BPHC HRSA-24-030 (H1C) Native Hawaiian Health Care Improvement Act_Modification.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2024

Bureau of Primary Health Care

Native Hawaiian Health Care Improvement Act Program

Funding Opportunity Number: HRSA-24-030

Funding Opportunity Type(s): Limited Competition

Assistance Listing Number: 93.932

Application Due Date: May 2, 2024 Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

We will not approve deadline extensions for lack of registration.

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

Issuance Date: February 2, 2024

MODIFIED on March 26, 2024, to clarify reporting requirements.

Marc Clark Public Health Analyst, Bureau of Primary Health Care (BPHC) Office of Policy and Program Development Ongoing Investments Call: 301-594-4300 Contact: BPHC Contact Form See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C. §§ 11705(a)(1)-(2), 11705(b)-(g), 11706, 11707(a)-(g), and 11709(a) (Sections 4(a)(1)-(2), 4(b)-(g), 5, 6(a)-(g), and 10(a) of the Native Hawaiian Health Care Improvement Act).

https://www.hrsa.gov/about/contact/bphc.aspx

HRSA-24-030

508 COMPLIANCE DISCLAIMER

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

SUMMARY

Funding Opportunity Title: Native Hawaiian Health Care Improvement Act

Funding Opportunity Number: HRSA-24-030

Assistance Listing Number: 93.932

Due Date for Applications: May 2, 2024

Purpose: The purpose of these Native Hawaiian Health Care Improvement Act (NHHCIA) awards is to provide Native Hawaiian health care programs with resources to raise the health status of Native Hawaiians to the highest possible health level.

Program Objective(s): The objectives of these NHHCIA awards are:

(1) For Papa Ola Lokahi (POL) for administrative purposes authorized under NHHCIA, and

(2) For five Native Hawaiian Health Care Systems (NHHCSs) that have been recognized and certified by POL as qualified to provide comprehensive health promotion, disease prevention, and primary health services tailored to fit the needs of Native Hawaiian Island communities.

Eligible Applicants: Eligible applicants include:

(1) POL; and

(2) NHHCSs listed in Table 1.

See Section III-1 of this NOFO for complete eligibility information.

Anticipated FY 2024 Total Available Funding:

Approximately $24,800,000

We’re issuing this notice to ensure that, should funds become available for this purpose, we can process applications and award funds appropriately. You should note that we may cancel this program notice before award if funds are not appropriated.

Estimated Number and Type of Award(s):

One award to POL

Five awards to NHHCSs

Estimated Award Amount: Varies by recipient (see Table 1)

Cost Sharing or Matching Required:

Awards to POL: No. No cost sharing or matching requirement.

Awards to NHHCSs: Yes. All applicants must make available non-federal matching funds in an amount equal to $1 for every $5 of federal funds.

Period of Performance: August 1, 2024 – July 31, 2027 (up to 3 years)

Agency Contacts: Business, administrative, or fiscal issues:

Nicole Turner Grants Management Specialist Division of Grants Management Operations, Office of Federal Assistance Management Email: NTurner@hrsa.gov

Program issues or technical assistance:

Marc Clark Public Health Analyst Office of Policy and Program Development Bureau of Primary Health Care Contact: BPHC Contact Form

Application Guide

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

mailto:NTurner@hrsa.gov https://www.hrsa.gov/about/contact/bphc.aspx http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application

Technical Assistance

The NHHCIA TA webpage includes:

• Application resources, such as fillable forms and sample documents,

• Answers to frequently asked questions,

• Details about our pre-application TA webinar, and

• Contact information for questions.

https://bphc.hrsa.gov/funding/funding-opportunities/native-hawaiian-health-care-improvement-act

HRSA-24-030

iv

Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING OR MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Attachments

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

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: REQUIRED AND OPTIONAL SERVICES FOR NATIVE HAWAIIAN HEALTH

CARE SYSTEMS

APPENDIX B: NHHCS ATTACHMENT INSTRUCTIONS

APPENDIX C: POL ATTACHMENT INSTRUCTIONS

APPENDIX D: PROJECT UPDATE INSTRUCTIONS

APPENDIX E: APPLICATION PAGE LIMIT WORKSHEET

I. Program Funding Opportunity Description

1. Purpose

This Notice of Funding Opportunity (NOFO) announces the opportunity to apply for funding under the Native Hawaiian Health Care Improvement Act (NHHCIA) program.

The purpose of these Native Hawaiian Health Care Improvement Act (NHHCIA) awards is to provide Native Hawaiian health care programs with resources to raise the health status of Native Hawaiians to the highest possible health level. This NOFO supports funding the following:

• One award to Papa Ola Lokahi (POL) for administrative purposes as authorized under 42 U.S.C. §§ 11705(a)(2) and 11706.

