BHW HRSA-24-075 State PCO_Final-MOD-10-31-23.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY Fiscal Year 2024

Bureau of Health Workforce

Division of Policy and Shortage Designation

State Primary Care Offices

Funding Opportunity Number: HRSA-24-075

Funding Opportunity Type(s): New and Competing Continuation

Assistance Listings Number: 93.130

Application Due Date: 12/14/2023 Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

We will not approve deadline extensions for lack of registration.

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

Issuance Date: 09/14/2023

MODIFIED October 18, 2023: Eligibility clarified in Summary and Section III.1

Modified 10/31 – Updated Grants.gov links on page 8

Alpha Bah Lead Management Analyst, Division of Policy and Shortage Designation Call: (301) 945-9653 Email: abah@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: Sections 330(l), 330(m), and 333(d) of the Public Health Service Act (42 U.S. Code § 254b(l), 254b(m) and 254f(d)) as amended.

mailto:abah@hrsa.gov

HRSA-24-075 PCOs i

508 COMPLIANCE DISCLAIMER

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.

SUMMARY

Funding Opportunity Title: State Primary Care Offices

Funding Opportunity Number: HRSA-24-075

Assistance Listing Number: 93.130

Due Date for Applications: December 14, 2023

Purpose: To assist states and/or territories in their efforts to improve outpatient primary care services, conduct a statewide Community Health Needs Assessment (CHNA), manage shortage designations, and assess the workforce availability to meet the needs of underserved populations

Program Objective(s): To improve access to health care services for people who are uninsured, isolated, or medically vulnerable.

Eligible Applicants: Eligible applicants include any state or territory, state or territory agency, or other statewide domestic public or nonprofit entity; state controlled (public) institutions of higher education; and non-profit, private institutions of higher education.

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

Anticipated FY 2024 Total Available Funding:

$11,000,000

We’re issuing this notice to ensure that, should funds become available for this purpose, we can process applications and award funds appropriately. You should note that we may cancel

HRSA-24-075 PCOs ii this program notice before award if funds are not appropriated.

Estimated Number and Type of Award(s):

Up to 54 competing continuation, new cooperative agreement(s)

Estimated Annual Award Amount:

Amount varies. Ranges from $150,800 to $550,500, subject to the availability of appropriated funds

Cost Sharing or Matching Required:

No

Period of Performance: April 1, 2024, through March 31, 2029 (5 years)

Agency Contacts: Business, administrative, or fiscal issues:

Carolyn J. Cobb Grants Management Specialist Division of Grants Management Operations, OFAM Email: ccobb2@hrsa.gov

Program issues or technical assistance:

Alpha Bah Division of Policy and Shortage Designation Bureau of Health Workforce Email: abah@hrsa.gov

Application Guide

You (the applicant organization / agency) are responsible for reading and complying with the instructions included in this NOFO and in HRSA R&R Application Guide (R&R Application Guide). Visit HRSA’s How to Prepare Your Application page for more information.

Technical Assistance

We 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.

mailto:ccobb2@hrsa.gov mailto:abah@hrsa.gov https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-rr-app-guide.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-rr-app-guide.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-rr-app-guide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://bhw.hrsa.gov/fundingopportunities/default.aspx

HRSA-24-075 PCOs iii

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 OR 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. 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-24-075 PCOs 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the State Primary Care Offices (PCOs) Program. The purpose of this funding opportunity is to support states and territories in undertaking the following overarching efforts:

1. Statewide Primary Care Needs Assessment

2. Technical Assistance and Collaboration

3. Shortage Designation Coordination

The funding will facilitate the coordination of activities within a state or territory that assess the need for primary care services and providers, promote the recruitment and retention of health care providers to help meet identified needs, and help reduce shortages of health care providers. These activities include working with other state or territorial agencies and organizations whose policies affect and are impacted by the availability of health care services.

Program Objective: This program’s objective is to improve access to health care services for people who are uninsured, isolated, or medically vulnerable.

For more details, see Program Requirements and Expectations under section IV, Application and Submission Information.

