FORHP HRSA-22-058 H3G Rural Vet HAP_FINAL.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Federal Office of Rural Health Policy Hospital State Division

Rural Veterans Health Access Program

Funding Opportunity Number: HRSA-22-058 Funding Opportunity Type: New

Assistance Listings (CFDA) Number: 93.241

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2022

Application Due Date: December 10, 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 may take up to 1 month to complete.

Issuance Date: September 9, 2021

Mikael Redmond Public Health Analyst, Federal Office of Rural Health Policy Telephone: (301) 443-2867 Email: Mredmond@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: Title XVIII, Section 1820(g)(6) of the Social Security Act (42 U.S.C. 1395i-4(g)(6)).

mailto:Mredmond@hrsa.gov

HRSA-22-058 i

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 Rural Veterans Health Access Program (RVHAP). The purpose of this cooperative agreement is to provide funding to states to work with providers and other key partners to improve access to needed healthcare services and improve coordination of care for veterans living in rural areas.

Funding Opportunity Title: Rural Veterans Health Access Program

Funding Opportunity Number: HRSA-22-058 Due Date for Applications: December 10, 2021

Anticipated Total Annual Available FY 2022 Funding:

$900,000

Estimated Number and Type of Awards: Up to three cooperative agreements

Estimated Annual Award Amount: Up to $300,000 per award, subject to the availability of appropriated funds

Cost Sharing/Match Required: No Period of Performance: August 01, 2022 through July 31, 2025

(3 years) Eligible Applicants: Only states (current Medicare Rural

Hospital Flexibility Program award recipients in states with certified critical access hospitals) are eligible to apply for funding under this notice. The Governor designates the eligible applicant from each state.

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

HRSA-22-058 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: Thursday, September 23, 2021 Time: 3 – 4 p.m. ET Call-In Number: 1-833-568-8864 Webinar ID: 160 022 1107 Participant Code: 41155387 Web link: https://hrsa-gov.zoomgov.com/j/1600221107?pwd=MXIzeWI0U3d5R1ROeHNmbFdrNUZHUT09

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

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

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://hrsa-gov.zoomgov.com/j/1600221107?pwd=MXIzeWI0U3d5R1ROeHNmbFdrNUZHUT09 https://hrsa-gov.zoomgov.com/j/1600221107?pwd=MXIzeWI0U3d5R1ROeHNmbFdrNUZHUT09 mailto:MRedmond@hrsa.gov

HRSA-22-058 iii

Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AW ARD

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

vi. 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. AW ARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

HRSA-22-058 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Rural Veterans Health Access Program (RVHAP). The purpose of this program is to provide funding to states to work with providers and other partners to improve access to needed health care services and to improve the coordination of care for veterans living in rural areas.

Award recipients can implement a variety of strategies to improve the capacity of critical access hospitals (CAHs) and other rural health care organizations to provide services that meet the needs of veterans living in rural areas. Award recipients can also assist providers in making connections to the Department of Veterans Affairs (VA) system to coordinate care for rural veterans using community health care providers as well as the VA system.

2. Background

This program is authorized by Title XVIII, Section 1820(g)(6) of the Social Security Act (42 U.S.C. 1395i-4(g)(6)).

There are a disproportionate share of veterans living in rural areas of the United States.

According to the Veterans Health Administration – Office of Rural Health (VHA – ORH) there are 4.7 million veterans residing in rural areas, with 2.7 million enrolled in the VA health care system. Veterans choose to reside in rural areas for a variety of reasons including proximity to family, friends and community; open space for recreation; more privacy; lower cost of living; and less crowded towns and schools. Veterans (and their caregivers) face many of the same challenges with accessing health care and other services as any rural resident including limited broadband, greater geographic and distance barriers, hospital closures due to financial instability, higher uninsured rates, longer wait times, fewer transportation options, fewer housing and employment options, and fewer options of care, particularly specialty care. Veterans also face unique challenges with care coordination as they routinely access care from multiple locations and can be included in multiple health care systems (e.g., through the VA system and through community providers).

