INFORMATION

1. Address to Request Application Package

2. Content and Form of Application Submission

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Justification Narrative

v. Standardized Work Plan (SWP) Form

vi. Attachments

3. Dun and Bradstreet Data Universal Numbering System (DUNS) Number Transition to the Unique Entity Identifier (UEI) and System for Award Management

(SAM)

4. Submission Dates and Times

5. Intergovernmental Review

6. Funding Restrictions

V. APPLICATION REVIEW INFORMATION

1. Review Criteria

2. Review and Selection Process

VI. AWARD ADMINISTRATION INFORMATION

1. Award Notices

2. Administrative and National Policy Requirements

3. Reporting

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Grants to States to Support Oral Health Workforce Activities program.

Program Purpose

The purpose of this program is to help States develop and implement innovative programs to address the dental workforce needs of designated dental health professional shortage areas (Dental HPSAs) in a manner appropriate to each State’s individual needs.

Program Goals

The goals of this program are to:

1) Encourage and support State innovation that will increase oral health services for populations living in Dental HPSAs;

2) Encourage and support the strategic use of evaluation to improve program performance, assess program impact, and address the concerns and needs of key stakeholders and decision makers within the State; and

3) Encourage States to develop ways to sustain those programs that increase the accessibility and quality of oral health services within Dental HPSAs, which can include the adoption of the innovation by stakeholders within the State.

Program Objectives

1) Develop and implement one or more innovative programs to meet the oral health workforce needs of Dental HPSAs in your State.

This must be the aim of your proposal as it aligns with the purpose of the Grants to States to Support Oral Health Workforce Activities program, For the purposes of this funding opportunity, an “innovative program” is a new or significantly changed program or service delivery system for your State that uses new ideas, methods and/or approaches to address the oral health workforce needs of Dental HPSAs in your State. Maintenance, additional funding, or minor changes to an established program, is not considered an innovative program.

i) Allowable activities for new or significantly changed programs or service delivery systems include:

1. Loan forgiveness and repayment programs for dentists who—

a. agree to practice in designated dental health professional shortage areas;

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b. are dental school graduates who agree to serve as public health dentists for the Federal, State, or local government; and

c. agree to—

i. provide services to patients regardless of such patients’ ability to pay; and

ii. use a sliding payment scale for patients who are unable to pay the total cost of services;

2. Dental recruitment and retention efforts;

3. Grants and low-interest or no-interest loans to help dentists who participate in the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et. seq.) to establish or expand practices in designated dental health professional shortage areas by equipping dental offices or sharing in the overhead costs of such practices;

4. The establishment or expansion of dental residency programs in coordination with accredited dental training institutions in States without dental schools;

5. Programs developed in consultation with State and local dental societies to expand or establish oral health services and facilities in designated health professional shortage areas, including services and facilities for children with special needs, such as-

a. The expansion or establishment of a community-based dental facility, free-standing dental clinic, consolidated health center dental facility, school-linked dental facility, or United States dental school-based facility;

b. The establishment of a mobile or portable dental clinic; and

c. The establishment or expansion of private dental services to enhance capacity through additional equipment or additional hours of operation;

d. The establishment or development of models for the provision of dental services to children and adults, such as dental homes, including for the elderly, blind, individuals with disabilities, and individuals living in long-term care facilities; and

e. The establishment of initiatives to reduce the use of emergency departments by individuals who seek dental services more appropriately delivered in a dental primary care setting

6. Placement and support of dental students, dental residents, and advanced dentistry trainees;

7. Continuing dental education, including distance-based education;

8. Practice support through teledentistry in accordance with State laws;

9. Community-based prevention services such as water fluoridation and dental sealant programs;

10. Coordination with local educational agencies within the State to foster programs that promote children going into oral health or science professions;

11. The establishment of faculty recruitment programs at accredited dental training institutions whose mission includes community outreach and service and that have a demonstrated record of serving underserved States; and

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12. The development of a State dental officer position or the augmentation of a State dental office to coordinate oral health and access issues in the State.

In accordance with 42 U.S.C. § 256g(b)(13) (§ 340G(b)(13) of the Public Health Service (PHS) Act), the following activities are also allowed under this funding opportunity:

13-A. Dental workforce programs designed to address opioid use disorder by advancing better practices for pain management and/or improving access to treatment and recovery services. Such programs may include the clinical training of oral health providers in the identification of and treatment of individuals with substance use disorders.

13-B. Activities designed to assess and/or address the impact of COVID-19 on the oral health workforce in underserved areas, which may include activities designed to better prepare the oral health workforce to adapt and respond to future public health emergencies and training on community mitigation strategies.