• Five awards for qualified entities as authorized under 42 U.S.C. §§ 11705(a)(1), 11705(b)-(g) and 11707(a)-(g) (Sections 4(a)(1), 4(b)-(g) and 6(a)-(g) of the Native Hawaiian Health Care Improvement Act, as amended). Per statute, a qualified entity is a Native Hawaiian Health Care System (NHHCS) that has been recognized and certified by POL as qualified to provide comprehensive health promotion, disease prevention, and primary health services that are tailored to fit the needs of the Native Hawaiian communities they serve. POL-recognized and certified NHHCSs and the communities they serve are listed in Table 1.

This is a limited competition program announcement. This NOFO provides instructions to be used by applicants in preparing applications for funding for fiscal years 2024 through 2026.

2. Background

This program is authorized under 42 U.S.C. §§ 11705(a)(1)-(2), 11705(b)-(g), 11706, 11707(a)-(g) and 11709(a) (Sections 4(a)(1)-(2), 4(b)-(g), 5, 6(a)-(g), and 10(a) of the Native Hawaiian Health Care Improvement Act), as amended).

The Native Hawaiian population experiences geographic isolation and other barriers to accessing health care services. These barriers have a significant negative impact on overall health status.

As a result, Native Hawaiians suffer disproportionately from many chronic diseases that lead to premature disability and high morbidity and mortality rates. When compared to other population groups, Native Hawaiians have significantly higher rates of diabetes mellitus, heart disease, obesity, stroke, asthma, hypertension, dental caries, and cancer.1

1 U.S. Department of Health and Human Services Office of Minority Health. Profile: Native Hawaiians/Pacific Islanders. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=65. Accessed September 21, 2023.

https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=65

II. Award Information

1. Type of Application and Award

Application type: Limited Competition.

We will fund you via a grant.

2. Summary of Funding

We estimate $24,800,000 will be available each year to fund the 6 recipients listed below. Each listed entity may apply annually for the ceiling amount listed next to your organization or island community’s name in Table 1. The ceiling amount includes both direct and indirect costs.

The period of performance is August 1, 2024 through July 31, 2027 (3 years).

Table 1: Maximum Awards for FY 2024 Applicant Type Eligible Organizations Maximum Funding

Amount Administrative Papa Ola Lokahi $10,000,000 System Ho'ola Lahui Hawaii, and/or any health care system that meets the definition of a NHHCS under NHHCIA and serves Native Hawaiians on the islands of Kaua'i and Ni'ihau.

$3,246,769

System Ke Ola Mamo, and/or any health care system that meets the definition of a NHHCS under NHHCIA and serves Native Hawaiians on the island of O'ahu.

$2,924,208

System Na Pu'uwai, and/or any health care system that meets the definition of a NHHCS under NHHCIA and serves Native Hawaiians on the islands of Moloka'i and Lana'I.

$2,530,712

System Hui No Ke Ola Pono, and/or any health care system that meets the definition of a NHHCS under NHHCIA and serves Native Hawaiians on the island of Maui.

$3,088,269

System Hui Malama Ola Ha’oiwi, and/or any health care system that meets the definition of a NHHCS under NHHCIA and serves Native Hawaiians on the island of Hawaii.

$3,001,484

TOTAL $24,791,442

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

Support beyond the first budget year will depend on:

• The availability and amount of appropriations

• Satisfactory progress in meeting the project’s objectives.

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

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

If you’ve never received a negotiated indirect cost rate, you may elect to charge a de minimis rate of 10 percent of modified total direct costs (MTDC)*. You may use this for the life of the award. If you choose this method, you must use it for all federal awards until you choose to negotiate for a rate. You may apply to do so at any time. See Section 4.1.v. Budget Narrative in the Application Guide.

*Note: One exception is a governmental department or agency unit that receives more than $35 million in direct federal funding.

III. Eligibility Information

1. Eligible Applicants

This is a limited competition program notice.

To be eligible for administrative funding under this NOFO, you must be Papa Ola Lokahi.

To be eligible for services funding under this NOFO, you must be a Native Hawaiian Health Care System (NHHCS) that has been recognized and certified by POL as qualified to provide comprehensive health promotion, disease prevention, and primary health services that are tailored to fit the needs of the Native Hawaiian communities.

Recognized and certified NHHCSs and their respective island communities are listed in Table 1.You must provide proof of Papa Ola Lokahi’s recognition and certification in Attachment 13, or your application will be considered non-responsive and will not be considered for funding.

2. Cost Sharing or Matching

Cost sharing/matching is required for NHHCS. The authorizing statute states in subsection 11705(e) that all applicants that will provide services must make available matching funds from non-federal sources. NHHCSs must make available $1 in non-federal funds for every $5 of federal funds (see Budget for details). In addition, as provided by statute, federal award funding may not exceed 83.3 percent of the costs of providing health services under the award or contract.

