FORHP HRSA-22-093 (G20) Small HCP QI Program FINAL.pdf

U.S. Department of Health and Human Services

Federal Office of Rural Health Policy

Community-Based Division

Small Health Care Provider Quality Improvement Program

Funding Opportunity Number: HRSA-22-093

Funding Opportunity Type: New

Assistance Listings (CFDA) Number: 93.912

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2022

Application Due Date: March 21, 2022 Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

HRSA will not approve deadline extensions for lack of registration.

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

Issuance Date: December 21, 2021

Kanokphan Mew Pongsiri, MPH Public Health Analyst, Federal Office of Rural Health Policy Telephone: (301) 443-2752 Email: kpongsiri@hrsa.gov

Authority: Public Health Service Act, Title III, Section 330A(g) (42 U.S.C. 254c(g)) mailto:kpongsiri@hrsa.gov

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508 COMPLIANCE DISCLAIMER

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

Agency Contacts.

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2022 Small Health Care Provider Quality Improvement Program.

The purpose of this program is to provide support to rural primary care providers, such as a critical access hospital, a rural health clinic, or a network of rural health providers, for the planning and implementation of quality improvement activities providing services to residents of rural areas.

Funding Opportunity Title: Small Health Care Provider Quality Improvement Program

Funding Opportunity Number: HRSA-22-093

Due Date for Applications: March 21, 2022

Anticipated Total Annual Available FY 2022 Funding:

$8,000,000 subject to the availability of appropriated funds

Estimated Number and Type of Awards: Up to 40 awards

Estimated Award Amount: Up to $200,000 per year

Cost Sharing/Match Required: No

Period of Performance: August 1, 2022 through July 31, 2026

(4 years)

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Eligible Applicants: Eligible applicants must:

• be a domestic rural public or rural nonprofit private health care provider or provider of health care services, such as a critical access hospital, a rural health clinic;

• or be another rural provider or network of small rural providers identified by the Secretary as a key source of local or regional care; and

• not previously have received an award under this subsection for the same or similar project.

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

Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 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, January 26, 2022 Time: 2 – 3 p.m. ET Call-In Number: 1-833-568-8864 Participant Code: 45653299 Weblink: https://hrsa-gov.zoomgov.com/j/1608411479?pwd=MDdBclFTTm8zK25ZWTZ2SDZPWHhadz09

NOTE: The webinar will be recorded and playback information can be requested at kpongsiri@hrsa.gov http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://hrsa-gov.zoomgov.com/j/1608411479?pwd=MDdBclFTTm8zK25ZWTZ2SDZPWHhadz09 https://hrsa-gov.zoomgov.com/j/1608411479?pwd=MDdBclFTTm8zK25ZWTZ2SDZPWHhadz09 mailto:kpongsiri@hrsa.gov

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. Purpose

2. Background

II. AWARD INFORMATION

1. Type of Application and Award

2. Summary of Funding

III. ELIGIBILITY INFORMATION

1. Eligible Applicants

2. Cost Sharing/Matching

3. Other

IV. APPLICATION AND SUBMISSION INFORMATION

1. Address to Request Application Package

2. Content and Form of Application Submission

PROGRAM-SPECIFIC INSTRUCTIONS

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 A: PERFORMANCE MEASURES .................................................................. I APPENDIX B: RESOURCES FOR APPLICANTS ........................................................... II

APPENDIX C: SMALL HEALTH CARE PROVIDER QUALITY IMPROVEMENT

PROGRAM GLOSSARY ................................................................................................... IV

HRSA-22-093 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Small Health Care Provider Quality Improvement Program. The purpose of this program is to support the planning and implementation of quality improvement activities for rural primary care providers or providers of health care services, such as critical access hospitals (CAH), rural health clinics (RHC), or a network of rural health providers, serving rural residents.

The goal of the Small Health Care Provider Quality Improvement Program is to promote the development of a quality improvement culture and the delivery of cost-effective, coordinated, culturally appropriate, and equitable health care services in rural primary care settings. Specifically, program objectives include increased care coordination, enhanced chronic disease management, and improved health outcomes for patients. An additional program goal is to prepare rural health care providers for quality reporting and pay-for-performance programs. In order to achieve these goals and objectives, applicants are required to use an evidence-based model or promising practice to demonstrate the following impact areas, by the end of the four-year period of performance:

1) Improved health outcomes,

2) Expanded capacity for essential health care services, and

3) Increased financial sustainability.

