BPHC HRSA-22-154 (H8I) FY 2022 Accelerating Cancer Screening_Final_r.pdf

U.S. Department of Health and Human Services

Bureau of Primary Health Care

Health Center Program

Fiscal Year 2022 Accelerating Cancer Screening

Funding Opportunity Number: HRSA-22-154

Funding Opportunity Type: New

Assistance Listings (AL) Number: 93.224

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2022

Application Due Date: June 15, 2022 Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

HRSA will not approve deadline extensions for lack of registration.

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

Issuance Date: May 4, 2022

Tirzah McClinton and Wendy Bowen Public Health Analysts, Bureau of Primary Health Care Office of Policy and Program Development Contact: https://hrsa.force.com/support/s/ Telephone: (301) 594-4300 AxCS technical assistance webpage: https://bphc.hrsa.gov/programopportunities/accelerating-cancer-screening See Section VII for a complete list of agency contacts.

Authority: Public Health Service Act § 330(e), (g), (h), and/or (i), 42 USC § 254b(e), (g), (h), and/or (i), as appropriate.

https://hrsa.force.com/support/s/ https://bphc.hrsa.gov/programopportunities/accelerating-cancer-screening

HRSA-22-154 i

508 COMPLIANCE DISCLAIMER

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

Agency Contacts.

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications from HRSA-funded health centers for the fiscal year (FY) 2022 Accelerating Cancer Screening (AxCS) funding opportunity under the Health Center Program. The purpose of this program is to support health centers to increase equitable access to cancer screening and referral for care and treatment by enhancing patient education, case management, outreach, and other enabling services, in close partnership or coordination with National Cancer Institute (NCI)-designated Cancer Centers that will deploy outreach specialists and patient navigators for populations served by health centers.

Funding Opportunity Title: Fiscal Year (FY) 2022 Accelerating Cancer Screening

Funding Opportunity Number: HRSA-22-154 Due Date for Applications (Grants.gov only):

June 15, 2022 (11:59 p.m. ET)

Anticipated Total Annual Available FY 2022 Funding:

Approximately $5 million

Estimated Number and Type of Awards: Up to 10 grants Estimated Award Amount: Up to $500,000 per award Cost Sharing/Match Required: No Period of Performance: September 1, 2022 through

August 31, 2024 (2 years) Eligible Applicants:

Organizations that are Health Center Program operational (H80) grant award recipients and that partner with an NCI-designated Cancer Center.

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

HRSA-22-154 ii

Application Guide You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 Application Guide, available online, except where instructed in this NOFO to do otherwise.

Technical Assistance

Application resources, including example forms and documents, as well as a frequently asked questions document, are available at https://bphc.hrsa.gov/programopportunities/accelerating-cancer-screening. HRSA will hold a pre-application technical assistance (TA) webinar that will include an overview of these instructions and address questions on the application process and AxCS objectives. Refer to “Apply for a Grant”, available at http://www.hrsa.gov/grants/apply, for general (i.e., not AxCS specific) information on a variety of application and submission components.

The HRSA Primary Health Care Digest is a weekly email newsletter containing information and updates pertaining to the Health Center Program, including competitive funding opportunities. Organizations interested in seeking funding under the Health Center Program are encouraged to have several staff subscribe.

Health center strategic partners are available to assist you in preparing a competitive application, including the National Training and Technical Assistance Partners (NTTAPs), Primary Care Associations (PCAs), and Health Center Controlled Networks (HCCNs). The HRSA-supported Telehealth Resource Centers offer technical assistance and coaching specific to advancing the use of telehealth. For a list of HRSA-supported PCAs, NTTAPs, and HCCNs, refer to HRSA’s Strategic Partnerships webpage.

Applicant Page Limit Checklist

The purpose of this worksheet is to give you a tool to ensure the number of pages you attach to Standard Forms is within the specified page limit (do not submit this worksheet as part of your application). The Standard Forms do not count against the page limit;

however, attachments to the Standard Forms do count toward the page limit. For example, the Budget Narrative Attachment Form does not count; however, the entire length of your attachment to that form does count against the page limit.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://bphc.hrsa.gov/programopportunities/accelerating-cancer-screening http://www.hrsa.gov/grants/apply https://public.govdelivery.com/accounts/USHHSHRSA/subscriber/new?topic_id=USHHSHRSA_118 https://bphc.hrsa.gov/qualityimprovement/strategicpartnerships/ncapca/natlagreement.html https://bphc.hrsa.gov/qualityimprovement/strategicpartnerships/ncapca/associations.html https://bphc.hrsa.gov/qualityimprovement/strategicpartnerships/hccn.html https://www.telehealthresourcecenter.org/ https://bphc.hrsa.gov/programopportunities/fundingopportunities/sac/supportnetworks/index.html

HRSA-22-154 i

Standard Form Name (Forms themselves do not count against the page limit)

Attachment File Name

(Unless otherwise noted, attachments count against the page limit)

Required OR Optional

Attachment

Section of the NOFO or

Application Package

# of Pages Applicant Instruction – enter the number of pages of the attachment to the

Standard Form

Application for Federal Assistance (SF-424 - Box 14)

Areas Affected by Project (Cities, Counties, States, etc.)

