BHW HRSA-23-120 ANE MatCare Program_Final.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2023

Bureau of Health Workforce

Division of Nursing and Public Health

Maternity Care Nursing Workforce Expansion (MatCare) Program Funding Opportunity Number: HRSA-23-120

Funding Opportunity Type(s): New

Assistance Listings Number: 93.247

Application Due Date: July 14, 2023 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: June 12, 2023

Courtney McRae Nurse Consultant/Project Officer, DNPH Telephone: (301) 945-5857 Email: MatCare@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C. § 296j (Section 811 of the Public Health Service Act) mailto:MatCare@hrsa.gov

HRSA-23-120 i

508 COMPLIANCE DISCLAIMER

Note: Persons using assistive technology may not be able to fully access information in this file. For assistance, 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) 2023 Maternity Care Nursing Workforce Expansion (MatCare) Program. The purpose of this program is to provide support to accredited nurse midwifery programs to train nurse midwives through trainee scholarships, stipends, curriculum enhancement, and community-based training in order to grow and diversify the maternal and perinatal health nursing workforce. The program seeks to increase the number of Certified Nurse Midwives (CNMs) prepared to address and reduce maternal mortality and morbidity in rural, urban underserved, and tribal communities.

Funding Opportunity Title: Maternity Care Nursing Workforce Expansion (MatCare) Program

Funding Opportunity Number: HRSA-23-120

Due Date for Applications: July 14, 2023

Anticipated FY 2023 Total Available Funding:

$8,000,000

Estimated Number and Type of Award(s): Approximately 8 grants

Estimated Annual Award Amount: Up to $1,000,000 per award

Cost Sharing/Match Required: No

Period of Performance:

September 30, 2023, through September 29, 2027 (4 years)

HRSA-23-120 ii

Eligible Applicants: Eligible applicants are accredited schools of nursing, nursing centers, academic health centers, state, or local governments, and other public or private nonprofit entities determined appropriate by the Secretary, such as HRSA-supported health centers or Rural Health Clinics.

Domestic community-based organizations, tribes and tribal organizations are eligible to apply, if otherwise eligible.

Individuals and for-profit entities are not eligible applicants under this NOFO.

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, except where instructed in this NOFO to do otherwise. Visit HRSA’s How to Prepare Your Application page for more information.

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 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/apply-for-a-grant/prepare-your-application https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://bhw.hrsa.gov/fundingopportunities/default.aspx

HRSA-23-120 iii

Table of Contents

I. PROGRAM 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 Justif ication Narrative

v. Standardized Work Plan (SWP) Form

vi. Program-Specific Forms

vii. Attachments

3. 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

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

HRSA-23-120 1

I. Program Description

1. Purpose

This notice announces the opportunity to apply for funding under the Maternity Care Nursing Workforce Expansion (MatCare) Program.

The purpose of the MatCare Program is to support accredited nurse midwifery programs to train nurse midwives through trainee scholarships, stipends, curriculum enhancement, and community-based training. The program seeks to grow and diversify the maternal and perinatal health nursing workforce through support for education and training in rural and underserved communities.

Program Goals

1. Increase the number of Certified Nurse Midwives (CNM) and diversify the maternal and perinatal health nursing workforce

2. Enhance maternal health training to better address maternal mental health, maternal mortality, and morbidity risk factors

3. Strengthen community-based training partnerships

2. Background

The MatCare Program is authorized by 42 U.S.C. § 296j (Section 811 of the Public Health Service Act).

More women die in the United States each year from pregnancy related complications than any other developed country.1 The maternal mortality rate for 2021 was 32.9 deaths per 100,000 live births, compared with a rate of 23.8 in 2020 and 20.1 in

2019.2 Disparities in maternal mortality persist due to variations in healthcare quality, access to care, underlying chronic conditions, and provider implicit bias, which contribute to the disproportionate impact of maternal deaths among underserved communities.3 American Indian/Alaska Native and Black women are 2 and 3 times more likely to die from pregnancy-related causes than White women.3 Rural and underserved populations experience maternal mortality more acutely4. Rural areas had a pregnancy-related mortality rate of 29.4 deaths per 100,000 live births versus 18.2 in urban areas.5

1 Tikkanen, R., Gunja, M. Z., FitzGerald, M., & Zephyrin, L. (2020, November 18). Maternal mortality and maternity care in the United States compared to 10 other developed countries. Maternal Mortality Maternity Care US Compared 10 Other Countries | Commonwealth Fund. (Accessed February 2023). https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries 2 Hoyert DL. Maternal mortality rates in the United States, 2021. NCHS Health E-Stats. 2023.