The benchmark activity under RVHAP has been to increase enrollment of veterans, living in rural areas into the VA benefits system, which improves their access to care by allowing rural veterans to receive VA services and benefits. This program allows recipients to identify and work with a variety of providers in rural areas whom can assist rural veterans in meeting their health care needs. Network development activities must include Critical Access Hospitals (CAHs), but may also include providers within the VA system, Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), home health agencies, mental health providers and community mental health centers, pharmacists, social service providers, local government, and other rural health organizations or providers deemed necessary to help meet the needs of veterans.

https://www.ssa.gov/OP_Home/ssact/title18/1820.htm https://www.ruralhealth.va.gov/aboutus/ruralvets.asp

HRSA-22-058 2

The Federal Office of Rural Health Policy (FORHP) is collaborating with the Veterans Health Administration - Office of Rural Health’s (VHA-ORH) Veterans Rural Health Resource Centers (VRHRCs) to strengthen partnerships between rural health providers and the VA system. The VRHRCs are located within the VA medical centers in Iowa City, Iowa; Salt Lake City, Utah; White River Junction, Vermont; Portland, Oregon; and Gainesville, Florida.

VRHRCs have the overarching goal to be the VHA-ORH’s field-based satellite offices and serve as hubs of rural health care research, innovation, and dissemination.

Congressional Mandate 38 USC § 7308 defines VRHRCs’ mission to:

• Improve understanding of the challenges faced by veterans living in rural areas.

• Identify disparities in the availability of health care to veterans living in rural areas.

• Formulate practices or programs to enhance the delivery of health care to veterans living in rural areas.

• Develop special practices and products for the benefit of veterans living in rural areas and for implementation of such practices and products in the VA system-wide.

VRHRCs complete their mission by:

• Administration and Operations: Providing operations and clinical leadership as well as administrative support;

• Studies: Responding to requests from VHA-ORH to prepare longer-term studies of matters affecting veterans living in rural areas of the United States;

• Innovations: Developing and piloting test innovations in the delivery of care and services to rural veterans, functioning as field-based "laboratories" for clinical and non-clinical pilot projects that address well-defined needs of veterans living in rural communities; and

• Promising Practices Dissemination and Technical Assistance:

o Disseminate VHA-ORH Rural Promising Practices through mentored implementation to targeted stakeholders, inside and outside the VA, that emerge from clinical and non-clinical pilot projects; and o Provide technical assistance and program consultation on programs, pilots, projects and issues affecting rural veterans to internal VA and external stakeholders.

https://www.ruralhealth.va.gov/aboutus/vrhrc.asp https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-chapter73&edition=prelim

HRSA-22-058 3

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 HRSA anticipates substantial involvement with the recipient during performance of the contemplated project.

HRSA program involvement will include:

• Advising on performance measures (refer to the Baseline Measures in the Evaluation and Technical Support Capacity section) to ensure that HRSA can capture any cross cutting outcomes among the award recipients.

• Facilitating partnerships with the VHA-ORH.

• Facilitating sharing of best practices and resources to other relevant stakeholders.

The cooperative agreement recipient’s responsibilities will include:

• Collaborating with HRSA and the VHA-ORH (including VRHRCs) in implementing program objectives, measuring program progress, and assessing program effectiveness.

• Executing program activities to meet the goals of the project, in conjunction with ongoing discussions and input from HRSA.

• Engaging with providers and stakeholders within your state to increase access to care and coordination of care for veterans in rural areas.

• Sharing best practices and resources developed to benefit interested stakeholders.

2. Summary of Funding

HRSA estimates approximately $900,000 to be available annually to fund up to three recipients. The actual amount available will not be determined until enactment of the final FY 2022 federal appropriation. You may apply for a ceiling amount of up to $300,000 total cost (includes both direct and indirect, facilities and administrative costs) per year. This program notice is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds appropriately.

The period of performance is August 1, 2022 through July 31, 2025 (3 years). Funding beyond the first year is subject to the availability of appropriated funds for RVHAP 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.