Program activities include, but are not limited to, providing clinical health services for rural residents and conducting community health and prevention efforts for rural communities. Applicants are highly encouraged to address the underlying factors that are driving growing rural health disparities related to the five leading causes of avoidable death1, which are heart disease, cancer, unintentional injury/substance use, chronic lower respiratory disease, and stroke. Previous award recipients implemented a range of activities, such as coordinating care among network members, leveraging use of new Centers of Medicare & Medicaid (CMS) billing codes under standard fee-for-service Medicare supporting chronic care management, and integrating mental/behavioral health services into the rural primary care setting. Refer to the program’s Sourcebook and Grantee Directory for a summary of previously funded programs.

Although it is not a requirement, HRSA strongly encourages applicants to form a network and to consider including a RHC as a member in their proposal. Meeting the needs of rural communities relies on expanding our partnerships, expanding the reach of our impact on rural communities. For more details, see Program Requirements and Expectations.

1 Garcia MC, Rossen LM, Bastian B, et al. Potentially Excess Deaths from the Five Leading Causes of Death in Metropolitan and Nonmetropolitan Counties — United States, 2010–2017. MMWR Surveill Summ 2019;68(No. SS-10):1–11. DOI:

http://dx.doi.org/10.15585/mmwr.ss6810a1external icon.

https://www.ruralhealthinfo.org/assets/3574-14618/small-healthcare-provider-quality-improvement-sourcebook-2016-2019.pdf https://www.ruralhealthinfo.org/assets/3929-16436/2019-2022-small-health-care-provider-quality-improvement-program-grantee-directory.pdf https://www.ruralhealthinfo.org/assets/3929-16436/2019-2022-small-health-care-provider-quality-improvement-program-grantee-directory.pdf

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2. Background

This program is authorized by the Public Health Service Act, Title III, Section 330A(g) (42 U.S.C.

254c(g)) and permits HRSA to support awards to rural primary care providers, such as critical access hospitals (CAH), rural health clinics (RHC), or a network of rural health providers, serving rural residents, for the planning and implementation of quality improvement activities.

The Institute of Medicine defines quality health care as care that is “safe, effective, patient-centered, timely, efficient, and equitable.”2 Engaging in ongoing quality improvement is essential for rural providers and communities to improve the health outcomes of the rural population, reduce the overall cost of care, and address the growing rural health disparities. Compared to their urban counterparts, rural residents are more likely to die from the five leading avoidable causes of death:

heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke.2,3,4 Rural residents have generally poorer health outcomes compared to their urban counterparts with higher prevalence of chronic diseases and mental illnesses.5,6 Many of these challenges are longstanding and finding sustainable solutions have often lie beyond the clinical setting. Overcoming these challenges takes a collaboration of public health stakeholders and their partners to address a broader range of social determinants of health. The Federal Office of Rural Health Policy (FORHP) envisions its grant programs, such the Small Health Care Provider Quality Improvement Program, to support capacity building at the local level to improve health care delivery and health outcomes as part of the FORHP’s ongoing Healthy Rural Hometown Initiative (HRHI). This effort intends to use grant funding to help rural communities develop successful and sustainable quality improvement strategies that target the five leading causes of avoidable death of heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke, address the underlying factors and social determinants of health, and ultimately overcome long-standing rural health disparities.

In addition to the growing rural health disparities between rural and urban areas, racial and ethnic minority populations in rural areas face even more challenges in terms of access to care and related health care challenges that are often overlooked.7 Recognizing the link between health disparities and the five leading causes of avoidable death in rural communities, it is important to bridge the gap between social determinants of health8 and other systemic issues that contribute to achieving health equity related to excess death. The Small Health Care Provider Quality Improvement Program supports creative programs that aim to confront these important public

2 CDC Center for Surveillance, Epidemiology, and Laboratory Services (CSELS). (2017). Leading Causes of Death in Rural America. Available at: https://www.cdc.gov/ruralhealth/cause-of-death.html.

3 Moy E, Garcia MC, Bastian B, et al. Leading Causes of Death in Nonmetropolitan and Metropolitan Areas — United States, 1999–2014.

