FINAL_FORHP HRSA-22-164 (T28) V2_Delta Workforce.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Federal Office of Rural Health Policy

Hospital State Division

Delta Region Rural Health Workforce Training Program Funding Opportunity Number: HRSA-22-164

Funding Opportunity Type: New

Assistance Listings (AL/CFDA) Number: 93.912

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2022

Application Due Date: June 17, 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: April 22, 2022

Jason Steele, MPH Public Health Analyst, Federal Office of Rural Health Policy Telephone: (301) 443-2203 Email: jsteele@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: §711(b)(5) of the Social Security Act, (42 U.S.C. 912(b)(5)) mailto:jsteele@hrsa.gov

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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 listed in Section VII.

Agency Contacts.

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2022 Delta Region Rural Health Workforce Training Program. The purpose of this program is to improve healthcare delivery in rural areas by training future and current health professionals for high-quality, good-paying jobs1 in the rural counties and parishes of the Mississippi River Delta Region and Alabama Black Belt (Delta Regional Authority (DRA) region) in the following critical administrative support professions: medical coding and billing, insurance claims processing, health information management, clinical documentation, business operations for healthcare organizations, and supply chain and materials management. These skilled administrative support professionals are key to increasing hospital revenues, thereby improving a hospital’s financial viability and thus its ability to improve health care in the rural areas it serves.

Funding Opportunity Title: Delta Region Rural Health Workforce Training Program

Funding Opportunity Number: HRSA-22-164

Due Date for Applications: June 17, 2022

Anticipated Total Annual Available

FY 2022 Funding:

$2,200,000

Estimated Number and Type of Awards: Up to four grants; approximately one recipient will be funded for each geographic region.

Estimated Annual Award Amount:

Up to $550,000 per year, subject to the availability of appropriated funds.

Cost Sharing/Match Required: No

1 High-quality, good-paying job is defined as a job that exceeds the local prevailing wage for an industry in the region, includes basic benefits (e.g., paid leave, health insurance, retirement/savings plan) and/or is unionized, and helps the employee develop the skills and experiences necessary to advance along a career path.

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Period of Performance: September 1, 2022 through

August 31, 2026 (4 years)

Eligible Applicants: All domestic public and private, nonprofit and for-profit entities are eligible to apply.

This includes, but is not limited to: faith-based and community- based organizations, federally recognized tribes and tribal organizations, state governments, and private institutions of higher education.

Applicants must be located in one of the eight states in the Delta Regional Authority (DRA) region. The DRA region includes 252 counties and parishes located across eight states - Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee. To view service area maps for each state, visit https://dra.gov/about-dra/map-room/.

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 HRSA’s SF-424 R&R Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf, except where instructed in this NOFO to do otherwise.

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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Technical Assistance

HRSA has scheduled the following technical assistance:

Webinar

Day and Date: Thursday, May 5, 2022

Time: 2 – 3 p.m. ET Call-In Number: (833) 568-8864 Webinar ID: 160 737 5943 Passcode: 47591877 Weblink: https://hrsa-gov.zoomgov.com/j/1607375943?pwd=WHk0UFhHaUtIczZSWVYzM3NWMlNqUT09

Participants also have the option of using VOIP (Computer Audio).

HRSA will record the webinar. Please contact jsteele@hrsa.gov for playback information.

https://hrsa-gov.zoomgov.com/j/1607375943?pwd=WHk0UFhHaUtIczZSWVYzM3NWMlNqUT09 https://hrsa-gov.zoomgov.com/j/1607375943?pwd=WHk0UFhHaUtIczZSWVYzM3NWMlNqUT09

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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

iii. Budget

iv. Budget Justification Narrative

v. Attachments

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

4. SUBMISSION DATES AND TIM ES

5. INTERGOV ERNM ENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSM ENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIV E AND NATIONAL POLICY REQUIREM ENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: DELTA REGION RURAL HEALTH WORKFORCE TRAINING PROGRAM

GLOSSARY OF TERMS

APPENDIX B: DELTA REGION RURAL HEALTH WORKFORCE TRAINING PROGRAM

USEFUL RESOURCES

HRSA-22-164 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Delta Regional Rural Health Workforce Training Program. The purpose of this program is to improve healthcare delivery in rural areas by training future and current health professionals, for high-quality, good-paying jobs in the rural counties and parishes of the Mississippi River Delta Region and Alabama Black Belt (Delta Regional Authority (DRA) region) in the following critical administrative support professions: medical coding and billing, insurance claims processing, health information management, clinical documentation, business operations for healthcare organizations, and supply chain and materials management.

