FORHP HRSA-21-107 (U3I) TTELP FINAL.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office for the Advancement of Telehealth

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2021

Application Due Date: June 25, 2021

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, including SAM.gov and Grants.gov, may take up to 1 month to complete.

Issuance Date: May 21, 2021

Carlos Mena, MS Public Health Analyst, Federal Office of Rural Health Policy Telephone: (301) 443-3198 Email: cmena@hrsa.gov

Authority: 42 U.S.C. § 254c -14(d)(1) (§ 330I(d)(1) of the Public Health Service Act)

Telehealth Technology-Enabled Learning Program

Funding Opportunity Number: HRSA-21-107

Funding Opportunity Type: New Assistance Listings (CFDA) Number: 93.211

HRSA-21-107 I

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2021 Telehealth Technology-Enabled Learning Program (TTELP).

The purpose of this program is to connect specialists at academic medical centers with primary care providers in rural, frontier, and underserved populations, providing evidence-based training and support to help them treat patients with complex conditions in their communities. The TTELP will facilitate learning community models of professional education and support that are adaptable to rural and underserved populations.

Funding Opportunity Title: Telehealth Technology-Enabled Learning Program

Funding Opportunity Number: HRSA-21-107 Due Date for Applications: June 25, 2021

Anticipated Total Annual Available FY 2021 Funding:

$4,275,000

Estimated Number and Type of Award: Up to 9 cooperative agreements

Estimated Award Amount: Up to $475,000 per year Cost Sharing/Match Required: No Period of Performance: September 30, 2021 through

September 29, 2026 (5 years) Eligible Applicants: Eligible applicants shall be domestic public or private, non-profit or for-profit entities with demonstrated experience utilizing telehealth technologies to serve rural underserved populations. This includes faith-based, community-based organizations, and federally-recognized tribes and tribal organizations.

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

HRSA-21-107 II

Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf, except where instructed in this NOFO to do otherwise.

Technical Assistance

HRSA has scheduled the following technical assistance:

Webinar

Day and Date: Wednesday, June 9, 2021 Time: 2 – 3 p.m. ET Call-In Number: 1-833-568-8864 Passcode: 84904476 Weblink: https://hrsa-gov.zoomgov.com/j/1619913737?pwd=a3g3dnZCS0R1cU1NejR1VGcwekdnUT09 Meeting ID: 161 991 3737 HRSA will record the webinar. Please contact cmena@hrsa.gov for playback information.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://hrsa-gov.zoomgov.com/j/1619913737?pwd=a3g3dnZCS0R1cU1NejR1VGcwekdnUT09 https://hrsa-gov.zoomgov.com/j/1619913737?pwd=a3g3dnZCS0R1cU1NejR1VGcwekdnUT09

HRSA-21-107 III

Table of Contents

I. Program Funding Opportunity Description

1. Purpose

2. Background

II. Award Information

1. Type of Application and Award

2. Summary of Funding

III. Eligibility Information

1. Eligible Applicants

2. Cost Sharing/Matching

3. Other

IV. Application and Submission Information

1. Address to Request Application Package

2. Content and Form of Application Submission

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Attachments

3. Dun and Bradstreet Data Universal Numbering System (DUNS) Number Transition to the 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: Common Definitions

HRSA-21-107 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Telehealth Technology-Enabled Learning Program (TTELP). The purpose of this program is to connect specialists at academic medical centers with primary care providers (PCPs) in rural, frontier, and underserved populations providing evidence-based training and support to help them treat patients with complex conditions in their communities.

TTELP recipients will develop learning community1 models that emphasize collaborative partnerships between such providers (i.e., telementoring2 models such as Project ECHO, ECHO-like models, distance learning, clinical decision support, and other emerging models in the field), to provide training and facilitate the dissemination of best practice specialty care to PCPs and care teams in rural, frontier, and underserved populations.

This cooperative agreement aligns with HRSA’s goals of fostering a health care workforce to address current and emerging needs, improving access to quality health services, achieving health equity3, and enhancing population health. The freely accessible tools and resources developed by the TTELP will enhance rural patients’ access to quality care using telehealth and innovative technology solutions. The TTELP will foster and support coordination of health services by encouraging the use of health care delivery models that utilize team-based approaches where each member practices at the full scope of their training.