Optional Application Package

My attachment = # pages

Box 16)

Additional Congressional District

Optional Application

Box 20)

Is the Applicant Delinquent On Any Federal Debt?

Required, if “Yes”

Application

Attachments Form Attachment 1:

Project Work Plan

Required Section IV.2.v My attachment = # pages

Attachments Form Attachment 2:

Partnership Documentation

Required Section IV.2.v My attachment = # pages

Attachments Form Attachment 3:

Letters of Support

Optional Section IV.2.v My attachment = # pages

HRSA-22-154 ii

Standard Form Name (Forms themselves do not count against the page limit)

Attachment File Name

(Unless otherwise noted, attachments count against the page limit)

Required OR Optional

Attachment

Section of the NOFO or

Application Package

# of Pages Applicant Instruction – enter the number of pages of the attachment to the

Standard Form

Attachments Form Attachment 4:

Summary of Contracts and Agreements

Optional Section IV.2.v My attachment = # pages

Attachments Form Attachment 5:

Equipment List

Optional Section IV.2.v My attachment = # pages

Attachments Form Attachment 6: Other Relevant Documents

Optional Section IV.2 v My attachment = # pages

Project/Performance Site Location Form

Additional Performance Site Location(s)

Optional Application Package

My attachment = # pages

Project Narrative Attachment Form

Project Narrative Required Section IV.2ii My attachment = # pages

Budget Narrative Attachment Form

Budget Narrative Required Section IV.2.iv My attachment = # pages

# of Pages Attached to Standard Forms Applicant Instruction Total the number of pages in the boxes above.

Page Limit for HRSA-22-154 is 60 pages My total = ## pages

HRSA-22-154 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/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

Program-Specific Instructions

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. 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

APPENDIX A: SCOPE OF PROJECT

HRSA-22-154 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity for HRSA-funded health centers to apply for FY 2022 Accelerating Cancer Screening (AxCS) funding. AxCS funding will support health centers to increase equitable access to cancer screening and referral for care and treatment1 by enhancing patient education, case management, outreach, and other enabling services, in close partnership or coordination with National Cancer Institute (NCI)-designated Cancer Centers that will deploy outreach specialists and patient navigators for populations served by health centers.

For more details, see Program Requirements and Expectations.

2. Background

The Health Center Program is authorized by the Public Health Service Act (PHS Act) § 330 (42 USC § 254b). For the purpose of this NOFO, health centers are defined as those receiving Health Center Program operational funding under sections 330(e), (g),

(h) and/or (i), otherwise referred to as H80 funding. AxCS funding will be awarded to health centers under the same subsection(s) of section 330 as their H80 award.

AxCS funding is being made available through the Alcee L. Hastings Program for Advanced Cancer Screening in Underserved Communities.

Cancer is the second leading cause of death in the United States, with nearly 600,000 deaths annually.2 In 2021, there were an estimated 281,550 breast cancers and 14,480 cervical cancers diagnosed in women3 and 149,500 colorectal cancers diagnosed in men and women.4 Breast, cervical, and colorectal cancer can be prevented or detected early through appropriate screening and timely follow-up care of an abnormal cancer screening test result. Yet, disparities in screening and follow-up care after an abnormal cancer screening test result persist by race/ethnicity, socioeconomic status, and health care access.5 Disruptions in cancer care during the COVID-19 pandemic resulted in

1 For the purpose of this NOFO, referral for care and treatment is defined as assisting patients with accessing appropriate follow-up care (e.g., diagnostic services, therapies, clinical trials) within 30 days of receiving an abnormal screening test result.

2 Centers for Disease Control and Prevention. An Update on Cancer Deaths in the United States. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, Division of Cancer Prevention and Control; 2021.

3 Cancer Stat Facts. Seer.cancer.gov. Updated September 27, 2021. Accessed December 8, 2021.

https://seer.cancer.gov/statfacts/.

4 Cancer Stat Facts: Colorectal Cancer. Seer.cancer.gov. Updated September 27, 2021. Accessed December 8, 2021. https://seer.cancer.gov/statfacts/html/colorect.html.