DOI: https://dx.doi.org/10.15620/cdc:124678 3 Centers for Disease Control and Prevention. (2022, April 6). Working together to reduce Black Maternal Mortality. Centers for Disease Control and Prevention. (Accessed February 2023). From https://www.cdc.gov/healthequity/features/maternal-mortality/index.html 4 Health disparities in rural women. ACOG. (2014, February). Retrieved February 10, 2023, from https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/02/health-disparities-in-rural-women 5 Maron, DF. Maternal Health Care Is Disappearing in Rural America. Scientific American. (2017). Retrieved from:

https://www.scientificamerican.com/article/maternal-health-care-is-disappearing-in-rural-america/ https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries https://www.scientificamerican.com/article/maternal-health-care-is-disappearing-in-rural-america/

Compounding this maternal mortality issue is the shortage of maternal health providers, with the shortage of obstetricians-gynecologists (OB/GYNs) projected to increase to more than 5,700 by 2030.6 Furthermore, shortages in rural areas persist, with 50 percent of US counties lacking OB/GYNs and 56 percent lacking nurse midwives.7 CNMs can help address this gap and meet the growing need for maternal health services and are well positioned to address issues related to social determinants of health for patients, families, and communities through primary care, gynecological care, and family planning services.8

Increasing and diversifying the number of CNMs is a high priority for addressing the maternal health workforce shortage and reducing maternal mortality disparities. Nurses from diverse backgrounds may be more sensitive to the issues of inequities and are more likely to work in underserved areas, providing lasting and sustainable health care to those who experience health, social, and economic disparities.9,10 Nurses who share a cultural or linguistic background with their patients may have a more in-depth knowledge of factors that impact their patients’ health outcomes, and can tailor treatment plans to appropriately meet patient needs.10 Research suggests that having a diverse nursing workforce population including from underrepresented minority (URM) groups are more likely to care for URM patients and serve in impoverished areas and thus improve access for underserved populations.11 Ensuring the maternal health workforce can address the needs of the communities they serve will help meet the cultural needs of an increasingly diverse population and achieving health equity in the

US.10

To better understand this NOFO, go to the dictionary of key program-related terms at Health Workforce Glossary.

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New

HRSA will provide funding in the form of a grant.

6 HRSA. (n.d.). Projections of Supply and Demand for Women’s Health Service Providers: 2018-2030. (Accessed February 202).

https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/projections-supply-demand-2018-2030.pdf 7 Hung, P., Henning-Smith, C. E., Casey, M. M., & Kozhimannil, K. B. (2017). Access to obstetric services in rural counties still declining, with 9 percent losing services, 2004-14. Health Affairs, 36(9), 1663-1671.

8 Workforce Projections. (Accessed February 2023). Data.hrsa.gov. https://data.hrsa.gov/topics/health-workforce/workforce-projections 9 Smith, G. R. (2007). Health Disparities: What Can Nursing Do? Policy, Politics, & Nursing Practice, 8(4), 285–291. Retrieved from: https://doi.org/10.1177/1527154408314600 10 How Nurses Can Help Address the Health Disparities Problem. (n.d.). Eastern Michigan University Online. Retrieved June 16, 2022, https://online.emich.edu/articles/rnbsn/the-health-disparities-problem.aspx#:~:text=Workplace%20Diversity%3A%20A%20diverse%20nursing%20workforce 11 Glazer, G., Tobias, B., & Mentzel, T. (2018). Increasing healthcare workforce diversity: Urban universities as catalysts for change.

