BPHC HRSA-23-022 (H80) Service Area Competition_Final.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2023

Bureau of Primary Health Care

Health Center Program

Service Area Competition

Funding Opportunity Number: HRSA-23-022

Funding Opportunity Types: Competing Continuation, Competing Supplement, New

Assistance Listings Number: 93.224

Application Due Date in Grants.gov: October 11, 2022 Supplemental Information Due Date in EHBs: November 10, 2022

Ensure your SAM 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 one month to complete.

Issuance Date: August 11, 2022

Itege Bailey, Beth Hartmayer, and Chrissy James Public Health Analysts, Bureau of Primary Health Care Office of Policy and Program Development Contact: https://bphccommunications.secure.force.com/ContactBPHC/BPHC_Contact_Form Phone: (301) 594-4300 SAC Technical Assistance webpage: https://bphc.hrsa.gov/program-opportunities/sac

See Section VII for a complete list of agency contacts.

Authority: Section 330 of the Public Health Service (PHS) Act (42 U.S.C. § 254b) https://bphccommunications.secure.force.com/ContactBPHC/BPHC_Contact_Form https://bphc.hrsa.gov/program-opportunities/sac

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508 COMPLIANCE DISCLAIMER

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

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2023 Service Area Competition (SAC) under the Health Center Program. The purpose of this grant program is to improve the health of the Nation’s underserved communities and vulnerable populations by assuring continued access to comprehensive, culturally competent, high-quality primary health care services.

Funding Opportunity Title: Service Area Competition (SAC)

Funding Opportunity Number: HRSA-23-022

Due Date for Applications – Grants.gov: October 11, 2022 (11:59 p.m. ET)

Due Date for Supplemental Information – HRSA Electronic Handbooks (EHBs):

November 10, 2022 (5 p.m. ET)

Anticipated FY 2023Total Available Funding:

Approximately $162 million

Estimated Number and Type of Awards: Up to 50 grants

Estimated Annual Award Amount: Varies and is subject to the availability of funds.

Cost Sharing/Match Required: No

Period of Performance: May 1, 2023 through

April 30, 2026 (up to 3 years)

Eligible Applicants: Domestic public or private, nonprofit entities, including tribal, faith-based, or community-based organizations.

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

http://www.hrsa.gov/

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Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in this NOFO and in HRSA’s SF-424 Two-Tier Application Guide. Visit HRSA’s How to Prepare Your Application page for more information.

Technical Assistance Application resources, as well as forms, instructions, and samples, and a frequently asked questions document are available at the SAC Technical Assistance webpage (https://bphc.hrsa.gov/program-opportunities/sac). Refer to “How to Apply for a Grant”, available at http://www.hrsa.gov/grants/apply, for general (i.e., not SAC 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 at https://public.govdelivery.com/accounts/USHHSHRSA/subscriber/new?topic_id=USHH

SHRSA_118.

HRSA-supported Primary Care Associations (PCAs) and/or National Health Center Training and Technical Assistance Partners (NTTAPs) are available to assist you in preparing a competitive application. For a listing of HRSA-supported PCAs and NTTAPs, refer to HRSA’s Strategic Partnerships webpage.

Other Federal Benefits

Other federal benefits are described in Section VIII.

Summary of Changes since the FY 2022 SAC Funding Opportunity

• For health centers in a multi-year period of performance, HRSA extended periods of performance scheduled to end in FY 2022 by 1 year to enable health centers to focus on COVID-19 public health emergency response efforts. These service areas are included in the FY 2023 SAC.

• Similarly, for health centers in a multi-year period of performance, HRSA extended periods of performance scheduled to end in FY 2023 by one year.

These service areas will be included in the FY 2024 SAC.1, 2

• If you are a new or competing supplement applicant for Health Care for the Homeless (HCH) and/or Public Housing Primary Care (PHPC) funding, you must attest on the Summary Page that you will utilize this funding to supplement, and

1 Current Health Center Program award recipients should refer to their most recent H80 Notice of Award (NoA) for the period of performance end date (Project Period End Date in item 26). A period of performance end date between October 1, 2022 and September 30, 2023 indicates that the service area is included in the FY 2023 SAC.