13-C. Activities to develop or improve dental therapy programs, including dental health aid therapist programs, in accordance with State laws and policies.

Proposals that involve loan repayment and water fluoridation systems activities must demonstrate that they do not duplicate other federal programs and demonstrate significant innovative changes. For States proposing Activity 13-C, dental therapy must be legally authorized in your State at the time of application. You are encouraged to work with tribal entities in your State for dental therapy under the Indian Health Service Community Aide Program.

As the ability of States to track their oral health workforce is essential to identifying and addressing workforce shortages, applications from States who cannot adequately track and assess the oral health workforce capacity within their State must include the development/enhancement of this capacity in their proposal under Activity 12. Activities solely to assess or track the impact of COVID-19 on the oral health workforce in underserved areas fall under activity 13-B. States are encouraged to use their programs to increase the diversity of their oral health workforce to better serve the oral health workforce needs in Dental HPSAs. Increasing diversity in the oral health workforce can dramatically reduce barriers to access for rural and underserved communities, as well as improve oral health care utilization and outcomes.

Telehealth and teledentistry can be an important tool for delivering oral health services and resources to the State’s and HRSA’s target populations.

Teledentistry is the use of the telehealth systems and methodologies in dentistry. Telehealth is defined as the use of electronic information and telecommunications technologies to support and promote, at a distance, health

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care, patient and professional health-related education, health administration, and public health. You are strongly encouraged to use teledentistry in your proposed innovative programs when feasible or appropriate. Additional information on telehealth can be found at https://telehealth.hhs.gov/. In addition, if you use broadband or telecommunications services for the provision of health care, HRSA strongly encourages you or your partners to seek discounts through the Federal Communication Commission’s Universal Service Program.

For information about such discounts, see https://www.usac.org/rural-health-care/. Patients may also be eligible for free or low cost mobile or broadband services through the Universal Service Lifeline program at https://www.lifelinesupport.org/.

You are encouraged to consider incorporating facilities that are automatically designated as HPSAs based on statute or through regulation in your plans.

Sites that receive automatic HPSA designations include Federally Qualified Health Centers (FQHCs), FQHC Look-A-Likes, Federal Indian Health Service (IHS) facilities, IHS and Tribal Hospitals, Dual-funded Community Health Centers/Tribal Clinics, and CMS-Certified Rural Health Clinics (RHCs). For more information visit https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation.

If you are interested in expanding or establishing oral health services and facilities in Dental HPSAs that will serve older adults, you are encouraged to consider integrating age-friendly health systems concepts.

2) Evaluate each innovative program for use in continuous quality improvement, assessment of outcomes and achieving desired results, and to inform key decision makers. Evaluation must be an objective of your program and include the evaluation of each innovative program proposed. Awardees must develop a written evaluation plan by the end of the first budget period to strategically improve project performance, measure impact, and for use in sustaining their successful innovative programs or encouraging adoption by key decision makers.

3) Sustain successful parts of your programs beyond the period of federal funding, which may include adoption of the innovation by other entities within your State.

HHS and HRSA Priorities

The Grants to States to Support Oral Health Workforce Activities program prioritizes transforming the oral health workforce, by targeting the needs of designated Dental HPSAs through the development and implementation of innovative programs.

General Emergency Preparedness Statement Eligible entities must be ready to continue programmatic activities in the event of a public health emergency – both those that are expected and unexpected. A training-focused emergency preparedness plan is critical for HRSA-funded projects and helps https://telehealth.hhs.gov/ https://www.usac.org/rural-health-care/ https://www.usac.org/rural-health-care/ https://www.lifelinesupport.org/ https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation

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ensure that recipients are able to continue programmatic activities, can coordinate effectively, and can implement recovery plans when emergencies disrupt project activities. You must develop and maintain a flexible training-focused emergency preparedness plan in case of public health emergencies to ensure continuation of programmatic and training activities.

2. Background

The Grants to States to Support Oral Health Workforce Activities program is authorized by 42 USC §256g (§340G of the Public Health Service (PHS) Act).The program awards grants to help States develop and implement innovative programs to address the dental workforce needs of designated Dental HPSAs in a manner appropriate to the States’ individual needs.

Title 42 USC §256f (§340F of the Public Health Service (PHS) Act) defines “a designated dental health professional shortage area” as “an area, population group, or facility that is designated by the Secretary as a dental health professional shortage area under section 254e or designated by the applicable State as having a dental health professional shortage.” As of June 30, 2021, there were 6,578 federally designated Dental HPSAs impacting over 61 million individuals and it would take 10,982 dentists, properly distributed, to remove these designations.1 For more information and to explore data on Dental HPSAs, please visit https://data.hrsa.gov/topics/health-workforce/shortage-areas.