2. Background

The State PCOs Program is authorized by sections §330(l), 330(m), and 333(d) of the Public Health Service Act as amended (42 U.S.C. § 254b(l), 254b(m) and 254f(d)).

Throughout the U.S., there are geographic areas, populations, and facilities with too few primary care, dental, and mental health providers, and services.1 HRSA continues to work with state and territory partners to determine which of these areas qualify as “shortage designations,” and therefore are eligible to receive certain federal resources.

By statute, HRSA uses shortage designations to help prioritize and focus agency resources on the areas of highest need. PCOs play an integral role in the shortage designation process by conducting needs assessments and surveying the availability of providers in their states and territories, then using that firsthand knowledge to identify the highest need areas eligible for shortage designations. The Program has provided the agency—and individual PCOs—with opportunities to highlight, disseminate, and discuss innovative solutions and best practices to help address provider tracking and

1 Pittman P, Chen C, Erikson C, Salsberg E, Luo Q, Vichare A, Batra S, Burke G. “Health Workforce for Health Equity.” Med Care. 2021 Oct 1;59(10 Suppl 5):S405-S408. doi: 10.1097/MLR.0000000000001609.

HRSA-24-075 PCOs 2 recruitment and retention issues, with the aim of improving access to care and reducing disparities.

HRSA is committed to maintaining and strengthening partnerships to assist in expanding access to quality health care.

Funding levels for FY 2024 – FY 2029 will be detailed in the Summary of Funding section below.

Program Definitions

To better understand this NOFO, go to the dictionary of key program-related terms at Health Workforce Glossary. In addition, the following definitions apply to the State PCOs Program for Fiscal Year 2024:

National Plan and Provider Enumeration System (NPPES): The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 mandated the adoption of standard unique identifiers for health care providers and health plans. The purpose of these provisions is to improve the efficiency and effectiveness of the electronic transmission of health information. The Centers for Medicare & Medicaid Services (CMS) has developed the NPPES to assign these unique identifiers.

NPPES National Provider Identifier (NPI) Registry: Healthcare providers acquire a unique 10-digit NPI to identify themselves in a standard way throughout their industry.

Individuals or organizations apply for NPIs through the CMS NPPES. After an NPI is supplied, CMS publishes the parts of the NPI record that have public relevance, including the provider's name, specialty (taxonomy), and practice address. CMS provides this service based on federal law (45 CFR Part 162).

II. Award Information

1. Type of Application and Award

Application type(s) Competing Continuation, New

We will fund you via a cooperative agreement.

A cooperative agreement is like a grant in that we award money, but we are substantially involved with program activities.

Aside from monitoring and technical assistance (TA), we also get involved in these ways:

• Participating, as appropriate, in meetings conducted during the period of performance including but not limited to: PCO Monthly Calls, Mentoring, PCO National Committee convenings, as well as user testing and HRSA-sponsored conferences;

• Reviewing and approving National Health Service Corps (NHSC) Site Applications;

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

HRSA-24-075 PCOs 3

• Reviewing submitted data and auditing the accuracy of Health Professional Shortage Area (HPSA), Medically Underserved Area/Population (MUA/P) application requests and Statewide Rational Service Area (SRSA) Plans; and

• Evaluating Needs Assessments and all other activity required under this Cooperative Agreement and provide feedback and approval to funding recipients.

You must follow all relevant federal regulations and public policy requirements. Your other responsibilities will include:

• Completing activities proposed in response to the program requirements described in Section IV of this NOFO;

• Communicating and collaborating on shortage designation activities with the Project Officer in meetings, calls, and ongoing review of activities, audits, procedures, and budget items;

• Informing stakeholders of those designations which are moved into a “Proposed for Withdrawal” status and highlighting the potential impact of designation withdrawals on state and federal workforce programs;

• Conducting a statewide assessment to identify shortages of health care providers and health care services, unmet need, and disparities in health outcomes by areas and/or population groups, and health workforce concerns;

• Collecting data on elements such as the number of NHSC site applications reviewed, measuring the impact of state/federally obligated providers serving in HPSAs, tracking the number of technical assistance and outreach sessions provided to stakeholders, among other activities;