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

HRSA-22-058 4

Limitations on Indirect Cost Rates The authorizing legislation (Title XVIII §1820(g)(4)(E) of the Social Security Act (42 U.S.C. 1395i-4(g)(4)(E)) limits indirect costs under this program. Indirect costs will be budgeted and reimbursed at the lesser of 15 percent of total direct costs or the applicant’s negotiated Indirect Cost Rate Agreement (ICRA). This limitation on indirect cost rates is a requirement of this federal award and, as required in 45 CFR § 75.351- 353, the limitation includes subrecipients.

III. Eligibility Information

1. Eligible Applicants

Only states (current Medicare Rural Hospital Flexibility Program award recipients in states with certified Critical Access Hospitals) are eligible to apply for funding under this notice, per the authorizing statute (Title XVIII, Section 1820(g)(6) of the Social Security Act (42 U.S.C. 1395i-4(g)(6)). The Governor designates the eligible applicant from each state. HRSA will only accept one application from each state.

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

Requirements for Second-Time Applicants Applicants shall not previously have received a Rural Veterans Health Access Program award for the same or similar projects, unless the entity is proposing to expand the scope of the project or the area that will be served by the project.

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.

HRSA-22-058 5

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 HRSA-22-058 in order to receive notifications including modifications, clarifications, and/or republications of the NOFO on Grants.gov.

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

NOFO.

2. Content and Form of Application Submission

Application Format Requirements Section 4 of HRSA’s SF-424 Application Guide provides general instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, etc. You must submit the information outlined in the HRSA SF-424 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 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 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-22-058, 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.

https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

HRSA-22-058 6

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-22-058 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. § 3321).

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachment #8: 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:

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 or it will count toward the page limitation. For information required in the Project Abstract Summary Form, see Section 4.1.ix of HRSA’s SF-424 Application Guide.

NARRATIVE GUIDANCE

To ensure that you fully address the review criteria, this 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.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

HRSA-22-058 7

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

Organizational Information (5) Resources/Capabilities

Budget and 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

Briefly describe the purpose of the proposed project.

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

The purpose of this section is to outline the needs and healthcare gaps of rural veterans within your state.

• Describe and document the rural veteran population and its unmet health needs.

• Discuss the demographics of the rural veteran population in your state, including age and gender identity. Use and reference demographic data whenever possible to support the information provided, for example: The National Center for Veterans Analysis and Statistics provides official data sets and visualization infographics, including the Veteran Population Model (VetPop) by key demographic characteristics.

Additional resources for rural veteran demographics include:

o The Veterans in Rural America, American Community Survey report includes a state by state breakdown of rural veteran population demographics.

o The Rural Health Information Hub also contains several resources regarding access to health care for veterans in rural areas.

https://www.va.gov/vetdata/veteran_population.asp https://www.va.gov/vetdata/docs/Demographics/New_Vetpop_Model/Vetpop_Infographic2020.pdf https://www.va.gov/vetdata/docs/Demographics/New_Vetpop_Model/Vetpop_Infographic2020.pdf https://www.census.gov/library/publications/2017/acs/acs-36.html https://www.ruralhealthinfo.org/topics/returning-soldier-and-veteran-health

HRSA-22-058 8

• Discuss unmet health needs specific to underserved veteran populations including geriatric, Native American, minority, and women veteran populations.

• Discuss gaps in rural veterans’ ability to receive care within their community and describe how this project will complement, but not supplant, existing programs, where applicable.

• Discuss existing resources to assist veterans to receive mental health care, crisis intervention, care for post-traumatic stress disorder (PTSD), or other health care services deemed necessary within your rural communities, where applicable.

• 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.

• Describe any existing efforts to coordinate care or efforts for veterans to receive care from community providers or providers from the VA system.

METHODOLOGY -- Corresponds to Section V’s Review Criterion (2) Response and Review Criterion (4) Impact

Propose methods that you will use to address the stated needs and meet each of the previously described program requirements and expectations in this NOFO.

This section should outline your approach to work with providers and partners in addressing the gaps and unmet health needs indicated in the needs assessment to improve access to care and needed services for veterans, including care coordination for veterans receiving care from multiple systems. As appropriate, include development of effective tools and strategies for ongoing staff training, outreach, collaborations, clear communication, and information sharing/dissemination with efforts to involve patients, families, and communities with veterans in need of health services. If applicable, include a plan to disseminate reports, products, and/or project outputs so key target audiences receive the project information.