The TTELP will also develop appropriate methodology to evaluate and identify outcomes associated with learning community model initiatives. The program’s objectives emphasize the following:

• identifying and expanding current and new learning community programs with a focus on one, or more, of the following diseases: infectious diseases, such as COVID-19, including COVID-19 “long haulers”4 or HIV/AIDS, mental health, substance use disorders (may include opioid use disorder), prenatal and maternal health, chronic diseases (such as heart disease, cancer, chronic lung disease, diabetes, multiple sclerosis, etc.), and pediatric care (including specialty care for children))

• developing freely accessible tools and resources to support learning community program’s planning and implementation

• identifying and addressing healthcare disparities for rural, frontier, and underserved populations

1 https://developingchild.harvard.edu/collective-change/key-concepts/learning-communities/ 2 University of Texas Health San Antonio. Rural Telementoring Training Center: https://wp.uthscsa.edu/echo/about/ 3 Off ice of Health Equity, Health Resources and Services Administration (HRSA), U.S. Department of Health & Human Services (2020).

https://www.hrsa.gov/about/organization/bureaus/ohe/index.html#:~:text=What%20is%20health%20equity%3F,disease%2C%2 0disability%2C%20or%20mortality 4 Centers for Disease Control and Prevention U.S. Department of Health & Human Services (2021). COVID-19 https://w ww.cdc.gov/coronavirus/2019-ncov/long-term-effects.html https://www.hrsa.gov/about/organization/bureaus/ohe/index.html#:%7E:text=What%20is%20health%20equity%3F,disease%2C%20disability%2C%20or%20mortality https://wp.uthscsa.edu/echo/about/ https://www.hrsa.gov/about/organization/bureaus/ohe/index.html#:%7E:text=What%20is%20health%20equity%3F,disease%2C%20disability%2C%20or%20mortality https://www.hrsa.gov/about/organization/bureaus/ohe/index.html#:%7E:text=What%20is%20health%20equity%3F,disease%2C%20disability%2C%20or%20mortality https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects.html

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• implementing cost-effective learning community programs to serve presented in rural populations

Specialists at the applicant, or hub, site must connect with PCPs in rural areas, or rural spoke sites, providing evidence-based training and support to help them treat patients with complex conditions in their rural communities. Applicants are encouraged to include populations that have historically suffered from poorer health outcomes and health disparities as compared to the rest of the rural population, when addressing health care needs via telehealth. Examples of these populations include, but are not limited to, racial and ethnic minorities, person/persons experiencing homelessness, pregnant women, disabled individuals, youth and adolescents, etc. The TTELP will assist health care organizations such as academic medical centers and other centers of excellence in the implementation of cost-effective learning community programs to serve rural and medically underserved areas and populations.

2. Background

This program is authorized by the 42 U.S.C. § 254c -14(d)(1) (§ 330I(d)(1) of the Public Health Service Act). The Office for the Advancement of Telehealth serves as the operational focal point for coordinating and advancing the use of telehealth technologies across all of HRSA’s programs including, but not limited to, the provision of health care at a distance (telemedicine), distance based learning to improve the knowledge of HRSA award recipients and others, and improved information dissemination to both consumers and providers about the latest developments in telemedicine.

In February 2019, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) published a Report to Congress entitled, “Current State of Technology-Enabled Collaborative Learning and Capacity Building Models.”5 This report describes collaborative learning and capacity building models as “ECHO and ECHO-like models” (EELM) and finds that the empirical evidence for the impact of EELM on patient and provider outcomes remains modest, though the evidence consistently shows positive effects in measured/evaluated areas. Research suggests incorporating learning community models for primary and specialty care into rural care practices could improve access to care among rural residents.

Approximately 18 percent of American citizens, or 57 million individuals, live in rural communities.6 Residents of rural communities typically are older and generally experience higher frequency of chronic disease and poorer health status than their urban counterparts.7 More specifically, “chronic diseases, risk factors for chronic disease, and COVID-19 all tend to disproportionately affect people of lower