This program supports HRSA’s collaboration with the Delta Regional Authority to enhance healthcare delivery in the rural counties and parishes of the DRA region, and addresses a key area of need identified by DRA and rural healthcare organizations in the region.

The Delta Region Rural Health Workforce Training Program addresses the ongoing need in healthcare facilities for trained administrative support professionals in rural communities through the development of networks that support recruitment, formal training, social needs, certification, and placement of students.2 This program aims to provide training and pathways to professional certifications to current administrative support professionals working in rural DRA region healthcare facilities as well as new entrants to the workforce3 and dislocated workers.4

The goals of the Delta Region Rural Health Workforce Training Program are:

• Enhance healthcare delivery in rural areas within the DRA region by creating training programs focused on building the skills and capacity of administrative support professionals in rural healthcare facilities.

2 For the purposes of this program, a network is defined as an organizational arrangement among at least four separately owned, non-profit or for-profit, public or private health care providers or other entities that provide or support the delivery of healthcare services.in which each member has its own EIN number and has a substantial role in the project.

3 “New entrants to the workforce” refers to those who have never worked before or who have been out of the workforce for a long enough time to make it as if they are entering the workforce for the first time. For example, this may include, but is not limited to, the long-term unemployed and formerly incarcerated individuals. Also eligible, consistent with federal and state wage and employment laws, are youth who are enrolled in their junior or senior year of high school and who could be employed before or within six months after the end of the grant l ifecycle, and youth who have dropped out of school and are seeking their first full-time job.

4 “Dislocated workers” refers to individuals who were terminated or laid-off or have received a notice of termination or lay-off from employment; or were self-employed but are now unemployed, as well as other individuals described at the Workforce Innovation and Opportunity Act (WIOA) sec. 3(15) (https://www.congress.gov/113/bills/hr803/BILLS-113hr803enr.pdf).

https://www.congress.gov/113/bills/hr803/BILLS-113hr803enr.pdf

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• Create a sustainable pipeline of trained professionals to rural areas through the development of networks between educational institutions, community based organizations, and rural healthcare facilities located in the DRA region.

• Improve recruitment and retention of critical administrative support professionals by providing a pathway to high-quality, good paying jobs in rural healthcare facilities through opportunities for training and education.

For more details, see Program Requirements and Expectations.

2. Background

The Delta Region Rural Health Workforce Training Program is authorized by §711(b)(5) of the Social Security Act, (42 U.S.C. 912(b)(5)). HRSA’s Federal Office of Rural Health Policy (FORHP) is the focal point for rural health activities within the U.S. Department of Health and Human Services. FORHP hospital and state programs provide technical assistance and other activities as necessary to support improving health care in rural areas. For additional information about FORHP, please see www.hrsa.gov/ruralhealth.

The DRA region includes eight states – Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee – that together have a population of almost 10 million people living in 252 counties and parishes. Of the 252 counties and parishes, 212 (84 percent) are rural (non-metropolitan area), and 41 percent of the total population in the Delta Regional Authority (DRA) region resides in one of these rural counties.5 The Delta Regional Authority , established in 2000 by Congress, makes investments into Delta communities’ human and physical infrastructure. The counties and parishes served by DRA are among the most distressed areas of the country.6

There is extensive documentation regarding the distress of the counties and parishes in the DRA region for both health and economic conditions. The population in the DRA region has been decreasing, and 20 percent of the region’s population has income below the poverty rate, compared with the national rate of 14 percent.7 Further, poverty is much more persistent in the DRA region than nationally; rural (non-metropolitan) counties with a high incidence of poverty are largely concentrated in the Southern region, with the most severe poverty found in the historically poor areas such as the DRA region.8

5 HRSA FORHP internal analysis of 2010 Census data, March 27, 2017.

6 Delta Regional Authority, www.dra.gov.

7 Rural Health Reform Policy Research Center, Exploring Rural and Urban Mortality Differences in the Delta Region, https://ruralhealth.und.edu/assets/1376-5956/exploring-rural-urban-mortality-differences-delta-region.pdf, 2016.