• Attending training on, responding to surveys about, and maintaining the capacity to accurately collect and record provider data;

• Coordinating the HPSAs and MUA/P designation processes within the state to ensure consistent and accurate assessment of underservice including data collection, verification, and analysis as applicable;

• Providing technical assistance and collaboration to expand access to primary care, including coordination of the NHSC and Nurse Corps programs and provider recruitment and retention;

• Collaborating with Health Center workforce planning and development including but not limited to scoring of HPSAs, and providing technical assistance on available federal and state recruitment and retention programs;

• Collaborating with other HRSA partners and organizations to support access to primary care services; and

• Developing statewide, long-term strategies to address identified shortages of health care providers.

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2. Summary of Funding

We estimate $11,000,000 will be available each year to fund 54 recipients. Your request for each subsequent year of the period of performance cannot exceed your year 1 request.

The period of performance is April 1, 2024, through March 31, 2029 (5 years).

This program notice depends on the appropriation of funds. If funds are appropriated for this purpose, we will proceed with the application and award process.

Support beyond the first budget year will depend on:

• Appropriation

• Satisfactory progress in meeting the project’s objectives

• A decision that continued funding is in the government’s best interest

The amount of funding awarded will be determined according to the following methodology. Each awardee has a base annual funding amount of $150,000 per year plus workload funding amount so that:

Annual Funding Amount = Base Funding + [(Total Workload Funding) x (Workload Units/Total Workload Units)]

• Base Funding is $150,000 x 54 recipients = $8,100,000

• Total Workload Funding is $11,000,000 – $8,100,000 = $2,900,000

• Workload Units include the number of providers in eligible disciplines listed in the National Plan and Provider Enumeration System National Provider Identifier Registry in your state/territory as of April 02, 2023.

• Total Workload Units include the total number of all Workload Units for each of the 54 states and territories.

HRSA intends to make awards to cover every state and territory listed. HRSA aims to award one cooperative agreement to each individual state, territory, or group of states and/or territories to achieve this goal. Please note that if you are applying to represent a group of states and/or territories, you are eligible for the base annual funding amount of $150,000 in addition to the annual workload unit funding amount associated with the states and/or territories represented as shown in the chart below.

HRSA-24-075 PCOs 5

For example, using the stated funding methodology, a state/territory/consortium with 1000 Workload Units will request the following in annual funding:

$150,000 + [$2,900,000 x (1000/1,440,794)] = $152,747 Annual Funding

Workload Units by State/Territory

State/Territory Workload units Annual Workload Funding

Alabama 12,049 $24,252

Alaska 4,114 $8,281

Arizona 23,236 $46,769

Arkansas 9,710 $19,544

American Samoa* 76 $153

California 198,990 $400,521

Colorado 26,987 $54,319

Connecticut 24,921 $50,160

Delaware 4,394 $8,844

District of Columbia 8,829 $17,771

Florida 73,372 $147,681

Federated States of Micronesia* 4 $8

Georgia 29,974 $60,331

Guam* 241 $485

Hawaii 7,785 $15,669

Idaho 7,389 $14,872

Illinois 58,484 $117,715

Indiana 22,955 $46,203

Iowa 11,566 $23,280

Kansas 13,918 $28,014

Kentucky 17,205 $34,630

HRSA-24-075 PCOs 6

Louisiana 15,327 $30,850

Maine 9,146 $18,409

Maryland 32,844 $66,107

Massachusetts 56,546 $113,814

Marshall Islands* 1 $2

Michigan 58,610 $117,968

Minnesota 27791 $55,937

Mississippi 7,878 $15,857

Missouri 24,119 $48,546

Montana 4,776 $9,613

Northern Mariana Islands* 72 $145

Nebraska 7,234 $14,560

Nevada 10,809 $21,756

New Hampshire 6,800 $13,687

New Jersey 40,059 $80,629

New Mexico 11,125 $22,392

New York 125,572 $252,747

North Carolina 41,527 $83,584

North Dakota 3,716 $7,479

Ohio 53,410 $107,502

Oklahoma 13,231 $26,631

Oregon 21,630 $43,536

Pennsylvania 55,606 $111,922

Puerto Rico 15,381 $30,958

Republic of Palau* 12 $24

Rhode Island 7,397 $14,888

South Carolina 15,890 $31,983

South Dakota 3,088 $6,215

HRSA-24-075 PCOs 7

Tennessee 21,694 $43,665

Texas 75,049 $151,056

Utah 14,808 $29,805

Vermont 4,165 $8,383

Virgin Islands 220 $443

Virginia 33,098 $66,619

Washington 33,497 $67,422

West Virginia 6,812 $13,711

Wisconsin 23,007 $46,308

Wyoming 2,648 $5,330

Total for All PCOs 1,440,794 $2,899,985.00

* For these territories, any territory or nonprofit organization that applies under this Notice of Funding Opportunity will be competing for a single award and will be responsible for all Pacific Basin territories.

45 CFR part 75 - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards applies to all HRSA awards.

III. Eligibility Information

1. Eligible Applicants

You can apply if your organization is in the United States and is:

• A state or territory, state agency, or other statewide public or nonprofit entity that operates solely within a state or U.S. territories, including state controlled (public) institutions of higher education, and non-profit, private institutions of higher education.

o In addition to the 50 states, only 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.

o Only one awardee will be selected and responsible for all Pacific Basin territories.

o Institutions of higher education must be non-profits.

https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75

HRSA-24-075 PCOs 8

• Knowledgeable of state/territory-wide primary health care workforce availability challenges and opportunities

• Representative of or has relationships with a broad range of primary health care delivery systems and programs in the state.

• Public or private, non-profit.

2. Cost Sharing or Matching

Cost sharing or matching is not required for this program.

3. Other

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

• Exceeds the funding ceiling amount

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

Multiple Applications

Multiple applications from an organization with the same Unique Entity Identifier (UEI) are not allowable.

We will only review your last validated application before the Grants.gov due date.

IV. Application and Submission Information

1. Address to Request Application Package

We require you to apply online through Grants.gov. Use the SF-424 Research and Related (R&R) workspace application package associated with this notice of funding opportunity (NOFO). Follow these directions: How to Apply for Grants. If you choose to submit using an alternative online method, see 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.

Note: Grants.gov calls the NOFO “Instructions.”

Select “Subscribe” and enter your email address for HRSA-24-075 to receive emails about changes, clarifications, or instances where we republish the NOFO. You will also 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/ https://www.grants.gov/applicants/grant-applications/how-to-apply-for-grants https://www.grants.gov/system-to-system/applicant-system-to-system/

HRSA-24-075 PCOs 9 be notified by email of documents we place in the RELATED DOCUMENTS tab that may affect the NOFO and your application. You’re responsible for reviewing all information that relates to this NOFO.

2. Content and Form of Application Submission

Application Format Requirements Submit your information as the R&R Application Guide and this program specific NOFO state. Do so in English and budget figures expressed in U.S. dollars. There’s an Application Completeness Checklist in the R&R Application Guide to help you.

Application Page Limit The total number of pages that count toward the page limit shall be no more than 60 pages when we print them. We 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 toward the page limit:

• Standard OMB-approved forms you find in the NOFO’s workspace application package

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

• Indirect Cost Rate Agreement

• Proof of non-profit status (if it applies)

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

If you use an OMB-approved form that is not in the HRSA-24-075 workspace application package, it may count toward the page limit.

Applications must be complete and validated by Grants.gov under HRSA-24-075 before the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

• When you submit your application, you certify that you and your principals2 (for example, program director, principal investigator) can participate in receiving award funds to carry out a proposed project. That is, no federal department or agency has debarred, suspended, proposed for debarment, claimed you ineligible, or you have voluntarily excluded yourself from participating.