MMWR Surveill Summ 2017. Available at: https://www.cdc.gov/mmwr/volumes/66/ss/ss6601a1.htm.

4 Garcia MC, Rossen LM, Bastian B, et al. Potentially Excess Deaths from the Five Leading Causes of Death in Metropolitan and Nonmetropolitan Counties — United States, 2010–2017. MMWR Surveill Summ 2019;68(No. SS-10):1–11. DOI:

http://dx.doi.org/10.15585/mmwr.ss6810a1external icon.

5.Alfero C, Coburn A, Lundblad J, MacKinney A, McBride T , Mueller K, Weigel, P. (2015). Care Coordination in Rural Communities Supporting the High Performance Rural Health System. Rural Policy Research Institute. Available at: http://www.rupri.org/wp-content/uploads/2014/09/Care-Coordination-in-Rural-Communities-Supporting-the-High-Performance-Rural-Health-System.-RUPRl-Health- Panel.-June-2015.pdf.

6 Rural Health Information Hub. (2019). Rural Health Disparities. Available at: https://www.ruralhealthinfo.org/topics/rural-health-disparities.

7 James, C. V., R. Moonesinghe, S. M. Wilson-Frederick, J. E. Hall, A. Penman-Aguilar, and K. Bouye. 2017. “Racial/Ethnic Health Disparities Among Rural Adults -United States, 2012-2015.” MMWR Surveill Summ66 (23): 1-9. https://doi.org/10.15585/mmwr.ss6623a1.

8 Rural Health Information Hub, 2020. Social Determinants of Health for Rural People [online]. Rural Health Information Hub. Available at: https://www.ruralhealthinfo.org/topics/social-determinants-of-health.

https://www.cdc.gov/ruralhealth/cause-of-death.html https://www.cdc.gov/mmwr/volumes/66/ss/ss6601a1.htm http://www.rupri.org/wp-content/uploads/2014/09/Care-Coordination-in-Rural-Communities-Supporting-the-High-Performance-Rural-Health-System.-RUPRl-Health-Panel.-June-2015.pdf http://www.rupri.org/wp-content/uploads/2014/09/Care-Coordination-in-Rural-Communities-Supporting-the-High-Performance-Rural-Health-System.-RUPRl-Health-Panel.-June-2015.pdf http://www.rupri.org/wp-content/uploads/2014/09/Care-Coordination-in-Rural-Communities-Supporting-the-High-Performance-Rural-Health-System.-RUPRl-Health-Panel.-June-2015.pdf https://www.ruralhealthinfo.org/topics/rural-health-disparities https://www.ruralhealthinfo.org/topics/social-determinants-of-health

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health issues and address the needs of target population groups who have historically suffered from poorer health outcomes, health disparities and other inequalities. Applicants are encouraged to give special consideration to populations that have historically suffered from poorer health outcomes or health disparities, as compared to the rest of the rural population. Examples of these populations include, but are not limited to, Black, Latino, and Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons; persons with disabilities; and persons otherwise adversely affected by persistent poverty or inequality.

II. Award Information

1. Type of Application and Award

Type of applications sought: New.

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA estimates approximately $8,000,000 to be available annually to fund up to 40 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 $200,000 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, 2026 (4 years). Funding beyond the first year is subject to the availability of appropriated funds for the Small Health Care Provider Quality Improvement Program in subsequent fiscal years, satisfactory recipient 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.

III. Eligibility Information

1. Eligible Applicants Eligible applicants must:

• be a domestic rural public or rural nonprofit private health care provider or provider of health care services, such as a critical access hospital, a rural health clinic;

• or be another rural provider or network of small rural providers identified by the Secretary as a key source of local or regional care; and

• not previously have received an award under this subsection for the same or similar project

(see Section 3. Other below for further details about HRSA Funding History).

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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The applicant organization must be located in a rural area.

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

• Exceeds the page limit.

• Fails to propose a service area that is entirely rural, as defined by the Rural Health Grants Eligibility Analyzer. All activities supported by the Small Health Care Provider Quality Improvement Program must exclusively occur in HRSA-designated rural areas. Please reference the Program Requirements and Expectations section for additional guidance.