8 United States Department of Agriculture, Economic Research Service. Geography of Poverty.

https://www.ers.usda.gov/topics/rural-economy-population/rural-poverty-well-being/#geography.

http://www.hrsa.gov/ruralhealth http://www.dra.gov/ https://ruralhealth.und.edu/assets/1376-5956/exploring-rural-urban-mortality-differences-delta-region.pdf https://www.ers.usda.gov/topics/rural-economy-population/rural-poverty-well-being/#geography

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Approximately 13 percent of the rural hospitals that closed between 2010 and 2020 are located in a Delta county or parish.9 Recent analysis found that multiple DRA states are among those determined to have the highest number of rural hospitals at risk of financial distress.10 Findings from HRSA’s Delta Region Community Health Systems Development Program, which provides in-depth technical assistance to rural healthcare facilities in the DRA region, show that trained administrative support professionals11 (i.e., staff specializing in billing/coding, claims processing, data analysis, and clinical documentation) are necessary for hospitals to meet key performance indicators around financial and quality improvement. These staff play a key role in increasing hospital revenue and therefore a hospital’s financial viability, which is key to improving health care in the rural communities they serve.

Economic and health disparities in addition to inadequate availability of rural health professional training sites make it challenging to maintain a strong healthcare workforce in rural communities. The majority of rural areas do not have the adequate workforce supply to meet their population needs, especially in healthcare facilities.12

The Delta Region Rural Health Workforce Training Program aims to train and place future professionals in critical administrative support roles in rural healthcare facilities in the DRA region. It is an expectation that proposed training programs would offer participants multiple pathways for training, including certificate programs, Associate Degree programs, and Bachelor’s Degree programs if these are applicable to the occupational training supported through this HRSA program. Proposed training programs optimally should also offer participants the opportunity to obtain professional certification(s) from appropriate credentialing bodies such as The American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC).

For the purposes of this program, the training disciplines associated with the administrative support field include the following:

• Health Information Management

• Medical Coding and Billing (including reimbursement fundamentals for various healthcare provider types – Critical Access Hospital (CAH), Prospective Payment System (PPS), Rural Health Clinic (RHC), etc.)

• Insurance Claims Processing

9 HRSA FORHP internal analysis of hospital closure data publicly available at:

https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/ 10 Thomas, S, et al. Geographic Variation in the 2019 Risk of Financial Distress among Rural Hospitals, April 2019.

https://www.ruralhealthresearch.org/publications/1251.

11 The American Health Information Management Association: Health Information 101. Accessed 2/14/2021 at https://www.ahima.org/certification-careers/certifications-overview/career-tools/career-pages/health-information-101/.

12 American Hospital Association. Rural Report. Accessed 3/16/2022 at https://www.aha.org/system/files/2019- 02/rural-report-2019.pdf.

https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/ https://www.ruralhealthresearch.org/publications/1251 https://www.ahima.org/certification-careers/certifications-overview/career-tools/career-pages/health-information-101/ https://www.ahima.org/certification-careers/certifications-overview/career-tools/career-pages/health-information-101/ https://www.aha.org/system/files/2019-02/rural-report-2019.pdf https://www.aha.org/system/files/2019-02/rural-report-2019.pdf

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• Clinical Documentation Improvement

• Business Operations for Healthcare Organizations (i.e., IT support, human resources, accounting, etc.)

• Supply Chain and Materials Management

II. Award Information

1. Type of Application and Award

Type of applications sought: New

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA estimates approximately $2,200,000 to be available annually to fund up to four recipients. HRSA anticipates funding at least one recipient within each geographic regions. The specific counties for each geographic region are listed under the Service Area Requirements section below.

You may apply for a ceiling amount of up to $550,000 total cost (includes both direct and indirect, facilities and administrative costs) per year.

The period of performance is September 1, 2022 through August 31, 2026 (4 years).

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

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

Limitations on indirect cost rates

Indirect costs under training awards to organizations other than state or local governments or federally recognized Indian tribes, will be budgeted and reimbursed at 8 percent of modified total direct costs rather than on the basis of a negotiated rate agreement, and are not subject to upward or downward adjustment. Direct cost amounts for equipment, tuition and fees, as otherwise allowable, and subawards and subcontracts in excess of $25,000 are excluded from the direct cost base for purposes of this calculation.

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

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III. Eligibility Information

1. Eligible Applicants

Eligible applicants include:

All domestic public and private, nonprofit and for-profit entities are eligible to apply. This includes, but is not limited to: faith-based and community- based organizations, federally recognized tribes and tribal organizations, state governments, and private institutions of higher education.