Include a description of any innovative methods that you will use to address the stated needs.

Goals and objectives

Discuss the methods you will employ to improve health care for rural veterans by addressing the required program objective (objective #1) and targeting at least one of the core program objectives (objectives 2, 3, 4):

1. Increasing access to care for underserved veteran populations, including geriatric, women, Native American, and minority veteran populations (required objective).

2. Increasing care coordination for veterans seeking care both at the VA system and from other community providers, including the VA community care program.

https://www.va.gov/communitycare/

HRSA-22-058 9

3. Increasing access to mental health services, substance use disorder (SUD) services, or other health care services deemed necessary to meet the needs of veterans living in rural areas.

4. Increasing access to crisis intervention services and the detection of PTSD, traumatic brain injuries, and other signature injuries for veterans in rural areas, which can include the referral of such veterans to medical facilities operated by the VA.

Award recipients should implement a variety of strategies to meet the core objectives of the program, including:

• Improving capacity of CAHs and other rural health care organizations to meet the needs of veterans in rural areas;

• Assisting providers with making connections to the VA system;

• Establishing or participating in advisory panels, task forces, committees, network development, or coalitions that address program development, health systems planning, and strategic planning. This can include addressing challenging health issues for rural veterans such as: behavioral health, aging, population health, racial and ethnic health disparities, substance use services, and social determinants of health (SDOH) factors.

o Network development activities must include CAHs, but may also include RHCs, FQHCs, Native American and Tribal Organizations, home health agencies, mental health providers and community mental health centers, pharmacists, social service providers, local government, and other rural health organizations or providers deemed necessary to help meet the needs of veterans.

• Improving the coordination of care for rural veterans, which can include efforts with community health care providers and coordination of the VA system; and

• Establishing or improving telehealth and/or telemedicine services that improve access to care for rural veterans.

o For any projects involving telehealth and telemedicine, you can find information on the Telehealth Resource Centers, Telehealth Centers of Excellence, and other telehealth resources at HRSA Telehealth Programs.

o RHI Hub has resources for Telehealth projects, including the Telehealth Toolkit.

o The VA Telehealth Services includes resources and services to assist implementing Telehealth for veterans.

Stakeholder Engagement Engaging with the VA is a required component of the project. Describe how you plan to facilitate state partnerships with the VA, including a discussion on how you plan to consult or collaborate with one of the five VRHRCs on activities and how that will ensure that RVHAP funds complement existing VHA-ORH work, and results in improving the health for veterans in rural areas. VRHRCs can facilitate and assist award recipients with navigating partnerships within the VA system.

VRHRCs have specific focus areas:

https://telehealthresourcecenter.org/ https://www.hrsa.gov/library/telehealth-coe-ummc https://www.hrsa.gov/library/telehealth-coe-ummc https://www.hrsa.gov/rural-health/telehealth https://www.hrsa.gov/rural-health/telehealth https://www.ruralhealthinfo.org/topics/telehealth https://www.ruralhealthinfo.org/toolkits/telehealth https://telehealth.va.gov/

HRSA-22-058 10

• White River Junction: research and care coordination

• Iowa City: health information exchange, opioids, telehealth, and FQHC pilot programs

• Salt Lake City: geriatric care, Native American veterans, and telehealth

• Portland: pain management, suicide prevention, and vulnerable populations

• Gainesville: rehabilitation and independent living for rural veterans, rural workforce recruitment, retention, and education

Include a letter acknowledging support from one of the VRHRCs for project collaboration and project sustainability in Attachment #4.

Collaboration activities should also include:

• A discussion on how you have engaged with providers and partners in the development of your proposal and their planned involvement with project implementation.

• A discussion on how you will get input from key stakeholders, including rural veteran populations, which should also include geriatric, female, Native American, and minority veteran populations, during project planning and implementation.

• Describe how to you will share best practices implemented or resources developed during your project for the benefit of interested stakeholders.