5 Office of the Assistant Secretary for Planning and Evaluation (ASPE). A Report to Congress on the Current State of Technology-Enabled Collaborative Learning and Capacity Building Models. https://aspe.hhs.gov/pdf- report/report-congress-current-state-technology-enabled-collaborative-learning-and-capacity-building-models 6 HRSA Federal Off ice of Rural Health Policy: https://w ww.hrsa.gov/rural-health/about-us/definition/index.html 7 ASPE Issue Brief, https://aspe.hhs.gov/system/files/pdf/211061/RuralHospitalsDSR.pdf https://aspe.hhs.gov/pdf-report/report-congress-current-state-technology-enabled-collaborative-learning-and-capacity-building-models https://aspe.hhs.gov/pdf-report/report-congress-current-state-technology-enabled-collaborative-learning-and-capacity-building-models https://aspe.hhs.gov/pdf-report/report-congress-current-state-technology-enabled-collaborative-learning-and-capacity-building-models https://www.hrsa.gov/rural-health/about-us/definition/index.html https://aspe.hhs.gov/system/files/pdf/211061/RuralHospitalsDSR.pdf

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socioeconomic status and certain racial and ethnic minority populations. As a result, African American, Hispanic or Latino people, and American Indian and Alaska Native people are all at higher risk than non-Hispanic White people of getting sick, being hospitalized, or dying of COVID-19.”8 Lack of access to care in rural areas is due, in part, to workforce issues within these communities. Over 4,700 out of the 7,578 Primary Medical Health Professional Shortage Areas are located in rural communities.9 Learning community models connect generalist providers, often located in remote areas, with specialists that help train these providers to deliver care for patients with conditions that they might not be adequately prepared to handle, but are within their purview. Evidence on promising practices for the COVID-19 long haulers is still emerging and the need for establishing learning communities is needed to effectively treat this population. In addition, substantial progress has been made in improving the health and well-being of all Americans, but health disparities between population groups and geographic areas continue to persist. Disparities are found in a number of health indicators, including infant mortality, life expectancy, cardiovascular disease, cancer, diabetes, COPD, HIV/AIDS, health care access and utilization, health insurance, disability, mental health, preventive health services such as cervical and colorectal cancer screening, smoking, obesity, substance use, suicide, homicide, and unintentional injuries. Causes of these disparities are multifactorial in nature.10 HRSA anticipates the TTELP will ultimately empower and enable providers in rural locations to continue pursuing enhancements to meet the challenging needs of caring for their communities.

Through this opportunity, HRSA will support innovative learning community models to address learning community support for PCPs in rural communities. Program results will include expansion of rural service areas/settings and capacity of existing models, developing innovative technological strategies, methods, or tools, to incorporate emerging telehealth based treatments for diseases listed above, and include the goal of publishing research articles based on data resulting from this funding support.

All applicants are required to submit information regarding each site that will be supported during this project [i.e., Hub Site(s), Spoke Site(s)] in Attachment 3. Only rural spoke sites (sites that receive learning community support through the TTELP proposal and/or supported with funds) will be considered in meeting the rural eligibility test.

Applicants are also encouraged to reach out to their regional Telehealth Resource Center and one of the two HRSA Telehealth Centers of Excellence. They serve as national clearinghouses for telehealth research and resources, including TA.

8 Hacker KA, Briss PA. An Ounce of Prevention Is Still Worth a Pound of Cure, Especially in the Time of COVID-19. Prev Chronic Dis 2021;18:200627. https://w ww.cdc.gov/pcd/issues/2021/pdf/20_0627.pdf 9 Bureau of Health Workforce, Health Resources and Services Administration (HRSA), U.S. Department of Health & Human Services. (2019). Third Quarter of Fiscal Year 2019 Designated HPSA Quarterly Summary.

https://data.hrsa.gov/Default/GenerateHPSAQuarterlyReport 10 Office of Health Equity, Health Resources and Services Administration (HRSA), U.S. Department of Health & Human Services (2020).

Health Equity Report 2019-2020: Special Feature on Housing and Health Inequalities.

https://w ww.hrsa.gov/sites/default/f iles/hrsa/health-equity/HRSA-health-equity-report-printer.pdf https://www.telehealthresourcecenter.org/who-your-trc/ https://www.telehealthresourcecenter.org/who-your-trc/ https://www.cdc.gov/pcd/issues/2021/pdf/20_0627.pdf https://data.hrsa.gov/Default/GenerateHPSAQuarterlyReport https://www.hrsa.gov/sites/default/files/hrsa/health-equity/HRSA-health-equity-report-printer.pdf

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II. Award Information

1. Type of Application and Award

Type of applications sought: New

HRSA will provide funding in the form of a cooperative agreement. A cooperative agreement is a financial assistance mechanism where substantial involvement is anticipated between HRSA and the recipient during performance of the contemplated project.