The program authorization provides for a number of specific activities that allow for a broad range of programs including support for dental pipeline and training programs, recruitment and retention programs for dental providers, the establishment or expansion of service delivery infrastructure, and population-based services and public health infrastructure. Examples of current or previously funded innovative programs include dental training rotations in underserved rural clinical sites, preventive services to tribal communities, the leveraging of new and expanded scopes of practice in new care models, new models of care with new types of oral health professionals, exploration of teledentistry or mobile care models, the testing of new payment models, training on opioids, and the assisting of dentists in establishing or taking over rural practices. While the approaches proposed are diverse, one thing that is common to all approaches is the requirement to address particular Dental Health HPSA workforce needs in the State through innovation.

The program authorization also allows the Secretary the flexibility to identify additional appropriate activities that States may pursue under this program.

1 Bureau of Health Workforce Health Resources and Services Administration (HRSA) U.S. Department of Health & Human Services. Designated Health Professional Shortage Areas Statistics: Third Quarter of Fiscal Year 2021 Designated HPSA Quarterly Summary As of June 30, 2021. Accessed from https://data.hrsa.gov/topics/health-workforce/shortage-areas on July 14, 2021.

https://data.hrsa.gov/topics/health-workforce/shortage-areas https://data.hrsa.gov/topics/health-workforce/shortage-areas https://data.hrsa.gov/topics/health-workforce/shortage-areas

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In addition to the twelve specific activities outlined in the authority, this funding opportunity includes three additional activities as allowed under 42 USC §256g(b)(13) (§340G(b)(13) of the Public Health Service (PHS) Act).

13-A: Addressing opioid use disorder through safe and effective pain management and identification and treatment of substance abuse. Opioid overdose deaths in the United States quadrupled between 1999 and 2015 and rates of death involving heroin, synthetic opioids, or a combination have increased more rapidly in recent years.2 Drug overdose deaths in the U.S. rose 29% in 2020 to an estimated 93,331, including 69,710 involving opioids, according to preliminary data released by the Centers for Disease Control and Prevention (CDC).3 Overdose from prescriptions opioids has been a driving factor in the increase of opioid overdose deaths, with sales of opioids to pharmacies, hospitals, and doctors’ offices rising dramatically with no overall change the amount of pain Americans report.4 While the overall national opioid dispensing rate declined from its peak in 2012 to 2019, dispensing rates continued to remain very high in certain areas and vary widely across different states and counties.5 As prescribers of opioids in the United States, dentists can help minimize the potential for their misuse and increase access to dental treatment through prevention, early intervention, and health system integration. A recent study found that patients that filled an opioid prescription after a dental procedure had an overdose rate of 5.7 per 10,000 verses 2.2 for those that did not.6 HRSA has a number of investments targeting opioid use disorder and substance use disorder across its Bureaus and Offices that you may be able to leverage. For information on HRSA-supported resources, technical assistance, and training, visit https://www.hrsa.gov/opioids. Find additional details on the opioid epidemic at https://www.hhs.gov/opioids/about-the-epidemic/index.html.

13-B: Activities designed to assess and/or address the impact of COVID-19 on the oral health workforce in underserved areas. During the response to COVID-19 the Centers for Disease Control and Prevention (CDC) Guidance for Dental Settings recognized dental settings have unique characteristics that warrant specific infection control considerations and recommended prioritizing only the most critical dental services while minimizing the impact of delaying other services. 7 At the state level, many oral health

2 O’Donnell JK, Gladden RM, Seth P. Trends in Deaths Involving Heroin and Synthetic Opioids Excluding Methadone, and Law Enforcement Drug Product Reports, by Census Region — United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017;66:897–903. DOI: http://dx.doi.org/10.15585/mmwr.mm6634a2.

3 American Hospital Association. Jul 14, 2021. https://www.aha.org/news/headline/2021-07-14-cdc-drug-overdose-deaths-294-2020 4 Centers for Disease Control and Prevention, Opioid Overdose: Understanding the Epidemic, August 30, 2017.

Accessed on September 27, 2017 from https://www.cdc.gov/drugoverdose/epidemic/index.html.

5 Centers for Disease Control and Prevention. Drug Overdose: U.S Opioid Dispensing Rate Maps. Accessed on 9/2/2021 from https://www.cdc.gov/drugoverdose/rxrate-maps/index.html.