HRSA Funding History

The applicant must not previously have received an award under this subsection for the same or similar project. Current and former award recipients of any HRSA/FORHP programs are eligible to apply if the proposed project is a new proposal for an entirely new project. Proposals that are an expansion or enhancement of a previously awarded project are only eligible if the applicant’s proposal was previously awarded under a HRSA/FORHP program other than the Small Health Care Provider Quality Improvement Program. The proposal should differ significantly from previous projects by expanding the service area of the project, serving a new population, providing a new service or expanding the scope of the previous award activities. Project proposals submitted to supplant an existing program are not eligible and will not be accepted.

For organizations that are funded by HRSA’s Health Center Program through Bureau of Primary Health Care (Section 330 of the Public Health Service Act (42 U.S.C. 254b)) and/or receiving support for the HRSA Accreditation and Patient-Centered Medical Home (APCMH) Recognition Initiative, any activities and personnel supported under this award must not be duplicative. Failure to explain how the funds will be managed and allocated separately to avoid duplicate funding may affect the score of your application. You are encouraged to develop innovative approaches to help your rural communities improve the health of your local population while including the community served in the development and ongoing operations of the program. See Attachment 11: Current and Previous HRSA Funding History Information for additional details and instructions.

https://data.hrsa.gov/tools/rural-health

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Tribal Exception

HRSA is aware that tribes and tribal governments may have an established infrastructure without separation of services recognized by filing for EINs. In case of tribes and tribal governments, only a single EIN located in a HRSA-designated rural area is necessary to form a network/consortium, if applicable. Refer to Attachment 10 for additional information on this exception.

Multiple EIN Exception

In general, multiple applications associated with the same DUNS number and/or EIN are not allowable. However, HRSA recognizes a growing trend towards greater consolidation within the health care industry and the possibility that health care organizations may share the same EIN as its parent organization. As a result, at HRSA’s discretion, multiple health care organizations that share the same EIN as its parent organization or, organizations within the same consortium (if applicable) who are proposing different projects are eligible to apply by requesting an exception.

Refer to Attachment 10 for additional information on this exception.

Multiple Submissions

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.

Notifying Your State Office of Rural Health (SORH)

You are required to notify your SORH of your intent to apply to this program. A list of all National Organization for State Offices of Rural Health can be accessed at https://nosorh.org/nosorhmembers/nosorh-members-browse-by-state/. A copy of the letter or email sent to your SORH, and any response received to your letter or email submitted to your SORH describing your proposed project, is required to be included in Attachment 3:

Required Documentation from State Office of Rural Health (SORH) Letter.

Applicants located 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, or the Republic of Palau that do not have the functional equivalent of a SORH are nevertheless eligible to apply.

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 Grants.gov: HOW TO APPLY FOR GRANTS.

http://nosorh.org/nosorh-members/nosorh-members-browse-by-state/ https://nosorh.org/nosorhmembers/nosorh-members-browse-by-state/ https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html

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The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-22-093 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 may not exceed the equivalent of 80 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- 22-093, 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 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.

https://www.govinfo.gov/content/pkg/GPO-STYLEMANUAL-2016/pdf/GPO-STYLEMANUAL-2016.pdf https://www.cdc.gov/socialdeterminants/index.htm https://www.hrsa.gov/sites/default/files/hrsa/HRSA-strategy-intimate-partner-violence.pdf

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

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachment 13: Other Relevant Documents.

Program Requirements and Expectations Applicants for the Small Health Care Provider Quality Improvement Program must meet all of the requirements stated below. Failure to respond to the requirements below may impact your application’s score.

Applicant Organization:

If the applicant is a nonprofit entity, one of the following documents must be included in Attachment 1: Proof of Nonprofit or Public Status to document nonprofit status (will not count toward the page limit):

• A letter from the IRS stating the organization’s tax-exempt status under Section 501(c)(3);

• A copy of a currently valid IRS tax exemption certificate;

• Statement from a state taxing body, state attorney general or other appropriate state official certifying that the applicant organization has a nonprofit tax status and that none of the next earnings accrue to any private shareholders or individuals;

• A certified copy of the organization’s certificate of incorporation or similar document if it clearly establishes the nonprofit status of the organization; or

• If the applicant is an affiliate of a parent organization, a copy of the parent organization’s IRS 501(c)(3) Group Exemption Letter, and if owned by an urban parent, a statement signed by the parent organization that the applicant organization is a local nonprofit affiliate.