2 See the FY 2023 SAC/BPR Extension Guide.

http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://bphc.hrsa.gov/program-opportunities/sac http://www.hrsa.gov/grants/apply https://public.govdelivery.com/accounts/USHHSHRSA/subscriber/new?topic_id=USHHSHRSA_118 https://public.govdelivery.com/accounts/USHHSHRSA/subscriber/new?topic_id=USHHSHRSA_118 https://bphc.hrsa.gov/qualityimprovement/strategicpartnerships/index.html https://bphc.hrsa.gov/program-opportunities/sac/extension-guide

HRSA-23-022 iii not supplant, the expenditures of the health center and the value of in-kind contributions for the delivery of services to these populations. You will provide supporting narrative information in the Summary Page, as well.

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract (Submit in Grants.gov)

ii. Project Narrative (Submit in EHBs – required for completeness)

iii. _*_ Budget (Submit in EHBs)

iv. _*_ Budget Narrative (Submit in EHBs)

v. Program-Specific Forms (Submit in EHBs)

vi. Attachments (Submit in EHBs)

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

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Health Center Program’s Service Area Competition (SAC). The Health Center Program supports domestic public or private, nonprofit community-based and patient-directed organizations that provide primary health care services to the Nation’s medically underserved populations. The purpose of the SAC notice of funding opportunity (NOFO) is to ensure continued access to comprehensive, culturally competent, high-quality primary health care services for communities and populations currently served by the Health Center Program.

2. Background

The Health Center Program is authorized by section 330 of the Public Health Service (PHS) Act, as amended (42 U.S.C. § 254b). Through the SAC, organizations compete for Health Center Program operational support to provide comprehensive primary health care services to defined service areas and patient populations already being served by the Health Center Program.

Service areas and target populations listed in the Service Area Announcement Table (SAAT) are currently served by Health Center Program award recipients whose periods of performance end in FY 2023. You must demonstrate how you will make primary health care services accessible in an announced service area, including the provision of services to the SAAT Patient Target and population type(s) for which funding is available. Only one award will be given to provide services for each announced service area.

Funding Requirements

Your application must document an understanding of the need for primary health care services in the service area and propose a comprehensive plan that demonstrates compliance with the Health Center Program requirements.3 The plan must ensure the availability and accessibility of primary health care services to all individuals in the service area and target population, regardless of ability to pay. Your plan must include collaborative and coordinated delivery systems for the provision of health care to the underserved.

If you are a new or competing supplement applicant, you must demonstrate readiness to meet the following requirements:

3 Requirements are stated in 42 U.S.C. § 254b (section 330 of the PHS Act) and corresponding program regulations (42 CFR part 51c and 56), and are reflected in the Health Center Program Compliance Manual (Compliance Manual).

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• Within 120 days of release of the Notice of Award (NoA), all proposed sites (as noted on Form 5B: Service Sites and described in the Project Narrative) must have the necessary staff and providers in place to begin operating and delivering services as described on Form 5A: Services Provided and in the Project Narrative and Attachment 12: Operational Plan.4

• Within 1 year of release of the NoA, all proposed sites on Form 5B: Service Sites must be open for the proposed hours of operation, with services as indicated on Form 5A: Services Provided delivered in a manner that will support the provision of care to the number of patients listed on Form 1A: General Information Worksheet.

HRSA expects SAC award recipients to make every reasonable effort to provide services to the number of unduplicated patients projected to be served on Form 1A:

General Information Worksheet in calendar year 2024. HRSA will track progress toward meeting the total unduplicated patient projection in calendar year 2024 (the patient projection from this application, plus other patient projections from funded supplemental applications for which the projections can be monitored in calendar year 2024). For more information, visit the Patient Target FAQs. If you do not serve the number of patients projected in calendar year 2024, announced funding for the service area may be reduced when it is next competed through a SAC.

Applicants for Health Care for the Homeless (HCH) and Public Housing Primary Care (PHPC) funding must utilize such grant funding to supplement, and not supplant, the expenditures of the health center and the value of in-kind contributions for the delivery of services to these populations. In accordance with this requirement, New and Competing Supplement applicants requesting funding for the first time to serve individuals experiencing homelessness (330(h) funding) and/or individuals in public housing (330(i) funding) must demonstrate that by receiving these funds, they will increase the level of services provided to these populations.