6 Rowe C, Vittinghoff E, Santos GM, Behar E, Turner C, Coffin PO. Performance Measures of Diagnostic Codes for Detecting Opioid Overdose in the Emergency Department. Acad Emerg Med. 2017 Apr;24(4):475-483. doi:

10.1111/acem.13121. Epub 2017 Mar 17. PMID: 27763703.

7 Centers for Disease Control and Prevention, Guidance for Dental Settings updated December 4, 2020 accessed on 9/1/2021 from https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html#print.

https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm https://www.hrsa.gov/opioids https://www.hhs.gov/opioids/about-the-epidemic/index.html https://www.aha.org/news/headline/2021-07-14-cdc-drug-overdose-deaths-294-2020 https://www.aha.org/news/headline/2021-07-14-cdc-drug-overdose-deaths-294-2020 https://www.cdc.gov/drugoverdose/epidemic/index.html https://www.cdc.gov/drugoverdose/rxrate-maps/index.html https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html#print

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programs in community settings, such as school based programs and service delivery in long term care facilities, were affected by steps taken to minimize the spread of COVOD-19, and partner organizations, such as local health departments, were too overwhelmed with their response to COVID-19 to focus on oral health issues. The American Dental Association (ADA), through regular surveys, found that the resumption of routine service was slower at public facilities that with private practices.8 At the same time, states may have found innovative ways to address oral health needs during the pandemic, such new and increased uses and reimbursement of teledentistry.9 Though the pandemic is not yet over, States may need to assess the impact of COVID-19 on their oral health workforce, address areas of concern, and take advantage of policy changes and lessons learned during the pandemic.

13-C: Activities to develop or improve dental therapy programs, including dental health aid therapist programs, in accordance with State laws and policies. Dental Therapists (DT) are primary care oral health professionals, who provide general dental care including restorative and limited surgical services. The first State dental therapy legislation passed in 2009. Today, DTs are authorized in thirteen States and two territories and a number of other States are considering authoring DTs. 10 DTs most often are required to work in specific communities (e.g. tribal) and/or serve specific populations (e.g. underserved, Medicaid) in order to increase dental access to underserved, rural/geographically isolated populations. 11,12,13,14,15,16 Dental Health Aide Therapist (DHAT) is a particular model of Dental Therapy. DHATs are most often individuals from the tribal communities they serve. DHATs have also been recognized by the Indian Health Service under the Community Health Aide Program provided that

8 American Dental Association, Health Policy Institute. Will COVID-19 Weaken the Dental Care Safety Net?

September 1, 2020 Webinar, https://www.youtube.com/watch?v=_azqSwE2L8s&feature=youtu.be 9 Allie Atkeson. State Levers to Support Dental Care in COVID-19’s Public Health and Economic Emergency.

National Academy for State Health Policy.

August 31, 2020. Accessed on 9/2/2021 from https://www.nashp.org/state-levers-to-support-dental-care-in-covid- 19s-public-health-and-economic-emergency/.

10 Lynch, Ann. Update on Dental Therapy in the United States. Perspectives on the Midlevel Practitioner, a supplement to Dimensions of Dental Hygiene. November 2020(12):28-30.

11 National Conference of State Legislators, NCSLSOP: Practitioner: Oral Health Providers: Dental Therapists.

Accessed on March, 4 2021 from https://scopeofpracticepolicy.org/practitioners/oral-health-providers/sop/dental-therapists/ 12 Dental Therapy Start up Guide for Tribal Leaders.

https://www.nihb.org/docs/03252019/NIHB%20TOHI%20Guidebook%20WEB.pdf12 13 Bolin KA,Assessment of treatment provided by dental health aide therapists in Alaska: a pilot study. J Am Dent Assoc. 2008 Nov;139(11):1530-5; discussion 1536-9.

14 Chi DL, Lenaker D, Mancl L, Dunbar M, Babb M. Dental therapists linked to improved dental outcomes for Alaska Native communities in the Yukon-Kuskokwim Delta. J Public Health Dent. 2018 Mar;78(2):175-182. doi:

10.1111/jphd.12263.

15 Senturia K, Fiset L, Hort K, Huebner C, Mallott E, Milgrom P, Nelson L, Parrish C, Cunha-Cruz J. Dental health aides in Alaska: A qualitative assessment to improve paediatric oral health in remote rural villages.

Community Dent Oral Epidemiol. 2018 Aug;46(4):416-424. doi: 10.1111/cdoe.12385.