Non-federal contributions may be in cash or in-kind. In-kind contributions must be fairly evaluated and may include plant, equipment, or services. When you calculate non-federal contributions, do not include amounts the federal government provides directly https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 or through services they subsidize. You may use federal sources as matching funds if they are received as:

• Fees;

• Payments; or

• Reimbursements for the provision of a specific service, like patient care reimbursements from Medicare or Medicaid.

You may include program income you generate from the NHHCIA award as matching funds.

3. Other

We may consider your application ineligible for funding if it:

• Exceeds the funding ceiling amount listed in Table 1;

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

• Fails to meet the deadline referenced in Section IV.4; or.

• Does not properly address the matching requirements identified above.

Multiple Applications

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

IV. Application and Submission Information

1. Address to Request Application Package

We require you to apply online through Grants.gov. Use the SF-424 workspace application package associated with this NOFO. Follow these directions: How to Apply for Grants. If you choose to submit using an alternative online method, see Applicant System-to-System.

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

Select “Subscribe” and enter your email address for HRSA-24-030 to receive emails about changes, clarifications, or instances where we republish the NOFO. You will also be notified by email of documents we place in the RELATED DOCUMENTS tab that may affect the NOFO and your application. You are responsible for reviewing all information that relates to this NOFO.

2. Content and Form of Application Submission

Application Format Requirements Submit your information following the instructions in the Application Guide and this program specific NOFO. Write your application in English. Use U.S. dollars for your https://www.grants.gov/ https://www.grants.gov/applicants/grant-applications/how-to-apply-for-grants https://www.grants.gov/applicants/grant-applications/how-to-apply-for-grants https://www.grants.gov/system-to-system/applicant-system-to-system/ https://www.grants.gov/system-to-system/applicant-system-to-system/ budget. There’s an Application Completeness Checklist in the Application Guide to help you.

Application Page Limit The page limit for your application is 80 pages. We will not review any pages that exceed the page limit. Using the pages within the page limit, we will determine eligibility using Section III. Eligibility Information of the NOFO.

These items do not count toward the page limit:

• Standard Office of Management and Budget (OMB)-approved forms required for NOFO application submission

• Abstract (standard form (SF) "Project Abstract Summary”)

• Indirect Cost Rate Agreement

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

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

If you use an OMB-approved form that is not required for the HRSA-24-030 application package, it may count toward the page limit.

It is important to ensure your application does not exceed the specified page limit. See Appendix E: Application Page Limit Worksheet for additional information.

Applications must be complete and validated by Grants.gov under HRSA-24-030 before the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

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

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

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

Other Relevant Documents.

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

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

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

https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180/subpart-I/section-180.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376 https://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-prelim-title31-chapter33&edition=prelim https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-B/section-75.113

Program Requirements and Recommendations Program Requirements

NATIVE HAWAIIAN HEALTH CARE SYSTEMS (NHHCS)

NHHCSs receiving service awards under this NOFO are required to provide comprehensive disease prevention, health promotion, and primary health services to Native Hawaiians, either directly or through contract, per 42 U.S.C. § 11705. NHHCS are required to provide all the following mandatory services in accordance with the authorizing legislation [see 42 U.S.C. § 11705(c)(1)(A-G)]:

(A) Outreach services to inform Native Hawaiians of the availability of health services.

(B) Education in health promotion and disease prevention of the Native Hawaiian population by, wherever possible, Native Hawaiian health care practitioners, community outreach workers, counselors, and cultural educators.

(C) Services of physicians, physicians’ assistants, nurse practitioners, or other health professional.

(D) Immunizations.

(E) Prevention and control of diabetes, high blood pressure, and otitis media.

(F) Pregnancy and infant care.

(G) Improvement of nutrition.

In addition to the mandatory services above, NHHCSs may provide the following optional services [see 42 U.S.C. § 11705(c)(2)(A-C)]:

(A) Identification, treatment, control, and reduction of the incidence of preventable illnesses and conditions endemic to Native Hawaiians.

(B) Collection of data related to the prevention of diseases and illnesses among Native Hawaiians.

(C) Services within the meaning of the terms "health promotion," "disease prevention," and "primary health services" as defined under the NHHCIA [see 42 U.S.C. § 11711], as excerpted below.

Under 42 U.S.C. § 11711(1), t, the term “disease prevention” includes:

a) Immunizations;

b) Control of high blood pressure;

c) Control of sexually transmittable diseases;

d) Prevention and control of diabetes;

e) Control of toxic agents;

f) Occupational safety and health;

g) Accident prevention;

h) Fluoridation of water;

i) Control of infectious agents; and

j) Provision of mental health care.

Under 42 U.S.C. § 11711(2), the term “'health promotion'” includes:

a) Pregnancy and infant care, including prevention of fetal alcohol syndrome;

b) Cessation of tobacco smoking;

c) Reduction in the misuse of alcohol and drugs;

d) Improvement of nutrition;

e) Improvement in physical fitness;

f) Family planning;

g) Control of stress; and

h) Educational programs with the mission of improving the health, capability, and well-being of Native Hawaiians.

