BHW HRSA-22-056 (UK1) NEPQR-MHTP_Final.pdf

HRSA- 22-056 i

U.S. Department of Health and Human Services

Bureau of Health Workforce

Division of Nursing and Public Health

Nurse Education, Practice, Quality and Retention-Mobile Health Training Program (NEPQR-MHTP)

Funding Opportunity Number: HRSA-22-056

Funding Opportunity Type(s): New

Assistance Listings (AL/CFDA) Number: 93.359

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2022

Application Due Date: February 22, 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 December 3, 2021

Michelle U. Osborne, MSN, RN, FNP-BC Nurse Consultant/Project Officer, DNPH Telephone: (301) 594-3803 Email: mosborne@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C §§ 296p, 296-1 (Section 831 of the Public Health Service Act) mailto:mosborne@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 listed in Section VII.

Agency Contacts.

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2022 Nurse Education, Practice, Quality and Retention-Mobile Health Training Program (NEPQR-MHTP). The purpose of this program is to strengthen the nursing workforce through education and training to provide culturally aligned quality care in rural and underserved areas and training of diverse nursing students to address and manage Social Determinants of Health (SDOH) factors and improve health equity and health literacy of vulnerable populations in rural and underserved communities through nurse-led mobile health training sites. The NEPQR-MHTP will create and expand experiential learning opportunities for nursing students, including: the provision of high-quality culturally sensitive care, identify and understand SDOH in local communities, engagement in critical thinking, and clinical practice highlighting a collaborative team approach to care.

This notice is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds appropriately. You should note that this program may be cancelled before award, due to availability of funds.

Funding Opportunity Title: Nurse Education, Practice, Quality and Retention (NEPQR)-Mobile Health Training Program (MHTP)

Funding Opportunity Number: HRSA-22-056

Due Date for Applications: February 22, 2022

Anticipated Total Annual Available FY 2022 Funding:

$35,000,000

Estimated Number and Type of Award(s): Up to 35 cooperative agreements

Estimated Annual Award Amount: Up to $1,000,000 per year subject to the availability of appropriated funds

Cost Sharing/Match Required: No

Period of Performance: July 1, 2022, through June 30, 2026 (4 years)

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Eligible Applicants: Eligible applicants are accredited schools of nursing, health care facilities, including federally qualified health centers, or nurse-managed health clinics or a partnership of such a school and facility.

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

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(s) for applicants seeking funding through this opportunity. The webinar(s) 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://bhw.hrsa.gov/fundingopportunities/default.aspx to learn more about the resources available for this funding opportunity.

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf https://bhw.hrsa.gov/fundingopportunities/default.aspx

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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

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 Nurse Education, Practice, Quality and Retention-Mobile Health Training Program (NEPQR-MHTP).

Through the expansion of experiential training opportunities in nurse-led community-based settings, the purpose of this mobile health training program is to increase and strengthen the diversity, education, and training of the nursing workforce to provide culturally aligned quality care in rural and underserved areas where there are health care disparities related to access and delivery of care. This program will provide enhanced education and training opportunities within collaborative, reciprocal partnerships, utilizing community-based, nurse-led mobile units. This program aims to strengthen the capacity of nursing students to address and manage Social Determinants of Health (SDOH) and improve health equity for vulnerable populations in rural and underserved areas. The NEPQR-MHTP aims to expand on the nursing education provided by emphasizing leadership and effective communication skills as well as innovative technological methods (i.e. telehealth) to deliver quality care in a rural or underserved environment.

For more details, see Program Requirements and Expectations.

Program Goals

1. Establish or expand Nurse-led mobile units to provide care to the target vulnerable populations in rural and underserved areas.

2. Expand the nursing workforce by creating experiential learning opportunities emphasizing advanced nursing skills and care delivery in rural and underserved communities.

3. Provide didactic nursing education geared toward the delivery of culturally competent care, addressing SDOH while developing skills in leadership, communication, and critical thinking in a technologically innovative and collaborative practice environment.

4. Foster a community-based learning environment which mentors nursing students to identify and implement evidence-based best practices in rural and medically underserved communities.

5. Increase the diversity of the nursing workforce by recruiting and supporting students and faculty from diverse populations, including those from disadvantaged backgrounds and underrepresented racial and ethnic minorities.

