BPHC HRSA-23-029 (U30) FY 2023 NTTAPs_Final.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2023

Bureau of Primary Health Care

Office of Policy and Program Development

FY 2023 National Training and Technical Assistance Partner (NTTAP) Cooperative Agreements

Funding Opportunity Number: HRSA-23-029

Funding Opportunity Type(s): Competing Continuation, New

Assistance Listings Number: 93.129

Application Due Date in Grants.gov: October 14, 2022 Supplemental Information Due Date in EHBs: November 14, 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: August 17, 2022

Shivani Purvis and Julia Tillman Public Health Analysts, Office of Policy and Program Development Bureau of Primary Health Care Phone: (301) 594-4300 Contact: BPHC Contact Form NTTAP Technical Assistance webpage

See Section VII for a complete list of agency contacts.

Authority: Section 330(l) of the Public Health Service Act, (42 U.S.C. 254(b)(l)) https://hrsa.force.com/support/s/ https://bphc.hrsa.gov/program-opportunities/nttap

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

Agency Contacts.

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2023 National Training and Technical Assistance Partner (NTTAP) Cooperative Agreements. The purpose of this funding opportunity is to support the development and delivery of training and technical assistance (T/TA) that support health centers to:

• Deliver comprehensive care;

• Address emergent public health issues and health needs;

• Improve operational effectiveness and quality; and

• Advance health equity.

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

Funding Opportunity Title: Fiscal Year (FY) 2023 National Training and Technical Assistance Partner (NTTAP) Cooperative Agreements

Funding Opportunity Number: HRSA-23-029 Due Date for Applications – Grants.gov: October 14, 2022 (11:59 p.m. ET) Due Date for Supplemental Information – HRSA Electronic Handbooks (EHBs)

November 14, 2022 (5:00 p.m. ET)

Anticipated FY 2023 Total Available Funding:

$23.5 million

Estimated Number and Type of Awards: Up to 22 cooperative agreements Estimated Annual Award Amount:

Varies and is subject to the availability of appropriated funds.

Cost Sharing/Match Required: No Period of Performance: July 1, 2023 through June 30, 2026

(3 years) http://www.hrsa.gov/

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Eligible Applicants: Eligible applicants include domestic public, non-profit, and for-profit entities, including tribes, tribal and faith-based organizations. New organizations and organizations currently receiving funding as NTTAPs may submit applications.

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

Application Guide You (the applicant organization/agency) are responsible for reading and complying with the instructions included in 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 HRSA will hold a pre-application technical assistance (TA) call for applicants seeking funding through this opportunity. This TA session will provide an overview of this NOFO and an opportunity for applicants to ask questions. Call-in information, as well as additional application resources, frequently asked questions (FAQs), and sample forms and documents are available on the NTTAP Technical Assistance webpage (https://bphc.hrsa.gov/program-opportunities/nttap).

Visit “Apply for a Grant”, available at http://www.hrsa.gov/grants/apply, for general (i.e., not NTTAP 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.

Summary of Changes since the FY 2020 NTTAP Funding Opportunity

• One new NTTAP type was added that will focus on Clinical Quality Improvement and Patient Safety.

• Name was updated from Lesbian, Gay, Bisexual, Transgender (LGBT) NTTAP to

Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) NTTAP.

• Minimum number of Activities and Learning Collaboratives was aligned with funding amounts. See Table 1: Minimum Number of Activities and Learning Collaboratives by Funding Level.

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/nttap http://www.hrsa.gov/grants/apply https://bphc.hrsa.gov/about/index.html https://bphc.hrsa.gov/about/index.html https://public.govdelivery.com/accounts/USHHSHRSA/subscriber/new?topic_id=USHHSHRSA_118 https://public.govdelivery.com/accounts/USHHSHRSA/subscriber/new?topic_id=USHHSHRSA_118

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• Program requirements for Learning Collaboratives were updated to remove the requirement for NTTAPs to lead Learning Collaboratives for each Objective, but now NTTAPs must lead a minimum number of Learning Collaboratives across all objectives.

• Program requirement for attendance at a HRSA-Sponsored NTTAP Forum was updated from the first budget period to during period of performance.