HRSA assesses health centers for Health Center Program compliance on a regular basis, including via SAC application reviews. Health Centers must demonstrate compliance with the program requirements either by submitting documentation as described in the Demonstrating Compliance sections of the Compliance Manual, or by the health center proposing an alternative means of demonstrating compliance with the specified requirements, which would include submitting an explanation and documentation that explicitly demonstrates compliance. All responses to conditions are subject to review and approval by HRSA. Failure to fulfill applicable SAC funding and Health Center Program requirements may jeopardize Health Center Program grant funding per Uniform Guidance 2 CFR Part 200, as codified by the United States Department of Health and Human Services (HHS) at 45 CFR Part 75. If you fail to

4 HRSA may release NoAs up to 60 days prior to the period of performance start date.

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resolve conditions through the progressive action process outlined in Chapter 2: Health Center Program Oversight of the Compliance Manual HRSA will withdraw support through termination of the award.

If your SAC application is selected for funding, you must attest on the Summary Page form that if you receive a 1-year period of performance (see details in the Period of Performance Length Criteria section), you will submit a Compliance Achievement Plan for HRSA approval within 120 days of release of the SAC NoA. If you do not provide the required attestation, HRSA will not award grant funding. If you receive a 1-year period of performance and you do not submit the required Compliance Achievement Plan within 120 days of release of the SAC NoA or demonstration of good cause as to why you have not submitted the Compliance Achievement Plan5, HRSA will withdraw support through termination of the award.

HRSA will not award funding under this NOFO for a third consecutive 1-year period of performance unless the Health Center Program determines that the health center is in compliance with all program requirements (see the Period of Performance Length Criteria section for details).

Service areas where the current award recipient is in a 1-year period of performance are highlighted in the SAAT. The SAAT distinguishes between first and second consecutive 1-year periods of performance. This distinction is necessary because a service area where the current award recipient is in a second consecutive 1-year period of performance is in jeopardy of having a gap in Health Center Program funding and services if HRSA does not receive an eligible, fundable application. For award recipient-specific period of performance information, see Health Center Program UDS Data Overview.

Failure to verify that all sites are operational within 120 days of the release of the NoA will also result in the placement of a condition of award, with 180 days for resolution. If you fail to successfully resolve this site-related condition within the specified time frame, HRSA may withdraw support through termination of all, or part, of the SAC grant award.

In addition to the general Health Center Program requirements discussed above, specific requirements for funding under each population type are outlined below.

COMMUNITY HEALTH CENTER (CHC) APPLICANTS:

• Ensure compliance with PHS Act section 330(e) and program regulations, requirements, and policies.

• Provide a plan that ensures the availability and accessibility of required primary health care services6 to underserved populations in the service area.

5 Refer to Section 330(e)(1)(B) of the PHS Act.

6 Refer to the Service Descriptors for Form 5A: Services Provided, for details regarding required primary health care services.

https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-2.html https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-2.html https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html http://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/uds/datacenter.aspx?q=d https://bphc.hrsa.gov/uds/datacenter.aspx?q=d https://bphc.hrsa.gov/about/requirements/scope/form5aservicedescriptors.pdf

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MIGRANT HEALTH CENTER (MHC) APPLICANTS:

• Ensure compliance with PHS Act section 330(g); and, as applicable, section

330(e), program regulations, requirements, and policies.

• Provide a plan that ensures the availability and accessibility of required primary health care services to migratory and seasonal agricultural workers and their families in the service area, which includes:

o Migratory agricultural workers who are individuals whose principal employment is in agriculture, who have been so employed within the last 24 months, and who establish for the purposes of such employment a temporary abode;

o Seasonal agricultural workers who are individuals whose principal employment is in agriculture on a seasonal basis and who do not meet the definition of a migratory agricultural worker;

o Individuals who are no longer employed in migratory or seasonal agriculture because of age or disability who are within such catchment area; and/or o Family members of the individuals described above.

NOTE: Agriculture refers to farming in all its branches (Section 330(g) of the PHS Act), as defined by the North American Industry Classification System under codes 111, 112, 1151, and 1152 (48 CFR § 219.303).

HEALTH CARE FOR THE HOMELESS (HCH) APPLICANTS:

• Ensure compliance with PHS Act section 330(h); and, as applicable, section

330(e), program regulations, requirements, and policies.

• Provide a plan that ensures the availability and accessibility of required primary health care services to individuals:

o Who lack housing (without regard to whether the individual is a member of a family);

o Whose primary residence during the night is a supervised public or private facility that provides temporary living accommodations;

o Who reside in transitional housing;

o Who reside in permanent supportive housing or other housing programs that are targeted to homeless populations; and/or o Who are children and youth at risk of homelessness, homeless veterans, and veterans at risk of homelessness.

• Provide substance use disorder services.