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Program Objectives

• Develop or enhance nurse-led mobile health units to provide quality health care to rural and underserved communities;

• Utilize the NEPQR-MHTP as an experiential platform for nursing students;

• Expand access to health care services in underserved and rural communities through the use of the mobile health unit and innovative technology solutions;

• Enhance current curriculum to integrate SDOH concepts, providing a foundation for nurses/nursing students to address and improve patient health outcomes;

• Implement professional development programs and share resources with faculty and preceptors related to social determinants; and

• Develop a nursing workforce that address the needs of the target populations being served in rural and underserved communities.

HHS and HRSA Priorities

You are encouraged to select and address one of the clinical priorities below which include HHS’s and HRSA’s priorities:

• COVID-19;

• Environment as it relates to climate change and health disparities/equity;

• Equity in HHS Service Delivery (racial, LGBTQ);

• Reproductive Health/Family Planning/teen pregnancy initiatives;

• Refugee/Immigration/unaccompanied children;

• Maternal Health;

• Mental Health; and

• SUD/Opioids.

Promoting equity is essential to the Department’s mission of protecting the health of Americans and providing essential human services. This view is reflected in Executive Order (E.O.) 13985 entitled Advancing Racial Equity and Support for Underserved Communities Through the Federal Government (Jan. 20, 2021).

Recipients of Federal Financial Assistance (FFA) from HHS must administer their programs in compliance with federal civil rights laws that prohibit discrimination on the basis of race, color, national origin, disability, age and, in some circumstances, religion, conscience, and sex. This includes ensuring programs are accessible to persons with limited English proficiency and persons with disabilities. The HHS Office for Civil Rights provides guidance on complying with civil rights laws enforced by HHS. See HHS Provider Obligations and HHS Nondiscrimination Notice. See Section VIII. Other Information for further details.

https://www.hhs.gov/civil-rights/for-providers/provider-obligations/index.html https://www.hhs.gov/civil-rights/for-providers/provider-obligations/index.html https://www.hhs.gov/civil-rights/for-individuals/nondiscrimination/index.html

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The Health Resources and Services Administration (HRSA), Bureau of Health Workforce (BHW), is committed to increasing diversity in health professions programs and the health workforce across the Nation. This commitment extends to ensuring that the U.S. has the right clinicians, with the right skills, working where they are needed.

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 ensure that grantees 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, including but not limited to experiential training on the NEPQR-MHTP.

2. Background

The NEPQR-MHTP is authorized by 42 U.S.C §§ 296p, 296-1 (Section 831 of the Public Health Service Act) to strengthen the capacity for basic nurse education and practice. The NEPQR program has statutory authority to address the development and enhancement of the nursing workforce. The three priority areas defined in the statute for this program are (1) Education, (2) Practice, and (3) Retention.

The NEPQR: MHTP addresses the following priority areas:

1. Education Priority (Section 831(a)(2) of the PHS Act):

• Provide education in new technologies, including distance learning methodologies.

2. Practice Priority (Section 831(b)(1-3) of the PHS Act)

• Establish or expand nursing practice arrangements in non-institutional settings to demonstrate methods to improve access to primary health care in underserved communities;

• Provide care for underserved populations and other high-risk groups such as the elderly, individuals living with HIV/AIDS, individuals with mental health or substance use disorders (SUD), individuals who are homeless, and survivors of domestic violence; and

• Provide coordinated care, and other skills needed to practice in existing and emerging organized health care systems.

3. Retention Priority (Sections 831(c)(1)(A)(i) and 831(c)(2)(A) of the PHS Act)

• Promote career advancement for nursing in a variety of training setting, cross training or specialty training among diverse population groups, and the advancement of individuals including become professional registered nurses, advanced practice registered nurses, and nurses with graduate nursing education; and

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• Improve the retention of nurses, and enhance patient care that is directly related to nursing activities, by enhancing collaboration and communication among nurses and other health care professionals, and by promoting nurse involvement in the organizational and clinical decision making processes of a health care facility.

Many people in the United States are unable to receive the health care services they need due to the lack of access and availability of health care services where they live.