Applicants must be located in one of the eight states in the Delta Regional Authority (DRA). Applicants must be able to serve a service area that meets the Service Area Requirements in the section below. The DRA region includes 252 counties and parishes located across eight states - Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee. To view service area maps for each state, visit https://dra.gov/about-dra/map-room/.

Applicants are encouraged to notify DRA early in the process of their intent to submit an application.

Service Area Requirements

Applicants are required to identify in which of the following geographic regions the proposed training program will operate. Applicants must identify a service area within the proposed geographic region. Training programs are not required to cover the entire geographic region.

Service areas must only include rural counties and parishes in the DRA region of the states listed. Counties and parishes outside of the DRA region will not be considered for funding. HRSA intends to fund at least one recipient for each geographic region—the highest ranked applications for each geographic region will receive consideration for award.

Table: DRA Counties by Geographic Region

Region State DRA region counties included Northern Region

Illinois Alexander, Franklin, Gallatin, Hamilton, Hardin, Jackson, Johnson, Massac, Perry, Pope, Pulaski, Randolph, Saline, Union, White

Kentucky Ballard, Caldwell, Calloway, Carlisle, Christian, Crittenden, Fulton, Graves, Hickman, Hopkins, Livingston, Lyon, Marshall, McCracken, McLean, Muhlenberg, Todd, Trigg, Union, Webster https://dra.gov/about-dra/map-room/

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Region State DRA region counties included Missouri Butler, Carter, Crawford, Dent, Douglas, Dunklin, Howell, Iron, Madison, Mississippi, New Madrid, Oregon, Ozark, Pemiscot, Perry, Phelps, Reynolds, Ripley, Ste.

Genevieve, St. Francois, Scott, Shannon, Stoddard, Texas, Washington, Wayne, Wright

Central Region

Arkansas Arkansas, Ashley, Baxter, Bradley, Calhoun, Chicot, Clay, Cross, Dallas, Desha, Drew, Fulton, Grant, Greene, Independence, Izard, Jackson, Jefferson, Lawrence, Lee, Lincoln, Lonoke, Marion, Mississippi, Monroe, Ouachita, Phillips, Poinsett, Prairie, Randolph, St. Francis, Searcy, Sharp, Stone, Union, Van Buren, White, Woodruff

Central Region (cont’d)

Mississippi Attala, , Bolivar, Carroll, Coahoma, Grenada, Holmes, Humphreys, Lafayette, Leflore, Montgomery, Panola, Quitman, Sunflower, Tallahatchie, Tippah, Tunica, Union, Washington, Yalobusha

Tennessee Benton, Carroll, Chester, Decatur, Dyer, Gibson, Hardeman, Hardin, Haywood, Henderson, Henry, Lake, Lauderdale, Madison, McNairy, Obion, Tipton, Weakley

Southern Region

Louisiana Acadia Parish, Allen Parish, Ascension Parish, Assumption Parish, Avoyelles Parish, Beauregard Parish, Bienville Parish, Caldwell Parish, Catahoula Parish, Claiborne Parish, Concordia Parish, East Carroll Parish, Evangeline Parish, Franklin Parish, Jackson Parish, Jefferson Davis Parish, Lafourche Parish, LaSalle Parish, Lincoln Parish, Madison Parish, Morehouse Parish, Natchitoches Parish, Plaquemines Parish, Pointe Coupee Parish, Rapides Parish, Red River Parish, Richland Parish, James Parish, Landry Parish, St. Martin Parish, St. Mary Parish, Tangipahoa Parish, Tensas Parish, Union Parish, Washington Parish, West Carroll Parish, West Feliciana Parish, Winn Parish

Mississippi Adams, Amite, Claiborne, Copiah, Covington, Franklin, Issaquena, Jasper, Jefferson, Jefferson Davis, Lawrence, Lincoln, Marion, Pike, Sharkey, Smith, Walthall, Warren, Wilkinson, Yazoo

Eastern Region

Alabama Barbour, Bullock, Butler, Choctaw, Clarke, Conecuh, Dallas, Escambia, Greene, Macon, Marengo, Monroe, Perry, Pickens, Sumter, Washington, Wilcox

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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 ceiling amount

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

NOTE: Multiple applications from an organization are not allowable.

HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, before the Grants.gov application due date as the final and only acceptable application.

Beneficiary Eligibility Requirements:

A student/trainee receiving support from award funds must be a citizen of the United States or a foreign national having in his/her possession a visa permitting permanent residence in the United States, or a non-citizen national.

All students/trainees receiving support from award funds must formally commit to working in the DRA region upon completion of the program.

IV. Application and Submission Information

1. Address to Request Application Package

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

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-22-164 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.

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

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2. Content and Form of Application Submission

Application Format Requirements Section 4 of HRSA’s SF-424 R&R Application Guide provides general instructions for the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, etc. You must submit the information outlined in the HRSA SF-424 R&R Application Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide except where instructed in the NOFO to do otherwise. You must submit the application in the English language and in the terms of U.S. dollars (45 CFR § 75.111(a)).

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

Application Page Limitation The total size of all uploaded files included in the page limit shall be no more than the equivalent of 50 pages when printed by HRSA. The page limit includes the project and budget narratives, and attachments required in the Application Guide and this NOFO.

Please note: Effective April 22, 2021, the abstract is no longer an attachment that counts in the page limit. The abstract is the standard form (SF) "Project_Abstract Summary.” Standard OMB-approved forms included in the workspace application package do not count in the page limit. If you use an OMB-approved form that is not included in the workspace application package for HRSA-22-164, it may 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. Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limit.

It is therefore important to take appropriate measures to ensure your application does not exceed the specified page limit. Any application exceeding the page limit of 50 will not be read, evaluated, or considered for funding.

Applications must be complete, within the maximum specified page limit, and validated by Grants.gov under HRSA-22-164 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).

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachment 5-15: Other Relevant Documents.

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371

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See Section 4.1 viii of HRSA’s SF-424 R&R Application Guide for additional information on all certifications.

Program Requirements and Expectations

Applicants will be required to facilitate the following program requirements:

1. Develop academic training programs that lead to professional certification and academic degrees focused on administrative support functions in healthcare facilities in the following areas: medical coding and billing, insurance claims processing, health information management, clinical documentation, business operations for healthcare organizations, and supply chain and materials management.

2. Develop a network of organizations to support recruitment, formal training, certification, and placement of participants/trainees that meets the requirements listed in the Network Requirements section of this NOFO.

3. As part of the network, establish or leverage relationships with rural-serving DRA region community-based organizations to recruit participants/trainees from rural communities to participate in the program.

4. As part of the network, establish or leverage relationships with rural DRA region healthcare facilities to place participants/trainees for hands-on training and employment in high-quality, good-paying jobs upon completion of the program.

5. As part of the network, establish or leverage relationships with healthcare facilities participating in the Delta Region Community Health Systems Development Program to recruit current administrative support professionals to participate in training and facilities to serve as practicum sites for hands-on learning and future employment of participants/trainees in rural areas.

6. Provide financial support to participants/trainees for items such as tuition, books, software, certification testing fees, childcare support, etc. to facilitate successful completion of the program. Detailed information on trainee expenses is included in the Budget Narrative section of this NOFO.

7. Promote equity, which is essential to the Department of Health and Human Services’ mission of protecting the health of Americans and providing essential human services. This view is reflected in Executive Order (E.O.) 13985, “Advancing Racial Equity and Support for Underserved Communities Through the Federal Government” (Jan. 20, 2021).

Recipients of Federal Financial Assistance (FFA) from HHS must administer their programs in compliance with federal civil rights laws that prohibit discrimination on the basis of race, color, national origin, disability, age and, in some circumstances, religion, conscience, and sex. This includes ensuring programs are accessible to persons with limited English proficiency and persons with disabilities. The HHS http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf https://www.hrsa.gov/rural-health/rural-hospitals/delta-region-community-health-systems-development-program-drchsd https://www.hrsa.gov/rural-health/rural-hospitals/delta-region-community-health-systems-development-program-drchsd

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Office for Civil Rights provides guidance on complying with civil rights laws enforced by HHS. See HHS Provider Obligations, HHS Nondiscrimination Notice, and Section VI. Award Administration Information for further details.

Network Requirements

For the purposes of this program, a network is defined as an organizational arrangement among at least four separately owned, non-profit or for-profit, public or private health care providers or other entities that provide or support the delivery of health care services.in which each member has its own EIN number and has a substantial role in the project. Applicants are required to create a network of organizations that meet the following requirements.