PUBLIC HOUSING PRIMARY CARE (PHPC) APPLICANTS:

• Ensure compliance with PHS Act section 330(i); and, as applicable, section

330(e), program regulations, requirements, and policies.

• Provide a plan that ensures the availability and accessibility of required primary health care services to residents of public housing and individuals living in areas immediately accessible to public housing. Public housing includes public housing agency-developed, owned, or assisted low-income housing, including mixed

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finance projects, but excludes housing units with no public housing agency support other than Section 8 housing vouchers.7

• Consult with residents of the proposed public housing sites regarding the planning and administration of the program.

II. Award Information

1. Type of Application and Award

Types of applications sought:

• Competing continuation – A current Health Center Program award recipient whose period of performance ends April 30, 2023 and that seeks to continue serving its current service area.

• New – An organization that is not currently funded through the Health Center Program that seeks to serve an announced service area through the proposal of one or more permanent service delivery sites.8

• Competing supplement – A current Health Center Program award recipient that seeks to serve an announced service area, in addition to its current service area, through the addition of one or more new permanent service delivery sites.

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA estimates approximately $162 million to be available annually to fund 50 recipients. The actual amount available will not be determined until enactment of the final FY 2023 federal appropriation. You may apply for a ceiling amount of up to the Total Funding listed in the SAAT for the proposed service area in total cost annually (reflecting direct and indirect, facilities, and administrative costs) per year. This program notice is subject to the appropriation of funds and is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds appropriately.

The period of performance is May 1, 2023 through April 30, 2026 (up to 3 years).

Funding beyond the first year is subject to the availability of appropriated funds for the Health Center Program in subsequent fiscal years, satisfactory progress, and a decision that continued funding is in the best interest of the Federal Government.

7 For the purpose of funding under section 330(i) of the PHS Act, and as presented in the Glossary of the Compliance Manual, "public housing” is defined in 42 U.S.C. § 1437a(b)(1).

8 A Health Center Program look-alike must apply as a “new” applicant.

http://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/programrequirements/compliancemanual/glossary.html

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You must propose to serve at least 75 percent of the SAAT Patient Target in calendar year 2024 (January 1 through December 31, 2024). If you propose to serve fewer than the total number of patients indicated in the SAAT, the request for federal funding on the SF-424A and Budget Narrative must reflect the required reductions noted below. If you do not reduce the funding request as noted below, HRSA will reduce the award accordingly. A funding calculator is available to help you determine if a funding reduction is required.

Table 1: Funding Reduction by Patients Projected to Be Served

Patient Projections Compared to SAAT Patient Target

Funding Request Reduction

95-100% of patients listed in the

SAAT

No reduction

90-94.9% of patients listed in the

SAAT

0.5% reduction

85-89.9% of patients listed in the

SAAT

1% reduction

80-84.9% of patients listed in the

SAAT

1.5% reduction

75-79.9% of patients listed in the

SAAT

2% reduction

< 75% of patients listed in the SAAT Not eligible for funding

The amount of funds awarded in any fiscal year may not exceed the costs of health center operations for the budget period less the total of state, local, and other operational funding provided to the center and the fees, premiums, and third-party reimbursements, which the center may reasonably be expected to receive for its operations in the fiscal year. Health Center Program award funds must be used in compliance with applicable federal statutes, regulations, and the terms and conditions of the federal award. Nongrant funds from state, local and other operational funding provided to the center and from fees, premiums, and third-party reimbursements, which the center may reasonably be expected to receive for its operations in the fiscal year shall be used as permitted under section 330 of the PHS Act and may be used for such other purposes as are not specifically prohibited under section 330, if such use furthers the objectives of the project.9

Note: The federal cost principles apply to use of grant funds, but do not apply to use of nongrant funds.

9 Section 330(e)(5)(D) of the PHS Act.

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All HRSA awards are subject to the Uniform Administrative Requirements, Cost Principles, and Audit Requirements at 45 CFR Part 75. See Section IV.2.iii for instructions on the development of the application budget.

III. Eligibility Information

1. Eligible Applicants

1) You must be a domestic public or private, nonprofit entity, as demonstrated through the submission of the Evidence of Non-profit/Public Center Status (Attachment 11), outlined in Section IV.2.vi.10 Faith-based and community-based organizations, Tribes, and tribal organizations are eligible to apply.11

2) You must propose in the RESPONSE section of the Project Narrative to operate a health center that makes all required primary health care services (see footnote 6) available and accessible in the service area, either directly or through established arrangements, without regard for ability to pay. You may not propose to provide ONLY a single service or any subset of the required primary health care services.