• National T/TA Center must now coordinate and conduct national health center T/TA needs assessment annually during both budget periods 1 and 2, with the intent that NTTAPs use the results to update their T/TA offerings in the following budget year.

• HRSA will establish standard measures to evaluate success (e.g., training utility, participant behavior change) that will be used by all NTTAPs.

• Key staff definition was updated.

• Competing Continuation applicants are no longer required to submit Non-competing continuation progress reports as part of their Competing Continuation application.

• Partnering Organizations was added as a new field in Project Work Plan (PWP).

• NTTAPs must now include publications as part of their T/TA Targets.

• NTTAPs must now include asynchronous T/TA sessions (e.g., views of recorded webinars) as part of their Participation Target.

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative (Required for Eligibility)

iii. Budget

iv. Budget Narrative

v. Program-Specific Forms

vi. Attachments

3. UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT

(SAM)

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: INSTRUCTIONS FOR COMPLETING FORM 1A IN EHBS

APPENDIX B: PROJECT WORK PLAN

APPENDIX C: NTTAP TYPES AND REQUIRED OBJECTIVES

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the fiscal year (FY) 2023 National Training and Technical Assistance Partner (NTTAP) cooperative agreements. NTTAPs develop, deliver, coordinate, and evaluate training and technical assistance (T/TA) to existing and potential Health Center Program award recipients and look-alikes (health centers)1 nationwide, both directly and through collaborations with other Health Resources and Services Administration (HRSA) funded T/TA partners. FY 2023 NTTAP award recipients will receive funding to provide T/TA that support health centers to:

• Deliver comprehensive care;

• Address emergent public health issues and health needs;

• Improve operational effectiveness and quality; and

• Advance health equity.

HRSA will provide funding to NTTAPs to identify health center T/TA needs nationwide and to provide T/TA to support health centers that serve statutorily defined special populations, other health center populations, and through specified development areas.

For more details and a list of all NTTAP types, refer to Program Requirements and Expectations.

2. Background

NTTAPs are authorized by the Public Health Service Act, Title III, Section 330(l), (42 U.S.C. 254b(l)).

The Department of Health and Human Services (HHS) is committed to improving the health and well-being of the nation through Healthy People 2030 (HP 2030), which establishes data-driven national health objectives and associated evidence-based interventions for priority public health issues. Addressing the impacts of social determinants of health (SDOH)2 on health outcomes is a priority for HHS embodied in a

1 Existing health centers include both Health Center Program award recipients and look-alikes. Potential health centers include organizations that are applying for or seeking information about applying for an award (e.g., NAP, SAC) or look-alike designation.

2 SDOH are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. They also include factors like socioeconomic status, neighborhood and physical environment, social support networks, community, violence, and intimate partner violence. Per the Centers for Disease Control and Prevention, National Intimate Partner and Sexual Violence Survey (NISVS), intimate partner violence (IPV) is any form of physical violence, sexual violence, stalking, or psychological harm by a current or former partner or spouse, and can have both direct and indirect effects on individual, family, and community health. Experiencing IPV impacts care seeking behaviors, and intersects with several critical public health priorities. IPV is among SDOH factors that can disproportionately affect underserved communities.

http://www.health.gov/healthypeople

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HP 2030 goal.3 Health centers are community-based and patient-directed organizations that deliver comprehensive, culturally competent, high-quality primary health care services and are uniquely positioned to understand and influence the impacts of SDOH and improve the health and well-being of the patients and communities they serve.

NTTAPs maximize the impact of the Health Center Program through the development and delivery of T/TA to health centers to support clinical quality improvement and culturally appropriate care; to address barriers to seeking care (e.g., trauma, stigma, other SDOH risk factors); and to help improve health outcomes, reduce health disparities, and support community resiliency.4,5

Achieving health equity6 is essential to HHS’ mission of protecting the health of Americans and providing essential human services. Individuals and communities often belong to more than one group that has been historically underserved, marginalized, or adversely affected by persistent poverty and inequality. The individuals at the nexus of multiple identities often experience unique forms of discrimination or systemic disadvantages that limit their access to needed services.7 To further maximize the impact of the Health Center Program, HRSA encourages you to apply your understanding of intersectionality and how multiple forms of discrimination impact individuals’ lived experiences when addressing issues of equity related to your proposed NTTAP type.