If the applicant is a public entity, proof of nonprofit status is not necessary. The applicant must submit an official signed letter on city, county, state or tribal government letterhead identifying them as a public entity in Attachment 1: Proof of Nonprofit or Public Status.

Management Requirements The applicant should have the staffing and infrastructure necessary to oversee program activities, serve as the fiscal agent for the award, and ensure that local control for award is vested in the targeted rural communities. The organization must:

• Exercise administrative and programmatic direction over award-funded activities;

• Be responsible for hiring and managing award-funded staff;

• Demonstrate administrative and accounting capabilities to manage award funds;

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

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• Have an Employer Identification Number (EIN) from the Internal Revenue Service;

and

• Identify a Project Director who will have administrative and programmatic direction over award-funded activities.

All award recipients are encouraged to allocate adequate time, qualifications and expertise to successfully support the project’s proposed data collection, tracking and analysis efforts, and effectively demonstrate the proposed project outcomes at the end of the four-year period of performance. HRSA strongly encourages award recipients to:

• Have at least one permanent staff at the time an award is made; and

• Have a minimum total equal to 2.0 full-time equivalent (FTE) allocated for implementation of project activities, met across two or more staffing positions, including the project director position.

• Refer to Evaluation and Technical Support Capacity narrative section under Resources/Capabilities, and Attachment 7: Staffing Plan and Position Descriptions for Key Personnel, for additional guidance.

Geographic Requirements

The applicant must be located in a HRSA-designated rural area, which is a non-metropolitan county or in a rural census tract of a metropolitan county.

• To determine rural eligibility, refer to the Rural Health Grants Eligibility Analyzer at https://data.hrsa.gov/tools/rural-health. This webpage allows potential applicants to search by county or street address to determine your rural eligibility. The applicant organization’s county name must be filled in on the SF-424 Box 8, Section d.

address. If the applicant is eligible by census tract, the census tract number must also be included next to the county name.

• 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 your organization is owned by or affiliated with an urban entity or health care system, the rural component may still apply as long as the rural entity has its own Employer Identification Number (EIN) and can directly receive and administer the funds in the rural area. The rural entity must be responsible for the planning, program management, financial management and decision making for the project, and the urban parent organization must assure HRSA in writing that, for the award, they will exert no control over or demand collaboration with the rural entity. This letter must be included in Attachment 2: Letter from Urban Parent Organization. If the applicant organization shares the same EIN as its parent organization or organizations within the same network/consortium (if applicable) are proposing different projects, and the applicant is eligible, then the applicant may request an exception in Attachment 10. Please see Multiple EIN Exception for additional details.

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All activities and services supported by this program must exclusively target populations residing in HRSA-designated rural counties or rural census tracts. Proposed rural counties should be fully rural. For partially rural counties, please include the rural census tract(s) in the Project Abstract.

Include a map of service area in Attachment 8.

Network Partnerships

The Small Health Care Provider Quality Improvement Program strongly encourages the establishment of a network or consortium to encourage relationships among service providers in rural areas. Examples of network member entities include rural and critical access hospitals, public health departments, Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), home health providers, primary care service providers, social service agencies, community and migrant health centers, and civic organizations.

Technical Assistance

All award recipients will have the opportunity to work closely with technical assistance (TA) providers throughout the four-year period of performance. The targeted TA will assist award recipients with achieving desired project outcomes, sustainability and strategic planning, and will ensure alignment of the awarded project with the program goals. The TA is provided to award recipients at no additional cost. This support is an investment made by HRSA in order to ensure the success of the awarded projects. HRSA has found that most award recipients benefit greatly from the support provided through these collaborations. If funded, award recipients will learn more about the targeted technical assistance and evaluation support.

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. Please use the guidance below. It is most current and differs slightly from that in Section 4.1.ix of HRSA’s SF-424 Application Guide.

Provide a summary of the application in the Project Abstract box of the Project Abstract Summary Form using 4,000 characters or less.