16 Brickle CM, Self KD. Dental Therapists a New Oral Health Practitioners: Increasing Access for Underserved Populations. JDE Sept 2017. Supplement (eS65) https://www.nashp.org/state-levers-to-support-dental-care-in-covid-19s-public-health-and-economic-emergency/ https://www.nashp.org/state-levers-to-support-dental-care-in-covid-19s-public-health-and-economic-emergency/ https://scopeofpracticepolicy.org/practitioners/oral-health-providers/sop/dental-therapists/ https://scopeofpracticepolicy.org/practitioners/oral-health-providers/sop/dental-therapists/ https://www.ncbi.nlm.nih.gov/pubmed/?term=Chi%20DL%5BAuthor%5D&cauthor=true&cauthor_uid=29377127 https://www.ncbi.nlm.nih.gov/pubmed/?term=Lenaker%20D%5BAuthor%5D&cauthor=true&cauthor_uid=29377127 https://www.ncbi.nlm.nih.gov/pubmed/?term=Mancl%20L%5BAuthor%5D&cauthor=true&cauthor_uid=29377127 https://www.ncbi.nlm.nih.gov/pubmed/?term=Dunbar%20M%5BAuthor%5D&cauthor=true&cauthor_uid=29377127 https://www.ncbi.nlm.nih.gov/pubmed/?term=Babb%20M%5BAuthor%5D&cauthor=true&cauthor_uid=29377127 https://www.ncbi.nlm.nih.gov/pubmed/29377127 https://www.ncbi.nlm.nih.gov/pubmed/?term=Senturia%20K%5BAuthor%5D&cauthor=true&cauthor_uid=29863284 https://www.ncbi.nlm.nih.gov/pubmed/?term=Fiset%20L%5BAuthor%5D&cauthor=true&cauthor_uid=29863284 https://www.ncbi.nlm.nih.gov/pubmed/?term=Hort%20K%5BAuthor%5D&cauthor=true&cauthor_uid=29863284 https://www.ncbi.nlm.nih.gov/pubmed/?term=Huebner%20C%5BAuthor%5D&cauthor=true&cauthor_uid=29863284 https://www.ncbi.nlm.nih.gov/pubmed/?term=Mallott%20E%5BAuthor%5D&cauthor=true&cauthor_uid=29863284 https://www.ncbi.nlm.nih.gov/pubmed/?term=Milgrom%20P%5BAuthor%5D&cauthor=true&cauthor_uid=29863284 https://www.ncbi.nlm.nih.gov/pubmed/?term=Nelson%20L%5BAuthor%5D&cauthor=true&cauthor_uid=29863284 https://www.ncbi.nlm.nih.gov/pubmed/?term=Parrish%20C%5BAuthor%5D&cauthor=true&cauthor_uid=29863284 https://www.ncbi.nlm.nih.gov/pubmed/?term=Cunha-Cruz%20J%5BAuthor%5D&cauthor=true&cauthor_uid=29863284 https://www.ncbi.nlm.nih.gov/pubmed/29863284

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they meet national training and certification requirements and practice in States that authorize the use of DHAT services.17

Program Definitions

A glossary containing general definitions for terms used throughout the Bureau of Health Workforce NOFOs can be located at the Health Workforce Glossary. In addition, the following definitions apply to the Grants to States to Support Oral Health Workforce Activities program for Fiscal Year 2022:

Age-friendly Health Systems – The essential elements of age-friendly health systems are to know and align care with the patients, and their caregivers, specific health outcomes and care preferences; use age-friendly medication; prevent, identify, treat and manage mental and behavioral health issues; and ensure patients maintain function/mobility.18

Dental Health Professional Shortage Area (Dental HPSA) - An area, population group, or facility that is designated by the Secretary as a dental health professional shortage area under section 254e or designated by the applicable State as having a dental health professional shortage (42 USC §256f (§340F of the PHS Act)). Also referred to as a Dental Health HPSA. A Dental HPSA is sometimes referred to as a Dental Health HPSA. See also Health Professional Shortage Area (HPSA) in the Health Workforce Glossary.

Innovative Program- A new or significantly changed program or service delivery system that uses new ideas, methods and/or approaches, designed to improve how the dental workforce needs of designated Dental HPSAs are addressed. The program must be new to your State to be considered innovative. Maintenance, expansion, or minor changes to an established program or service is not considered an innovative program.

Programs that simply increase funded positions or service capabilities through efforts very similar to those already in use are not considered innovative programs.

Teledentistry- The use of telehealth systems and methodologies in dentistry. See also Telehealth in the Health Workforce Glossary.

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: Competing Continuation and New

HRSA will provide funding in the form of a grant.