Public health events, both natural and manmade, can exacerbate existing health disparities and deepen inequalities. These events include disasters and extreme climate variability that are intensifying and occurring more frequently. Certain populations experience disproportionate health effects resulting from climate change, such as increased likelihood of asthma diagnoses and more severe health responses or

3 Addressing Social Determinants of Health in Federal Programs: https://aspe.hhs.gov/topics/health-health-care/addressing-social-determinants-health-federal-programs 4 You can explore evidence-based resources at the following link: https://health.gov/healthypeople/tools-action/browse-evidence-based-resources; CDC: https://www.cdc.gov/socialdeterminants/index.htm; CDC Social Vulnerability Index (SVI) County Maps: https://svi.cdc.gov/prepared-county-maps.html; HHS National Partnership to End Health Disparities; Opportunity Zones: Guidance and Examples of language.

5 Culturally and linguistically appropriate services are respectful of and responsive to the health beliefs, practices and needs of diverse patients. By tailoring services to an individual's culture and language preference, health professionals can help bring about positive health outcomes for diverse populations.

US Department of Health and Human Services-Office of Minority Health: Cultural and Linguistic Competency.

6 HHS defines equity as “[T]he consistent and systematic fair, just, and impartial treatment of all individuals, including individuals who belong to underserved communities that have been denied such treatment, such as Black, Latino, Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality.” 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).

7 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://bphc.hrsa.gov/about/what-is-a-health-center/index.html https://aspe.hhs.gov/topics/health-health-care/addressing-social-determinants-health-federal-programs https://aspe.hhs.gov/topics/health-health-care/addressing-social-determinants-health-federal-programs https://health.gov/healthypeople/tools-action/browse-evidence-based-resources https://health.gov/healthypeople/tools-action/browse-evidence-based-resources https://www.cdc.gov/socialdeterminants/index.htm https://svi.cdc.gov/prepared-county-maps.html https://www.minorityhealth.hhs.gov/assets/pdf/npa/NPA_Toolkit.pdf https://www.minorityhealth.hhs.gov/assets/pdf/npa/NPA_Toolkit.pdf https://intranet.hhs.gov/sites/default/files/s3fs-public/s3fs-public/2021-01/guidance-for-hhs-opdivs-on-oz-targeting-11-18-2020.pdf https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=1&lvlid=6 https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=1&lvlid=6 https://www.govinfo.gov/content/pkg/FR-2021-01-25/pdf/2021-01761.pdf https://www.govinfo.gov/content/pkg/FR-2021-01-25/pdf/2021-01761.pdf https://www.govinfo.gov/content/pkg/FR-2021-01-25/pdf/2021-01761.pdf https://www.govinfo.gov/content/pkg/FR-2021-01-25/pdf/2021-01761.pdf https://www.govinfo.gov/content/pkg/FR-2021-01-25/pdf/2021-01761.pdf

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mortality caused by extreme temperatures.8 In 2021, 35% of health centers across the United States (U.S.) were located in areas impacted by significant disaster and weather-related hazards.9 HRSA is committed to positioning health centers to prepare for emergencies and maintain delivery of essential and routine health services in a rapidly evolving healthcare landscape through evidence-based innovative models of care.

HRSA developed the Health Center Excellence Framework (HCEF) as a tool to define health center performance across seven domains: Access and Affordability; Patient Experience; Quality, Patient Care and Safety; Population Health and Social Determinants of Health; Financial Sustainability; Workforce; and Governance and Management. The HCEF allows health centers to assess their current state of performance across the seven domains, identify a desired future state of performance, and identify data-driven and evidence-based capabilities, activities, behaviors, and resources needed to reach and sustain a higher level of domain performance. NTTAPs will collectively develop, deliver, coordinate, and evaluate T/TA opportunities for health centers across all seven HCEF domains to help health centers improve performance.

NTTAPs will also develop and coordinate their T/TA resources with other HRSA-supported T/TA providers, including other NTTAPs, State and Regional Primary Care Associations (PCAs), and Health Center Controlled Networks (HCCNs) in order to maximize the impact of all HRSA-supported T/TA resources.