3) You must propose on Form 5A: Services Provided to make General Primary Medical Care available directly (Column I) and/or through formal written contractual agreements in which the health center pays for the service (Column II).

4) You must provide continuity of services, ensuring availability and accessibility of services to residents of the service area, by proposing to serve an announced service area, as well as:

a) Patients: The total number of unduplicated patients that you project to serve in calendar year 2024 (January 1 – December 31, 2024) as entered on Form 1A:

General Information Worksheet must be at least 75 percent of the SAAT Patient Target.

b) Services: You must project patients on Form 1A: General Information Worksheet for each Service Type (e.g., Medical, Mental Health, Enabling) listed for the service area in the SAAT.

10 Only public agency health centers can demonstrate compliance with governance requirements through a co-applicant structure. A co-applicant is the established body that serves as the health center’s governing board when the public agency cannot meet the Health Center Program governing board requirements directly (Section 330(r)(2)(A) of the Public Health Service Act). However, status as a co-applicant is limited to this purpose and does not confer awardee rights to the co-applicant organization.

11 Refer to Chapter 1: Health Center Program Eligibility of the Compliance Manual.

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c) Service Area: If you are a new or competing supplement applicant, you must enter Service Area Zip Codes on Form 5B: Service Sites for service delivery sites (administrative-only sites will not be considered) that:12

• Include a combination of SAAT Service Area Zip Codes where zip code patient percentages total at least 75 percent of the current patients served; or

• Include all SAAT Service Area Zip Codes for the proposed service area, if the sum of all zip code patient percentages is less than 75 percent of the current patients served.

d) Populations: You must propose to serve all population types listed in the SAAT (i.e., CHC, MHC, HCH, and/or PHPC) and maintain the funding distribution from the SAAT in the federal funding request on the SF-424A. You may not add new population types (those noted in the SAAT with $0 in funding).

5) If you are a new or competing supplement applicant, you must propose at least one new full-time (operational 40 hours or more per week) permanent, fixed building service site on Form 5B: Service Sites.13, 14 You must provide a verifiable street address for each proposed site on Form 5B: Service Sites.

6) You must propose to provide access to services for all individuals in the service area and target population, as described in the RESPONSE section of the Project Narrative. In instances where one or more services will be provided at a location that targets a sub-population (e.g., a school-based site that targets school-aged children), you must ensure that all health center services will be made available and accessible to others who seek services at the proposed site(s). You may not propose to serve only a single sub-population.

7) PUBLIC HOUSING PRIMARY CARE APPLICANTS: If you are a new or competing supplement applicant applying for 330(i) funding, you must demonstrate that you have consulted with residents of public housing in the preparation of the SAC application. You must also ensure ongoing consultation with the residents regarding the planning and administration of the health center, as documented in the COLLABORATION section of the Project Narrative.

8) HEALTH CARE FOR THE HOMELESS AND PUBLIC HOUSING PRIMARY CARE

APPLICANTS: If you are a new or competing supplement applicant applying for 330(h) or 330(i) funding for the first time, you must attest on the Summary Page that you will utilize this funding to supplement, and not supplant, the expenditures of the

12 HRSA considers service area overlap when making funding determinations for new or competing supplement applicants if zip codes are proposed on Form 5B: Service Sites beyond those listed in the SAAT. For more information about service area overlap, refer to Policy Information Notice 2007-09.

13 Policy Information Notice 2008-01: Defining Scope of Project and Policy for Requesting Changes describes and defines the term “service sites.”

14 If you propose to serve only migratory and seasonal agricultural workers, you may propose a full-time seasonal (rather than permanent) service site.

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health center and the value of in-kind contributions for the delivery of services to these populations.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

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

• Exceeds the funding ceiling amount (the amount of Total Funding available in the SAAT) on the SF-424A and Budget Narrative.

• Does not include all documents indicated as “required for completeness” in Section IV.2.ii and Section IV.2.vi. This includes the Project Narrative, as well as Attachments 6: Co-Applicant Agreement (as applicable) and 11: Evidence of Nonprofit or Public Center Status.

• Applicant organization (as listed on the SF-424) does not propose to perform a substantive role (consistent with application components, such as the Budget Narrative, Attachment 2: Bylaws, and Form 8: Health Center Agreements and its attachments). Note: Evidence that the applicant organization is performing a substantive role in the project may include, but is not limited to, providing general primary medical care directly through the applicant organization’s employees and sites. Applications in which the applicant organization proposes to perform a substantive role in the project in addition to conducting a portion of the project through a subrecipient arrangement are allowable.