1. The network must be composed of at least four separate organizations. These members may be for-profit or non-profit and may be in a rural or urban area. All members must be able to provide services in the identified service area. It is recommended that the network maintain at least two health care provider organizational members throughout the entire period of performance. It is also recommended that networks include an educational institution or other education provider, and that the network also be able to address the social needs of the students enrolled in the proposed training program. Note: the award will be made to only one member of the network, the applicant organization, which will serve as the recipient of record.

Network members should come from multiple sectors and disciplines. Examples of potential network members include, but are not limited to:

• Educational institutions or other training providers13

• Health care providers, such as:

o Critical access hospitals or other hospitals;

o Rural health clinics;

o Local or state health departments;

o Federally qualified health centers; and o Nursing homes.

13 It is recommended that networks that include a four-year college or university also include at least one additional training institution or institution of higher education located in the DRA region such as community colleges, technical colleges, and vocational schools to broaden the reach of the proposed training program in the region. A l ist of Minority Serving Institutions, including HBCUs, HSIs, and TCUs can be found here (also available on Grants.gov in the Related Documents Tab):

https://www.minorityhealth.hhs.gov/assets/PDF/2020_Minority_Serving_Institutions.pdf https://www.hhs.gov/civil-rights/for-providers/provider-obligations/index.html https://www.hhs.gov/civil-rights/for-individuals/nondiscrimination/index.html https://www.minorityhealth.hhs.gov/assets/PDF/2020_Minority_Serving_Institutions.pdf

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• Rural-serving community-based organizations that can assist in addressing the social needs of the students enrolled in the proposed training program

• Community Action Agencies, Chambers of Commerce, Health Equity Councils, and other community groups

• State or Local Workforce Development Boards

• Labor Unions

• Area Health Education Centers

• State Offices of Rural Health

• State Rural Health Associations

2. Each member of the network must sign a Memorandum of Agreement or a Memorandum of Understanding (MOA/MOU) submitted within the first six months of the period of performance. The purpose of this document is to signify the formal commitment of members. The MOA/MOU must describe the network’s purpose. It must also describe each member’s expertise relevant to the goals of the network and the member’s responsibilities in terms of financial contribution, participation and membership benefits.

3. Networks will identify and link training to actual high-quality job opportunities or career advancements within the selected training discipline. Networks will be expected and required to offer apprenticeships or internships so that those in training get the real-world experience they need to obtain quality employment that seeks to provide at or exceeds the local prevailing wage for the field in the region, includes basic benefits (e.g., paid leave, health insurance, retirement/savings plan) and/or is unionized, and helps the employee develop the skills and experiences necessary to advance along a career path.

Accreditation/Approval Documentation

Organizations who are providing training must be accredited by a nationally recognized accrediting agency, and provide a copy of their active accreditation or active approval from state government within the first six months of the period of performance.

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

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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 limitation. For information required in the Project Abstract Summary Form, see Section 4.1.ix of HRSA’s SF-424 R&R 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 Review Criteria

Introduction (1) Need

Needs Assessment (1) Need

Methodology (2) Response and (4) Impact

Work Plan (2) Response

Resolution of Challenges (2) Response

Evaluation and Technical Support Capacity

(3) Evaluative Measures and

(4) Impact

Organizational Information (5) Resources/Capabilities

Budget Narrative (6) Support Requested

ii. Project Narrative

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

Use the following section headers for the narrative:

INTRODUCTION -- Corresponds to Section V’s Review Criterion #1 Need This section should briefly describe the purpose of the proposed project. It should be succinct, self-explanatory and well organized so that reviewers can understand the proposed project.

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NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criterion #1 Need This section will help reviewers understand the service area the network will serve with the proposed project. Describe and document the target population and its unmet administrative workforce needs. Use and cite demographic data whenever possible to support the information provided.

Include a clear description of the rural service area to be addressed by the proposed training program. Include a list the counties to be served by the training program. Please note, service areas do not need to cover the entire geographic region. Compare local data to state and federal data where possible to highlight the proposed service area’s unique need.

Describe the needs of healthcare facilities for trained administrative support professionals in the selected service area.

Present concrete data that supports the need for the targeted discipline(s), such as the turnover rate, service gaps, etc. (Targeted disciplines must fall under the approved discipline categories listed in the Background section of this NOFO.