• If you fail to make mandatory disclosures, we may take an action like those in 45 CFR § 75.371. This includes suspending or debarring you.3

2 See definitions at eCFR :: 2 CFR 180.995 -- Principal. and eCFR :: 2 CFR 376.995 -- Principal (HHS supplement to government-wide definition at 2 CFR 180.995).

3 See also 2 CFR parts 180 and 376, 31 U.S.C. § 3354, and 45 CFR § 75.113.

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 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 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180/subpart-I/section-180.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376 https://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-prelim-title31-chapter33&edition=prelim https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-B/section-75.113

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• If you cannot certify this, you must include an explanation in Attachment 7-15:

Other Relevant Documents.

(See Section 4.1 viii “Certifications” of the R&R Application Guide)

Program Requirements and Expectations

Successful recipients should address the following program expectations:

Statewide Community Health Needs Assessment: By year three of the period of performance, each recipient must conduct a statewide Community Health Needs Assessment that identifies the communities with the greatest unmet health care needs, disparities in health outcomes, poverty, health workforce shortages, and barriers to health care access. The Needs Assessment should provide:

1. A description of the target populations in your state or territory and their unmet primary, dental, and mental health needs, including:

• An analysis of poverty rates using generally accepted measures (e.g., the Federal poverty rate or concentrations of individuals on Medicaid);

• An analysis of standard mortality and morbidity rates among geographic areas and/or target populations at the county and subcounty level (applicants may include infant mortality or low-birth rates in addition to standard mortality rates, if relevant);

• A description of unmet health needs, including updates or emerging challenges since the issuance of the previous awards under this title;

• A description of disparities in health outcomes (e.g., disparities based on geography, socioeconomic status, race, ethnicity, disability, primary language, health literacy, sex, gender identity, sexual orientation, etc.);

and

• Citations to verifiable demographic data to support the information provided (e.g., data from a U.S. government agency or survey).

2. A discussion of any relevant barriers, by service area, that the project will work to overcome, including:

• A description of infrastructure challenges (e.g., access to transportation, technological barriers, water fluoridation, etc.);

• A description of challenges target populations face (e.g., socioeconomic factors, waiting time to receive care, linguistic barriers, etc.);

• A description of challenges health care providers face (e.g., cultural competence, insufficient availability of training, etc.); and

• A description of the state or territory’s political and/or fiscal climate, or other possible issues that may affect your ability to achieve the project’s goals.

HRSA-24-075 PCOs 11

3. A plan for ongoing collaboration with recipients or interested parties in your state or territory, including:

• Partnership with at least two external interested parties (e.g., public health organizations, agencies or associations, health care facilities, local health departments, State Health Departments, or members of communities with higher levels of need) to effectively identify health needs;

• A description of what input external interested parties will provide in the development of the Needs Assessment; and

• A plan and/or timeline for meeting with external interested parties to review and update the Needs Assessment and conduct ongoing assessments.

Shortage Designation Coordination: Recipients are required to coordinate the HPSA and MUA/P designation process within the state/territory to ensure accurate assessment of underservice. The recipient will use the Shortage Designation Management System (SDMS) to manage health workforce data for their state/territory and apply for HPSAs and MUAs/Ps. Recipients must:

1. Provide technical assistance to interested parties about the designation process;

2. Assess the eligibility of new and existing HPSA and MUA/P designations;

3. Support designation applications with the most up-to-date and appropriate data by establishing systematic data collection methods such as state-wide provider surveys, or entering into agreements with state licensing boards, medical associations or societies, or other groups that collect up-to-date provider data in the state;

4. Proactively seek designations for areas and populations with barriers to care as demonstrated by primary care, dental, or mental health provider shortages or other high need indicators as detailed in the HPSA regulations;

5. Inform stakeholders of designations in Proposed for Withdrawal status and highlight potential impact of such withdrawal on workforce programs;

6. Maintain up-to-date knowledge of how to submit complete and accurate HPSA and MUA/P designation applications;

7. Participate in Shortage Designation Branch (SDB) training programs, recipient meetings, and distance learning training (web-based training modules, videoconferences, etc.) as deemed appropriate by SDB staff, including an annual Reverse Site Visit; and

8. Submit work products by the due date specified by SDB staff.

Please note that recipients may be required to revise rational areas previously identified in State Rational Service Area (SRSA) Plans.