Under 42 U.S.C. § 11711(8) the term “primary health services” includes:

a) Services of physicians, physicians' assistants, nurse practitioners, and other health professionals;

b) Diagnostic laboratory and radiologic services;

c) Preventive health services (including children's eye and ear examinations to determine the need for vision and hearing correction, perinatal services, well child services, and family planning services);

d) Emergency medical services;

e) Transportation services as required for adequate patient care;

f) Preventive dental services; and

g) Pharmaceutical services, as may be appropriate.

Governance: Each NHHCS receiving funding under this NOFO must be organized under the laws of the State of Hawaii; provide or arrange for health care services through practitioners licensed by the State of Hawaii; and be a public or nonprofit private entity in which Native Hawaiian health practitioners significantly participate in the planning, management, monitoring, and evaluation of health services [see 42 U.S.C. § 11711(6)].

PAPA OLA LOKAHI (POL)

POL must perform activities in accordance with the administrative grant section of the authorizing legislation [see: 42 U.S.C. § 11706(a)]. POL must:

1. Coordinate, implement, and update a Native Hawaiian comprehensive health care master plan developed pursuant to 42 U.S.C. § 11703 [see 42 U.S.C. § 11706(a)(1)].

2. Conduct training for Native Hawaiian health care practitioners, community outreach workers, counselors, and cultural educators to educate the Native Hawaiian population regarding health promotion and disease prevention [see 42 U.S.C. §§ 11704(a)(2), 11705(c)(1)(B) and 11706(a)(2)].

3. Identify and research the diseases that are most prevalent among Native Hawaiians, including behavioral, biomedical, epidemiological, and health services [see 42 U.S.C. §§ 11704(a)(3) and 11706(a)(3)].

4. Develop an action plan outlining the contributions that each member organization of POL will make in carrying out the policy of the NHHCIA [see 42 U.S.C. §§ 11704(a)(4) and 11706(a)(4)].

5. Serve as a clearinghouse for:

a) Collection and maintenance of data associated with the health status of Native Hawaiians.

b) Identification and research into diseases affecting Native Hawaiians.

c) Availability of Native Hawaiian project funds, research projects, and publications.

[see 42 U.S.C. §§ 11704(c) and 11706(a)(5)]

6. Coordinate and assist with the health care programs and services provided to Native Hawaiians [see 42 U.S.C. §§ 11704(d) and 11706(a)(6)].

7. Administer special project funds [see 42 U.S.C. §§ 11704(b) and 11706(a)(7)].

Additionally, POL is responsible for [see 42 U.S.C. § 11711(6)(F)]:

1. Recognizing entities for the purpose of planning, conducting, or administering programs, or portions of programs, authorized by NHHCIA for the benefit of Native Hawaiians.

2. Certifying entities that have the qualifications and the capacity to provide the services and meet the requirements of this program.

[see 42 U.S.C. § 11711(6)(F)]

3. Planning Native Hawaiian health care systems to serve the health needs of Native Hawaiian communities on each of the islands of O’ahu, Moloka’i, Maui, Hawai’i, Lana’i, Kaua’i, and Ni’ihau [see 42 U.S.C. §§ 11705(a)(2)].

Governance: As defined by 42 U.S.C. § 11711(7), Papa Ola Lokahi (POL) consists of E Ola Mau, the Office of Hawaiian Affairs of the State of Hawaii, Alu Like, The University of Hawaii, the Office of Hawaiian Health of the Hawaii State Department of Health, and five NHHCSs: Ho`ola Lahui Hawai`i, Hui Malama Ola Na `Oiwi, Hui No Ke Ola Pono, Ke Ola Mamo, Na Pu’uwai, and other entities or organizations as described in 42 U.S.C. § 11711(7).

Program Recommendations We encourage you to propose activities that promote health equity by addressing health-related social needs. Health-related social needs are an individual’s unmet social needs that contribute to poor health outcomes including, but not limited to, food insecurity, housing insecurity, financial strain, intimate partner violence, and lack of transportation/access to public transportation. See the 2023 UDS Manual (hrsa.gov) for additional information.

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

i. Project Abstract

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

In addition to the information requested in the application guide, the project abstract must provide a brief history of the organization and how the proposed project will address the health care needs of the Native Hawaiian population.