Journal of Professional Nursing, 34(4), 239- 244. https://doi.org/10.1016/j.profnurs.2017.11.009 https://bhw.hrsa.gov/grants/resourcecenter/glossary https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/projections-supply-demand-2018-2030.pdf https://data.hrsa.gov/topics/health-workforce/workforce-projections https://data.hrsa.gov/topics/health-workforce/workforce-projections https://doi.org/10.1177/1527154408314600 https://online.emich.edu/articles/rnbsn/the-health-disparities-problem.aspx#:%7E:text=Workplace%20Diversity%3A%20A%20diverse%20nursing%20workforce https://online.emich.edu/articles/rnbsn/the-health-disparities-problem.aspx#:%7E:text=Workplace%20Diversity%3A%20A%20diverse%20nursing%20workforce

2. Summary of Funding

HRSA estimates approximately $8,000,000 to be available annually to fund approximately 8 award recipients. You may apply for a ceiling amount of up to $1,000,000 annually (reflecting direct and indirect costs) per year. Your request for each subsequent year of the period of performance cannot exceed your year 1 request.

The period of performance is September 30, 2023 through September 29, 2027 (4 years). Funding beyond the first year is subject to the availability of appropriated funds in subsequent fiscal years, satisfactory progress, and a decision that continued funding is in the best interest of the Federal Government.

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, tuition and fees, as otherwise allowable, and subawards and subcontracts in excess of $25,000 are excluded from the direct cost base for purposes of this calculation.

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 accredited schools of nursing, nursing centers, academic health centers, state or local governments, and other public or private nonprofit entities determined appropriate by the Secretary, such as HRSA supported health centers or Rural Health Clinics.

Eligible applicants located in 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 for these funds. Domestic community-based organizations, tribes and tribal organizations are also eligible to apply, if otherwise eligible.

Under an academic-clinical partnership, either partner may apply under this NOFO, provided the applicant is an eligible entity. Only one of the partners may apply and be awarded.

Individuals and for-profit entities are not eligible applicants under this NOFO.

http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

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 funding 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 42 U.S.C. § 296b(b) (Section 803(b) of the Public Health Service Act). 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 5.

HRSA will enforce statutory MOE requirements through all available mechanisms.

Beneficiary Eligibility Requirement

A trainee receiving support from grant funds under this program must be a citizen, non-citizen national of the United States, an individual lawfully admitted for permanent residence to the United States, or any other “qualified alien” under section 431(b) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. L. 104- 193, as amended. Individuals on temporary or student visas are not eligible to participate.

To be eligible for MatCare traineeship support, the student/trainee must meet all of the following requirements:

• Be a licensed registered nurse (RN).

• Be eligible to work in the United States.

• Be enrolled full-time in an advanced nursing education program to become certified as a CNM.

• Maintain the predetermined academic standards of the recipient institution.

Multiple Applications

Multiple applications from an organization with the same Unique Entity Identifier (UEI) are not allowable. Applicants can submit only one application per unique entity with distinct UEI. For example, the University of Homestate at Smalltown campus and the University of Homestate at Anytown campus with their own separate UEIs and separate 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 grounds, buildings (e.g., school of nursing), and faculty, can each submit an application for this program.

HRSA will only accept your last validated electronic submission 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. Where required, applications received without the appropriate tables will be deemed non-responsive to the NOFO and will not be considered for funding under this notice.

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 Grants.gov: HOW TO APPLY FOR GRANTS. If you use an alternative electronic submission, see Grants.gov: APPLICANT SYSTEM-TO-SYSTEM.

Form Alert: For the Project Abstract Summary, applicants using the SF-424 R&R Application Package are encountering a “Cross-Form Error” associated with the Project Summary/Abstract field in the “Research and Related Other Project Information” form, Box 7. To avoid the “Cross-Form Error,” you must attach a blank document in Box 7 of the “Research and Related Other Project Information” form and use the Project Abstract Summary Form in workspace to complete the Project Abstract Summary. See Section IV.2.i Project Abstract for content information.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-23-120 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 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 narrative, staffing plan and personnel requirements, assurances, certifications, etc. You must submit the information outlined in HRSA’s 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 https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/s2s/applicant-system-to-system.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/sf424guide.pdf submit the application in the English language and budget figures expressed in 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 to assist you in completing your application.

Application Page Limit The total number of pages that count against the page limit shall be no more than 50 pages when we print them. HRSA will not review any pages that exceed the page limit.