5 American Association for Cancer Research. Cancer Disparities Progress Report 2020. Philadelphia:

American Association for Cancer Research; 2020. 59-72. Accessed December 6, 2021.

https://cancerprogressreport.aacr.org/disparities/chd20-contents/chd20-disparities-in-cancer-screening-for-early-detection/.

http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim https://seer.cancer.gov/statfacts/ https://seer.cancer.gov/statfacts/html/colorect.html https://cancerprogressreport.aacr.org/disparities/chd20-contents/chd20-disparities-in-cancer-screening-for-early-detection/ https://cancerprogressreport.aacr.org/disparities/chd20-contents/chd20-disparities-in-cancer-screening-for-early-detection/

HRSA-22-154 2

reductions in breast, cervical, and colorectal cancer screening.6 Disparities in cancer care were exacerbated during the pandemic in communities less likely to use telehealth.7

Health centers are a key point of entry to screening for breast, cervical, and colorectal cancer. In 2020, over 1.4 million female health center patients had a mammogram to screen for breast cancer, and over 3.8 million health center patients were screened for cervical cancer.8 Additionally, over 2.4 million health center patients were screened for colorectal cancer.9 Health center non-clinical enabling services, including translation, transportation, outreach and education, case management, care coordination, and eligibility assistance can help to reduce disparities in access to cancer screening and referral for care and treatment for underserved populations.

NCI-designated Cancer Centers10 (Cancer Centers) are scientific leaders in the efforts to reduce the unequal burden of cancer through basic, clinical translational, and population science research, and serve their communities and the broader public by integrating training and education for biomedical researchers and health care professionals. Cancer Centers disseminate evidence-based findings to their communities and study how they can be translated to benefit similar populations around the country. Cancer Centers also provide public education and outreach programs on cancer prevention and screening, with special attention to the needs of underserved populations.

As part of your AxCS project, you will leverage the community outreach and engagement resources of the Cancer Centers to increase access and address barriers to cancer screening and referral for care and treatment.

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 Mayo M, Potugari B, Bzeih R, Scheidel C, Carrera C, Shellenberger RA. Cancer Screening During the COVID-19 Pandemic: A Systematic Review and Meta-analysis. Mayo Clin Proc Innov Qual Outcomes.

2021;5(6):1109-1117. doi:10.1016/j.mayocpiqo.2021.10.003.

7 Schmidt AL, Bakouny Z, Bhalla S, et al. Cancer Care Disparities during the COVID-19 Pandemic:

COVID-19 and Cancer Outcomes Study. Cancer Cell. 2020 Dec 14;38(6):769-770. www.cell.com/cancer-cell/fulltext/S1535-6108(20)30554-7. Accessed December 23, 2021.

8 U.S. Department of Health and Human Services, Health Resources and Services Administration, Health Center Data and Reporting, available at https://data.hrsa.gov/tools/data-reporting.

9 U.S. Department of Health and Human Services, Health Resources and Services Administration, Health Center Data and Reporting, available at https://data.hrsa.gov/tools/data-reporting.

10 There are 71 NCI-designated Cancer Centers, located in 36 states and Washington, D.C. For a list of NCI-designated cancer centers, see https://www.cancer.gov/research/infrastructure/cancer-centers.

http://www.cell.com/cancer-cell/fulltext/S1535-6108(20)30554-7 http://www.cell.com/cancer-cell/fulltext/S1535-6108(20)30554-7 https://www.cancer.gov/research/infrastructure/cancer-centers

HRSA-22-154 3

2. Summary of Funding

HRSA estimates approximately $5 million willbe available to fund approximately 10 recipients. You may apply for a ceiling amount of up to $500,000 total (includes both direct and indirect costs), to be spent over the 2-year period of performance (e.g., $250,000 in year 1 and $250,000 in year 2). The period of performance is September 1, 2022 through August 31, 2024 (2 years).

HRSA may adjust the final award amounts based on the number of fundable applications.

If funded, HRSA will award AxCS funding as a new grant award, separate from your H80 award. Under 45 CFR § 75.302, you must document use of AxCS funds separately and distinctly from other Health Center Program funds and other federal award funds. If funded, you must maintain your H80 award status throughout the 2-year period of performance to maintain your AxCS funding.