NARRATIVE GUIDANCE

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

https://bphc.hrsa.gov/sites/default/files/bphc/data-reporting/2023-uds-manual.pdf

Narrative Section, Forms, and Attachments Review Criteria

Need section Criterion (1) NEED

Response section

Attachment 1: Project Work Plan*

Attachment 12: Summary of Contracts and Agreements

Attachment 14: Formal Certification Procedure*

Required and Optional Additional Services**

Criterion (2) RESPONSE

Collaboration section

Attachment 11: Letters of Support

Attachment 15: Other Relevant Documents

Criterion (3) COLLABORATION

Evaluative Measures section

Attachment 2: Required Service Projections**

Attachment 3: Required Clinical Performance** Measures

Attachment 4: Optional Clinical Performance** Measures

Attachment 5: Required Financial Performance** Measures

Criterion (4) EVALUATIVE

MEASURES

Resources/Capabilities section

Attachment 6: Income Analysis Form**

Attachment 7: Staffing Plan

Attachment 8: Position Descriptions for Key Personnel

Attachment 9: Biographical Sketches for Key Personnel

Attachment 10: Current Board Member Characteristics

Attachment 13: Recognition and Certification from POL**

Criterion (5) RESOURCES/

CAPABILITIES

Support Requested section

SF-424A

Budget Narrative

Criterion (6) SUPPORT

REQUESTED

*Item only applies to POL.

**Item only applies to NHHCSs.

ii. Project Narrative

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

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

This ensures reviewers can understand your proposed project.

NHHCS Narrative Instructions

Need -- Corresponds to Section V’s NHHCS Review Criteria #1 o Using reliable, island-specific data, describe the characteristics of your population of focus that could impact access to health care and health care utilization. Include data related to:

• Island-specific geographic areas where significant numbers of Native Hawaiians will be served.

• Demographic, cultural, and ethnic factors.

• Unemployment or educational factors.

• Barriers to accessing health services.

• Health-related social needs (including food insecurity, housing insecurity, financial strain, lack of transportation or access to public transportation, and intimate partner violence).

• Health status and unique treatment needs.

o Describe the health care environment of the service area including:

• Existing health services currently available to your population of focus.

• Barriers to service delivery.

• Significant challenges that affect the availability of health care services.

Response -- Corresponds to Section V’s NHHCS Review Criteria #2 The Response section and related attachments should discuss program activities and services you will provide over the 3-year period of performance of August 1, 2024 – July 31, 2027.

o Describe how you will provide all required services listed in Appendix A and any proposed optional services that address the needs of your population of focus.

o Describe arrangements you have with other organizations to provide services, including contractual and financial agreements with other health care entities in the community (for example, HRSA-funded health centers, Area Health Education Centers, hospitals, universities, other community-based organizations).

o Describe your plans to ensure that proposed activities will begin within 60 days of award. If relevant, provide a timeline for hiring, training, and onboarding staff.

o Describe your plans to implement continuous quality improvement/quality assurance activities to assess whether your proposed project is meeting the goal of improving the health status and advancing health equity for your population of focus.

Collaboration -- Corresponds to Section V’s NHHCS Review Criteria #3 o Describe how you plan to work with other Native Hawaiian Health Care programs and other organizations providing health services to Native Hawaiians. In Attachment 11, include dated letters of support, signed memoranda of agreement or other documentation in support of your collaborations.

o Describe how you will work with POL to carry out award-funded activities. In Attachment 15, include a copy of the formal agreement you have with POL.

Evaluative Measures -- Corresponds to Section V’s NHHCS Review Criteria #4 o For the required services of outreach, health promotion and education, and provision of health services, you must develop service projections.

Describe the data source(s) and process you used to develop realistic and achievable goals for the required service projections. Upload your required service projections in Attachment 2.

o Describe the data source(s) and process you used to develop realistic and achievable goals for the required and optional clinical services you will provide. Describe how you selected the key factors and planned actions for each performance measure. Upload your required and optional clinical services in Attachments 3 and 4.

o Describe the data source(s) and process you used to develop realistic and achievable goals for the required financial measure of Cost Per Total Patient and at least one other financial measure. Describe how you selected the key factors and planned actions for each financial measure.

Upload your financial performance measures in Attachment 5.

o Describe how you will measure and evaluate your progress towards meeting your identified goals, including what data you will collect and how often you will review this data to assess performance.

o Describe how you will use evaluation results to improve program performance throughout the 3-year period of performance.

Resources/Capabilities -- Corresponds to Section V’s NHHCS Review Criteria #5 o Describe your organizational capabilities to implement your proposed project. Explain how the key positions described in Attachment 8 will support the successful implementation of your proposed project. In Attachment 9, note relevant experience and expertise of your proposed key personnel.

o Describe your financial management and management information systems (MIS) capacity. Describe how you will use these systems to track and report on financial performance and risk management. Ensure that Attachments 8, 9, and 10 clearly demonstrate financial leadership capabilities and experience at the NHHCS staff and board levels.

o Describe how you will retain and, if necessary, recruit qualified staff to carry out your proposed project.

o Describe how you will work with POL to facilitate the recruitment and placement of Native Hawaiian health scholarship recipients at your or other NHHCSs.

o Describe your corporate compliance competencies, including financial and operational oversight procedures and procedures for reviewing and updating malpractice and other insurances.

o Describe your data analysis and data reporting capabilities. Explain how you will use these capabilities to meet the Program Requirements.

o Describe how your NHHCS governing board, listed in Attachment 10:

• Brings appropriate expertise to establish and approve policies impacting your organization’s operations.