Using the pages within the page limit, HRSA will determine eligibility using Section III.

Eligibility Information of the NOFO.

These items DO NOT count in the Page Limit:

• Standard OMB-approved forms included in the workspace application package

• Abstract (standard form (SF) “Project_Abstract Summary”

• The Indirect Cost Rate Agreement (if it applies)

• The proof of non-profit status (if it applies)

If there are other items that do not count against the page limit, we’ll make this clear in Section IV.2.vii Attachments.

If you use an OMB-approved form that isn’t in the HRSA-23-120 workspace application package, it may count toward the page limit. We recommend you only use Grants.gov workspace forms related with this NOFO to avoid going over the page limit.

Applications must be complete, within the maximum specified page limit, and validated by Grants.gov under HRSA-23-120 before 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 9-15: Other Relevant Documents.

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

Program Requirements and Expectations

Successful award recipients must address and implement the following program requirements:

https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-rr-app-guide.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

Increase the Number of Certified Nurse Midwives and Diversify the Maternal and Perinatal Health Workforce

1. Recruit, train, support (e.g., through mentorship, peer support, social support), and graduate students, from diverse backgrounds, including those from disadvantaged and underrepresented populations, who will become certified nurse midwives. Applicants/award recipients are strongly encouraged to recruit faculty and preceptors from diverse populations.

2. Provide financial traineeship support, such as tuition scholarships and/or stipends, to student nurse midwives committed to working with rural and or underserved populations. Trainees who receive HRSA funds from the MatCare program must apply for and obtain a National Provider Identifier (NPI) number as a condition of their traineeship support.

o Award recipients must collect and report the NPI numbers of nursing students who receive traineeship funds and follow-up with graduates to collect post-graduation employment demographics for a minimum of 1 year after graduation.

Expand Maternal Health Training and Enhance Curriculum

3. Expand accredited certified nurse midwifery training programs to increase the number of students trained and graduated. Funding can be used to support infrastructure funding and project costs to administer training, such as administrative costs, preceptor stipends, faculty salary, and other project costs.

4. Implement or enhance didactic and clinical curriculum that addresses maternal mental health, social determinants of health (SDOH), care for individuals with limited English proficiency (LEP) and/or individuals with physical disabilities and/or intellectual and developmental disabilities (IDD), and promotes health equity for rural and underserved populations.

Strengthen Community-Based Training Partnerships

5. Establish or enhance academic-clinical/community-based partnerships that facilitate immersive, clinical training experiences (e.g., 3-6 months) for trainees in community-based settings with the goal of pairing them with competent preceptors and preparing them to provide high quality, culturally competent care.

Such training experiences must include a focus on addressing maternal mental health, reducing health disparities, decreasing maternal mortality and morbidity, and addressing the needs of underserved populations. Award recipients are responsible for establishing community-based clinical training experiences with competent clinical preceptors, and ensuring each trainee has a placement.

Examples of community-based settings to train and provide experiential learning experiences to participants include HRSA-supported health centers and Rural Health Clinics or other entities serving rural and underserved communities.

https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand

6. Develop or expand partnerships with other academic institutions (including Historically Black Colleges and Universities (HBCUs), Tribal Colleges and Universities (TCUs), Minority Serving Institutions (MSIs)), community-based organizations, or other community-based entities, to develop strategies to recruit a diverse group of trainees (through holistic admissions, career pathway programs, etc.), a diverse group of faculty and preceptors, and to assist graduates in finding employment.

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

Develop and upload (in Attachment 9) a disparities impact statement. Regularly report to HRSA the increase in the numbers of student nurse midwives that are (1) in training and (2) graduated as a result of grant funding.

Follow-up with graduates to collect post-graduation employment information for a minimum of 1 year after graduation and regularly report to HRSA the number of grant program-funded graduates providing maternal health care as certified nurse midwives.

Award recipients must adhere to HHS Evaluation Policy and evaluation standards and best practices described in OMB Memorandum M-20-12 when evaluating their program. Award recipients are required to participate in federally-designed evaluations to assess program effectiveness and efficiency upon request.

i. Project Abstract Use the Standard OMB-approved Project Abstract Summary Form that is included in the workspace application package. Do not upload the abstract as an attachment or it may count toward the page limit. See Form Alert in Section IV.1 Application Package.