These barriers lead to an increased risk of poor health outcomes as well as health disparities.1 According to the Centers for Disease Control and Prevention (CDC), 46 million or 15 percent of the United States (U.S.) population lives in rural areas.2 Many rural communities suffer from poor health due to a lack of health care services, coupled with low socioeconomic status.3 The lack of access to health services has a significant impact on overall well-being. Through community-based partnerships addressing SDOH, NEPQR-MHTP can make a difference in rural and underserved communities

Today, Americans are less healthy than previous generations and their global counterparts3. The CDC reports that six in ten Americans live with at least one chronic disease, and four in ten have two or more chronic diseases.4 Chronic diseases in the United States have a significant health and financial cost and they are among the most prevalent and costly health conditions in the United States.5 The annual health care expenditures in the U.S. are close to 3.8 trillion dollars, and a substantial percentage of those costs go to caring for people living with chronic and mental health conditions.4

Many health disparities impact racial and ethnic minorities living in underserved (rural or urban) communities in America.4 Rural residents are more likely to die prematurely from the five leading causes of death (heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke).6 Access to screening and health care services can lead to early detection and management of chronic diseases.

Healthy People 2030 (HP2030) establishes national health objectives with targets and monitors and catalyzes progress over time to measure the impact of research and prevention efforts. An important objective of HP2030 is the health care access and

1 "HealthyPeople.gov," [Online]: https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/access-to-health#2 2 "Centers for Disease Control and Prevention," [Online]. https://www.cdc.gov/ruralhealth/about.html .

(Accessed 17 June 2021).

3 OECD, "Health Spending. Organization for Economic Co-operation and Development," 2021. [Online].

Available: https://data.oecd.org/healthres/health-spending.htm . (Accessed 29 June 2021).

4 "Centers for Disease Control and prevention," [Online].

https://www.cdc.gov/chronicdisease/about/index.htm . (Accessed 29 June 2021).

5 E. Solomon, HW. Wing, J. Steiner and L. Gottlieb, "Impact of Transportation Interventions on health care outcomes A systematic review," Medical Care, vol. 58, no. 4, pp. 384-391, April 2020.

6 "CDC National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP)," [Online].

Available: https://www.cdc.gov/chronicdisease/resources/publications/factsheets/rural-health.htm .

[Accessed 30 June 2021].

https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/access-to-health#2 https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/access-to-health#2 https://www.cdc.gov/ruralhealth/about.html https://data.oecd.org/healthres/health-spending.htm https://www.cdc.gov/chronicdisease/about/index.htm https://www.cdc.gov/chronicdisease/resources/publications/factsheets/rural-health.htm

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quality domain of SDOH.7 HP2030 also highlights that having access to health services is a step toward reducing health disparities.7 The absence or limited access to transportation can be a significant barrier to receiving timely and appropriate health care services.5 For nursing to improve communities’ access to health care services, there needs to be a shift in thinking about how nurses can provide much needed care in rural and underserved communities. The Department of Health and Human Services (HHS) is committed to improving the health and well-being of the nation through HP2030.

Providing care to some of our most vulnerable and underserved populations in the U.S.

through a Mobile Health Clinic (MHC) can help reduce health care disparities and limitations in access to care.8 There are approximately 1,500-2,000 mobile clinics nationwide, providing up to 6.5 million visits annually within the United States. Bridging the gap between the clinics and the community, MHCs can improve health care delivery by reaching people where they live and where they work. A literature review by Yu et al.

notes that MHCs successfully provide health care services “directly at the curbside in communities of need and flexibly adapting their services based on the changing needs of the target community MHCs can provide various services in the community”, such as primary care, preventive screenings, women’s health, patient education, and pediatric care, amongst many other beneficial services.9

As recommended in Future of Nursing 2030 report, nursing education programs, including continuing education, and accreditors and the National Council of State Boards of Nursing should ensure that nurses are prepared to address SDOH10 In alignment with this recommendation, nurse educators must continuously evaluate and revise education curricula and programs used to educate new and practicing nurses.

Likewise, to prepare nurses to practice in new models of care, clinical rotations need to include exposure to high-performing teams in community-based settings, and provide longitudinal experiences within non-traditional, community-based settings. Effective academic, practice, and community partnerships create systems where students have relevant curricula, quality training sites, well-trained faculty and preceptors, and produce graduates with the experience and competencies that facilitate employment in rural and underserved communities.