17Community Health Aid Program, Indian Health Service Circular No. 20-06. Accessed on March 4, 2021 frohttps://www.ihs.gov/ihm/circulars/2020/community-health-aide-program/ 18 The John A. Hartford Foundation & The Institute for Healthcare Improvement. (2018). Age-Friendly Health Systems.

https://bhw.hrsa.gov/grants/resourcecenter/glossary

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2. Summary of Funding

HRSA estimates approximately $12,800,000 to be available annually to fund 32 recipients. The actual amount available will not be determined until enactment of the final FY 2022 federal appropriation. You may apply for a ceiling amount of up to $400,000 total cost (includes both direct and indirect, facilities and administrative costs) per year. This program notice is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds appropriately.

The period of performance is September 1, 2022 through August 31, 2026 (4 years).

Funding beyond the first year is subject to the availability of appropriated funds for Grants to States to Support Oral Health Workforce Activities program in subsequent fiscal years, satisfactory progress, and a decision that continued funding is in the best interest of the Federal Government. HRSA may reduce a recipient’s future funding after the first year if they are unable to fully succeed in achieving the goals and objectives listed in the application or cannot further develop or implement one or more innovative programs proposed.

All HRSA awards are subject to the Uniform Administrative Requirements, Cost Principles, and Audit Requirements at 45 CFR part 75.

III. Eligibility Information

1. Eligible Applicants

Eligible applicants include only Governor-designated, State government entities, such as the office of State’s dental director or a State-run university or dental school. In additional to the 50 States, eligible applicants include the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, the U.S. Virgin Islands, America Samoa, the Federated States of Micronesia, the Republic of Marshall Islands, and the Republic of Palau. Private institutions are not eligible to apply. States are encouraged to work with tribal entities to facility greater consultation and coordination between State and tribal governments.

All applications submitted by any State-governmental entity other than the office/division housing the State dental director (such as a State-run university of dental school) MUST include a letter of support in Attachment 9 from either the Governor or the State’s dental director that specifically endorses the applicant as the State’s sole designated representative to apply for these federal dollars on the State’s behalf. Such applicants must coordinate with the office/division housing the State dental director as only one application per State will be accepted. The letter must detail how the State’s dental director will be actively involved in the project, include the State’s investment of resources to the project and any planned coordination activities at the State level, and these must be included in the application. Applications from State government http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

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entities, other than the office/division housing the State dental director, that do not contain this letter WILL NOT be considered for funding.

An application submitted by the State governmental office/division housing the State dental director does not need to include a letter of support from the Governor. For States without an official oral health program or without a State-level oral health leadership position, the eligible entity to apply on the State’s behalf would include the individual or entity within the State government that holds the primary responsibility for the State’s dental workforce.

All States are eligible to apply. If you are a current recipient with a period of performance ending August 31, 2022 at the time of submission, you are eligible to apply. If you are a current recipient with a period of performance ending August 31, 2023, you may apply for a new award with different innovative programs. For more information, contact your HRSA project officer.

2. Cost Sharing/Matching

Cost sharing/matching is required for this program. 42 USC §256g(d) (§340G (d) of the Public Health Service (PHS) Act) requires a 40 percent match in non-federal contributions for this grant. States must match at least 40 percent of federal funds provided under this grant either in cash or in-kind. In-kind contributions may include plant, equipment, and services and may be provided from State, local, or private sources. The budget justification narrative located in Section IV.2.iv MUST include a line-item breakdown and narrative description of all matching funds proposed for this project. Matching funds must be non-federal contributions related directly to carrying-out project activities. Applications that fail to address cost sharing/matching requirements will be deemed ineligible and not considered for funding under this announcement (see Attachment 9).

3. Other

HRSA may not consider an application for funding if it contains any of the non-responsive criteria below:

• Exceeds the ceiling amount in Section II.2.

• Exceeds the page limit outlined in Section IV.2

• Fails to satisfy the deadline requirements referenced in Section IV.4

• Fails to include a required letter of support from either the Governor or the State’s dental director that specifically endorses the applicant as the State’s sole designated representative to apply. See Section III.1 and Section vi Attachment 9 for additional details concerning this requirement for additional details.

• Fails to provide the required letter with all mandatory assurances as outlined in Section vi Attachment 9

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NOTE: Multiple applications from a State are not allowable.

HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, before the Grants.gov application due date as the final and only acceptable application. In the event applications are received from more than one entity within a State, the application from the office/division housing the State dental director will supersede applications from any other State-governmental entity.

Failure to include all required documents as part of the application may result in an application being considered incomplete or non-responsive.