For information required in the Project Abstract Summary Form, see Section 4.1.ix of HRSA’s SF-424 R&R Application Guide. When applicable, identify if a funding priority/ preference is being requested.

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 http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.evaluation.gov/assets/resources/Program-Evaluation-Practices.pdf

Narrative Section Review Criteria

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.

Successful applications will contain the information below. Please use the following section headers for the narrative:

PURPOSE AND NEED -- Corresponds to Section V’s Review Criterion(a) 1

Use and cite demographic data whenever possible to support the information provided. In your application:

• Briefly describe the purpose of the proposed project and how it will address the need for certified nurse midwives.

• Include a discussion of the target population served by certified nurse midwives, including the unmet needs as well as the maternal mental health, SDOH and health disparities impacting the population or communities served. Applicants may also use HRSA’s Maternal & Child Health Infant Mapping Tool or HPSA Find (Primary Care Maternity Care Target Area Score) to obtain additional data on maternal health in their community.

• Describe the need to diversify the CNM workforce in your locality, state or region and your institution’s commitment to train individuals who are from diverse backgrounds, including rural or disadvantaged backgrounds. This will also be demonstrated by completing the BHW Program Specific Data https://data.hrsa.gov/maps/mchb/ https://data.hrsa.gov/maps/mchb/ https://data.hrsa.gov/tools/shortage-area/hpsa-find

Form and uploading in Attachment 8, providing information about your institution’s student and graduate demographics.

• Include a Disparities Impact Statement (DIS) in Attachment 9. The DIS is an instrument used to measure and describe how training will support trainees’ capacity to meet the needs of underserved populations.

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(a) 2 (a)

In your application, provide a detailed work plan that demonstrates your ability to implement 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. Specific instructions on filling out the Standardized Work Plan Form are at Section IV.2.v. In addition to completing the Standardized Work Plan, applicants should include a brief narrative as outlined below.

In your work plan:

• Describe the activities or steps you will use to achieve each of the objectives proposed in your Methodology section throughout the entire four-year period of performance for the grant.

• Describe the timeframes, deliverables, and key partners/stakeholders required during the grant period of performance to address each of the needs described in the Purpose and Need section.

• Identify meaningful support and collaboration with key stakeholders in planning, designing, and implementing all activities, including securing clinical training sites.

• Explain how the work plan is appropriate for the program design and how the targets fit into the overall timeline of grant implementation.

(b) METHODOLOGY/APPROACH -- Corresponds to Section V’s Review Criterion 2 (b)

In your application, and consistent with the Program Requirements and Expectations in this NOFO:

• Outline your proposed project objectives, including proposed number of student NMs to be trained, and activities to achieve those objectives, and describe how they link to the project purpose and stated needs.

• Propose methods that you will use to address the stated needs. Include a description of any innovative methods that you will use. Specifically, applicants must describe the following:

o Strategies to recruit and enroll trainees that address the needs of the communities served including those from diverse backgrounds, which may include but are not limited to, outreach through HBCUs, TCUs and MSIs, holistic admissions, and career pathway programs.

o Approach in providing trainee retention and graduation support services such as mentoring, peer support, tutoring, counseling, academic coaching, stipends to support eligible non-tuition costs, etc.

o How the project will provide funds to trainees, including a disbursement plan for provision of traineeship support, including stipends.

o Plans to establish or expand partnerships with community-based clinical sites, other academic institutions (which may include HBCUs, TCUs, MSIs), community-based organizations, or other community-based entities, to recruit, retain and graduate trainees, provide community-based clinical training experiences, and assist graduates to find employment.

o Plans to secure community-based clinical training sites and competent clinical preceptors, that will prepare trainees to reduce health disparities, decrease maternal mortality and morbidity, and address the needs of underserved populations. Such plan must include ensuring that each trainee has placement with competent clinical preceptors.

• Identify strategies, tools and/or activities to address the SDOH, increase health literacy, and advance health equity.