While AxCS funding will be issued as a new award, all uses of AxCS funds must align with your current Health Center Program scope of project. See Appendix A for information about reviewing and/or updating your scope of project, if needed. When implementing your AxCS project, you must comply with all Health Center Program requirements as described in the Health Center Program Compliance Manual, and applicable law.11

Additional funding to support cancer screening may be made available beyond the 2 years of funding under this NOFO. If additional funding is made available, HRSA will assess your performance on the AxCS objectives and activities through various means, which may include biannual reports and your calendar year 2023 Uniform Data System (UDS) data. Performance assessments may result in increased, level, reduced, or no funding beyond the initial 2-year funding period. If AxCS funding is continued, this initial award may be supplemented and/or additional funding may be made available under your H80 award.

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

Organizations eligible for AxCS funding are Health Center Program operational (H80) grant award recipients12 that partner with an NCI-designated Cancer Center.

11 Requirements are stated in 42 U.S.C. § 254b (section 330 of the PHS Act), and in applicable program regulations (42 CFR parts 51c and 56, as appropriate) and grants regulations (HHS Grants Policy Statement and 45 CFR part 75).

12 Funded under sections 330(e), (g), (h), and/or (i) of the PHSA.

https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.302 https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 https://www.ecfr.gov/current/title-42/chapter-I/subchapter-D/part-51c/ https://www.ecfr.gov/current/title-42/chapter-I/subchapter-D/part-56?toc=1 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75

HRSA-22-154 4

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

HRSA will consider any application that exceeds the ceiling amount of $500,000 non-responsive and will not consider it for funding under this notice.

HRSA will consider any application that does not include the Project Narrative described in Section IV.2.ii, and the Project Work Plan and partnership documentation13 with a Cancer Center described in Section IV.2.v non-responsive and will not consider it for funding under this notice.

HRSA will consider any application that fails to satisfy the deadline requirements referenced in Section IV.4 non-responsive and will not consider it for funding under this notice.

HRSA will only accept your last validated electronic submission under HRSA-22-154 in Grants.gov, before the application due date as the final and only acceptable application.14

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically through Grants.gov using the SF-424 workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at Grants.gov: HOW TO APPLY FOR

GRANTS.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-22-154 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.

13 The partnership documentation must include a commitment from the Cancer Center to deploy trained and supervised outreach specialists and patient navigators to improve cancer screening and referral within the health center’s service area.

14 Grants.gov has compatibility issues with Adobe Reader DC. Direct questions pertaining to software compatibility to Grants.gov. See Section VII for contact information.

https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html

HRSA-22-154 5

2. Content and Form of Application Submission

Application Format Requirements

Section 4 of HRSA’s SF-424 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 the HRSA SF-424 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 Application Guide except where instructed in the NOFO to do otherwise. You must submit the application in the English language and in the terms of U.S. dollars (45 CFR § 75.111(a)).

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

The following application components must be submitted in Grants.gov:

• Application for Federal Assistance (SF-424)

• Project Abstract

• Project/Performance Site Locations

• Grants.gov Lobbying Form

• Key Contacts

• Project Narrative Attachment Form

• Budget Information – Non-Construction Programs (SF-424A)

• Budget Narrative Attachment Form (include a Table of Personnel to be Paid with

Federal Funds)

• Attachments

Application Page Limitation

The total size of all uploaded files may not exceed the equivalent of 60 pages when printed by HRSA. The page limit includes the project and budget narratives and attachments. Note that effective April 22, 2021, the abstract is no longer an attachment that counts in the page limit. The abstract is the standard form "Project Abstract Summary.” Standard OMB-approved forms do not count in the page limit. However, if you use an OMB-approved form that is not included in the application package for HRSA-22-154, it may count against the page limit. Therefore, HRSA strongly recommends that you only use the Grants.gov workspace forms associated with this NOFO to avoid exceeding the page limit. The indirect cost rate agreement does not count in the page limit. It is important to take appropriate measures to ensure that your application does not exceed the specified page limit.

Applications must be complete, within the specified page limit, validated by Grants.gov, and submitted under HRSA-22-154 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, http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-B/section-75.111 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-B/section-75.111

HRSA-22-154 6

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 USC § 3321).

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachment 6: 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

Program Requirements

You must propose to use AxCS funds to achieve two objectives:

1. Increase the number and percentage of patients screened for at least one of the following cancer types: cervical,15 breast,16 or colorectal cancer.17

2. Increase the number of patients assisted with accessing appropriate follow-up care (e.g., diagnostic services, therapies, clinical trials) within 30 days of receiving an abnormal cancer screening test result.18

You will also track the percentage of patients that you refer for care and treatment for whom you receive a report from the provider to whom the patient was referred.

You will advance progress on the AxCS objectives by implementing at least one activity within each of the four focus areas:

1. Access and affordability;

2. Patient experience;

3. Screening; and

4. Workforce development.

You are required to establish or enhance a partnership with an NCI-designated Cancer Center that leverages Cancer Center expertise, including Cancer Center trained and supervised outreach specialists and patient navigators, to improve cancer screening

15 Cervical cancer: Screening. Recommendation: Cervical Cancer: Screening | United States Preventive Services Taskforce. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening. Published August 21, 2018. Accessed December 21, 2021.