• Monitors and evaluates your organization’s operational and financial performance.

• Communicates and coordinates with POL to achieve shared goals of improving the health and well-being of Native Hawaiians.

o Upload your most recent certification from POL in Attachment 13.

Describe any compliance issues or areas for growth identified by POL during your most recent certification process and how you addressed them.

o Describe your revenue and collection activities, including self-pay income, third-party reimbursement, and sliding-fee schedule collections.

Your description should be consistent with the information you provide in Attachment 6.

o Describe plans for maintaining financial viability, including establishment or maintenance of required Medicaid reimbursement arrangement.4

Support Requested -- Corresponds to Section V’s NHHCS Review Criteria #6 o Provide a budget presentation that:

• Is consistent across all budget documents including the SF-424A and budget narrative.

• Is consistent with identified needs, proposed activities, and project goals.

• Demonstrates how NHHCIA award funding will not be duplicative of existing resources.

o Describe plans to:

• Acquire and make available non-federal matching funds in an amount equal to $1 for every $5 of federal funds.

• Adhere to the 10 percent administrative cap.

Please note: If you anticipate challenges with meeting the matching requirement, you must discuss these anticipated challenges with POL and HRSA before you submit your application. You must also discuss your contingency plans to achieve full compliance.

PAPA OLA LOKAHI (POL) : Narrative Instructions

Need -- Corresponds to Section V’s POL Review Criterion #1 o Describe the need for coordinating, implementing, and updating a Native Hawaiian comprehensive health care master plan designed to promote comprehensive health promotion and disease prevention services and to maintain and improve the health status of Native Hawaiians. Describe barriers to coordinating, implementing, and updating the master plan.

o Describe the need for collecting data on the health care status and health care needs of Native Hawaiians to inform the development of the

4 A Medicaid reimbursement is required if the entity provides services directly or if the entity will provide such health services through a contract with an organization 42 U.S.C. § 11707(a)(c).

master plan. Include any unique, population specific health care data needs. Discuss any significant barriers you encounter with data collection.

o Describe the need for, and barriers to, collecting data related to the services provided by the NHHCSs.

o Describe the need for, and barriers to, training Native Hawaiian health care practitioners, community outreach workers, counselors, and cultural educators who are carrying out health education, health promotion and disease prevention activities on behalf of NHHCSs for the Native Hawaiian population.

o Describe the need for, and barriers to, identifying and researching the diseases that are most prevalent among Native Hawaiians.

Response -- Corresponds to Section V’s POL Review Criterion #2

The Response section and related attachments should address program activities that will occur over the 3-year period of performance of August 1, 2024 to July 31, 2027.

o In Attachment 1, provide a 3-year Project Work Plan that describes how you will carry out the requirements of the NHHCIA. In the Project Work Plan, indicate which activities were added in response to increased funding identified by Congress as being made available for award by HRSA to POL.5 The Project Work Plan must include plans for the following requirements:

• Coordinating, implementing, and updating a Native Hawaiian comprehensive health care master plan.

• Conducting training for Native Hawaiian health care practitioners, community outreach workers, counselors, and cultural educators.

• Identifying and performing research into the diseases most prevalent among Native Hawaiians.

• Expanding research and surveillance related to the health status of Native Hawaiians.

5 See page 51 of the Explanatory Statement for Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Bill, 2023:

https://www.appropriations.senate.gov/imo/media/doc/LHHSFY23REPT.pdf https://www.appropriations.senate.gov/imo/media/doc/LHHSFY23REPT.pdf

• Developing or updating a plan outlining the contributions of each POL member organization in carrying out the requirements of the NHHCIA.

• Serving as a clearinghouse for data collection and maintenance, research, project funds, research projects, publications, and dissemination of information pertinent to the NHHCSs as described in 42 U.S.C. § 11704(c).

• Coordination of health care programs and services provided to Native Hawaiians.

• Providing technical support and coordination of training and technical assistance to the NHHCSs, including strengthening the capacity of the NHHCSs to provide comprehensive disease prevention, health promotion, and primary care services.

• Administering special projects as outlined in 42 U.S.C. § 11704(b).

• Strengthening the capacity of NHHCSs to provide comprehensive disease prevention, health promotion, and primary care services.

• Recognizing NHHCSs for the purpose of planning, conducting, or administering programs, or portions of programs, authorized by this chapter for the benefit of Native Hawaiians.

• Certifying that NHHCS have the qualifications and capacity to provide the services and meet the requirements of the NHHCIA.