Program Requirements and Expectations

Training and Technical Assistance

For the purposes of this funding opportunity, training is defined as an educational tool designed to teach key concepts related to a particular topic, which is often delivered in small or large group settings. Technical assistance is the process of providing targeted support to an organization to facilitate quality or performance improvement.

T/TA activities can take many forms, which can include but are not limited to:

• Developing and delivering training courses, seminars, and workshops to achieve a higher level of performance in one or more HCEF domains;

• Developing relevant content for conferences that will be available online for no charge after the conference;

• Conducting consultations to facilitate health center implementation of roadmap/best practices covered in a previously attended learning collaborative;

• Developing and sharing digital resources such as readiness tools, implementation manuals, and fact sheets;

8 The term socially vulnerable populations encompasses four populations: low-income, minority, no high school diploma, and 65 and older. EPA. 2021. Climate Change and Social Vulnerability in the United States: A Focus on Six Impacts. U.S. Environmental Protection Agency, EPA 430-R-21-003.

https://www.epa.gov/cira/social-vulnerability-report 9 HRSA analysis of number of active health centers located in FEMA-designated disasters and impacted counties.

https://bphc.hrsa.gov/programopportunities/strategic-initiatives https://www.epa.gov/cira/social-vulnerability-report

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• Identifying, disseminating, and facilitating the implementation of evidence-based and promising practices; and

• Facilitating health center peer-to-peer training and mentorship.

Training audiences will include both learning collaborative audiences and national audiences. Learning collaborative audiences include small groups of health centers that come together to study or learn about a particular topic area and model the implementation of successful interventions. National audiences include a wider potential health center target audience such as health centers attending a national conference or participating in a webinar that has broad applicability and/or is more didactic and short-term than a learning collaborative.

NTTAP Categories and Types

For the purposes of this funding opportunity, applicants must propose to provide T/TA for only one NTTAP type in one category as summarized below. The number of projected awards for each NTTAP category and type is also indicated.

• Special Populations (9 awards) category:

o Migratory and Seasonal Agricultural Workers type (5 awards) o People Experiencing Homelessness type (2 awards) o Residents of Public Housing type (2 awards)

• Other Health Center Populations (4 awards) category:

o Asian Americans, Native Hawaiians and other Pacific Islanders type (1 award) o Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+)10 type (1 award) o School-Aged Children type (1 award) o Older Adults type (1 award)

• Development Areas (8 awards) category:

o Capital Development and Growth type (1 award) o Clinical Quality Improvement and Patient Safety type (1 award) o Clinical Workforce Development type (1 award) o Health Information Technology and Data type (1 award) o Health Workforce Recruitment and Retention type (1 award) o Intimate Partner Violence and Human Trafficking Prevention type (1 award) o Medical-Legal Partnerships type (1 award) o Oral Health Care type (1 award)

• National T/TA Center category and type (1 award)

NTTAP Program Requirements

NTTAPs will develop, deliver, coordinate, and evaluate T/TA activities for existing and potential health centers. T/TA activities will support achievement of Objectives outlined

10 The 'plus' represents sexual orientations and gender identities not specifically covered by the five letters.

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in Appendix C: NTTAP Types and Required Objectives.

For the purposes of this funding opportunity:

• You will monitor factors that are or have the potential to impact health centers to inform your T/TA activities and support HRSA awareness of issues that may affect health centers’ ability to maximize their impact and effectively address HRSA priorities, including achieving key programmatic results with supplemental funds awarded to health centers.

• You will support health centers to identify and implement evidence-based and promising practices and innovations in ways that are most effective for the population or development area of your NTTAP type.

• You will leverage health centers’ shared experience and data, along with evidence-based and promising practices and innovations to increase patient-centered care and improve health outcomes.

• You will engage and collaborate with other HRSA-supported T/TA partners (e.g., PCAs, HCCNs), to share data on T/TA needs, coordinate and align T/TA activities, and share T/TA resources and tools that have the potential to amplify T/TA impact and reduce duplication of effort.

• You will participate in the HRSA-Sponsored NTTAP Forum that will be convened during the period of performance.

• You will collect, analyze, and share the evaluation results of your T/TA with HRSA, and you will share results with health centers and HRSA-supported T/TA partners, as appropriate.

• You will contribute to a national health center T/TA needs assessment that covers topics relevant to your NTTAP type, as coordinated by the National T/TA Center.