• Describe collaborative efforts planned to address challenging health issues for rural veterans including: access to broadband, telehealth and telemedicine, behavioral health, aging, population health, racial and ethnic health disparities, substance use, and SDOH factors for veterans in rural areas.

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

While HRSA understands ongoing support for these projects may be challenging, HRSA expects that award recipients will consider how to sustain key elements of their RVHAP project, including the continuation of activities and services, ongoing work with partners, and continued use of assets such as (HIT and Telehealth equipment) purchased with RVHAP funding, which have proven to be effective in improving practices and have led to improved outcomes for the target population.

Sustainability should be considered during the planning phase of the project.

Find additional rural-specific sustainability planning tools at https://www.ruralhealthinfo.org/sustainability https://www.ruralhealthinfo.org/sustainability

HRSA-22-058 11

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 during the entire period of performance in the Methodology section. The work plan should provide a succinct overview of projects goals, objectives, activities, and projected outcomes. It is recommended that this information is provided in table format. The work plan must include each activity, responsible staff, estimated completion dates for activities, progress or process measures, and intended outcomes. As appropriate, identify meaningful support and collaboration with key stakeholders or partners in planning, designing, and implementing all activities, including developing the application.

Submit work plan as Attachment #1.

Logic Model

Provide an “outcomes approach” logic model that clearly illustrates the inputs, activities, outputs, short-term and long-term outcomes, and the impact of the proposed program and clearly provides a basis for the RVHAP work plan.

The logic model should illustrate how the proposed program relates to veterans in rural areas, the required collaboration with a VRHRC, and the service area at all social-ecological levels (intrapersonal/individual, interpersonal, organizational/institutional, community, and public policy). The logic model should summarize the connection between the:

• Goals of the project (e.g., reasons for proposing the intervention, if applicable);

o Goals should be aligned with the core program objectives described in the methodology. Short, mid, and long-term project goals that demonstrate work towards the completion of the core program objectives can be included;

• Assumptions (e.g., beliefs about how the program will work and support resources. Base assumptions on research, best practices, and experience.);

• Inputs (e.g., organizational profile, collaborative partners, key personnel, budget, other resources);

• Target population (e.g., the individuals to be served);

• Activities (e.g., approach, listing key intervention, if applicable);

• Outputs (i.e., the direct products of program activities); and

• Outcomes (i.e., the results of a program, typically describing a change in people or systems).

Although there are similarities, a logic model is not a work plan. A work plan is an “action” guide with a time line used during program implementation; the work plan provides the “how to” steps. You can find additional information on developing logic models at the following website: https://www.acf.hhs.gov/archive/ana/training-technical-assistance/ana/resource/ana/resource/logic-model-template

Submit logic model with work plan in Attachment #1.

https://www.acf.hhs.gov/archive/ana/training-technical-assistance/ana/resource/ana/resource/logic-model-template https://www.acf.hhs.gov/archive/ana/training-technical-assistance/ana/resource/ana/resource/logic-model-template

HRSA-22-058 12

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

(2) Response

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

EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to Section V’s Review Criterion (3) Evaluative Measures

Describe the plan for program performance evaluation that will contribute to continuous quality improvement. The program performance evaluation should monitor ongoing processes and the progress towards the goals and objectives of the project. Include descriptions of the inputs (e.g., organizational profile, collaborative partners, key personnel, budget, and other resources), key processes, expected outcomes of the funded activities, and dissemination of program results.

As appropriate, describe the strategy to collect, analyze and track data to measure process and impact/outcomes. Explain how data will be used to inform program development and service delivery. Describe any potential obstacles for implementing the program performance evaluation and your plan to address those obstacles.

Describe your capacity to work with HRSA and the VHA-ORH to adjust measures, collect data, and demonstrate the impact of the program.

Baseline Measures Propose baseline health measures that will be monitored and tracked throughout the period of performance in order to demonstrate the effectiveness of the project.

Baseline measures should be collected from the start of the project. Baseline measures determine where the rural veteran target population currently is on a given health problem (e.g., the number of sites delivering PTSD screenings for veterans) or issue (e.g., the percentage of veterans who do not have access to care) to setup the benchmarks/targets for assessment of program performance.