Because the abstract is often distributed to provide information to the public and Congress, prepare this so that it is clear, accurate, concise, and without reference to other parts of the application. It must include a brief description of the proposed project including the needs to be addressed, the proposed services, and the population group(s) to be served. If the application is funded, your project abstract information (as submitted) will be made available to public websites and/or databases including USAspending.gov.

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

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ABSTRACT HEADER CONTENT

Applicant Organization Information:

Organization Name, Address, Facility/Entity Type (e.g., CAH, tribal organization, FQHC, RHC, public health department, etc.) and Website

Designated Project Director Information:

Project Director Name & Title, Contact Phone Numbers and E-Mail Address

Quality Improvement Project:

Project Title and Goal(s), Requested award amount for each project year (Years 1-4)

ABSTRACT BODY CONTENT

Service Area Brief description of the service area, including a list of rural counties served o Entirely Rural Counties (list county names) o Partially Rural Counties (list city, state, zip code, and census tract). Applicants should specify whether the area is in a HRSA-designated rural county or rural census tract in an urban county. To ascertain whether a particular county or census tract is rural, refer to https://data.hrsa.gov/tools/rural-health.

Target Population Brief description of the target population the project proposes to serve and track

Network Partnerships (if applicable) Briefly describe the network including name and goals, Total number and facility/entity type of partner(s) comprising named collaboration Quality Improvement Model(s) Brief description of the project’s proposed quality improvement model approach(es) and application

Project Activities/Services Brief description of the proposed project activities and/or services

Expected Outcomes Brief description of the proposed expected outcomes. Clearly label and organize these expected outcomes by the Small Health Care Provider Quality Improvement Program’s key impact areas:

1) Improved health outcomes, 2) Expanded capacity for essential health care services, and 3) Increased financial sustainability. Refer to the Logic Model section and Impact section for guidance.

Funding Preference If requesting a funding preference, place request for funding preference at the bottom of the abstract. Applicants must explicitly request a qualifying funding preference and cite the qualification that is being met. HRSA highly recommends you include this language: “Applicant’s organization name is requesting a funding preference based on qualification X. County Y is in a designated HPSA” at the bottom of the abstract if requesting funding preference. If applicable, you need to provide supporting documentation in Attachment 9: Funding Preference.

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NARRATIVE GUIDANCE

To ensure that you fully address the review criteria, the table below provides a crosswalk between the narrative language and where each section falls within the review criteria. Any forms or attachments referenced in a narrative section may be considered during the objective review.

Narrative Section Review Criteria Introduction (1) Need

Needs Assessment (1) Need

Methodology (2) Response and (3) Evaluative Measures Work Plan (2) Response, (3) Evaluative Measures, and (4)

Impact Resolution of Challenges (2) Response

Evaluation and Technical Support Capacity

(3) Evaluative Measures, (4) Impact, and

(5) Resources/Capabilities

Organizational Information (5) Resources/Capabilities

Budget and Budget Narrative

(6) Support Requested – the budget section should include sufficient justification to allow reviewers to determine the reasonableness of the 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, Needs Assessment, Methodology, Work Plan, Resolution of Challenges, Evaluation and Technical Support Capacity, Organizational Information, and Budget.

INTRODUCTION -- Corresponds to Section V’s Review Criterion 1: NEED Provide a brief overview of the target population and service area and the network members (if applicable) involved in the project. This section should clearly outline the purpose of the proposed project. It should summarize the project’s goals, activities and expected outcomes as they relate to each of the Small Health Care Quality Improvement Program key impact areas:

improved health outcomes, expanded capacity for essential health care services, and increased financial sustainability.

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

NEED

Outline the community’s need for the proposed project, and how the local community will be involved in the ongoing operations of the project. Describe how the target population was involved in determining the need and relevant barriers the project intends to overcome, and provide a geographical snapshot of the service area. A list of resources is located in Appendix B.

Use the following sub-headings for this section: 1.Target Population, 2. Barriers/Challenges, 3.

Geographic Details of Service Area, and 4. Health Care in Service Area.