7 https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality/reduce-proportion-people-who-cant-get-medical-care-when-they-need-it-ahs-04

8 N. Malone, M. Williams, M. Smith Fawzi, J. Bennet, C. Hill, J. Katz and e. al., "Mobile health clinics in the United States," Mobile health clinics in the United States, vol. 19, no. 1, p. 1–9, 2020.

9 Yu, S.W.Y., Hill, C., Ricks, M.L., Bennet, J., Oriol, N.E. “The scope and impact of mobile health clinics in the United States: A Literature Review.” International Journal for Equity in Health, October 5, 2017.

https://doi:10.1186/s12939-017-0671-2.

10 National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030:

Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press.

https://doi.org/10.17226/25982.

https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality/reduce-proportion-people-who-cant-get-medical-care-when-they-need-it-ahs-04 https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality/reduce-proportion-people-who-cant-get-medical-care-when-they-need-it-ahs-04

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The complex health care needs of individuals and underserved communities call for the nursing practice to shift to provide quality community care. 11, Fostering this change to population and community health, MHCs can play an important role in developing the nursing workforce where it is needed. Many nursing programs face challenges related to obtaining clinical sites and qualified preceptors; the nurse-led MHC can serve as a clinical training site for nursing students and practice site for current nurses. 12,13 The MHC can address medical and SDOH in the community, an essential component in nursing education and training.14

Preparing the future nursing workforce to provide culturally sensitive, patient-focused care should be strongly considered moving forward Studies have found that racial and ethnic concordance between providers and patients can improve patient outcomes.15 A study done in 2012 showed that race or race concordance were significantly associated with increased patient trust score outcomes.16 Patients’ decision making can be affected by race concordance between a provider and patient.17 Diversifying the nursing workforce will be a step toward improving the healthcare disparities faced by our target population.

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 specifically to the NEPQR-MHTP for Fiscal Year 2022:

• Collaborative care team: communication, sharing, and problem solving between the health care personnel as peers; this pattern of practice also implies a shared responsibility and accountability for patient care. At a minimum, the proposed system must include collaborative practice across disciplines, mechanisms to

11 S. Randall, T. Crawford, J. Currie, J. River and V. Betihavas, "Impact of community based nurse-led clinics on patient outcomes, patient satisfaction, patient access and cost effectiveness: A systematic review," International Journal of Nursing Studies, vol. 73, pp. 24-33, 2017.

12 M. Cockroft, J. Laboy, L. Mullen and S. Hubbell, "Nurse-Led Mobile Health Clinics: An Opportunity for Student Scholarship and Faculty Practice," Journal of Nursing Education, vol. 59, no. 10, 2020.

13 S. Drayton-Brooks, P. Gray, N. Turner and J. Newland, "Building clinical education training capacity in nurse practitioner programs," Journal of Professional Nursing, vol. 33, no. 6, pp. 422-428, 2017.

14 K. Porter, G. Jackson, R. Clark, M. Waller and A. Grimes Stanfill, "Applying Social Determinants of Health to Nursing Education Using a Concept-Based Approach," Journal of Nursing Education, vol. 59,

no. 5, pp. 293-296, 2020 15 A. Nguyen, N. Siman, M. Barry, C. Cleland, H. Pham-Singer, C. Ogedegbe and D. Shelley, "Patient- Physician Race/Eghnicity Concordance Improves Adherence to Cardiovascular Disease Guidelines," Health Services Research, vol. 55, no. 51, pp. 51-51, 2020.

16 G. H. C. H. a. W. P. B. Smith, "Physicians, Physician Extenders and Health Outcomes: Race, Gender and Patient-Health Provider Concordance in North Carolina Medicaid," ournal of health care for the poor and underserved , vol. 29, no. 1, pp. 530-555, 2018.

17 S. &. B. M. C. Saha, "Impact of Physician Race on Patient Decision-Making and Ratings of Physicians:

a Randomized Experiment Using Video Vignettes.," Journal of General Internal Medicine, vol. 34, no. 4,

p. 1084–1091, 2020.

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

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improve care coordination, and system level initiatives, such as integrated electronic health records or care protocols, to improve the quality of care provided.

• Disparity Impact Statement- is a statement applicants are expected to develop using local data (e.g. the CDC Social Vulnerability Index (SVI)) to identify populations at highest risk for health disparities and low health literacy. The disparity impact statement will provide the framework for ongoing monitoring and determining the impact of the NEPQR-MHTP proposed project. See Section VIII.