(c) RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review Criterion 2 (c)

In your application:

• Discuss challenges that you are likely to encounter in designing and implementing the activities described, such as challenges with recruitment, retention, and graduation of trainees, including those from diverse backgrounds.

• Discuss approaches that you will use to resolve challenges described.

IMPACT -- This section includes two sub-sections— (a) Evaluation and Technical Support Capacity; and (b) Project Sustainability—both of which correspond to Section V’s Review Criteria 3 (a) and (b).

(a) EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to Section V’s Review Criterion) 3 (a)

In your application:

• Describe the systems and processes that will enable you to meet HRSA’s performance measurement requirements for the MatCare Program. This should include your strategy for collecting, managing, and reporting required performance data in an accurate and timely manner. At the following link you will find examples of reporting forms required for other BHW nursing workforce development grants that include data elements that you may be required to collect:

http://bhw.hrsa.gov/grants/reporting/index.html. Note: Performance measures and data forms are subject to change each academic year.

• Document the procedure for assuring the data collection, management, storage, and reporting of National Provider Identifier numbers for individuals participating in the Program. Describe your process to track trainees after program completion/ graduation for up to 1 year, to include collection of trainees’ NPIs. (Note: Trainees in eligible professions/disciplines who receive HRSA funds as a result of this award are required to apply for an NPI for the purpose of collecting post-graduation employment demographics).

• Describe the program performance evaluation. The program performance evaluation should monitor ongoing processes and the progress towards meeting the goals and objectives of the project. Include evidence that the evaluative measures will be able to assess: 1) to what extent the program objectives have been met, and 2) to what extent these can be attributed to the project. Include descriptions of the inputs (e.g., organizational profile, collaborative partners, key personnel, budget, and other resources), key processes, variables to be measured, and expected outcomes of the funded activities. Evaluations must adhere to HHS Evaluation Policy and evaluation standards and best practices described in OMB Memorandum M-20-12. The evaluation and reporting plan also should include the plans for dissemination of project results.

(b) PROJECT SUSTAINABILITY -- Corresponds to Section V’s Review Criterion 3 (b)

In your application:

• Propose a plan for project sustainability after the period of federal funding ends. Award recipients are expected to sustain key elements of their projects that have been effective in improving practices and that have led to improved outcomes for the target population.

• Include a description of specific actions you will take to (a) highlight key elements of your grant projects, e.g., training methods or strategies, which have been effective in improving practices; (b) obtain future sources of potential funding; and (c) provide a timetable for becoming self-sufficient.

• Discuss challenges that are likely to be encountered in sustaining the program and approaches that will be used to resolve such challenges.

ORGANIZATIONAL INFORMATION, RESOURCES, AND CAPABILITIES --

http://bhw.hrsa.gov/grants/reporting/index.html https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Faspe.hhs.gov%2Fsites%2Fdefault%2Ffiles%2Fmigrated_legacy_files%2F200386%2Fhhs-evaluation-policy.pdf&data=05%7C01%7CSLevant%40hrsa.gov%7Ca124bcd0f48f49734a0108db15bc1e92%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C638127670798899539%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=8ueiCkmhVkYaEwk1haAQRR6UB0IB7m3eQjv0%2B2RKtiQ%3D&reserved=0 https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.whitehouse.gov%2Fwp-content%2Fuploads%2F2020%2F03%2FM-20-12.pdf&data=05%7C01%7CSLevant%40hrsa.gov%7Ca124bcd0f48f49734a0108db15bc1e92%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C638127670798899539%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=qATMeAfSr2NAO1sOf33W4zfnTuRU6iuGR1bs9i0X9PM%3D&reserved=0 https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.whitehouse.gov%2Fwp-content%2Fuploads%2F2020%2F03%2FM-20-12.pdf&data=05%7C01%7CSLevant%40hrsa.gov%7Ca124bcd0f48f49734a0108db15bc1e92%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C638127670798899539%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=qATMeAfSr2NAO1sOf33W4zfnTuRU6iuGR1bs9i0X9PM%3D&reserved=0

Corresponds to Section V’s Review Criterion(a) 4

In your application:

• Succinctly describe your organization’s current mission, structure, and scope of current activities and how these elements all contribute to the organization’s ability to implement the program requirements and meet program expectations. Include an organizational chart (requested in Section IV.2.v./vi., Attachment 3).