For each of the requirements listed above, include the following information in the Project Work Plan:

• Goal – Goals should outline what you hope to accomplish in the 3-year period of performance, be time-framed, and measurable.

• Key Action Steps – Activities you will implement to achieve the goal.

• Timeline – When each action step will be accomplished.

• Expected Outcome – The predicted result of what each action step will accomplish.

• Data – The data you will use to track progress toward goals.

• Person/Area Responsible – Who will be accountable for accomplishing the goal.

• Collaborative Partners –The community or member organizations that will contribute to carrying out the key action steps.

o Describe how you will ensure any newly proposed activities will be initiated within 60 days of award.

o In Attachment 14, clearly describe your process for recognizing and certifying NHHCSs. Include:

• A detailed explanation of the steps involved in your certification process.

• A list and description of the qualifications and capabilities NHHCSs must demonstrate to continue to be recognized and certified by POL.

• Copies of documents and other materials (for example, checklists, guidelines, interview questions) you use to determine if an NHHCS continues to have the qualifications and capacity necessary to provide services and meet the requirements of this funding opportunity under Section 6(a) of NHHCIA. Include both the materials you use as well as descriptions of any documents you request from the NHHCSs.

• The dates of recognition and recertification for each existing

NHHCS.

o Clearly describe how you publicize the NHHCS recognition and certification process within island communities so that new organizations that are not currently recognized and certified can express interest in becoming a recognized and certified NHHCS. Include the following details:

• How you reach out to island communities to describe the recognition and certification process. Describe your current processes including how often you reach out and any planned changes for the 3-year period of performance of August 1, 2024 – July 31, 2027.

• Results of your outreach, including how many new organizations have expressed interest in recognition and certification.

o Clearly describe the process you would use to recognize and certify a new organization that is not currently certified as an NHHCS. If the recognition and certification for new organizations differs from the recognition and certification process for current NHHCS, describe how.

Collaboration -- Corresponds to Section V’s POL Review Criterion #3 o Describe your efforts to coordinate and assist with the health care programs and services provided to Native Hawaiians by NHHCSs. In Attachment 11 include any documents that support your description (for example, dated letters of support, signed memoranda of agreement).

o Describe your efforts to collaborate with other medical providers or federally funded entities (as applicable) to provide health services to Native Hawaiians. Such providers or entities may include but are not limited to: HRSA-funded health centers (including look-alikes), NHHCS, local hospitals, state and local health services delivery organizations, specialty providers, and social service organizations. Include a copy of any formal agreements as part of Attachment 15: Project Update and Other Relevant Documents.

Evaluative Measures -- Corresponds to Section V’s POL Review Criterion #4 o Describe how you will evaluate your progress towards meeting identified goals and expected outcomes.

o Describe how you will use evaluation results to improve program performance over the course of the period of performance.

Resources/Capabilities -- Corresponds to Section V’s POL Review Criterion #5 o Describe your organizational capabilities to implement the project.

Examples of organizational capacity include leadership capabilities, human resource development, risk management approaches, governance, and strategic planning. Describe how key personnel included in Attachment 9 contribute to your organizational capacity.

o Describe the experience and expertise of the proposed key personnel listed in Attachment 9 and their responsibilities as they relate to activities described in the Project Work Plan. If you plan to add new management or leadership positions supported by this award, attach a position description for the new roles in Attachment 8 Position Descriptions for Key Personnel.

o Describe your financial management and management information systems (MIS) capacity. Describe how you will use these systems to track and report on financial performance and risk management. Ensure that Attachments 8, 9, and 10 clearly demonstrate financial leadership capabilities and experience of POL staff and board members o Describe how you will assist the NHHCSs with the retention and recruitment of qualified staff, including the recruitment and placement of Native Hawaiian scholarship recipients.

o Describe how your organization’s governance, as listed in Attachment 10:

• Complies with the requirements of the NHHCIA authorizing legislation at 42 U.S.C. § 11711(7) regarding its composition (see Program Requirements).

• Monitors and evaluates your organization’s operational and financial performance.

• Collaborates with the governing boards of each NHHCS to achieve shared goals of improving the health and well-being of Native Hawaiians. Include specific examples of this collaboration.

o Describe your plans for maintaining long-term financial viability. In your description, include your plans for sustaining personnel added in response to recently increased funding for award to POL.

o Describe your data analysis and data reporting capability, as required to meet the Program Requirements.

Support Requested -- Corresponds to Section V’s POL Review Criterion #6 o Provide a complete and detailed budget presentation that:

• Is consistent across all budget documents including the SF-424A and budget narrative.