Beneficiary Eligibility Requirements

Financial support for trainees is an allowable expense under some activities. Recipients of financial support must 1) be a citizen of the United States, a non-citizen national, or a foreign national having in his/her possession a visa permitting permanent residence in the United States, 2) demonstrate need of the support, and 3) meet other criterial outlined in the activity.

Recipients of loan repayment under this grant cannot receive financial support from another federally-funded program requiring the fulfillment of a service commitment that would run concurrently with commitments under the State’s proposed innovative program. This includes, but is not limited to, scholarship and loan repayment programs through the National Health Service Corps (NHSC), the Indian Health Service (IHS), HRSA’s Faculty Loan Repayment Program, and the Armed Forces Health Professions Scholarship Programs. The Public Service Loan Forgiveness Program is not considered a service obligation. In addition to the listed examples, a more complete list can be found on page 12 of the NHSC guidelines. Those listed programs include qualifying and non-qualifying educational loans: https://nhsc.hrsa.gov/sites/default/files/NHSC/loan-repayment/nhsc-students2service-LRP-application-program-guidance.pdf. In addition, the loans must remain in good standing in order to receive loan repayment.

Federal employees are not allowed to receive financial support under this grant program.

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically. HRSA encourages you to apply through Grants.gov using the SF-424 Research and Related (R&R) workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at http://www.grants.gov/applicants/apply-for-grants.html.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-22-050 in order to receive notifications including modifications, clarifications, and/or republications of the NOFO on Grants.gov.

https://nhsc.hrsa.gov/sites/default/files/NHSC/loan-repayment/nhsc-students2service-LRP-application-program-guidance.pdf https://nhsc.hrsa.gov/sites/default/files/NHSC/loan-repayment/nhsc-students2service-LRP-application-program-guidance.pdf https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html

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You will also receive notifications of documents placed in the RELATED DOCUMENTS tab on Grants.gov that may affect the NOFO and your application. You are ultimately responsible for reviewing the For Applicants page for all information relevant to this

NOFO.

2. Content and Form of Application Submission

Application Format Requirements Section 4 of HRSA’s SF-424 R&R Application Guide provides general instructions for the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, etc. You must submit the information outlined in the HRSA SF-424 R&R Application Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide except where instructed in the NOFO to do otherwise. You must submit the application in the English language and in the terms of U.S. dollars (45 CFR § 75.111(a)).

See Section 8.5 of the HRSA SF-424 R&R Application Guide for the Application Completeness Checklist.

Application Page Limitation The total size of all uploaded files included in the page limit shall not exceed the equivalent of 75 pages when printed by HRSA. The page limit includes project and budget narratives, attachments including biographical sketches (biosketches), and letters of commitment and support required in HRSA’s SF-424 R&R Application Guide and this NOFO.

Please note: Effective April 22, 2021, the abstract is no longer an attachment that counts in the page limit. The abstract is the standard form (SF) "Project Abstract Summary.”

Standard OMB-approved forms that are included in the workspace application package, including the Standardized Work Plan (SWP), do not count in the page limit.

Biographical sketches do count in the page limitation. Note: If you use an OMB-approved form that is not included in the workspace application package for HRSA-22- 050, it may count against the page limit. Therefore, we strongly recommend you only use Grants.gov workspace forms associated with this NOFO to avoid exceeding the page limit. Indirect Cost Rate Agreement (see Attachment 10) and proof of non-profit status (if applicable) do not count in the page limit. It is therefore important to take appropriate measures to ensure your application does not exceed the specified page limit. Any application exceeding the page limit of 75 pages will not be read, evaluated, or considered for funding.

Applications must be complete, within the maximum specified page limit, and validated by Grants.gov under HRSA-22-050 prior to the deadline.

https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) You certify on behalf of the applicant organization, by submission of your proposal, that neither you nor your principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

2) Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75.371, including suspension or debarment. (See also 2 CFR parts 180 and 376, and 31 U.S.C. § 3321).

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachment 10: Other Relevant Documents.

See Section 4.1 viii of HRSA’s SF-424 R&R Application Guide for additional information on all certifications.

Temporary Reassignment of State and Local Personnel during a Public Health Emergency Section 319(e) of the Public Health Service (PHS) Act provides the Secretary of the Department of Health and Human Services (HHS) with discretion upon request by a state or tribal organization to authorize the temporary reassignment of state, tribal, and local personnel during a declared federal public health emergency. The temporary reassignment provision is applicable to state, tribal, and local public health department or agency personnel whose positions are funded, in full or part, under PHS programs and allows such personnel to immediately respond to the public health emergency in the affected jurisdiction. Funds provided under the award may be used to support personnel who are temporarily reassigned in accordance with § 319(e). Please reference detailed information available on the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) website.