16 Breast cancer: Screening. Recommendation: Breast Cancer: Screening | United States Preventive Services Taskforce. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening. Published January 11, 2016. Accessed December 21, 2021.

17 Colorectal cancer: Screening. Recommendation: Colorectal Cancer: Screening | United States Preventive Services Taskforce.

https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening.

Published May 18, 2021. Accessed December 21, 2021.

18 For more information, see Cancer Control Continuum available at https://cancercontrol.cancer.gov/about-dccps/about-cc/cancer-control-continuum.

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 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376 http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening https://cancercontrol.cancer.gov/about-dccps/about-cc/cancer-control-continuum

HRSA-22-154 7

and referral for care and treatment within your service area. You may use AxCS funds to contract with Cancer Centers to train new and existing health center personnel to build capacity in these areas within your health center. You will leverage Health Center Program and Cancer Center resources to assess and address barriers to cancer screening through outreach, patient education, case management, and other enabling services that will support the AxCS objectives. In collaboration with the Cancer Center, you may establish additional objectives and measures of success that you will collect and monitor throughout the period of performance.

You may propose a project that focuses only on the required partnership with a Cancer Center, or you may also partner with other health centers, state/local health departments, Native American Tribal organizations, and/or community and faith-based organizations to leverage community outreach and engagement resources to increase cancer screening and referral for care and treatment. Health centers may use AxCS funds to purchase training and/or technical assistance from Cancer Centers and other partner organizations. You must clearly describe any training or technical assistance contractual or consulting costs in your budget request and ensure that all procurement costs are consistent with federal procurement standards and cost principles.19

Refer to Figure A for a visual representation of the documented partnership between the health center award recipient, the required NCI-designated Cancer Center, and optional partnering organizations.

Figure A

Program Expectations

19 See 45 CFR part 75 Subpart D: Procurement Standards and 45 CFR part 75 Subpart E: Cost Principles.

https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR640bc005c7f52f6 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-E https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-E

HRSA-22-154 8

Post-award oversight of your AxCS award may include Project Work Plan status updates, interim data reports, or participation in site visits or targeted technical assistance. Additional details will be provided on the terms of award.

HRSA expects that you will leverage AxCS funds to address issues of equity20 in cancer screening and referral for care and treatment, including applying an understanding of intersectionality and how multiple forms of discrimination affect individuals’ lived experiences. Individuals and communities often belong to more than one group that has been historically underserved, marginalized, or adversely affected by persistent poverty and inequality. Individuals at the nexus of multiple identities often experience unique forms of discrimination or systemic disadvantages, including in their access to needed services.21

Consider your team’s cultural and clinical competence, and the barriers to patients seeking cancer screening and care and treatment, including social risk factors such as food insecurity, housing insecurity, financial strain, lack of transportation/access to public transportation;22 and other social determinants that may affect access to care, contribute to poor health outcomes, and exacerbate health disparities.23 Addressing Social Determinants of Health (SDOH) is a HRSA objective to improve health and well-being of individuals and the communities in which they reside.

Telehealth24 can be an important tool for delivering services and resources to patients, including cancer screening and referral for care and treatment. You are encouraged to use telehealth in your proposed service delivery plan when feasible and appropriate.

Additional general information on telehealth can be found at https://telehealth.hhs.gov/.

Information specific to your health center scope of project is available at https://bphc.hrsa.gov/sites/default/files/bphc/programrequirements/pdf/telehealth-pal.pdf.

In addition, if you use broadband or telecommunications services for the provision of health care, HRSA strongly encourages you to seek discounts through the Federal Communication Commission’s Universal Service Program. For information about such discounts, see https://www.usac.org/rural-health-care/. Patients may also be eligible for free or low cost mobile or broadband services through the Universal Service Lifeline program at https://www.lifelinesupport.org/.

20 See the HRSA Office of Health Equity and National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care for additional information.

21 See Executive Order 13988 on Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation, 86 FR 2023, at § 1 (Jan. 20, 2021), https://www.govinfo.gov/content/pkg/FR-2021-01-25/pdf/2021-01761.pdf.

22 See the 2021 UDS Manual for additional information.

23 The PRAPARE Assessment Tool or PhenX Toolkit may support your health center with collecting data needed to understand and act on patients’ social determinants of health. For additional information, see https://www.nachc.org/research-and-data/prapare/ or https://www.phenxtoolkit.org/collections/view/6.