Applicants that propose disciplines outside of the list will not be considered for funding.)

Include a description of the proposed student population. Include a discussion focused on the needs of students from underrepresented backgrounds. These populations include, but are not limited to, racial and ethnic minorities, veterans, people with disabilities, first generation college students, etc.

METHODOLOGY -- Corresponds to Section V’s Review Criteria #2 Response and #4 Impact

Propose methods that the network will use to address the stated needs and meet each of the previously described program requirements and expectations in this NOFO. Include a description of any innovative methods that the network will use to address the stated needs.

Define the specific goals and objectives of the network’s proposed activities as well as the strategy for meeting these goals and objectives. Goals and objectives should directly relate to the information presented in the Needs Assessment section.

Describe the recruitment strategy the network will use. Include a discussion on how the program will be advertised to local professionals already working in healthcare settings, particularly those from facilities participating in the Delta Region Community Health Systems Development Program.

Describe how the program will ensure that students demonstrate a substantive commitment to working in rural communities in the DRA region upon completion of the training program.

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Describe the retention strategy the network will use. Include a discussion on tools and resources will the program provide to students, especially underrepresented students, participating in the program to ensure successful completion of the program.

Describe the strategy the network will use to place students in rural DRA region healthcare facilities to provide them hands-on experience, and in rural employment in the DRA region after completing the training program.

Propose a plan for project sustainability after the period of federal funding ends.

HRSA expects recipients to sustain key elements of their projects, e.g., strategies or services and interventions, which have been effective in improving practices and those that have led to improved outcomes for the target population. A sustainability plan that incorporates recruitment, training, and retention of rural administrative support professionals is essential to the network’s ability to create meaningful long-term change in rural DRA region communities.

Find additional rural-specific sustainability planning tools at:

https://www.ruralhealthinfo.org/sustainability

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

Describe the activities or steps that you will use to achieve each of the objectives proposed in the Methodology section during the entire period of performance. Use a time line that includes each activity and identifies responsible staff. As appropriate, identify meaningful support and collaboration with key stakeholders in planning, designing, and implementing all activities.

Present a work plan matrix that illustrates the network’s goals, objectives, strategies, activities, and measurable process and outcome measures in Attachment 1. The work plan must outline the individual or organization responsible for carrying out each activity and include a timeline for all five years of the program. It is expected that year one of the program will focus on planning, while years two through five will be focused on program implementation.

To ensure the program will be ready for implementation, the following activities are required within year one of the program:

Year 1: Planning Year

• Month 6: By the end of Month 6, finalize all network members; clearly identify roles/responsibilities of each member; submit an MOA/MOU to

HRSA.

• Month 9: By the end of Month 9, the formal recruitment process for trainees commences.

• Month 12: Finalize plan to assess program performance. Develop a strategic plan for remaining four years of the program.

https://www.ruralhealthinfo.org/sustainability

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RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review Criterion #2 Response

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

Discuss barrier and challenges to recruiting into training and retaining students in and after training.

Discuss barriers specific to the DRA region such as geographic, socioeconomic, cultural, or other barriers and the plan to address these barriers.

EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to Section V’s Review Criteria #3 Evaluative Measures and #4 Impact

Performance Evaluation Plan

Describe the plan for tracking, measuring and evaluating program performance.

Discuss the anticipated outputs and outcomes of proposed activities. Both outcome and process measures may be used to evaluate the progress of the program.

At a minimum, the evaluation plan must contain the following measures. Please note this list is not exhaustive and additional measures should be included, as applicable:

• Number of trainees enrolled in training program, per year

• Number of trainees completing either a certificate or Associate Degree

• Number of trainees placed in a rural healthcare practicum site

• Number of trainees placed in salaried positions upon completion of the program

Describe the process for collecting and analyzing data for these measures, including how the network will track students after they complete training to determine employment and retention in rural areas of the DRA region.

ORGANIZATIONAL INFORMATION -- Corresponds to Section V’s Review Criterion #5 Resources/Capabilities

Provide evidence of the applicant organization’s ability to collaborate with appropriate organizations to carry out all the program requirements. Describe the relationship between the applicant organization and the proposed network members. Explain why each of the proposed network members are appropriate collaborators and what expertise they bring to the network.

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Include an organizational chart of the network that depicts the relationship between the proposed network members as Attachment 4. Identify and describe each network member and include each member’s organization name, address, primary contact person, and current role in the DRA region. It is recommended that you use a table to present this information and include with Attachment 4.