Program Requirements and Expectations You must propose one or more innovative programs to meet the oral health workforce needs of Dental HPSAs in your state. All innovative programs must fall under one or more allowable activities outlined in Section I.1 Program Objectives. In addition, you must develop and implement an evaluation of each program that will assist you in improving program performance, assessing program outcomes and impact, and sustaining or diffusing your successful innovations and program.

Program-Specific Instructions In addition to application requirements and instructions in Section 4 of HRSA’s SF-424 R&R Application Guide (including the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, and abstract), include the following:

https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx

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i. Project Abstract Use the Standard OMB-approved Project Abstract Summary Form 2.0 that is included in the workspace application package. Do not upload the abstract as an attachment or it will count toward the page limitation. For information required in the Project Abstract Summary Form, see Section 4.1.ix of HRSA’s SF-424 R&R Application Guide.

The Abstract must include:

1. A brief overview of the project as a whole;

2. Specific, measurable objectives that the project will accomplish;

3. Which of the clinical priorities will be addressed by the project, if applicable;

and

4. How the proposed project for which funding is requested will be accomplished, i.e., the "who, what, when, where, why, and how" of a project.

NARRATIVE GUIDANCE

To ensure that you fully address the review criteria, the table below provides a crosswalk between the narrative language and where each section falls within the review criteria. Any forms or attachments referenced in a narrative section may be considered during the objective review.

Narrative Section Review Criteria

Purpose and Need (1) Purpose and Need

Response to Program Purpose:

(a) Methodology/Approach

(b) Work Plan

(c) Resolution of Challenges

(2) Response to Program Purpose

(a) Methodology/Approach

(b) Work Plan

(c) Resolution of Challenges

Impact:

(a) Evaluation and Technical Support Capacity

(b) Project Sustainability

(3) Impact:

(a) Evaluation and Technical Support Capacity

(b) Project Sustainability

Organizational Information, Resources, and Capabilities

(4) Organizational Information, Resources, and Capabilities

Budget and Budget Justification Narrative

(5) Support Requested

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ii. Project Narrative This section provides a comprehensive description of all aspects of the proposed project. It should be succinct, self-explanatory, consistent with forms and attachments, and organized in alignment with the sections and format below so that reviewers can understand the proposed project.

Use the following section headers for the narrative:

PURPOSE AND NEED -- Corresponds to Section V’s Review Criterion #1

State the purpose of your proposal. To align with the purpose of this funding opportunity, the aim of your proposal must be to develop and implement one or more innovative programs to address the dental workforce needs of designated dental health professional shortage areas (Dental HPSAs) in your State.

Outline the capacity of the existing oral health workforce in your State and indicate any gaps that exist. Include any relevant oral health workforce trends. Outline the oral health workforce needs of your State’s Dental HPSAs and underserved populations. Identify the specific oral health workforce needs in Dental HPSAs they address. Describe how these needs affect the supply and distribution of the oral health workforce and affect the access to quality oral health services in Dental HPSAs. Include any relevant oral health workforce trends that have been identified. Provide and cite recent data whenever possible to support the information provided.

Describe the specific Dental HPSAs you plan to target through your proposed innovative program(s), including the population, the oral health workforce, oral health care infrastructure, gaps in the oral workforce, and unmet oral health needs.

Include factors that contribute to the gaps and unmet needs such as location of services, language, geography, transportation barriers, or care coordination.

Describe specific populations or communities that your innovative program(s) will target within the Dental HPSAs including accessibility of quality oral health services, oral health status, social determinants of health, any health disparities, and issues of health equity. If the specific Dental HPSAs to be targeted are not known, indicate what criteria will be used to select them.

For programs targeting specific workforce needs at the State level, describe the ability of your State to track its oral health workforce, identifying workforce shortages, and assess and monitor oral health workforce needs. Highlight any gaps that prevent your State from adequately tracking and assessing the oral health workforce capacity within your State and indicate how you will develop this capacity under Activity 12 and under Activity 13-B if they relate to the impact of COVID-19. Describe any other needs at the State level to assess, monitor, and meet the oral health workforce needs of Dental HPSAs in the State that you will address through innovative programs under Activity 12 or Activity 13-B.

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RESPONSE TO PROGRAM PURPOSE -- This section includes three sub-sections

— (a) Methodology/Approach; (b)Work Plan; and (c) Resolution of Challenges—all of which correspond to Section V’s Review Criteria 2 (a), (b), and (c).

(a) METHODOLOGY/APPROACH -- Corresponds to Section V’s Review

Criterion(a) 2 (a)

Clearly describe each…