1) Target Population

a. Identify and describe the target population and service area, including a list of rural county names that will receive the intervention services. If the target population and service area are the same, this must be stated and reflected in the description provided in response to this section. Refer to Program Requirements and Expectations:

Geographic Requirements for rural service area requirements.

b. Use the following guidance in providing descriptions of the target population and service area in response to this section:

• Social determinants of health and health disparities impacting the target population that include considerations to disparities based on race, ethnicity, gender identity, sexual orientation, geography, socioeconomic status, disability status, primary language, health literacy, access to transportation, and any other relevant elements;

• Inclusion and selection criteria for the service area and target population should be clearly stated and should remain consistent across the four-year period of performance to minimize service and measurement disruptions should patients move, change or become deceased during project implementation;

• Any relevant available local, state, federal and/or national data or rankings in describing unique patient population needs; and

• Health care needs, including the identification of needs and how they will be met.

• If applicable, relationship to project goals, which should include considerations to relationships with project focus on at least one of the five leading causes of avoidable death (heart disease, cancer, unintentional injury/substance use, chronic lower respiratory disease, and stroke).

c. Health Inequity among Target Population: Describe the population you propose to serve includes subpopulations who have historically suffered from poorer health outcomes, health disparities, and other inequities among the target population. These populations may include, but are not limited to: Black, Latino, and Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color;

members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons; persons with disabilities; and persons otherwise adversely affected by persistent poverty or inequality. Also, include information regarding the social determinants of health and health disparities affecting the population or communities served. Refer to Appendix C for the NOFO’s definitions of equity and underserved communities.

https://sharepoint.hrsa.gov/teams/forhp/cbd/Quality/FY22%20NOFO/FORHP%20HRSA-22-093%20(G20)%20Small%20HCP%20QI%20Program%20Pre-Final_FORHP%20edits.docx#_Appendix_C:_Rural

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d. Specify how the patients will be served, measured and tracked across the four-year period of performance.

2) Barriers/Challenges

Describe any barriers or challenges relevant to project implementation that the proposed project hopes to overcome. Socioeconomic, linguistic, cultural, ethnic or other relevant barriers should be discussed. Some examples in rural communities include, but are not limited to, access to health care services, Health Information Technology (HIT) interoperability, and health care professional shortages. Your response must include a plan to overcome any barriers identified. This should also, include any pertinent challenges and/or barriers related to project data, as well as steps that will be taken to resolve any challenges or barriers identified.

3) Geographic Details of Service Area

Describe geographical features for the proposed project service area. Description must include a map that clearly shows the entire service area and indicates any relevant geographic barriers (e.g., mountainous terrain). Ensure maps in Attachment 8 included are clear and are easily reproducible in black and white, as this is what reviewers will see.

4) Health Care in Service Area

Identify and describe any other existing health care services available in or near the proposed service area. This includes: 1) a rationale for why the existing health care services do not sufficiently meet the need of the service area and target population; 2) how the proposed project will address any health care service gap(s) for the service area; and 3) how this grant program is the best and most appropriate opportunity to address identified gap(s), including how other grant programs and/or resources are unable to fulfill these gaps, as appropriate.

Any potential adverse effects are particularly important to include in response to this section, as well as any estimates for how the project might augment and enhance any existing capabilities in the service area.

METHODOLOGY -- Corresponds to Section V’s Review Criteria 2:

RESPONSE and 3: EVALUATIVE MEASURES

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

Use the following sub-headings in responding to this section: 1. Goals & Objectives, 2. Quality Improvement Model(s), 3. Sustainability Approach and 4. Data Methodology Approach.

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1. Goals & Objectives

a. Define the specific goals and objectives of the proposed project. These goals and objectives should directly relate to the information presented in the Introduction and Needs Assessment narrative sections. The stated goals and objectives should be specific, measurable, realistic, and achievable in a specific timeframe.

b. Align the goals with the Centers for Disease Control and Prevention (CDC)’s Healthy People 2030 Initiative, as may be feasible and applicable to do so. It is strongly encouraged that project goals and objectives align with the national initiatives, including alignment with additional quality improvement initiatives such as, but not limited to, the National Quality Strategy, Centers for Medicare & Medicaid (CMS) Rural Strategy, CDC Million Hearts, and the HHS Healthy Rural Hometown Initiative among others.

c. Addressing Health Inequity: Describe how the project will address health inequity among target population and/or any subsets of the target population you propose to serve. Refer to Appendix C for the NOFO’s definitions of equity and underserved communities.