Discuss how the network will follow the approved work plan, as outlined in the application, properly account for the federal funds, and document all costs to avoid audit findings.

Provide examples of prior experience delivering training programs of a similar nature as outlined in this NOFO. Include a discussion of the outcomes and results of these experiences to show that they were successful.

Describe current experience, knowledge, and skills, including subject matter expertise of staff, materials published, and previous work of a similar nature.

Include a staffing plan and job descriptions for key personnel that clearly identifies a project director of at least 0.5 FTE capable of overseeing the program’s administrative, fiscal, and business operations for the entirety of the project as Attachment 2. Include biographical sketches for all key personnel as Attachment 3.

iii. Budget

The directions offered in the SF-424 R&R Application Guide may differ from those offered by Grants.gov. Follow the instructions in Section 4.1.iv of HRSA’s SF-424 R&R Application Guide and the additional budget instructions provided below. A budget that follows the R&R Application Guide will ensure that, if HRSA selects your application for funding, you will have a well-organized plan and, by carefully following the approved plan, may avoid audit issues during the implementation phase.

Reminder: The Total Project or Program Costs are the total allowable costs (inclusive of direct and indirect costs) you incur to carry out a HRSA-supported project or activity. Total project or program costs include costs charged to the award and costs borne by you to satisfy a matching or cost-sharing requirement, as applicable.

As required by the Consolidated Appropriations Act, 2022 (P.L. 117-103), Division H, § 202 and Division A of the FY 2022 Extending Funding and Emergency Assistance Act (P.L. 117-43), “None of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of Executive Level II.” See Section 5.1.iv Budget – Salary Limitation of HRSA’s SF-424 R&R Application Guide for additional information. Note that these or other salary limitations may apply in the following fiscal years, as required by law.

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Indirect costs under training awards to organizations other than state or local governments, or federally recognized Indian tribes, will be budgeted and reimbursed at 8 percent of modified total direct costs rather than on the basis of a negotiated rate agreement, and are not subject to upward or downward adjustment. Direct cost amounts for equipment, tuition and fees, and subawards and subcontracts in excess of $25,000 are excluded from the direct cost base for purposes of this calculation.

iv. Budget Justification Narrative

See Section 4.1.v of HRSA’s SF-424 R&R Application Guide.

In addition, the Delta Region Rural Health Workforce Training Program requires the following:

Participant/Trainee Support Costs: List tuition/fees, books, stipends, travel, subsistence, and other related education expenses, and the number of participants/trainees. Ensure that your budget breakdown separates these trainee costs, and includes a separate sub-total entitled “Total Participant/Trainee Support Costs” which includes the summation of all trainee costs. NOTE: Participants/trainees are NOT required to pay back any participant/trainee support costs if they do not complete the program or do not work in a rural area upon completing the program.

It is recommended that Participant/Trainee support account for up to 60 percent of the total annual budget, and 40 percent of the budget be allocated to all other program administrative and management costs, including indirect.

Stipends: Requests for stipends (general living expenses to help defray the student’s costs and shall be used at the discretion of the student) for students participating in the training program should be entered under a separate budget justification heading, entitled "Trainee Expenses." Enter the number of students and the total amount requested under “Stipend.”

In the budget justification, provide the stipend rate (e.g., $40/day), the number of stipends to be awarded, and total stipend amount for the training program. The methodology for determining stipend rates should be clear and justifiable. If stipend rates vary across individual students or programming those differences should be clearly explained. If stipends are being paid for through sources other than the Delta Region Workforce Training funding, please provide the number, amount of stipend, and funding source.

Scholarships: Include the amount requested for student scholarship support to cover tuition, fees, books, and other related educational expenses. Scholarship funds must be disbursed in logical increments throughout the academic or calendar year and may not exceed $10,000 in an academic year. Scholarships should be disbursed at the beginning of each period within the academic year (e.g., semester, quarter, term). A student can receive both a scholarship and a stipend as long as the scholarship award limitation is not exceeded and the awards do not cover the same expenses.

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Students are designated to receive scholarships by the applicant institution in accordance with the guidelines established by the applicant organization. The proposed project must use scholarship funds in a manner that will meet the needs of eligible underrepresented students. The budget narrative must indicate the number of students to receive scholarships for each year of the award and the proposed amount of each scholarship per student.