24 Telehealth is the use of electronic information and telecommunications technologies to support and promote, at a distance, health care, patient and professional health-related education, health administration, and public health. Technologies include video conferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.

https://telehealth.hhs.gov/ https://bphc.hrsa.gov/sites/default/files/bphc/programrequirements/pdf/telehealth-pal.pdf https://bphc.hrsa.gov/sites/default/files/bphc/programrequirements/pdf/telehealth-pal.pdf https://www.usac.org/rural-health-care/ https://www.lifelinesupport.org/ https://www.hrsa.gov/about/organization/bureaus/ohe/index.html https://thinkculturalhealth.hhs.gov/clas https://thinkculturalhealth.hhs.gov/clas https://www.govinfo.gov/content/pkg/FR-2021-01-25/pdf/2021-01761.pdf https://bphc.hrsa.gov/sites/default/files/bphc/datareporting/pdf/2021-uds-manual.pdf https://www.nachc.org/research-and-data/prapare/ https://www.phenxtoolkit.org/collections/view/6

HRSA-22-154 9

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

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 will count toward the page limitation. For information required in the Project Abstract Form, see Section 4.1.ix. of HRSA’s SF-424 Application Guide. In addition, provide your Health Center Program grant number (H80CSXXXXX – reminder: this is an eligibility factor) and a brief summary of how your proposed project will increase access and address barriers to cancer screening and referral to care and treatment, and a brief description of your proposed partnerships, including your required partnership with an NCI-designated Cancer Center.

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 will be considered during the objective review.

Narrative Section Review Criteria Need section of the Project Narrative (1) Need Response section of the Project Narrative Attachment 1: Project Work Plan

(2) Response

Collaboration section of the Project Narrative Attachment 2: Partnership Documentation Attachment 3: Letters of Support Attachment 4: Summary of Contracts and Agreements

(3) Collaboration

Resources/Capabilities section of the Project Narrative

(4) Resources/Capabilities

Evaluative Measures section of the Project Narrative

(5) Evaluative Measures http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

HRSA-22-154 10

Narrative Section Review Criteria Support Requested section of the Project Narrative Forms: SF-424A Budget Information Form, Attachment 5: Equipment List Form (if applicable) Budget Narrative

(6) Support Requested

ii. Project Narrative

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

Use the following section headers for the narrative: Introduction, Need, Response, Collaboration, Resources/Capabilities, Evaluative Measures, and Support Requested.

INTRODUCTION

1) Identify the cancer type(s) that you are proposing to address through your AxCS project. At a minimum, you must address breast, cervical, and/or colorectal cancer screening through your project.

Note: If you propose to increase screening and referral for care and treatment for more than one cancer type, you must provide information related to each proposed cancer type throughout your Project Narrative. To ensure thorough responses, you may choose to organize requested Project Narrative information using cancer type sub-headers.

2) Identify your proposed AxCS project partners, including:

a) Required: NCI-designated Cancer Center.

b) Optional: Other health centers, state/local health departments, Native American

Tribal organizations, and community and faith-based organizations, if any.

Note: Any partners’ contributions to your AxCS project must be clearly reflected in all applicable sections of your Project Narrative. For example, if you partner with another health center, the NEED section must reflect both health centers’ service areas, and the RESPONSE section must reflect all partners’ proposed contributions to your AxCS project.

NEED – Corresponds to Section V.1 Review Criterion 1: NEED

Information provided in the NEED section must:

• Be specific to the cancer type(s) you propose to address in the INTRODUCTION section

HRSA-22-154 11

• Serve as the basis for, and align with, the activities, focus areas, and objectives described throughout the application.

• Be used to inform and improve the delivery of the proposed services.

1) Provide data that describes the impact of the selected cancer type(s) in your service area. Data must include prevalence, death rate, and screening rate, and should be provided by race/ethnicity where possible. Include national data for comparison.

Data sources may include but are not limited to, your current needs assessment25 and community health needs assessments (such as those conducted by a state/local health department, NCI-designated Cancer Center, hospital, or other organization in the service area), and Service Area Status.

2) Describe barriers to maximizing equitable access to cancer screening and referral for care and treatment in your service area. Include identified workforce, care integration, care coordination, community outreach and education, assistance with enrollment in affordable health insurance, and other program and technology-related needs, as applicable.

3) Describe the health-related social needs of health center patients in your service area that affect equitable access to cancer screening and referral for care and treatment.1 Address the following, referencing your UDS data, as applicable, or other data sources:

a) Language access challenges

b) Cultural barriers

c) Housing insecurity

d) Food insecurity

e) Financial strain

f) Lack of transportation/access to public transportation

g) Other SDOH

4) Describe changes in cancer screening, including UDS data, and changes in referral for care and treatment in your service area between 2019 and 2021 that may be attributed to the COVID-19 pandemic.