Other Information for further details.

• Health equity- is the consistent and systematic fair, just, and impartial treatment of all individuals, including individuals who belong to underserved communities that have been denied such treatment, such as Black, Latino, Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons; persons with disabilities; persons who live in rural areas;

and persons otherwise adversely affected by persistent poverty or inequality.

Addressing issues of equity should include an understanding of intersectionality and how multiple forms of discrimination impact individuals’ lived experiences.

Individuals and communities often belong to more than one group that has been historically underserved, marginalized, or adversely affected by persistent poverty and inequality. Individuals at the nexus of multiple identities often experience unique forms of discrimination or systemic disadvantages, including in their access to needed services

• Longitudinal experiential training - is the process of instruction between a designated faculty and/or nursing preceptor and an individual(s) that includes a component of direct work experience over a period of time to adequately immerse the individual(s) in that training, for the purposes of this NOFO, longitudinal is a minimum of 80 hours.

• Mobile Health Unit – is an innovative model of health care delivery to address health disparities and improve health outcomes utilizing intermittent sites to provide direct health care services to a target population. Intermittent sites operate on a regular scheduled basis for a short period of time at locations that change frequently as necessary to continue services to the target population. Generally, these sites are established to assure access to care for more mobile populations, who may not be in one area for an extended period of time and, therefore, may not access care.

• Nurse-led – is a care practice in which the lead care provider is a registered nurse (RN) or advanced practice registered nurse (APRN).

• Social Determinants of Health- is defined by HHS as the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

SDOH can be grouped into 5 domains: economic stability; education access and

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quality; health care access and quality; neighborhood and built environment; social and community context.

• Underserved Communities- are populations sharing a particular characteristic, as well as geographic communities that have been systematically denied a full opportunity to participate in aspects of economic, social, and civic life, as exemplified by the list in the preceding definition of ‘equity’.

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New

HRSA will provide funding in the form of a cooperative agreement. A cooperative agreement is a financial assistance mechanism where HRSA anticipates substantial involvement with the recipient during performance of the contemplated project.

HRSA program involvement will include:

1) Make available the services of experienced HRSA/BHW personnel as participants in the planning and development of all phases of the project;

2) Provide programmatic consultation for development and delivery of training and technical assistance, project data collection methods and a set of core measures and metrics across projects;

3) Provide ongoing input in all phases of the project to accomplish the goals;

4) Participate, as appropriate, in meetings or site visits conducted during the period of the cooperative agreement;

5) Review and approve project information prior to dissemination;

6) Provide direction, assistance and recommendations in the establishment and facilitation of effective collaborative relationships with federal and state agencies, HRSA grant projects, and other resource centers and entities relevant to the project’s mission;

7) Provide guidance concerning the content, structure and format of required reports;

and

8) Support and direct the dissemination of effective education or practice models that emerge from the NEPQR-MHTP and identifying opportunities to expand best practice models to diverse populations.

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The cooperative agreement recipient’s responsibilities will include:

1) Develop, implement, and evaluate projects to ensure that they meet the goals outlined in Section I of this NOFO, and comply with all applicable grant requirements;

2) Engage, collaborate, and communicate with HRSA staff for input on project activities, quality improvement, and dissemination of lessons learned and effective education and practice models;

3) Participate in training and technical assistance by HRSA and other stakeholders, as appropriate;

4) Engage with relevant stakeholders to ensure project success and sustainability;

5) Engage, collaborate, and communicate with other NEPQR-MHTP recipient in a learning community to share practice innovations and leverage resources; and

6) Adhere to HRSA guidelines pertaining to acknowledgement and disclaimer on all products produced by HRSA award funds, per Section 2.2 of the SF-424 R&R Application Guide (Acknowledgement of Federal Funding).

2. Summary of Funding

HRSA estimates approximately $35,000,000 to be available annually to fund up to 35 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 $1,000,000 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 July 1, 2022 through June 30, 2026, (4 years). Funding beyond the first year is subject to the availability of appropriated funds for NEPQR- MHTP in subsequent fiscal years, satisfactory progress, and a decision that continued funding is in the best interest of the Federal Government.