• Is consistent with identified needs, proposed activities, and project goals.

o Demonstrate that NHHCIA award funds will not be duplicative of existing resources.

iii. Budget

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

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

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

Program Income

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

Specific Instructions

The NOFO requires the following:

STANDARD FORM 424A:

Complete Sections A, B, C, E, and F of the SF-424A Budget Information – Non- Construction Programs. The budget must be prepared for the requested first 12-month period (August 1, 2024 – July 31, 2027) as listed in Table 1. All budget amounts must be rounded to the nearest whole dollar.

The following guidelines must be used in the completion of the SF-424A. A sample SF- 424A is available at https://bphc.hrsa.gov/program-opportunities/nhhcs.

• Section A – Budget Summary: Under New or Revised Budget, use row 1 to provide the proposed budget for the first 12-month budget period.

• Section B – Budget Categories: Enter an object class category (line item) budget for year 1. Each line represents a distinct object class category that must be addressed in the budget narrative. The federal, match, and administrative expenses must be entered in columns 1, 2, and 3 (label the columns accordingly) and equal the total proposed budget identified in Section A. NHHCS applicants are required to show the 10 percent administrative cap in the line-item budget detail.

https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.307 https://bphc.hrsa.gov/programopportunities/fundingopportunities/NHHCS/

• Section C – Non-Federal Resources: Enter all sources of funding for year 1 except the federal funding request. NHHCS applicants are required to include non-federal matching funds in an amount equal to $1 for every $5 of federal funds. See Cost Sharing/Matching for guidance.

• Section D – Forecasted Cash Needs: Leave this section blank.

• Section E – Budget Estimates of Federal Funds Needed for Balance of the Project: Enter the federal funds requested for future budget periods within the 3-year period of performance. Enter the federal request for Year 2 in the (a) First column and Year 3 in the (b) Second column. For the purpose of this application, enter the amount listed in Table 1 for Year 2 and Year 3, with the knowledge that based on federal appropriation and subsequent funding distribution negotiations, this value may change from year to year within the period of performance. The Third- and Fourth-year columns must remain $0.

• Section F – Other Budget Information: If applicable, explain amounts for individual object class categories that may appear to be out of the ordinary in Line 21. Enter the type of indirect rate (provisional, predetermined, final, fixed or de minimis) that will be in effect during the period of performance (Line 22).

Provide other explanation as necessary. (Line 23)

As required by the Consolidated Appropriations Act, 2023 (P.L. 117-328), Division H, § 202, “None of the funds appropriated in this title shall be used to pay the salary of an individual, through an award or other extramural mechanism, at a rate in excess of Executive Level II.” Effective January 2023, the salary rate limitation is $221,900. As required by law, salary rate limitations may apply in future years and will be updated.

iv. Budget Narrative

The NHHCIA program requires a detailed budget narrative that outlines federal and non-federal costs in line-item format for the first 12-month period (August 1, 2024 – July 31, 2027) as listed in Table 1. The sum of line-item costs for each category must align with those presented in Section B of the SF-424A.

Your budget narrative must:

• Demonstrate that you will use NHHCIA funds to meet program objectives.

• Clearly detail proposed costs for each line item on your SF-424A Budget Information Form, section B, with calculations for how you estimated each cost.

• For NHHCS only: Include a detailed presentation of the breakdown and sources for matching funds as required in 42 U.S.C. § 11705(e).

• For NHHCS only: Demonstrate adherence to the 10 percent administrative cap.

https://nih.sharepoint.com/sites/hrsa-dynamics/nofo_nofo/HRSA-24-030_942A309C157BED1181AD001DD806A76E/HYPERLINK#_Cost_Sharing/Matching https://www.congress.gov/bill/117th-congress/house-bill/2617/text

• For POL only: Include – if relevant – one-time minor capital needs, defined as the purchase of equipment with a useful life of more than1 year and costing more than $5,000.

Format the budget narrative to have all columns fit on an 8.5 x 11 page when printed.

v. Attachments

Provide the following attachments in the order we list them.

OMB approved forms required for application submission do not count toward the application page limit. Indirect cost rate agreement and proof of non-profit status (if it applies) also do not count toward the application page limit.

Clearly label each attachment. Upload attachments into the application. Reviewers will not open any attachments you link to. Instructions for filling out attachments with a standard format can be found in Appendix B. Fillable forms and sample attachments are available at https://bphc.hrsa.gov/program-opportunities/nhhcs.

Attachment 1: Project Work Plan (Required for POL)

Upload the Project Work Plan for the 3-year period of performance. Refer to the Response section for details on the required elements.

Attachment 2: Required Service Projections (Required for NHHCSs)

Upload service projections for the 3 required services: outreach, health promotion and education, and services of health professionals. Refer to Appendix B for detailed instructions on how to fill out the form.

Attachment 3: Required Clinical Performance Measures (Required for NHHCSs)

Upload the target goal, baseline data, key factors, and action steps for all 7 required Clinical Performance Measures. Refer to Appendix B for detailed instructions on how to fill out the form.

Attachment 4: Optional Clinical Performance Measures (Optional for…