• You will initiate T/TA delivery within 60 days of award.

• You will ensure access to T/TA resources to the widest possible health center audience nationwide without regard to health center award or designation status, NTTAP membership status, or location.

• You will provide T/TA supported solely with HRSA funds at no charge. If T/TA is funded with a mix of HRSA and non-HRSA funds, charging participants to offset non-HRSA funded costs is permissible if you can demonstrate that the charge is not a barrier to access (e.g. the training will be accessible online without charge).

• You will make the T/TA you develop with HRSA funds available through the Health Center Resource Clearinghouse11 operated by the National T/TA Center.12

11 The National Resource Center for Training and Technical Assistance serves as the vehicle through which all of the national training and technical assistance partners collaborate and coordinate activities to support health centers. The Health Center Resource Clearinghouse is the National Resource Center’s online repository of informational resources which they have collected and organized and have made available to assist health professionals to create healthier communities. The Clearinghouse contains a summary of the resources and provides weblinks to the resources’ original locations and often to the organizations’ own webpages.

12 To see the current version of the Health Center Resource Clearinghouse, visit https://www.healthcenterinfo.org/.

https://www.healthcenterinfo.org/

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• You will make steady progress towards your Objective Targets throughout the 3-year period of performance.

• You must have a minimum number of Activities and lead a minimum number of Learning Collaboratives that support Objective achievement every budget period.

See Table 1: Minimum Number of Activities and Learning Collaboratives by Funding Level below.

• Your minimum number of Learning Collaboratives must:

o Align with your project objectives and be tailored to health center needs, including planning periods, action periods, coaching, scaled implementation of models, and evaluation.

o Include health center-level objectives that are clear, specific, data-driven, and measurable.

o Include a minimum of 10 unique health centers organizations or health center sites, with the majority being funded health centers.

o Identify your organization as the NTTAP lead.

o Include documentation of commitment from participating health center leadership.13 o Include at least 4 sessions in each budget period.

• For National T/TA Center Only:

o Coordinate and conduct the national health center T/TA needs assessment two times per period of performance (budget year 1 and 2).

Needs assessments may target different topic areas from year to year in order to obtain more granular results in a particular area.

o Use the needs assessment results from one budget period to inform T/TA offered in the following budget year.

o Maintain the Health Center Resource Clearinghouse.14

Table 1: Minimum Number of Activities and Learning Collaboratives by Funding Level

Base Funding Level Minimum number of activities across all objectives per budget period

Minimum number of learning collaboratives led per budget period

$0—$550,000 16 minimum activities 2 learning collaboratives

$550,001—$1,000,000 20 minimum activities 3 learning collaboratives

$1,000,001—$1,500,000 24 minimum activities 4 learning collaboratives

13 Documentation should include approval of participation in all learning collaborative sessions and activities from a supervisor or designated member of the health center's leadership team.

14 If a new applicant is awarded as the National T/TA Center through this NOFO, the current award recipient must conduct an orderly phase-out of the Health Center Resource Clearinghouse and transition the consolidated access to T/TA resources, as appropriate, to the FY23 National T/TA Center award recipient.

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Base Funding Level Minimum number of activities across all objectives per budget period

Minimum number of learning collaboratives led per budget period

$1,500,001—$2,000,000 32 minimum activities 5 learning collaboratives

$2,000,001—$7,000,000 72 minimum activities 10 learning collaboratives

Failure to meet these requirements may jeopardize NTTAP funding per Uniform Guidance 2 CFR part 200 as codified by HHS at 45 CFR part 75. HRSA will assess award recipients for compliance during the period of performance. When non-compliance is identified, HRSA will place a condition on the recipient’s award. If an organization fails to successfully resolve conditions, HRSA may withdraw support through cancellation of all or part of the cooperative agreement award (see penalties for noncompliance outlined by 45 CFR 75.371).

II. Award Information

1. Type of Application and Award

Type(s) of applications sought:

• Competing Continuation — A current NTTAP U30 award recipient whose period of performance ends June 30, 2023 that seeks to continue providing health center T/TA.

• New — An organization not currently receiving NTTAP funding that seeks to provide national T/TA as one of the NTTAPs outlined in the Program Requirements and Expectations section and listed in Appendix C: NTTAP Types and Required Objectives.