• Discuss how the organization will follow the approved plan, as outlined in the application, properly account for the federal funds, ensure appropriate oversight of funds, and document all costs to avoid audit findings.

• Describe current experience, skills, and knowledge of personnel on previous work of a similar nature. Include the staffing plan and job descriptions for key faculty/staff to be involved in the proposed project in Attachment 2. Describe the minimum qualifications for each faculty/staff position in the job description.

Functional and program responsibilities should be specified in the narrative and position descriptions. A position description should not exceed one page in length but can be as short as one paragraph in length due to page limits.

• Include biographical sketches for key personnel in the SF-424 RESEARCH & RELATED Senior Key Person Profile (Expanded) form that can be accessed in the Application Package under “Mandatory”. (See details below).

• Describe organizations who will partner with yours to fulfill the goals of the program and meet the training objectives. Include, noting overall page limits, select copies of letters of agreement/MOU (Attachment 4), letters of support (Attachment 7) or similar documents from key organizations/individuals of their willingness to perform in accordance with the plan presented in the application, indicating partnership or support.

Project Director: The Project Director for the proposed project must at a minimum be a licensed Registered Nurse, with a master’s or doctoral level degree with experience in maternal health care. HRSA encourages applicants to select Project Directors with demonstrated competence (e.g., student/faculty/preceptor recruitment; community partnerships, program design), appropriate academic preparation, clinical (CNM) expertise, and experience as an educator. The Project Director maintains primary oversight for the project and is responsible to HRSA for all deliverables, requests for information, participation in HRSA requirements, and collaborations required for the grant. The Project Director is the primary contact and works closely with HRSA staff, members of the project staff and partners, and other award recipients as needed, to synergize efforts and ensure success of the project, and accomplish the goals of the MatCare program. NOTE: There can only be one Project Director for the MatCare Program.

Project Coordinator: The MatCare Program must include a Project Coordinator role that can be supported with grant funds or in-kind funds. The Project Coordinator is the point of contact for day-to-day operations of the project and will be responsible for implementing, overseeing, managing, coordinating, and tracking project activities and trainees, and will serve as a liaison between project partners. The Project Coordinator will also be responsible for data collection and ensuring timely reporting of data to

HRSA.

Biographical Sketches

Provide a biographical sketch for key faculty/staff contributing to the project (at a minimum, include a biographical for the Project Director). The information must be current, indicating the individual’s position and sufficient detail to assess the individual’s qualifications for the position being sought and consistent with the position description.

Each biographical sketch should be limited to two pages as they count toward the overall page limit. Include all degrees and certificates.

Biographical sketches (see Appendix C for sample) must be uploaded in the SF-424 RESEARCH & RELATED Senior/Key Person Profile (Expanded) form that can be accessed in Grants.gov via the NOFO Application Package under “Mandatory.”

Biographical sketches should include the following information:

• Senior/key personnel name

• Position Title

• Education/Training - beginning with baccalaureate or other initial professional education, such as nursing, including postdoctoral training and residency training if applicable:

o Institution and location o Degree (if applicable) o Date of degree (MM/YY) o Field of study

• Section A (required) Personal Statement. Briefly describe why the individual’s experience and qualifications make them particularly well-suited for their role (e.g., PD/PI) in the project that is the subject of the award.

• Section B (required) Positions and Honors. List in chronological order previous positions, concluding with the present position. List any honors. Include present membership on any Federal Government public advisory committee.

• Section C (optional) Other Support. List both selected ongoing and completed (during the last 3 years) projects (federal or non-federal support). Begin with any projects relevant to the project proposed in this application. Briefly indicate the overall goals of the projects and responsibilities of the Senior/Key Person identified on the Biographical Sketch.

• When applicable, biographical sketches must include training, language fluency and experience working with populations that are culturally and linguistically different from their own.

iii. Budget The directions offered in the SF-424 may differ from those offered by Grants.gov. Follow the instructions in Section 4.1.iv of HRSA’s SF-424 R&R Application Guide and any additional budget instructions provided below. A budget that follows the Application https://www.grants.gov/web/grants/search-grants.html?keywords=aNE-NPRF https://www.grants.gov/web/grants/search-grants.html?keywords=aNE-NPRF

Guide will ensure that, if HRSA selects your application for funding, you will have a well-organized plan and, by carefully following the approved plan, may avoid audit issues during the implementation phase. Follow the instructions in Section 4.1.iv of HRSA’s SF-424 R&R Application Guide and any additional budget instructions provided below.