HRSA program involvement will include:

• Ongoing review of award activities and input on content or approach;

• Participating in conference calls or meetings with the award recipients;

• Reviewing and providing recommendations regarding additional uses of the

TTELP funds. This may include using related telehealth technologies to provide clinical services for patients, beyond the award’s primary focus of care;

• Reviewing and providing recommendations on the final work plan;

• Providing guidance and assistance to TTELP recipients in identifying key academic medical centers and other centers of excellence through which to share freely accessible resources and tools;

• Providing common measures that must be reported by all recipients;

• Participating, as appropriate, in the planning and implementation of any meetings, training activities or workgroups conducted during the period of performance for the cooperative agreement;

• Providing assistance in identifying opportunities for disseminating information about TTELP programs nationally that coordinate both health and human services; and

• Reviewing, providing comments, and recommendations for documents, curricula, program plans, budgets, work to be contracted out (including the work plan), key personnel (including consultants and contractors), work plan revisions, etc. prior to printing, dissemination, or implementation.

The cooperative agreement recipient’s responsibilities will include:

• Supporting collaboration between the TTELP program award recipients and the Telehealth-Focused Rural Health Research Center (TFRHRC) award recipient;

• Supporting collaboration with HRSA’s Telehealth Centers of Excellence, Telehealth Resource Centers and the Rural Telementoring Training Center

• Planning and delivering training and Technical Assistance (TA) on TTELP activities to PCPs in rural communities that seek to deliver health care to rural and underserved populations and ensuring that the learning community uses models of professional education and support that are adapted to culturally and regionally diverse populations;

• Identifying opportunities and promoting best practices for TTELP programs to increase their viability in rural areas by identifying successful models and administrative support strategies as well as disseminating information about learning community models that coordinate both health and human services;

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• Identifying opportunities and promoting best practices for learning community programs to evaluate their impacts and improve their services and strategies over time;

• Providing rural and underserved PCP’s with tools for collecting and interpreting applicable data to support evaluation of rural learning community models;

• Adhering to HRSA guidelines pertaining to acknowledgement and disclaimer on all products produced by HRSA award funds, per Section 2.2 of the Application Guide (Acknowledgement of Federal Funding);

• Completing activities included in the final work plan, specifically data collection on measures identified by HRSA;

• Actively participating in efforts to contribute to the learning community evidence-base;

• Networking with telehealth stakeholders;

• Engaging in webinars presented by TA providers (e.g., program best practices, sustainability, etc.);

• Identifying professional opportunities to present, exhibit, or publish program findings that contribute to the learning community models evidence-base;

• Collaborating with HRSA in ongoing review of activities and budgets;

• Identifying key organizations through which to share information on emerging policy issues related to rural learning community programs;

• Disseminating project deliverables that result from any meetings, training activities, or workgroups conducted during the period of performance for the cooperative agreement and ensuring free public access to resources developed under the cooperative agreement;

• Adhering to all applicable HHS policies and federal law including Section 508 of the Rehabilitation Act of 1973, as amended; and

• Responding timely to requests for information, including requests for data submissions, from HRSA or the Telehealth-Focused Rural Health Research Center award recipient.

2. Summary of Funding

HRSA estimates approximately $4,275,000 to be available annually to fund up to 9 recipients. You may apply for a ceiling amount of up to $475,000 total cost (includes both direct and indirect, facilities and administrative costs) per year. The period of performance is September 30, 2021 through September 29, 2026 (5 years). Funding beyond the first year is subject to the availability of appropriated funds for the Telehealth Technology-Enabled Learning Program (TTELP) in subsequent fiscal years, satisfactory recipient performance, 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.

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 shall be domestic public or private, non-profit or for-profit entities with demonstrated and established experience in utilizing telehealth technologies to serve rural underserved populations. Faith-based, community-based organizations, and federally recognized tribes and tribal organizations are eligible to apply.

A. Geographic Requirements:

The applicant organization may be located in an urban or rural area. All applicants are required to submit information regarding each site that will be supported during this project [i.e., Hub Site(s), Spoke Site(s)]. Only rural spoke sites (sites that receive learning community support through the TTELP proposal and/or supported with funds) will be considered in meeting the rural eligibility test. Applicants must include at least two entity spoke sites that must be located in rural areas. The spoke site is required to be solely located in HRSA-defined rural areas in order to receive funds through this award. Proposed learning community urban spoke sites are NOT eligible to receive funding through this award. Specifically, the applicant’s proposed service area must be located in a non-metropolitan county or in a rural census tract of a metropolitan county. All services must be provided in a non-metropolitan county or rural census tract. To ascertain rural eligibility, please refer to HRSA’s Rural Health Grants Eligibility Analyzer. This webpage allows you to search by county or street address and determine your rural eligibility.