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

Note: Multiple applications from an organization with the same Unique Entity Identifier (UEI) are allowed if the applications propose to serve different service areas announced under this notice. If you plan to apply to serve two or more service areas announced under this NOFO, you must contact the SAC Team through the BPHC Contact Form for guidance.

HRSA will only accept and review your first validated electronic submission under the correct funding opportunity number, in Grants.gov. Applications submitted after the first submission will be marked as duplicates and considered ineligible for review. If you wish to change attachments submitted as part of your Grants.gov application, you may do so in the HRSA Electronic Handbooks (EHBs) application phase.

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IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically through Grants.gov and the EHBs. You must use a two-phase submission process associated with this NOFO and follow the directions provided at Grants.gov: HOW TO APPLY FOR GRANTS and the EHBs.

• Phase 1 – Grants.gov – Required information must be submitted and validated via Grants.gov with a due date of October 11, 2022 at 11:59 p.m. ET; and

• Phase 2 – EHBs – Supplemental information must be submitted via EHBs with a due date of November 10, 2022 at 5 p.m. ET.

Only applicants who successfully submit the workspace application package associated with this NOFO in Grants.gov (Phase 1) by the due date may submit the additional required information in EHBs (Phase 2).

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-23-022 in order to receive notifications, including modifications, clarifications, and/or republications of the NOFO on Grants.gov.

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

NOFO.

2. Content and Form of Application Submission

Application Format Requirements Section 5 of HRSA’s SF-424 Two-Tier Application Guide provides general instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, and certifications. You must submit the information outlined in Application Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in this NOFO and HRSA’s SF-424 Two-Tier Application Guide. You must submit the application in English and U.S. dollars (45 CFR § 75.111(a)).

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

• Application for Federal Assistance (SF-424)

• Project Abstract Summary form

• Project/Performance Site Locations (Enter information for the site that you consider to be your primary service delivery site.)

• Grants.gov Lobbying Form

• Key Contacts

The following application components must be submitted in EHBs:

http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf https://ecfr.io/Title-45/Section-75.111 https://ecfr.io/Title-45/Section-75.111

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• Project Narrative

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

• Budget Narrative and Table of Personnel Paid with Federal Funds

• Program-Specific Forms

• Attachments

See Section 9.5 of HRSA’s SF-424 Two-Tier Application Guide for the Application Completeness Checklist to assist you in completing your application.

Application Page Limit The total of uploaded attachment pages that count against the page limit shall be no more than 160 pages when printed by HRSA. Standard OMB-approved forms included in the workspace application package do not count in the page limit. The abstract is the standard form (SF) “Project Abstract Summary.” If there are other attachments that do not count against the page limit, this will be clearly denoted in Section IV.2.vi Attachments.

The abstract is no longer an attachment that counts in the page limit. Additionally, Indirect Cost Rate Agreement (Attachment 13) and proof of non-profit status (Attachment 11) (if applicable) do not count in the page limit. However, if you use an OMB-approved form that is not included in the workspace application package for HRSA-23-022, it will count against the page limit. Therefore, we strongly recommend you only use Grants.gov workspace forms associated with this NOFO to avoid exceeding the page limit.

It is important to take appropriate measures to ensure your application does not exceed the specified page limit.

Applications must be complete, within the maximum specified page limit, and validated by Grants.gov under HRSA-23-022 before the deadlines.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

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

2) Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75.371, including suspension or debarment. (See also 2 CFR Parts 180 and 376, and 31 U.S.C. § 3354.)

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachment 13: Other Relevant Documents.

See Section 5.1.viii of HRSA’s SF-424 Two-Tier Application Guide for additional information on all certifications.

http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf

HRSA-23-022 12

Program-Specific Instructions In addition to application requirements and instructions in Sections 4 and 5 of HRSA’s SF-424 Two-Tier Application Guide (including the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract), include the following:

i. Project Abstract (Submit in Grants.gov) Use the Standard OMB-approved Project Abstract Summary Form that is included in the workspace application package. Do not upload the abstract as an attachment or it may count toward the page limit. For information required in the Project Abstract Summary Form, see Section 5.1.ix. of HRSA’s SF-424 Two-Tier Application Guide.