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

Limitations on indirect cost rates

Indirect costs under training awards to organizations other than state, or local governments or federally recognized Indian tribes, will be budgeted and reimbursed at 8 percent of modified total direct costs, rather than on the basis of a negotiated rate agreement, and are not subject to upward or downward adjustment. Direct cost amounts for equipment and capital expenditures, tuition and fees, and subawards in excess of $25,000 are excluded from the direct cost base for purposes of this calculation.

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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III. Eligibility Information

1. Eligible Applicants

In accordance with Section 831(f) of PHS Act, eligible entities are an accredited school of nursing as defined in section 801(2), a health care facility, including federally qualified health centers or nurse-managed health clinics, or a partnership of such a school and facility.

Schools of nursing affiliated with the proposed project must be accredited. Applicants must provide documentation of current accreditation by a national nurse education accrediting agency or a state agency by the U.S. Department of Education as Attachment 10. Individuals and for-profit entities are not eligible to apply.

In addition to the 50 states, the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau may apply. Tribes and Tribal organizations may apply for these funds, if otherwise eligible. Foreign entities are not eligible for this HRSA award.

A trainee receiving support from grant funds under this program must be a citizen, national, or permanent resident of the United States. Individuals on temporary or student visas are not eligible to participate.

2. Cost Sharing/Matching Cost sharing/matching is not required for this program.

3. Other

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

• Exceeds the ceiling amount

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

Maintenance of Effort The recipient must agree to maintain non-federal funding for award activities at a level that is not less than expenditures for such activities maintained by the entity for the fiscal year preceding the fiscal year for which the entity receives the award, as required by Sec. 803 (b) of the Public Health Service Act (42 U.S.C. §296b). Such federal funds are intended to supplement, not supplant, existing non-federal expenditures for such activities. Complete the Maintenance of Effort (MOE) information and submit as Attachment 6.

HRSA will enforce statutory MOE requirements through all available mechanisms.

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NOTE: Multiple applications from an organization are not allowable. Separate organizations are those entities that have unique DUNS numbers or Unique Entity Identifier (UEI).

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.

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

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-22-056 in order to receive notifications including modifications, clarifications, and/or republications of the NOFO on Grants.gov.

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 or 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.

https://www.gsa.gov/about-us/organization/federal-acquisition-service/office-of-systems-management/integrated-award-environment-iae/iae-information-kit/unique-entity-identifier-update https://www.gsa.gov/about-us/organization/federal-acquisition-service/office-of-systems-management/integrated-award-environment-iae/iae-information-kit/unique-entity-identifier-update https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html 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

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Application Page Limitation

The total size of all uploaded files included in the page limit shall not exceed the equivalent of 70 pages when printed by HRSA. The page limit includes project and budget narratives, attachments including biographical sketches (bio sketches), 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- 056, 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 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 70 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-22-056, prior to the deadline.

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. § 3354).

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachment 11: 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 http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf 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

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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 via http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx.

Program Requirements and Expectations All applicants funded under this funding opportunity will be required to implement the following:

1. Establish or enhance a nurse-led mobile unit(s) to meet the health care needs of populations at highest risk for health disparities and low health literacy in rural, underserved or marginalized communities providing mobile health services;

2. Establish or enhance reciprocal collaborative partnerships to develop and implement a work plan to address and manage SDOH factors and improve health outcomes in underserved communities utilizing the NEPQR-MHTP;

3. Provide longitudinal experiential clinical training for nursing students (BSN and or APRNs) in a mobile-based community setting to provide essential services to the targeted communities;

4. Enhance didactic nursing curriculum and continuing professional education and development (for faculty and/or staff) with an emphasis on a collaborative team- based practice model to integrate:

o Social determinants of health factors, o Health equity, o Populations at highest risk for health disparities;

o Low health literacy, and o Leadership and communication skills

5. Expand health care access to rural and underserved areas through the use of the mobile health unit and innovative technological solutions; and

6. Increase the diversity of the nursing workforce with the recruitment of nursing students and faculty from diverse populations, including individuals from disadvantaged backgrounds and underrepresented racial and ethnic minorities.

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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7. Develop a business model outlining the development and/or enhancement of the proposed nurse-led mobile unit.

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:

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. Please use the guidance below. It is most current and differs slightly from that in Section 4.1.ix of HRSA’s SF-424 R&R Application Guide.