In addition to the 50 states, only organizations in Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau are eligible. If you are located outside the 50 states, you must still meet eligibility requirements.

B. Composition of the technology-enabled collaborative learning community model:

The technology-enabled collaborative learning community model shall include at least two

(2) of the entities as rural spoke sites (at least one of which shall be a community-based health care provider) listed from a. through l. below:

a. Community or migrant health centers or other Federally Qualified Health Centers

b. Health care providers, including pharmacists, in private practice

c. Entities operating clinics, including Rural Health Clinics

d. Local health departments

e. Nonprofit hospitals, including Community Access Hospitals

f. Other publicly funded health or social service agencies

g. Long-term care providers

h. Providers of health care services in the home.

i. Providers of outpatient mental health and substance abuse disorder services and entities operating outpatient mental health and substance abuse disorder facilities https://data.hrsa.gov/tools/rural-health?tab=Address https://data.hrsa.gov/tools/rural-health?tab=Address https://www.cms.gov/Center/Provider-Type/Home-Health-Agency-HHA-Center

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j. Local or regional emergency health care providers

k. Institutions of higher education

l. Entities operating dental clinics

In addition to including at least two of the above entities, the model may also include Rural Emergency Hospitals.

C. Focus Areas:

The applicant must choose at least one of the following primary focus areas and identify them in the Project Abstract (Section IV.2.i.l.):

• Infectious diseases, including COVID long haulers, or HIV/AIDs

• Behavioral health

• Substance use disorder, including opioid use disorder

• Prenatal care

• Maternal care

• Those recovering from COVID-19 and facing longer-term health care challenges

The applicant may also choose a secondary focus area from the following:

• Chronic diseases (such as heart disease, cancer, chronic lung disease, diabetes, multiple sclerosis, etc.); or

• Pediatric care (including specialty care for children).

D. Examples of Primary Care Providers who can benefit from the program:

a. Medical Doctors (MDs)

b. Obstetrician/Gynecologists (OB/GYNs)

c. Nurse practitioners (NPs)

d. Physician assistant (PAs)

e. Licensed practical nurses (LPNs)

f. Registered nurses (RNs)

g. Advanced practice nurses (APNs)

h. Clinical nurse specialists (CNSs)

i. Community Health Workers (CHWs)

j. Licensed clinical social workers (LCSWs)

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

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

HRSA will consider any application that exceeds the page limit referenced in Section. IV non-responsive and will not consider it for funding under this notice.

https://rules.house.gov/sites/democrats.rules.house.gov/files/BILLS-116HR133SA-RCP-116-68.pdf

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

NOTE: Multiple applications from an organization are not allowable.

If for any reason (including submitting to the wrong funding opportunity number or making corrections/updates) an application is submitted more than once prior to the application due date, HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, prior to the Grants.gov application due date as the final and only acceptable application.

The HRSA Rural Telementoring Training Center recipient is eligible to apply for funds through this notice for the FY 2021 cycle if the proposed project is a new proposal (entirely new project). The proposed project should not supplant an existing program from any applicant. The proposal should differ significantly from the existing project by expanding the service area to support many rural PCPs of the project.

Each state has a State Office of Rural Health (SORH) or another appropriate state entity, and HRSA recommends making every effort to contact the SORH or entity early in the application process to advise them of your intent to apply. The SORH or entity may be able to provide consultation to you regarding your TTELP proposal, data resources, and TA for consortiums, evaluation, partner organizations, or support of information dissemination activities. A TTELP applicant should make every effort to seek consultation from its SORH or other appropriate state entity.

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 workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at http://www.grants.gov/applicants/apply-for-grants.html.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for each NOFO you are reviewing or preparing in the workspace application package in order to receive notifications including modifications, clarifications, and/or republications of the NOFO on Grants.gov. You will also receive notifications of documents placed in the RELATED DOCUMENTS tab on Grants.gov that may affect the NOFO and your application. You are ultimately responsible for reviewing the For Applicants page for all information relevant to this NOFO.

2. Content and Form of Application Submission

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

See Section 8.5 of the Application Guide for the Application Completeness Checklist.