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

In addition to the usual monitoring and technical assistance (TA) provided directly to award recipients, HRSA program involvement will include:

• Collaborating with award recipients to refine and approve the Project Work Plan based on HRSA priorities, including priorities supported with supplemental funding, and changes in the health care landscape by identifying and prioritizing T/TA needs to be addressed using federal funds.

• Establishing standard measures that will be used by all NTTAPs to evaluate success (e.g., training utility, participant behavior change) that may evolve throughout the period of performance.

• Monitoring and supporting the implementation of the Project Work Plan through collaborative meetings, monthly calls, and progress report reviews.

http://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title02/2cfr200_main_02.tpl http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 http://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75&rgn=div5#se45.1.75_1371

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• Reviewing and supporting the development of key deliverables, including approval of the publication plan and specialized materials for general distribution prior to publication, distribution, and/or online posting.

• Participating in NTTAP-related meetings, as appropriate.

• Coordinating with other Bureaus and Offices within HRSA to identify and support collaboration across and within programs.

• Identifying opportunities to coordinate activities with other federally funded cooperative agreements.

• Conducting an NTTAP site visit once per period of performance to review and assess Program Requirements and Expectations compliance, review activities and key accomplishments, and identify promising practices that support the T/TA needs of health centers.

In addition to adhering to all applicable federal regulations and public policy requirements, the cooperative agreement recipient’s responsibilities shall include:

• Collaborating with HRSA on refining and implementing the Project Work Plan based on HRSA priorities, supplemental funding, and changes in the health care landscape, to include updates needed based on changes at the national level.

• Providing input on standard measures that will be used by all NTTAPs to evaluate success.

• Engaging with HRSA to update Project Work Plans at least annually, or more frequently as needed (e.g., in response to site visit findings, to establish new Activities once current Activities are met).

• Providing a plan for publications to be created or disseminated with NTTAP funds and are intended for general audiences. The plan should include each publication’s purpose, target audience, title, publication type, summary description, expected impact and benefit, and projected publication date.

Publications must also contain an acknowledgement of Federal funding in accordance with the requirements listed on the Communicating and Acknowledging Federal Funding.

• Adhering to HRSA guidelines pertaining to data rights and required acknowledgement and disclaimer on all products produced with HRSA award funds15, as noted on the Notice of Award.

• Participating in HRSA and related stakeholder meetings, as appropriate.

• Coordinating with national, federal, and state organizations to strengthen Project

Work Plan development and implementation.

• Ensuring compliance with NTTAP Program Requirements and Expectations, including that activities, supported in whole or in part with NTTAP funds, are available to all existing and potential health centers, regardless of Health Center Program award or look-alike status, NTTAP organization membership, and/or location.

• Participating in a HRSA-led NTTAP site visit once during the 3-year period of

15 Section VI.2 Data Rights details the government’s rights to publications developed with grant funding.

45 CFR Part 75.322(d).

https://www.hrsa.gov/grants/manage/acknowledge-hrsa-funding https://www.hrsa.gov/grants/manage/acknowledge-hrsa-funding https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75#p-75.322(d)

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performance. Information about the current NTTAP site visit process is available in the NTTAP Site Visit Guide.

2. Summary of Funding

HRSA expects approximately $23.5 million to be available annually to fund 22 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 maximum award amounts 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.

You may apply for up to the maximum annual award amount for the NTTAP type you selected.

• Special Populations (9 awards) category (Migratory and Seasonal Agricultural Workers; People Experiencing Homelessness; Residents of Public Housing) o New applicants in this category may request up to $550,000 annually o Currently funded applicants will receive communication directly from

HRSA with the maximum annual award amount, based on their FY 2022 award.