d. If applicable, discuss how the project plans to address at least one of the five leading causes of avoidable death (heart disease, cancer, unintentional injury/substance use, chronic lower respiratory disease, and stroke)

2. Quality Improvement Model(s)

a. Propose projects based on an evidence-based, effective, and/or promising practice quality improvement (QI) model(s) shown to be effective in addressing improvements to health care quality and patient health outcomes.

b. Explicitly identify the proposed QI model(s), describe how the identified model(s) will contribute to improvements in patient health and care delivery, and detail how the model(s) framework will be applied, including how staff will be trained, the roles of staff in model(s) implementation and, if applicable, any network partner roles.

c. Provide rationale for choosing the identified QI model(s) and justification for why the selected model(s) serves as the best selection for meeting project’s proposed goals should also be included. All quality improvement model(s) identified should effectively align with the proposed project and clearly link to the proposed goals, objectives, activities and target population.

d. Include a thorough rationale supporting how the proposed model(s), and any necessary adaptations, if appropriate and relevant to the identified model(s) application to the proposed project. Applicants must clearly explain the extent identified model(s) are tailored and/or modified and describe how the tailored model(s) are effective in meeting project goals, as applicable. HRSA recognizes few evidence-based QI models specific to rural communities exist. Given that rural communities differ across the country, non-rural specific evidence- based QI models may be utilized and adapted to fit for proposed projects. To best fit rural adaptation needs, effective or promising practices, as defined by the Rural Health Information (RHIhub) level of evidence criterion, will also be accepted when proposed with a comprehensive rationale and justification that is supportive to the https://www.cdc.gov/nchs/healthy_people/index.htm https://www.cdc.gov/nchs/healthy_people/index.htm https://www.ahrq.gov/workingforquality/about/index.html https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/Rural-Strategy-2018.pdf https://millionhearts.hhs.gov/index.html https://www.hhs.gov/sites/default/files/hhs-rural-action-plan.pdf https://sharepoint.hrsa.gov/teams/forhp/cbd/Quality/FY22%20NOFO/FORHP%20HRSA-22-093%20(G20)%20Small%20HCP%20QI%20Program%20Pre-Final_FORHP%20edits.docx#_Appendix_C:_Rural https://www.ruralhealthinfo.org/project-examples/criteria-evidence-base

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effective utilization of the identified proposed approach, as an alternative to utilization of an evidence based model approach. Refer to the RHIhub’s evidence-based toolkits for additional program approaches that applicants can adapt to fit their community.

e. Align quality improvement initiatives, such as the Patient-Centered Medical Homes (PCMH), Value-Based Care (VBC), and HRSA/FORHP Healthy Rural Hometown Initiative (HRHI). Describe how the project’s proposed quality improvement model(s) align with any relevant quality improvement initiatives and detail how alignments will be incorporated into project implementation, as applicable. In aligning with value-based care efforts, applicants are highly encouraged to look at all relevant payers (Medicare, Medicaid, tribal, private, etc.) and their specific value-based models. Toward that end, applicants are encouraged to engage payers early in the application phase to identify how the proposed QI approach can align with the value-based models.

3. Sustainability Approach

a. Develop a sustainability plan that addresses how the proposed project will continue after the Small Health Care Provider Quality Improvement Program federal funding has ended.

HRSA strongly encourages applicants to focus on approaches that emphasize value across public and private insurers as an approach to sustainability. For example, leveraging use of new CMS billing codes under standard fee-for-service Medicare supporting chronic care management and population health and other resources can be a strategy for continuing proposed project activities after any award funding ends. For applicants serving Medicare Advantage (MA) enrollees, MA plans may see benefit in partnering with award recipients with a strong quality improvement focus. All MA organizations must have a Quality Improvement (QI) program as described in 42 CFR 422.152, and the primary goal of these QI programs is to sustain improvement in patient outcomes. Additionally, these QI programs must include a chronic care improvement program, and applicants that emphasize care coordination and population health could be seen as particularly valued partners by MA organizations.

b. For applicants serving Medicaid populations, develop a plan to engage with state Medicaid officials to explore how proposed project activities may align with state efforts to focus on value within the Medicaid population, both in standard fee-for-service and in Medicaid Managed Care, is also an encouraged consideration to sustainability strategies for applicants.