Application Page Limit

The total size of all uploaded files included in the page limit shall not exceed the equivalent of 80 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments, and letters of commitment and support 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 "Project_Abstract Summary.” Standard OMB-approved forms that are included in the workspace application package do not count in the page limit.

Please note: If you use an OMB-approved form that is not included in the workspace application package for HRSA-21-107, 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 80 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 the correct funding opportunity number prior to 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. § 3321).

3) Where you are unable to attest to the statements in this certification, an explanation shall be included in Attachment 9: Other Relevant Documents.

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

Program-Specific Instructions

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

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i. Project Abstract

Use the Standard OMB-approved Project Abstract Summary Form 2.0 that is included in the workspace application package. Do not upload the abstract as an attachment.

For the information required in the Project Abstract Summary Form, see Section 4.1.ix of HRSA’s SF-424 Application Guide.

Please also include the following information in addition to the required information requested in the Project Abstract Summary Form:

a. Applicant organization facility type and rural spoke sites (See Section III.1.B for examples)

b. Service Area – Briefly identify the geographic service area that the TTELP serves or will serve, including its size and population. Note how many full and partial Health Professional Shortage Areas (HPSAs), and full and partial Medically Underserved Areas (MUAs) the service area contains. Also, note any mental health and/or dental HPSAs. Note any other critical characteristics of the service area and its population.

c. Needs, Objectives, and Projected Outcomes – Briefly describe the identified needs and expected demand for evidence-based training and support from PCPs, project objectives, and expected outcomes.

d. Indicate the number of rural spoke sites to be supported through this TTELP opportunity.

e. Focus areas to be provided:

The applicant must choose at least one of the following primary focus areas:

• Infectious diseases, including COVID long haulers, or HIV/AIDs;

• Behavioral health;

• Substance use disorder, including opioid use disorder;

• Prenatal care; or

• Maternal care.

The applicant may also choose a secondary focus area from the following:

• Chronic diseases (such as heart disease, cancer, chronic lung disease, diabetes, multiple sclerosis, etc.); or

• Pediatric care (including specialty care for children).

f. Self-Assessment – Briefly describe how the applicant plans to measure their progress achieving the goals stated in their application.

g. Outcomes – Describe the project’s anticipated added value to healthcare using learning community models resulting from the evaluation of the proposed diseases.

h. Additional Activities – Describe any additional services and activities for which the learning community models are being utilized or will be utilized and include an estimated amount of time (administrative meetings, community meetings, etc.).

i. Sustainability – Briefly describe activities to sustain the learning community models once federal funding ends.

j. Evidence of Local Support – Briefly describe evidence of local support for the project, and a description of how the areas, communities, or populations to be served will be involved in the development and ongoing operations of the proposed project.

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ii. Project Narrative

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

Successful applications will contain the information below. Please use the following section headers for the narrative:

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

Succinctly (1-2 pages) describe the purpose of the learning community model proposed project. Include an overview of the rural spoke site entities and plans for addressing the identified health care need in the rural communities in your proposed service area, including a list of the focus areas that will be offered. Clearly and succinctly, submit information on the collaborating rural spoke site members, and expected program outcomes and community impact.

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

This section outlines the needs of the community and/or organization. Describe and document the target population and its unmet health needs. Use and cite demographic data whenever possible to support the information provided. Discuss any relevant barriers in the service area that the project hopes to overcome. This section will help reviewers understand the community and/or organization that you will serve with the proposed project.

Please use the following sub-headings (1) Target Population Details, (2) Target Service Area Details, and (3) Technology-Enabled Learning Community Service Area Details.

Target Population Details:

• Describe the target population. Consider disparities based on race, ethnicity, gender identity, sexual orientation, geography, socioeconomic status, disability status, primary language, health literacy, and other relevant elements. You should also consider people with disabilities; non-English speaking populations; minority populations; people with limited health literacy; or populations that may otherwise be overlooked when identifying target populations. The needs assessment should focus on learning community model needs in HRSA designated rural areas, including tribal entities.