Additionally, include the proposed service area identification number (ID), city, and state (available in the SAAT); and the total number of unduplicated patients that you project to serve in calendar year 2024.

NARRATIVE GUIDANCE

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

Narrative Section, Forms, and Attachments15

Review Criteria

Need section of the Project Narrative (1) Need

Response section of the Project Narrative

Attachment 10: Sliding Fee Discount Schedule

Attachment 12: Operational Plan

(2) Response

Collaboration section of the Project Narrative

(3) Collaboration

Evaluative Measures section of the Project Narrative

(4) Evaluative Measures

Resources/Capabilities section of the Project Narrative

(5) Resources/Capabilities

15 Forms and attachments in the table are included within a specific review criteria element. All forms and attachments referenced throughout the NOFO will be considered during application review.

http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf

HRSA-23-022 13

Narrative Section, Forms, and Attachments15

Review Criteria

Form 8: Health Center Agreements

Governance section of the Project Narrative

Form 6B: Request for Waiver of Board Member Requirements

(6) Governance

Support Requested section of the Project Narrative

SF-424A

Budget Narrative

(7) Support Requested

ii. Project Narrative (Submit in EHBs – required for completeness) This section provides a comprehensive framework and 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 numbering format below to facilitate reviewer understanding of the proposed project and, where applicable, HRSA assessment of compliance with Health Center Program requirements, consistent with the Compliance Manual.

The application content that HRSA will utilize, in whole or in part, in the SAC-based assessment of compliance is noted with a bolded, underlined asterisk (_*_). Refer to the SAC Compliance Assessment Guide at the SAC Technical Assistance webpage for the specific Compliance Manual chapters and elements that relate to items with a bolded, underlined asterisk.

Successful applications will contain the information below. Use the following section headers for the Project Narrative: Need, Response, Collaboration, Evaluative Measures, Resources/Capabilities, Governance, and Support Requested.

If you are a competing continuation applicant, ensure that the Project Narrative reflects your approved scope of project. You must request any needed changes in scope separately through EHBs.16

If you are a new applicant, ensure that the Project Narrative reflects your entire proposed project for the proposed service area.

If you are a competing supplement applicant, ensure that the Project Narrative reflects only the proposed project for the proposed service area. In addition to the

16 Refer to the Scope of Project guidance for details.

https://bphc.hrsa.gov/program-opportunities/sac https://bphc.hrsa.gov/programrequirements/scope.html

HRSA-23-022 14

required new full-time site, additional new sites may also be proposed, and current sites in scope may also be included if they will provide services to the proposed new patients.

You may reference current services, policies, procedures, and capacity (e.g., experience, resources) to the extent that they relate to the proposed service area.

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

Information provided in the NEED section must:

• Serve as the basis for, and align with, the activities and goals described throughout the application.

• Be utilized to inform and improve the delivery of health center services.

1) Describe the proposed service area (consistent with Attachment 1: Service Area Map and Table), including:

a) The service area boundaries.

b) If it is located in an Opportunity Zone (if applicable).17

c) If you are a:

• New or competing supplement applicant: How you determined the proposed service area, including the zip codes listed on Form 5B: Service Sites, based on where the proposed patients reside.

• Competing continuation applicant: How you annually review and, if necessary, update your service area based on where patients reside. Such updates should be consistent with data reported in the Uniform Data System (UDS) (e.g., service area zip codes listed on Form 5B: Service Sites represent those where 75 percent of current patients reside).

2) Describe your process for assessing proposed service area/target population need,18 including:

a) How often you conduct or update the needs assessment.

b) How you use the results to inform and improve service delivery.

c) Using and citing current data (including data for each special population (MHC, HCH, PHPC) identified in the SAAT, if applicable), address the following:

• Factors associated with access to care and health care utilization (e.g., geography, transportation, occupation, transience, unemployment, income level, educational attainment).

• Any unique health care needs or characteristics that impact health status (e.g., language barriers, food insecurity, housing insecurity, financial strain, 17 The lists of Qualified Opportunity Zones are available at IRS Notices 2018-48 and 2019-42.