Describe the methodology for collecting baseline measures.

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 veteran’s receiving care or services and the types of services provided

• Number of underserved veterans (geriatric, minority, Native American, and women veterans- differentiate between which underserved veterans) receiving services and types of services provided

• Number of veteran’s or number of sites enrolled in the VA system

• Number of veteran’s receiving Telehealth or Telebehavioral health services

(and the types of services)

HRSA-22-058 13

• Number of veterans and/or number of underserved veterans receiving Telehealth or Telebehavioral health services

• Number of providers recruited assisting rural veterans in meeting health needs

• Number of sites using veteran screenings and/or number of veterans screened by providers or organizations

ORGANIZATIONAL INFORMATION -- Corresponds to Section V’s Review

Criterion (5) Resources and Capabilities

• Succinctly describe your organization’s current mission, structure, and scope of current activities, and describe how these elements all contribute to the organization’s ability to implement the program requirements and meet program expectations.

• Include an organizational chart as Attachment #6.

• Include a staffing plan and job descriptions for key personnel as

Attachment #2.

• Include biographical sketches of key personnel as Attachment #3.

• Discuss any subcontracts that you are proposing to use to achieve project goals and describe your oversight role.

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

• Describe how you will routinely assess and improve the unique needs of rural veteran populations of the communities served.

iii. Budget

The directions offered in the SF-424 Application Guide may differ from those offered by Grants.gov. Follow the instructions in Section 4.1.iv of HRSA’s SF-424 Application Guide and the additional budget Instructions provided below. A budget that follows the 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.

The General Provisions in Division H of the Consolidated Appropriations Act, 2021 (P.L. 116-260) are in effect at the time this NOFO is posted. Please see Section 4.1.iv Budget-Salary Limitation of HRSA’s SF-424 Application Guide for additional information. Awards will be made subsequent to enactment of the FY 2022 appropriation. The NOA will reference the FY 2022 appropriation act and any http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

HRSA-22-058 14

restrictions that may apply. Note that these or other restrictions will apply in the next fiscal year, as required by law.

Limitations on Indirect Cost Rates Authorizing legislation (Title XVIII, §1820(g)(4)(E) of the Social Security Act (42 U.S.C. 1395i-4(g)(4)(E)), as amended) limits indirect costs under this program.

Indirect costs will be budgeted and reimbursed at the lesser of 15 percent of total direct costs or the applicant’s negotiated Indirect Cost Rate Agreement (ICRA). This limitation on indirect cost rates is a requirement of this federal award and, as required in 45 CFR § 75.351-353, the limitation includes contractual and subrecipients.

iv. Budget Narrative

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

In addition, the RVHAP program requires the following:

The budget narrative should include sufficient justification to allow reviewers to determine the reasonableness of the support requested.

v. Attachments

Provide the following items in the order specified below to complete the content of the application. Unless otherwise noted, attachments count toward the application page limitation. Your indirect cost rate agreement and proof of non-profit status (if applicable) will not count toward the page limitation. Clearly label each attachment.

You must upload attachments into the application. Any hyperlinked attachments will not be reviewed/opened by HRSA.

Attachment 1: Work Plan and Logic Model

Attach the work plan for the project that includes all information detailed in Section IV.2.ii. Project Narrative. Also include the required logic model in this attachment. If you will make subawards or expend funds on contracts, describe how your organization will ensure proper documentation of funds.

Attachment 2: Staffing Plan and Job Descriptions for Key Personnel (see Section

4.1. of HRSA’s SF-424 Application Guide)

Keep each job description to one page in length as much as is possible. Include the role, responsibilities, and qualifications of proposed project staff. Also, include a description of your organization’s timekeeping process to ensure that you will comply with the federal standards related to documenting personnel costs.

Attachment 3: Biographical Sketches of Key Personnel

Include biographical sketches for persons occupying the key positions described in Attachment 2, not to exceed two pages in length per person. In the event that a biographical sketch is included for an identified individual not yet hired, include a letter of commitment from that person with the biographical sketch.

https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#sg45.1.75_1344_675_1350.sg4

HRSA-22-058 15

Attachment 4: VHA-ORH VRHRC Letter of Support Provide a letter acknowledging support from one of the VHA-ORH VRHRCs that the applicant organization will be collaborating with on this project and for project sustainability.