• Describe the associated unmet health needs of the target population of the proposed project (if funded, this is the population that you will monitor and track). When possible, incorporate any national and/or local rankings data to aid in illustrating the community’s need. Cite data for factors that are relevant to the project, such as: specific national, state, and regional health status indicators and unmet health need (as it relates to your primary focus area); percentage of target population with health insurance coverage and estimated proportion of major payers within this population (e.g., any commercial health plan, Medicare, Medicaid, dual Medicare-Medicaid, CHIP, TRICARE, Indian Health Service, uninsured/self-pay, etc.); percentage of target population without health insurance coverage that is likely eligible for health insurance coverage; and percentage

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of target population living below the federal poverty line, etc. Also, include information regarding the social determinants of health and health disparities affecting the population or communities served.

• Within your proposed service area, identify and describe the presence of any racial and ethnic minority subpopulations. Explain how your project will meet the needs of these populations in terms of racial and ethnic health disparities and barriers (social, cultural, infrastructure etc.) that affect their health status. If your organization has not historically served the identified racial and ethnic minority subpopulations in your proposed service area, describe the vehicles, data points and/or partnerships needed to make the project successful. If your service area does not include any racial and ethnic minority subpopulations, describe your population demographics and any unique disparities they face.

Target Service Area Details:

• Identify the target service area(s) for the proposed project. Describe any relevant geographical features of the service area that affect access to health care services.

• Describe the health care services available in or near the target service area and any gaps in services.

• Describe the types of relevant health and PCPs that are located in and near the service area of the project as well as their relation to the project.

• Describe the existing primary health care providers, home health agencies, or other health networks in the region that are serving the area that you are incorporating as a part of your proposed program. Detail how this project would foster or/and enhance collaboration.

• Provide details how the project will not compete with other regional health care service providers (e.g., changes in referral patterns, practice patterns, provider reimbursement impact, etc.).

• Provide a map (Attachment 8) that details the location of the learning community model spoke sites and the rural area(s) that will be served by the program.

Technology-Enabled Learning Community Service Area Details:

• Outline the needs and issues that affect the development of a rural learning community and their ability to offer additional training/practicum to physicians and other PCPs in rural communities.

• Outline the challenges and barriers impacting the development and sustainability of rural technology-enabled learning community models and the communities they serve, as well as the larger contextual challenges facing rural communities’ abilities to recruit, train, and retain health care professionals. Use supporting data to provide context to the demand of learning community models in rural communities. This section should also describe the significance of your organization to support provider in rural communities.

• Identify key stakeholders that will serve rural PCPs, discuss the impact of the project on interested stakeholders, and describe how stakeholder representatives will are or will be involved in program planning. Cite demographic data whenever possible to support the information requested.

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

This section outlines the methods that the applicant organization will use to address the stated need and meet each of the previously described program requirements and expectations in this NOFO.

The following headings must be addressed within the methodology sections. Please address these headings: “Methods for Fulfilling Goals and Objectives;” “Methods for Maintaining Rural Stakeholder Commitment;” “Methods for Implementing a Promising Practice Model;” and “Methods for Sustaining Project Beyond the Period of Performance.”

Methods for Fulfilling Goals and Objectives:

• Define the specific goals and objectives.

• The stated goals and objectives should be measurable and align with the intent to the TTELP period of performance.

• These goals and objectives should directly relate to the information presented in the prior section, or “Needs Assessment.”

• The modality by which the learning community models will be delivered, including the required telecommunications infrastructure (e.g., equipment, bandwidth) required to support service delivery.

• Describe how the proposed project will promote the use of the learning community models.

• Describe your experience in improving health inequities between population groups and geographic areas.

• Propose methods to address disparities found in your targeted disease(s) for this proposal, or in one, or more, of the following health indicators: COVID long haulers, Infant mortality, life expectancy, cardiovascular disease, cancer, diabetes, COPD, HIV/AIDS, health care access and utilization, health insurance, disability, mental health, preventive health services such as cervical and colorectal cancer screening, smoking, obesity, substance use, suicide, homicide, and unintentional injuries.

• Include a detailed and clear understanding of the intricacies of various learning community models, including distance learning and clinical decision support through telehealth.

• Describe how you will work closely with HRSA to adapt the learning community approach as needed in response to stakeholder feedback and changing priorities.

• Propose additional measures explaining how you will evaluate work and track progress through appropriate data collections.

Methods for Maintaining Rural Stakeholder Commitment:

• Describe how your TTELP proposal will maintain rural partner spoke site commitment throughout the period of performance.

• Describe how the TTELP proposal will build and maintain s stakeholder involvement and commitment throughout period of performance.