A budget that follows the Application Guide will ensure that, if HRSA selects your application for funding, you will have a well-organized plan and, by carefully following the approved plan, may avoid audit issues during the implementation phase.

Additional Budget Instructions:

Subawards/subcontracts

A detailed line-item budget form is required for each subaward and should be uploaded to the Subaward Budget Attachment(s) Form. NOTE: The R&R Subaward Budget Attachment Form limits the number of attachments for subawards to 10. If you need to include additional line-item budget forms, upload the attachment in R&R Other Project Information Form, block 12 “Other Attachments.” These additional line-item budget forms for subawards will not count against the page limit. Note that any additional budget justifications (i.e., back-up information) are included in the page limit.

Reminder: The Total Project or Program Costs are the total allowable costs (inclusive of direct and indirect costs) you incur to carry out a HRSA-supported project or activity.

Total project or program costs include costs charged to the award and costs borne by you to satisfy a matching or cost-sharing requirement, as applicable.

As required by the Consolidated Appropriations Act, 2023 (P.L. 117-328), Division H, § 202, “None of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of Executive Level II.” Effective January 2023, the salary rate limitation is $212,100. Note that these or other applicable salary limitations may apply in the following fiscal years, as required by law.

In addition, the MatCare Program requires the following:

1. Applicants may request a maximum annual budget of $1,000,000 per year.

Annual budget includes:

o traineeship funding to cover participant/trainee support costs, and o infrastructure funding to cover administrative costs, preceptor stipends, faculty salary, and other project costs.

2. Dedicate a minimum of 70 percent of the total direct costs for Participant/Traineeship support. Charge costs to “Participant/Trainee Support Costs” in Section E of the SF424 R&R form. Allowable costs for traineeship awards may include:

o Scholarship to cover the total cost of tuition, books, fees, and health insurance for the duration of the nurse midwifery program to which the traineeship is provided; and o Stipends (reasonable living expenses), travel, and subsistence for the individual participants for the period for which the traineeship is provided.

This may include stipends to cover preceptor costs for preceptors who are not employees of the institution.

Note: Stipend support for preceptors who are not employees of the Applicant’s institution may be supported under Participant/Traineeship support category, or under contractual or consultant categories, as justifiable based on institutional policy. Award recipients are responsible for paying stipends support to the preceptors.

3. Salary for faculty/staff involved in the proposed project should be commensurate with the level of effort dedicated to the project.

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, tuition, and fees, and subawards and subcontracts in excess of $25,000 are excluded from the direct cost base for purposes of this calculation.

iv. Budget Justification Narrative See Section 4.1.v. of HRSA’s SF-424 R&R Application Guide.

All budgets must provide sufficient details to fully explain and justify the resources needed to accomplish all program objectives.

In your application:

• Describe all line-item federal funds (including subawards), and matching non-federal funds proposed for this project. Please note: all budget justification narratives count against the page limit.

In addition, MatCare requires the following:

Participant/Trainee Support Costs: List tuition, fees, health insurance, stipends (reasonable living expenses), travel, subsistence, other allowable expenses, and the number of trainees. Ensure that the total trainee costs are at least 70 percent of the total direct costs. Ensure that your budget breakdown separates these trainee costs, and includes a separate sub-total entitled “Total Participant/ Trainee Support Costs” which includes the summation of all trainee costs.

Participant/Trainees are not the employees of the applicant.

Consultant Services: If you are using consultant services, list the total costs for all consultant services. In the budget justification, identify each consultant, the services they will perform, the total number of days, travel costs, and the total estimated costs.

Disbursement Plan: Include a Disbursement Plan for the traineeship awards to be made to students from the MatCare grant funds. The plan must be included in the budget justification narrative at the time of application and should include a planned schedule of disbursement for student awards for the entire period of performance.