Attachment 5: Letters of Agreement, Memoranda of Understanding, and/or Description(s) of Proposed/Existing Contracts (project-specific)

Provide any documents that describe working relationships between your organization and other entities and programs cited in the proposal. Documents that confirm actual or pending contractual or other agreements should clearly describe the roles of the contractors and any deliverable. Make sure any letters of agreement are signed and dated.

Attachment 6: Project Organizational Chart Provide a one-page figure that depicts the organizational structure of the project.

Attachment 7: Tables, Charts, etc.

This attachment should give more details about the proposal (e.g., Gantt or PERT charts, flow charts).

Attachments 8–15: Other Relevant Documents

Include here any other documents that are relevant to the application, including letters of support. Letters of support from the VRHRCs should not be included under Attachments 8-15; all other letters of support can be included here. Letters of support must be dated and specifically indicate a commitment to the project/program (in-kind services, dollars, staff, space, equipment, etc.).

3. Dun and Bradstreet Data Universal Numbering System (DUNS) Number Transition to the Unique Entity Identifier (UEI) and System for Award Management (SAM)

You must obtain a valid DUNS number, also known as the Unique Entity Identifier (UEI), and provide that number in the application. In April 2022, the *DUNS number will be replaced by the UEI, a “new, non-proprietary identifier” requested in, and assigned by, the System for Award Management (SAM.gov). For more details, visit the following webpages: Planned UEI Updates in Grant Application Forms and General Service Administration’s UEI Update.

You must register with SAM and continue to maintain active SAM registration with current information at all times during which you have an active federal award or an application or plan under consideration by an agency (unless you are an individual or federal agency that is exempted from those requirements under 2 CFR § 25.110(b) or (c), or you have an exception approved by the agency under 2 CFR § 25.110(d)). For your SAM.gov registration, you must submit a notarized letter appointing the authorized Entity Administrator.

https://www.grants.gov/web/grants/forms/planned-uei-updates.html https://www.gsa.gov/entityid https://www.gsa.gov/entityid https://www.fsd.gov/fsd-gov/answer.do?sysparm_kbid=d2e67885db0d5f00b3257d321f96194b&sysparm_search=kb0013183

HRSA-22-058 16

If you are chosen as a recipient, HRSA will not make an award until you have complied with all applicable SAM requirements. If you have not fully complied with the requirements by the time HRSA is ready to make an award, you may be deemed not qualified to receive an award, and HRSA may use that determination as the basis for making an award to another applicant.

If you have already completed Grants.gov registration for HRSA or another federal agency, confirm that the registration is still active and that the Authorized Organization Representative (AOR) has been approved.

Currently, the Grants.gov registration process requires information in three separate systems:

• Dun and Bradstreet (http://www.dnb.com/duns-number.html)

• System for Award Management (SAM) (https://sam.gov/content/home | SAM.gov

Knowledge Base)

• Grants.gov (http://www.grants.gov/)

For more details, see Section 3.1 of HRSA’s SF-424 Application Guide.

In accordance with the Federal Government’s efforts to reduce reporting burden for recipients of federal financial assistance, the general certification and representation requirements contained in the Standard Form 424B (SF-424B) – Assurances – Non- Construction Programs, and the Standard Form 424D (SF-424D) – Assurances – Construction Programs, have been standardized. Effective January 1, 2020, the forms themselves are no longer part of HRSA’s application packages. Instead, the updated common certification and representation requirements will be stored and maintained within SAM. Organizations or individuals applying for federal financial assistance as of January 1, 2020, must validate the federally required common certifications and representations annually through SAM.gov.

If you fail to allow ample time to complete registration with SAM or Grants.gov, you will not be eligible for a deadline extension or waiver of the electronic submission requirement.

4. Submission Dates and Times

Application Due Date The due date for applications under this NOFO is December 10, 2021 at 11:59 p.m. ET.