HRSA-24-075 PCOs 12

Efforts to Expand Access to Primary Care. Recipients must engage in:

1) Recruitment and Retention Activities, including:

• Provider outreach and education activities in underserved areas. Efforts may include, distributing BHW loan repayment and scholarship program information, or speaking about BHW programs at academic institutions, conferences, meetings, or other public events, among other activities;

• Technical assistance, and application support to potential and current NHSC sites. Examples of technical assistance include:

o Helping site’s point of contact complete NHSC site applications and answering questions about their site’s HPSA designations.

o Contacting site points of contact with initiated applications, but unsubmitted applications.

o Providing site applicants notice of any missing documentation and/or non-compliance with NHSC eligibility and application requirements and forwarding any revised or new documentation to the Division of Regional Operations for their review.

• Maintaining up-to-date knowledge and capacity to review NHSC Site Applications for merit and completeness (Note: final decision on site approval rests with HRSA);

• Coordinating and collaborating with other state agencies and recruitment efforts to incorporate resources including NHSC Scholars, Loan Repayors, J-1 Visa Waiver holders, and other program participants into the state’s strategy to increase the number of providers in shortage areas.

2) Collaboration in Health Center Planning and Development; including:

• Providing information to assist in the development of new and the expansion of existing health centers in the state or territory;

• Serving as the point of contact for your state to the Primary Care Association (PCA) and other entities for access to and use of relevant data to support applications for new and expanded capacity of health centers;

• Facilitating the ability of PCAs and other entities to work with various divisions of the State Health Department to obtain data needed to educate leaders about unmet needs and the role of health centers;

• Partnering with PCAs, National Organizations of State and Local Officials (NOSLO) Program (which assists states and local authorities in: 1.

preserving and improving public health, 2. building capacity to address other public health matters and support and enforce regulations intended to improve the public’s health, and 3. preventing and suppressing communicable disease), State Offices of Rural Health (SORH), Area Health https://www.hrsa.gov/grants/find-funding/HRSA-23-059

HRSA-24-075 PCOs 13

Education Centers, State Health Departments, National Governor's Association (NGA), the Association of Clinicians for the Underserved (ACU) and other entities to maintain and strengthen the growth of health centers, and other community-based partners and training sites to encourage the provision of quality care; and

• Working with PCAs, SORHs, and other entities to develop reciprocal mechanisms of communication with organizations seeking information about Section 330 of the Public Health Service Act, creating, and authorizing the Health Center Program, and other funding opportunities.

3) Collaboration with Other HRSA Partners and Organizations to Support Access to Primary Care Services, including:

• Partnering with other entities, (e.g., the state PCA, the SORH, Rural Health Clinics, Indian Health Service, Tribal Health, and Urban Indian Health Organizations, and/or other appropriate entities) to provide technical assistance to communities and organizations interested in expanding access to care and strengthening the health care safety net.

• Establishing and maintaining an open line of communication with interested parties about provider availability and its effect on HPSA designations in the state.

• Collecting, maintaining, and reporting on the number and practice location of J-1 visa waiver and other similar program clinicians in the state.

Long-term Plan to Address Shortages of Health Care Providers Recipients must provide a plan, with specific objectives and timetables, that details strategies to fill the gap of identified health professional shortages, by discipline, including outreach and utilization of federal and state recruitment and retention programs.

Award recipients are required to participate in federally designed evaluations to assess program effectiveness and efficiency.

Program-Specific Instructions Include application requirements and instructions from Section 4 of the R&R Application Guide (budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract). Also include the following:

i. Project Abstract

Use the Standard OMB-approved Project Abstract Summary Form that you’ll find in the workspace application package. Do not upload the abstract as an attachment or it may count toward the page limit. For information you must include in the Project Abstract Summary Form, see Section 4.1.ix of the R&R Application Guide.