RESPONSE – Corresponds to Section V.1 Review Criterion 2: RESPONSE

1) Upload a 2-year project work plan in Grants.gov as Attachment 1 that describes activities that you will conduct to increase cancer screening and referral for care and treatment. Refer to Section IV.2.v. Attachments for detailed guidance.

2) Referencing your work plan, describe how AxCS-supported activities will:

a) Address unmet needs or barriers (described in the NEED section) to achieve increases in cancer screening and referral for care and treatment.

b) Enhance or expand strategies, including use of enabling services, to improve the patient experience (e.g., activate and engage patients, build trusting

25 See Chapter 3: Needs Assessment of the Compliance Manual.

https://bphc.hrsa.gov/programopportunities/strategic-initiatives https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-3.html

HRSA-22-154 12

relationships, build partnership with families and caregivers, provide patient-centered care coordination).

c) Promote equity in access to cancer screening and referral for care and treatment for current patients, Health Center Program statutorily-defined special populations (migratory and seasonal agricultural workers, people experiencing homelessness, and residents of public housing), as applicable, and other residents of your health center’s service area.

d) Address the impact of COVID-19 on cancer screening and referral for care and treatment.

e) Leverage health IT, including electronic health record (EHR) systems and telehealth, to improve equitable access and quality of cancer screening and referral for care and treatment, including closing referral loops.

3) If applicable, describe any changes in scope required to implement your AxCS project and how they are necessary for the project’s success, including changes to your Form 5A: Services Provided, Form 5B: Service Sites, and/or Form 5C: Other Activities/Locations.

Access the technical assistance materials on the Scope of Project resource webpage and contact your Health Center Point of Contact for guidance in determining if a scope adjustment or change in scope will be necessary.26 See Appendix A for additional guidance.

4) Describe how the proposed personnel (e.g., direct hire and contracted) listed in the Budget Narrative are essential to successfully implement the proposed project, including clearly describing each individuals’ role in the proposed project. Reference the staff details listed in the Budget Narrative, as applicable.

COLLABORATION – Corresponds to Section V.1 Review Criterion 3:

COLLABORATION

1) Describe how you will leverage Cancer Center trained and supervised outreach specialists and patient navigators to improve cancer screening and referral for care and treatment within your service area, as defined in the required partnership documentation with the NCI-designated Cancer Center.

2) Describe how you will leverage the resources of your Cancer Center partner, as defined in the required partnership documentation with the NCI-designated Cancer Center, to:

a) Build capacity of health center staff in the areas of outreach and patient navigators that will last beyond the funding period.

b) Facilitate referrals of individuals in need of cancer screening, referral for care and treatment, and other comprehensive primary care services to your health center.

c) Share data on relevant cancer statistics (e.g., cancer prevalence, screening rates) to support health center program planning and quality improvement.

26 You can view your scope of project in the Approved Scope section of your H80 grant folder in EHBs.

https://bphc.hrsa.gov/programrequirements/scope https://bphc.hrsa.gov/programrequirements/scope

HRSA-22-154 13

3) As applicable, describe how you will leverage the resources of any AxCS partners beyond the required NCI-designated Cancer Center, as defined in the LOS, to:

a) Address health center patients’ barriers to cancer screening and referral for care and treatment.

b) Strengthen and improve care coordination, community engagement, and population health.

c) Share data, if applicable, on relevant cancer statistics in the service area (e.g., cancer prevalence, screening rates) to support health center program planning and quality improvement.

4) In Attachment 2: Partnership Documentation, provide documentation of the required partnership, such as a memorandum of understanding (MOU), with an NCI-designated Cancer Center that defines the nature of the relationship and describes specific collaboration and/or coordinated activities in support of your project. This attachment must:

a) Clearly document the Cancer Center’s commitment to deploy trained and supervised outreach specialists and patient navigators to improve cancer screening and referral within your health center’s service area if the project is funded.

b) Be current and include a signature from the Cancer Center’s CEO or other appropriate key management staff member.

5) If applicable, in Attachment 3: Letters of Support, provide letters of support from partnering health centers, state/local health departments, Native American Tribal organizations, and/or community and faith-based organizations. Letters of support must define the nature of the relationship and describe specific collaboration and/or coordinated activities in support of your project. Letters of support must be current, include a signature, and be addressed to your health center’s board, CEO, or other appropriate key management staff member.