Provide a summary of the application in the Project Abstract box of the Project Abstract Summary Form using 4,000 characters or less. The summary must include:

Address Project Director Name Contact Phone Numbers (Voice, Fax) Email Address Website Address, if applicable List all grant program funds requested in the application, if applicable If requesting a funding preference, priority, or special consideration as outlined in Section V. 2. of the program-specific NOFO, indicate here.

Because the abstract is often distributed to provide information to the public and Congress, prepare this so that it is clear, accurate, concise, and without reference to other parts of the application. It must include a brief description of the proposed project including the needs to be addressed, the proposed services, and the population group(s) to be served. If the application is funded, your project abstract information (as submitted) will be made available to public websites and/or databases including USAspending.gov.

The abstract must also 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.

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.usaspending.gov/

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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) Work Plan

(b) Methodology/Approach

(c) Resolution of Challenges

(2) Response to Program Purpose

(a) Work Plan

(b) Methodology/Approach

(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

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 You must identify and describe the needs of the target community being supported by the proposed project. You must directly link all aspects of the project to its goals and objectives, including its contribution to improving health equity, access to care, and diversity within the nursing workforce. You must describe the following:

• A disparity impact statement using local data (e.g., the CDC Social

Vulnerability Index (SVI) https://www.atsdr.cdc.gov/placeandhealth/svi/index.html]) to identify https://www.atsdr.cdc.gov/placeandhealth/svi/index.html

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populations at highest risk for health disparities18, low health literacy and infrastructure to receive necessary services in rural, underserved, or marginalized communities;

• The community that will benefit from the proposed project activities. Include information and quantifiable data, such as the demographics of the population, health status, including existing health disparities and unmet health care needs of the community, SDOH, and barriers accessing care;

• The development of an experiential longitudinal clinical training opportunity for nursing students (BSN and or APRNs) in the project;

• Nursing curricula modifications and enhancements needed to incorporate SDOH, populations at highest risk for experiencing health disparities, low health literacy, and health equity;

• Develop critical thinking and introduce leadership skills in order to prepare students to enter the nursing workforce and with skillsets to in rural and underserved areas;

• How the NEPQR-MHTP and innovative technology will improve health outcomes related to the SDOH factors and contribute to enhancing resiliency of the community or catchment area;

• Demographic data of the target student and faculty population, including but not limited to demographic characteristics, geographic background, and race/ethnicity background; and

• Demographics of the current nursing workforce in the geographic area of the proposed project.

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

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

(a) WORK PLAN -- Corresponds to Section V’s Review Criterion 2 (a)

Provide a detailed work plan that demonstrates your experience implementing a project of the proposed scope. Your work plan must be submitted through the Standardized Work Plan (SWP) Form located in the Grants.gov workspace. The SWP form is organized by budget period and must include all activities and deliverables for each objective and program goal. The program goals for this NOFO must be entered in the Program Goals section of the SWP form. For example, Goal 1 in the Purpose section of the NOFO will need to be entered as Goal 1 in the SWP form. Objectives and sub-objectives can be tailored to your

18 National Institute on Minority Health and Health Disparities, Health Disparity Populations (April 1, 2021). See Section VIII. Other Information for details.

https://www.nimhd.nih.gov/about/overview/ https://www.nimhd.nih.gov/about/overview/

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project needs. Objectives may be tagged with organizational priorities by selecting applicable priorities on the SWP form. For the purpose of this NOFO, please write in COVID-19 or Health Equity in the “Other Priority Linkage” if your objective or sub-objectives align with those priorities. Form instructions are provided along with the SWP form, and are included in the application package found on Grants.gov.

You must complete the Standardized Work Plan (SWP) mandatory from in the Application Package. The work plan must:

• Describe of the goals of the proposed project; including the subjective, objectives, reasons for proposing the intervention and how they relate to attainment of the goals of the Disparities Impact Statement;

• Include the responsible entity/entities (i.e., key staff and partners) and collaboration with key stakeholders for carrying out the project;

• Detail the timeline, deliverables, and key partners required during the award period of performance to address each of the needs described in the Purpose and Need section;

• Describe existing resources and programs available for target population;

• Proposed outcomes including the number of current and future nurses trained each year in the proposed project;

• Identify the plan for the recruitment of students and faculty from diverse…