The Abstract must include:

• A brief overview of the project as a whole;

https://www.nga.org/about/ https://www.nga.org/about/ https://clinicians.org/who-we-are/our-mission/

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• Specific, measurable objectives that the project will accomplish, and;

• How the proposed project will be accomplished (i.e., the "who, what, when, where, and why).

NARRATIVE GUIDANCE

The following table provides a crosswalk between the narrative language and where each section falls within the review criteria. Make sure you’ve addressed everything. We may consider any forms or attachments you reference in a narrative section during the merit review.

Narrative Section Review Criteria

Introduction and Purpose Criterion 1: PURPOSE AND NEED

Organizational Information Criterion 4: ORGANIZATIONAL

INFORMATION, RESOURCES, AND

CAPABILITIES

Need Criterion 1: PURPOSE AND NEED

Approach - Work Plan Criterion 2a: RESPONSE TO PROGRAM

PURPOSE

Approach - Methodology Criterion 2b: RESPONSE TO PROGRAM

PURPOSE

Approach - Resolution of Challenges

Criterion 2c: RESPONSE TO PROGRAM PURPOSE – Resolution of Challenges

Evaluation and Technical Support Capacity

Criterion 3 (a): IMPACT - EVALUATION

AND TECHNICAL SUPPORT CAPACITY

Sustainability Criterion 3 (b): IMPACT – PROJECT

SUSTAINABILITY

Budget and Budget Justification Narrative

Criterion 5: SUPPORT REQUESTED

ii. Project Narrative

This section must describe all aspects of the proposed project. Make it brief and clear.

Provide the following information in the following order. Please use the section headers.

This ensures reviewers can understand your proposed project.

Introduction and Purpose – Corresponds to Section V’s Review Criterion #1:

PURPOSE AND NEED

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Briefly describe the purpose of the proposed project.

Organizational Information – Corresponds to Section V’s Review Criterion #4:

ORGANIZATIONAL INFORMATION/RESOURCES/CAPABILITIES

This section will help reviewers understand the organization:

• 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, Attachment 4).

Discuss how the organization will follow the approved plan, as outlined in the application, properly account for the federal funds, and document all costs to avoid audit findings. Describe how you will routinely assess and improve the unique needs of target populations of the communities served.

• Include a staffing plan and job descriptions for key staff in Attachment 1 (Staffing Plan and Job Descriptions for Key Personnel). 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.” If a biographical sketch is included for an individual who is not yet hired, please include a letter of commitment from that person.

Biographical Sketches

• Provide a biographical sketch for key staff contributing to the project. 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 one page as they count toward the overall page limit. Include all degrees and certificates. The biographical sketch should include:

• 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

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• 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.

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

This section will help reviewers understand the needs of the communities served by the proposed project.

• Outline the needs for the State PCOs Program and how the cooperative agreement would assist in fulfilling those needs. You should include a discussion of the target populations that lack access to primary, dental, and mental health care and the availability of the appropriate health workforce.

• In addition, discuss the relevant social determinants of health and health outcome disparities impacting the population or communities served as well as their unmet needs. Use and cite demographic data whenever possible to support the information provided.

APPROACH –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) WORK

PLAN

Provide a detailed work plan that demonstrates your experience or ability 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. Applicants should include a brief narrative element outlined below, in addition to completing the SWP.

In your work plan (SWP and narrative section):

• Describe the activities or steps you will use to achieve each of the objectives proposed during the entire period of performance identified in the Methodology

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

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

• Identify meaningful support and collaboration with key stakeholders in planning, designing, and implementing all activities, including development of the application and, further, the extent to which these contributors reflect the cultural, racial, linguistic, and/or geographic diversity of the populations and communities served.

• If funds will be sub-awarded or expended on contracts, describe how your organization will ensure the funds are properly documented.

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 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 Health Equity in the “Other Priority Linkage” if your objective or sub-objectives align with that priority. Form instructions are provided along with the SWP form and are included in the application package found on Grants.gov. The Project Director must register in the HRSA Electronic Handbooks (EHBs) once award is made, in order to review and finalize the completed SWP.