• Other Health Center Populations (4 awards) category: New and currently funded applicants in this category may request up to the following maximum annual funding amount o Asian Americans, Native Hawaiians and other Pacific Islanders: $550,000 o Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+): $625,000 o School-Aged Children: $550,000 o Older Adults: $550,000

• Development Areas NTTAPs: New and currently funded applicants in this category may request up to the following maximum annual funding amount:

o Capital Development and Growth: $1,170,000 o Clinical Quality Improvement and Patient Safety (new): $1,500,000 o Clinical Workforce Development: $550,000 o Health Information Technology and Data: $693,000 o Health Workforce Recruitment and Retention: $550,000 o Intimate Partner Violence and Human Trafficking Prevention: $550,000 o Medical-Legal Partnerships: $550,000 o Oral Health Care: $550,000

• National T/TA Center: New and currently funded applicants in this category may request up to $6,625,000 annually.

The period of performance is July 1, 2023 through June 30, 2026 (3 years). Funding beyond the first year is subject to the availability of appropriated funds for NTTAPs in subsequent fiscal years, satisfactory progress, and a decision that continued funding is in the best interest of the Federal Government.

Recipients may request supplemental funding at any point in their period of performance to address unique national health center T/TA needs that continue or https://bphc.hrsa.gov/sites/default/files/bphc/technical-assistance/nttap-site-visit-guide.pdf

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enhance activities within the funded scope of work. HRSA may support such supplemental projects if funding is available and allocable, the request is reasonable and allowable, sufficient time remains in the budget period to approve the request, and the activities are aligned with HRSA priorities and non-duplicative of work performed by HRSA or other funding recipients. Supplemental funding will not be included in the funding level used to determine the minimum number of activities of learning collaboratives as listed in Table 1: Minimum Number of Activities and Learning Collaboratives by Funding Level.

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

III. Eligibility Information

1. Eligible Applicants

Eligible applicants include domestic public or private, non-profit, or for-profit entities.

Faith-based organizations, tribes, and tribal organizations are eligible to apply for NTTAP funding. New organizations and organizations currently receiving funding as an NTTAP under Section 330(l) may submit applications.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

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

• Exceeds the maximum allowable funding for your NTTAP type, as outlined in the Summary of Funding section or communicated by HRSA

• Fails to satisfy the deadline requirements referenced in Section IV.3

• Does not include the Project Narrative as described in Section IV.2.ii

You may apply for only one NTTAP type listed in the Program Requirements and Expectations section.

NOTE: Multiple applications from an organization are not allowed.

HRSA will only accept and review your first validated electronic submission, under the correct funding opportunity number (HRSA-23-029), 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 in a Grants.gov application, you may do so in the HRSA Electronic Handbooks (EHBs) application phase.

If you wish to change information submitted in EHBs, you may reopen and revise your application prior to the EHBs deadline. You must ensure that the application is http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 https://grants.hrsa.gov/2010/WebEPSExternal/Interface/Common/AccessControl/Login.aspx

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resubmitted to HRSA before the EHBs deadline, or HRSA will not consider it for funding under this notice.

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 notice of funding opportunity (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 14, 2022 at 11:59 p.m. ET; and

• Phase 2 – EHBs – Supplemental information must be submitted via EHBs with a due date of November 14, 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-23-029 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 HRSA SF-424 Two-Tier 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 the English language and in the terms of U.S. dollars (45 CFR § 75.111(a)).

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

• Application for Federal Assistance (SF-424)

• Attachment Form (submit form with or without attachments)

• Project/Performance Site Locations (list only your administrative site address)

• Project Narrative Attachment Form (attach your project narrative)

• Grants.gov Lobbying Form

• Budget Narrative Attachment Form (attach your budget narrative) 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 http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf

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

• Key Contacts

• Project Abstract Summary

The following application components must be submitted in EHBs:

• Project Narrative

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

• Budget Narrative

• Program-Specific Forms

• Attachments

See Section 9.5 of the HRSA 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 the equivalent of 80 pages when printed by HRSA. Standard OMB-approved forms that are 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 and proof of non-profit or public center status (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-23-029, 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. Any application exceeding the page limit will not be read, evaluated, or considered for funding.

Applications must be complete, within the maximum page limit, validated by Grants.gov and EHBs under HRSA-23-009 before the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

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

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

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

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3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachment 7: Other Relevant Documents.

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

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

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.