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• Demonstrate your experience in supporting the solicitation, review, selection, compilation and dissemination of best practices to medical educators and professionals for rural learning community models of care that will provide high quality continuing training.

Methods for Implementing an Evidence-Based or Promising Practice Model:

• Identify an evidence-based or promising practice model that has been shown to be effective in addressing modality by which the learning community models will serve the targeted rural communities.

• Describe how the evidence-based or promising practice model is appropriate for your proposed project, and effective in meeting the rural target population’s need.

Methods for Sustaining Project Beyond the Period of Performance:

• Describe the methods by which you will sustain program activities beyond the period of performance.

• Describe some of the potential sources of support for achieving sustainability.

Sources of support could include but are not limited to financial, in-kind, or the absorption of activities by learning community models.

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

Describe the activities or steps that will be used to achieve each of the activities proposed during the entire period of performance in this section. Use a timeline 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.

Provide a clear and coherent work plan that aligns with the project’s goals and objectives.

Present a matrix that illustrates the project’s goals, strategies, activities, and measurable process and outcome measures (it is recommended to provide this information in a table format). The work plan must outline the individual and/or organization responsible for carrying out each activity and include a timeline for all five-years of the award. The applicant should include the work plan as Attachment 5.

Describe the following elements for your project model:

• The process to achieve the activities and implement a project as proposed in the methodology section. This section should provide clear evidence that you have a well-considered plan to train rural PCPs in the creation of learning community programs that facilitate the dissemination of best practice specialty care for treatment of complex conditions to care teams across the country.

• Describe the timeframes, deliverables, and key partners required during the cooperative agreement period of performance to establish the TTELP.

• Discuss how the TTELP plans to reach out, engage and promote freely accessible resources and tools to rural PCPs.

• Identify meaningful support and collaboration with key stakeholders in planning, designing and implementing all activities, including development of this application and, further, the extent to which these contributors reflect the cultural, racial, HRSA-21-107 15 linguistic and/or geographic diversity of the rural populations and communities served. You may include, but are not limited to the following examples: broadly accessible modalities such as webinars and meetings to increase collaboration with stakeholders.

• Explain how the work plan is appropriate for the program design and how the work plan targets fit into the overall timeline of implementation of the cooperative agreement.

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

• Describe barriers to developing rural technology-enabled learning community models for rural providers and how you will address these barriers. This description should include challenges in developing new rural learning community programs, e.g., recruiting participants, creating partnerships, and expanding partnerships.

• Discuss any additional challenges both internal and external to the applicant organization that may directly or indirectly affect successful execution of the cooperative agreement and provide details and strategies for how these will be resolved.

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

• Propose clearly defined, viable measurements of success in evaluation of a technology-enabled learning community center of this scope, including process and outcome indicators for evaluating whether activities are being implemented as planned and whether the activities are achieving the expected effects/changes in the short and long-term.

• Describe current and past experience, skills, and knowledge, including individuals on staff, materials published, and previous work of a similar nature.

• You are required to utilize HRSA’s measures (also commonly referred to as Performance Improvement Measurement System (PIMS) measures) to help monitor your project progress. You are also required to utilize HRSA’s evaluation measures (to be identified upon award along with the Rural Telehealth-Focused Research Center) to collect evidence-based data.

• Describe the strategy (including staffing and workflow) and the frequency to collect, analyze, and track data to measure process outcomes and impact outcomes, including, as appropriate, among different cultural groups (e.g., race, ethnicity, language) and explain how the data will be used to inform program development.

• Identify and present clear benchmarks of success for each year. Describe how the benchmarks to be applied to the project are industry standard from recognized sources, such as the National Quality Forum (NQF), National Committee for Quality Assurance (NCQA), Centers for Medicare & Medicaid Services (CMS); or, describe and justify appropriate benchmarks if industry standards are not available.

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• Describe your capacity to effectively manage the programmatic, fiscal, and administrative aspects of the proposed project. You must demonstrate knowledge, skills, and expertise required to run a learning community model and build coalitions with stakeholders for the purpose of creating new and expanding existing model programs across your state or region.

• Describe a plan for, and cite specific subject matter knowledge, experience in, and ability to develop relevant materials to be used by rural health care providers to successfully develop new rural learning community programs, improve existing programs, and successfully evaluate the proposed program.

NOTE: TTELP award recipients will be expected to work with a Rural Telehealth Focused Research Center during the period of performance (and potentially share project updates and information with them after the period of performance ends).