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

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

• Describe your objectives and proposed activities and provide evidence for how they link to the project purpose and stated needs.

• Propose methods that you will use to address the stated needs and meet each of the previously described program requirements and expectations in this NOFO. As appropriate, include development of effective tools and strategies for ongoing staff training, outreach, collaborations, clear communication, and information sharing/dissemination to involve providers, patients, families, and communities.

• Include a plan to disseminate reports, products, and/or project outputs so that key target audiences receive the project information.

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

Discuss challenges that you are likely to encounter in designing and implementing the activities described in the work plan, and approaches that you will use to resolve such challenges.

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 Impact.

(a) EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to Section V’s Review Criterion #3 (a) Evaluation and Technical Support Capacity

• Describe the systems and processes that will enable you to meet HRSA’s performance measurement requirements for the State PCOs Program. This should include your strategy for collecting, managing, and reporting required performance data in an accurate and timely manner. Sample data elements that you may be required to collect include, but are not limited to, the following:

o Number of NHSC site applications reviewed.

o Changes in the number of state/federally obligated providers serving in HPSAs.

o Number of technical assistance and outreach sessions provided to stakeholders, among others.

Note: Performance measures and data forms are subject to change each year.

• Describe the plan for the program performance evaluation that will contribute to continuous quality improvement. The program performance evaluation should monitor ongoing processes and the progress towards meeting the workplan goals and objectives of 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.

• Describe current experience, skills, and knowledge, including individuals on staff, materials published, and previous evaluation work. Describe any potential obstacles for implementing the program performance evaluation and meeting HRSA’s performance measurement requirements and your plan to address those obstacles. The evaluation and reporting plan also should indicate the feasibility and effectiveness of plans for dissemination of project results, the extent to which project results may be national in scope, and the degree to which the project activities are replicable.

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• Document the procedure for assuring accurate and up-to-date provider FTE data collection, management, storage, and reporting of National Provider Identifier (NPI) numbers for relevant providers in the state or territory.

(b) SUSTAINABILITY -- Corresponds to Section V’s Review Criterion #3 (b) Project Sustainability

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. Propose a plan for project sustainability after the period of federal funding ends. 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; as well as (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.

iii. Budget

Budget - Corresponds to Section V’s Review Criterion #5 Support Requested

The R&R Application Guide directions may differ from those on Grants.gov.

Follow the instructions in Section 4.1.iv Budget of the R&R Application Guide and any specific instructions listed in this section. Your budget should show a well-organized plan.

Reminder: The total project or program costs are all allowable (direct and indirect) costs used for the HRSA activity or project. This includes costs charged to the award and non-federal funds used to satisfy a matching or cost-sharing requirement (which may include MOE, if applicable).

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, as applicable.

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As required by the Consolidated Appropriations Act, 2023 (P.L. 117-328), “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.” See Section 4.1.iv Budget – Salary Limitation of HRSA’s SF-424 R&R Application Guide. for additional information. Note that these or other salary limitations may apply in the following fiscal years, as required by law.

Program Income

You must use any program income you generate from awarded funds for approved project-related activities. Use program income under the addition alternative (45 CFR § 75.307(e)(2)). Find post-award requirements for program income at 45 CFR § 75.307.

iv. Budget Justification Narrative

Budget Justification – Corresponds to Section V’s Review Criterion #5 Support Requested

See Section 4.1.v. of the R&R Application Guide.

The budget justification narrative must describe all line-item federal funds (including subawards), and matching non-federal funds proposed for this project, if applicable.

Please note: all budget justification narratives count against the page limit.

In addition, the State Primary Care Offices requires the following:

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.

v. Standardized Work Plan (SWP) Form

As part of the application package submitted through Grants.gov, you must complete and electronically submit the SWP Form by the application due date. Ensure it includes all the information detailed in Section IV.2.ii. Project Narrative.

vi. Attachments

Provide the following attachments in the order we list them.

Most attachments count toward the application page limit. Indirect cost rate agreement and proof of non-profit status (if it applies) are the only exceptions. They will not count toward the page limit.

Clearly label each…