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 Attachments Review Criteria

Need section of the Project Narrative (1) Need

Response section of the Project Narrative

Form: Project Work Plan

(2) Response

Collaboration section of the Project Narrative

Attachment 5: Letters of Agreement

(2) Collaboration

Evaluative Measures section of the Project Narrative (3) Evaluative Measures

Resources and Capabilities section of the Project Narrative

Attachment 1: Organizational Chart

Attachment 2: Staffing Plan

Attachment 3: Job Descriptions for Key Personnel

Attachment 4: Biographical Sketches of Key Personnel

Attachment 6: Summary of Contracts and Agreements

(5) Resources/Capabilities http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf

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Narrative Section, Forms, and Attachments Review Criteria Support Requested section of the Project Narrative

Budget Narrative

Attachment 2: Staffing Plan

Attachment 6: Summary of Contracts and Agreements

Attachment 7: Other Relevant Documents

(6) Support Requested

ii. Project Narrative (Required for Eligibility)

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

Successful applications will contain the information below, specific to your proposed NTTAP type. Please use the following section headers for the narrative:

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

Information provided in this section must serve as the basis for the proposed Activities for Objectives, specific to your proposed NTTAP type (see Appendix C: NTTAP Types and Required Objectives).

1) Describe the needs and expected changes in the health care landscape for existing and potential health centers relevant to your selected NTTAP type:

a. All NTTAP applicants must address:

i. Access to comprehensive, affordable, culturally, and linguistically appropriate health services in a timely manner;

ii. Patient experience that is respectful of, and responsive to, individual preferences, culture, needs, values and helps guide clinical decisions;

iii. Clinical quality, patient care, and safety; and

iv. Health equity and social risk factors.

b. Organizations applying as Capital Development and Growth NTTAP must also address: Health center accounting, revenue cycle, and financial management.

c. Organizations applying as Clinical Quality Improvement and Patient Safety NTTAP must also address: Health center governance to promote a culture of quality improvement and patient safety, leadership, and management.

d. Organizations applying as Clinical Workforce Development NTTAP must also address: Health center workforce development of career pathways, team-based care, engagement, and retention.

e. Organizations applying as Health Workforce Recruitment and Retention NTTAP must also address: Health center workforce recruitment, development, engagement, retention.

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f. Organizations applying as Migrant and Seasonal Agricultural Worker NTTAP must also address: Health center governance, leadership and management.

g. Organizations applying as National T/TA Center NTTAP must also address:

i. Health center governance, leadership and management; and

ii. Health center workforce recruitment, development, engagement and retention.

2) Describe the data sources that inform your understanding of national T/TA needs of existing and potential health centers. Data must be specific to NTTAP type population of focus or developmental area (e.g., organizations applying for the Oral Health Care NTTAP must describe the sources of oral health care data used). Data sources may include, but are not limited to, Health Center Program data (e.g., Uniform Data System (UDS) reports), annual T/TA satisfaction survey results, participant feedback from past T/TA trainings, and the national health center T/TA needs assessment.

3) Based on your current understanding of national T/TA needs of existing and potential health centers in the areas outlined above, discuss short- and long-term health center T/TA priorities specific to your proposed NTTAP type over the 3-year period of performance. For the purpose of this NOFO, short-term refers to the first 12 months of funding, while long-term refers to the remaining two years of the 3-year period of performance.

RESPONSE -- Corresponds to Section V’s Review Criterion 2: Response

1) Complete the structured Project Work Plan (PWP) in EHBs (see Appendix B:

Project Work Plan for instructions). The PWP must:

a) Include realistic and achievable Objective Targets to be attained by the end of the period of performance for each objective for your NTTAP type listed in Appendix C: NTTAP Types and Required Objectives.

b) Include Objective Impact narratives that link proposed Activities to the attainment of the Objective Targets.

c) Outline Year 1 Activities for each Objective that are tailored to the needs of existing and potential health centers nationwide for your NTTAP type and are scaled to ensure attainment of the Objective Targets.

d) Include the required number of activities and learning collaboratives across all Objectives.

2) Describe how you will use data to evolve and/or modify activities in Years 2 and 3 of the period of performance to achieve the stated Objectives by the end of the period of performance (June 30, 2026). For Objective 2: Emerging Issues, include how you will evaluate the need to change the issue you will address throughout the period of performance.

3) Describe strategies that will leverage strengths (contributing factors) and overcome potential challenges (restricting factors) in implementing the Activities

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described in the PWP, referencing the Key Factors included in the…