HRSA suggests submitting applications to Grants.gov at least 3 calendar days before the deadline to allow for any unforeseen circumstances. See Section 8.2.5 – Summary of emails from Grants.gov of HRSA’s SF-424 Application Guide for additional http://www.dnb.com/duns-number.html https://sam.gov/content/home https://www.fsd.gov/gsafsd_sp?id=gsa_kb_view2&kb_id=f66d8e6cdb76d4100d73f81d0f9619c6 https://www.fsd.gov/gsafsd_sp?id=gsa_kb_view2&kb_id=f66d8e6cdb76d4100d73f81d0f9619c6 http://www.grants.gov/ http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.sam.gov/

HRSA-22-058 17

5. Intergovernmental Review

RVHAP is not subject to the provisions of Executive Order 12372, as implemented by 45 CFR part 100.

See Section 4.1 ii of HRSA’s SF-424 Application Guide for additional information.

6. Funding Restrictions

You may request funding for a period of performance of up to three years, at no more than $300,000 per year (inclusive of direct and indirect costs). This program notice is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds appropriately. Awards to support projects beyond the first budget year will be contingent upon Congressional appropriation, satisfactory progress in meeting the project’s objectives, and a determination that continued funding would be in the best interest of the Federal Government.

The General Provisions in Division H of the Consolidated Appropriations Act, 2021 (P.L.

116-260) are in effect at the time this NOFO is posted. Please see Section 4.1 of HRSA’s SF-424 Application Guide for additional information. Awards will be made subsequent to enactment of the FY 2022 appropriation. The NOA will reference the FY 2022 appropriation act and any restrictions that may apply. Note that these or other restrictions will apply in the next fiscal year, as required by law.

You are required to have the necessary policies, procedures, and financial controls in place to ensure that your organization complies with all legal requirements and restrictions applicable to the receipt of federal funding including statutory restrictions on use of funds for lobbying, executive salaries, gun control, abortion, etc. Like all other applicable grants requirements, the effectiveness of these policies, procedures, and controls is subject to audit.

Be aware of the requirements for HRSA recipients and subrecipients at 2 CFR §

200.216 regarding prohibition on certain telecommunications and video surveillance services or equipment. For details, see the HRSA Grants Policy Bulletin Number: 2021- 01E.

All program income generated as a result of awarded funds must be used for approved project-related activities. Any program income earned by the recipient must be used under the addition/additive alternative. You can find post-award requirements for program income at 45 CFR § 75.307.

https://www.hrsa.gov/sites/default/files/hrsa/grants/manage/grants-policy-bulletin-2021.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/manage/grants-policy-bulletin-2021.pdf https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

HRSA-22-058 18

V. Application Review Information

1. Review Criteria

HRSA has procedures for assessing the technical merit of applications to provide for an objective review and to assist you in understanding the standards against which your application will be reviewed. HRSA has critical indicators for each review criterion to assist you in presenting pertinent information related to that criterion and to provide the reviewer with a standard for evaluation.

These criteria are the basis upon which the reviewers will evaluate and score the merit of the application. The entire proposal will be considered during objective review.

Six review criteria are used to review and rank RVHAP applications. Below are descriptions of the review criteria and their scoring points.

Criterion 1: NEED (10 points) – Corresponds to Section IV’s Introduction and Needs Assessment

The extent to which the application:

• Clearly and succinctly describes the purpose of the proposed project.

• Clearly describes the rural veteran population and their unmet health needs in their state and includes demographic data in their discussion.

• Clearly discusses the unmet health needs specific to underserved veteran populations in their state including, geriatric, Native American, minority, and women veteran populations, where applicable.

• Clearly explains the current gaps in rural veterans’ ability to receive care within their communities and describes how this project will complement, but not supplant, existing programs

• Clearly describes the existing resources to assist rural veterans in receiving mental health care, crisis intervention, care for PTSD, and other health care services deemed necessary within their rural communities, where applicable.

• Clearly discusses any relevant barriers in the service area that the project hopes to overcome and demonstrates the community and/or organization that you will serve with the proposed project.

• Clearly discusses any existing efforts to coordinate care or efforts for veterans to…