6) If applicable, in Attachment 4: Summary of Contracts and Agreements, provide a brief summary of all other formal written contracts or agreements that includes the following for each contact or agreement:

a) Name of the contract or agreement organization,

b) Type of contract or agreement,

c) Brief description of the purpose and scope of the contract or agreement, and

d) Timeframe for each contract or agreement.

RESOURCES/CAPABILITIES – Corresponds to Section V.1 Review Criterion 4:

RESOURCES/CAPABILITIES

1) Describe your past efforts, alone and/or in collaboration with other partners, to increase the number and percentage of patients accessing cancer screening and referral for care and treatment, including the success of those efforts.

2) Describe your capabilities and expertise to carry out the proposed project, including:

HRSA-22-154 14

a) Your capacity to manage the collaboration with AxCS partners to accomplish the AxCS objectives, including how past partnership experiences have informed the proposal.

b) Your organizational systems for tracking and closing referral loops.

c) The skills and experience of the proposed project personnel, as indicated in your

Budget Narrative.

d) The capability of key management staff to provide the operational and clinical oversight necessary to increase patients accessing cancer screening and referral for care and treatment.

3) Describe how you will ensure culturally affirming care that takes into account individual patient preferences, culture, values, and needs (including linguistic accessibility needs) to facilitate equitable access to cancer screening and referral for care and treatment.

4) Describe resources that you will leverage to support project implementation in addition to your required Cancer Center partnership, such as Health Center Program technical assistance resources (e.g., PCAs, NTTAPs, HCCNs); other national, state, or local organization resources (e.g., American Cancer Society, state breast and cervical cancer control programs, community-based organizations); or federal resources (e.g., Centers for Disease Control and Prevention, including the National Breast and Cervical Cancer Early Detection Program or other National Cancer Institute resources).

5) Describe how you plan to sustain increased cancer screening and enhanced referral tracking efforts if funding is not continued after the 2-year period of performance for this award.

EVALUATIVE MEASURES – Corresponds to Section V.1 Review Criterion 5:

EVALUATIVE MEASURES

1) Provide baseline UDS data for calendar year 2021 and estimated data showing increases in the number and percentage of patients accessing cancer screening for each cancer type that you are proposing to address by December 31, 2023 (as will be reflected in your 2023 UDS report)27:

a) Number and percentage of women screened for cervical cancer.

b) Number and percentage of women who had a mammogram to screen for breast cancer.

c) Number and percentage of adults screened for colorectal cancer.

Describe how you determined your estimates and why you consider them achievable by December 31, 2023.

Note: 2023 UDS data will be segmented (e.g., race/ethnicity, language, age group).

If available, you may provide segmented baseline data and corresponding

27 See 2021 UDS Manual for definitions of baseline and estimates.

https://bphc.hrsa.gov/sites/default/files/bphc/datareporting/pdf/2021-uds-manual.pdf

HRSA-22-154 15

segmented estimated data in alignment with your identified needs and proposed plans.

2) Provide baseline data for calendar year 2021 and estimated data showing increases by December 31, 2023 for each cancer type that you are proposing to address:

a) Number of women assisted with accessing appropriate follow-up care within 30 days of receiving an abnormal cervical cancer screening test result.

b) Number of women assisted with accessing appropriate follow-up care within 30 days of receiving an abnormal breast cancer screening test result.

c) Number of adults assisted with accessing appropriate follow-up care within 30 days of receiving an abnormal colorectal cancer screening test result.

If this data is not available for 2021, explain how baseline data will be calculated to include in the first biannual progress report.

Describe how you determined your estimates and why you consider them achievable by December 31, 2023.

3) Describe how your Quality Improvement/Quality Assurance (QI/QA) program will support the proposed AxCS project, including:

a) How you include or will incorporate cancer screening and referral for care and treatment activities and data into your QI/QA program.

b) How your QI/QA program will support evolution of your cancer screening and referral for care and treatment activities commensurate with the evolving needs of your patient population and service area.

c) How you will use QI/QA reports for AxCS project improvement.

d) How you include or will incorporate into your QI/QA procedures and processes current clinical guidelines, standards of care, and standards of practice in the provision of cancer screening and referral for care and treatment.

SUPPORT REQUESTED – Corresponds to Section V.1 Review Criterion 6: SUPPORT

REQUESTED

1) Provide a budget that:

a) Is consistent across all documents (i.e. SF-424A, Budget Narrative).

b) Aligns with the proposed AxCS project to increase cancer screening and referral for care and treatment (as outlined in the RESPONSE section and the project work plan).

c) Will reasonably support an increased number and percentage of patients accessing cancer screening and referral for care and treatment (see the EVALUATIVE MEASURES…