18 In addition to your needs assessment, the Service Area Status (SAS) can be useful in understanding service area need. SAS describes the health, social, and economic status of a health center’s service area using a standardized methodology and public data sources. See the Health Center Program Strategic Initiatives webpage for details.

https://www.irs.gov/newsroom/opportunity-zones-frequently-asked-questions http://bphc.hrsa.gov/sac/ https://www.irs.gov/pub/irs-drop/n-18-48.pdf https://www.irs.gov/pub/irs-drop/n-19-42.pdf https://bphc.hrsa.gov/programopportunities/strategic-initiatives https://bphc.hrsa.gov/programopportunities/strategic-initiatives

HRSA-23-022 15

lack of transportation, neighborhood and the built environment, environmental issues/changes, intimate partner violence, human trafficking).19

3) Describe how the COVID-19 public health emergency impacted service area/target population need.

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

1) Describe how you provide access to all required and any proposed additional services (consistent with Form 5A: Services Provided), including how you will address health care access and utilization barriers (e.g., geography, transportation, occupation, transience, unemployment, income level, educational attainment) and other factors that impact health status (e.g., language barriers, food insecurity, housing insecurity, financial strain, lack of transportation, neighborhood and the built environment, environmental issues/changes, intimate partner violence, human trafficking).

Note: If you are requesting HCH funding, you must provide substance use disorder services (documented on Form 5A: Services Provided) to this population directly (Column I) and/or through contractual agreement (Column II).

2) Describe how the proposed service delivery sites on Form 5B: Service Sites assure the availability and accessibility of services (consistent with Form 5A: Services Provided) within the proposed service area, relative to where the target population lives and works (e.g., areas immediately accessible to public housing for health centers targeting residents of public housing). Specifically address:

a) Access barriers (e.g., distance or travel time for patients, physical geographic barriers, residential patterns, economic and social groupings).

b) How the following service delivery site factors facilitate access: total number and type (e.g., fixed, mobile, school-based), hours of operation, and overall location (e.g., proximity to public housing). Note: Ensure information aligns with Form 5B:

Service Sites.

c) If you are a competing supplement applicant: If the proposed service area is not contiguous with the current Health Center Program service area for which you are funded, explain how all patients in the proposed service area and the currently funded service area will have access to all required and additional services.

3) Describe how you educate patients on affordable insurance options, including how you inform them of third-party coverage options (e.g., determine their eligibility for federal, state, and local programs that provide support for medical and enabling

19 Social determinants of health (SDOH) include factors like socioeconomic status, neighborhood and physical environment, social support networks, community violence, and intimate partner violence. SDOH affect a wide range of health, functioning, and quality-of-life outcomes and risks. Addressing SDOH, such as intimate partner violence, is a HRSA objective to improve the health and well-being of individuals and the communities in which they reside.

HRSA-23-022 16

services; information to support patients’ informed decision making, including potential out-of-pocket costs), and provide enrollment assistance.

4) Describe your communication tools and protocols, referral processes, and electronic exchange of patient health records that facilitate continuity of care, including:

a) Hospital admitting privileges.

b) Receipt, follow-up, and recording of medical information from referral sources.

c) Follow-up for patients who are hospitalized or visit a hospital’s emergency department.

5) _*_ Describe the following aspects of the sliding fee discount program (SFDP) policies to complement the more specific information you will provide in your SFDS attachment to document that both your SFDP and SFDS are compliant with all Health Center Program requirements:

a) How they apply uniformly to all patients.

b) Definitions of income and family.

c) Methods for assessing all patients for sliding fee discount eligibility based only on income and family size.

d) How the structure of each sliding fee discount schedule (SFDS) ensures that patient charges are adjusted based on ability to pay (consistent with Attachment 10: Sliding Fee Discount Schedule).

e) If you have a nominal charge20 for patients with incomes at or below 100 percent of the Federal Poverty Guidelines (FPG),21 whether the nominal charge: (1) is flat, (2) is set at a level that is nominal from the perspective of the patient, and (3) does not reflect the actual cost of the service being provided. State if you do not have a nominal charge for patients with incomes at or below 100 percent of FPG.

6) Describe how you determined the number of:

a) Unduplicated patients that you project to serve in calendar year 2024, as documented on Form 1A: General Information Worksheet.

b) Patients that you project for each service type, as documented on Form 1A:

General Information Worksheet, in alignment with the services currently provided in the service area (as listed in the Service Type column of the SAAT).

Include how these projections took into consideration recent or potential changes in the local health care landscape and resulting impacts to patient health (e.g., after-effects of the COVID-19 public health emergency, potential changes in insurance coverage), organizational structure, and/or workforce.

20 Nominal charges are not minimum fees, minimum charges, or co-pays. See Chapter 9: Sliding Fee Discount Program of the Compliance Manual.

21 FPG are available…