FORHP HRSA-22-114 (T28) Delta Workforce_R&R FINAL.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Federal Office of Rural Health Policy

Hospital State Division

Delta Region Rural Health Workforce Training Program Funding Opportunity Number: HRSA-22-114

Funding Opportunity Type: New

Assistance Listings (AL/CFDA) Number: 93.912

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2022

Application Due Date: January 25, 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: October 20, 2021

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

See Section VII for a complete list of agency contacts.

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

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508 COMPLIANCE DISCLAIMER

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

Agency Contacts.

EXECUTIVE SUMMARY

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

Funding Opportunity Title: Delta Region Rural Health Workforce Training Program

Funding Opportunity Number: HRSA-22-114

Due Date for Applications: January 25, 2022

Anticipated Total Annual Available

FY 2022 Funding:

$1,400,000

Estimated Number and Type of Awards: Up to three grants; approximately one recipient will be funded for each service area.

Estimated Annual Award Amount:

Up to $600,000 per award, based on service area:

Northern Service Area: $500,000 per year

Central Service Area: $600,000 per year

Eastern Service Area: $300,000 per year

Cost Sharing/Match Required: No

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Period of Performance: September 1, 2022 through

August 31, 2026 (4 years)

Eligible Applicants: Eligible applicants include domestic public, private, and non-profit organizations, including tribes and tribal organizations, faith-based and community-based organizations, and accredited domestic institutions of higher education including public or private non-profit educational entities, such as four-year colleges and universities, community colleges, technical colleges, vocational schools, Historically Black Colleges and Universities (HBCUs), Hispanic Serving Institutions (HSIs), and Tribal Colleges and Universities (TCUs) located in one of the eight states in the DRA region.

The DRA region includes 252 counties and parishes located across eight states - Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee. To view service area maps for each state, visit https://dra.gov/about-dra/map-room/.

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

Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf, except where instructed in this NOFO to do otherwise.

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

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Technical Assistance HRSA has scheduled the following technical assistance:

Webinar

Day and Date: Wednesday, November 10, 2021

Time: 2 – 3 p.m. ET Call-In Number: 1-833-568-8864 Webinar ID: 161 262 9156 Passcode: 95093046 Weblink: https://hrsa-gov.zoomgov.com/j/1612629156?pwd=R2VNWjY1bThXK0xLMG5RZ3loRnZkZz09

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

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

https://hrsa-gov.zoomgov.com/j/1612629156?pwd=R2VNWjY1bThXK0xLMG5RZ3loRnZkZz09 https://hrsa-gov.zoomgov.com/j/1612629156?pwd=R2VNWjY1bThXK0xLMG5RZ3loRnZkZz09

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Justification Narrative

v. Attachments

3. DUN AND BRADSTREET DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER TRANSITION

TO THE UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEM ENT (SAM)

4. SUBMISSION DATES AND TIM ES

5. INTERGOV ERNM ENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSM ENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIV E AND NATIONAL POLICY REQUIREM ENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Delta Regional Rural Health Workforce Training Program. The purpose of this program is to educate and train future and current health professionals in the rural counties and parishes of the Mississippi River Delta Region and Alabama Black Belt (Delta Regional Authority (DRA) region) in the following critical administrative support occupations: medical coding and billing, claims processing, information management, and clinical documentation.

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

The Delta Region Rural Health Workforce Training Program addresses the ongoing need in healthcare facilities for trained administrative support or business operations professionals in rural communities through the development of Strategic Networks that support recruitment, formal training, certification, and placement of students. This program aims to provide training and pathways to professional certifications to current administrative support professionals working in rural DRA region healthcare facilities as well as new entrants to the workforce1 and dislocated workers.2

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

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

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

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

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

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• Provide students with training opportunities and experiences within community focused rural healthcare facilities, which will build and reinforce ties within rural communities in the DRA region.

• Retain current healthcare staff in rural areas with opportunities for training and education in critical positions.

• Expand the uptake of industry-validated credentials that are competency based, empowering job seekers and reducing barriers to hiring and promotion in rural areas.

For more details, see Program Requirements and Expectations.

2. Background

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

The DRA region includes eight states – Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee – that together have a population of almost 10 million people living in 252 counties and parishes. Of the 252 counties and parishes, 212 (84 percent) are rural (non-metropolitan area), and 41 percent of the total population in the DRA region resides in one of these rural counties.3 The Delta Regional Authority (DRA), established in 2000 by Congress, makes investments into Delta communities’ human and physical infrastructure. The counties and parishes served by DRA are among the most distressed areas of the country.4

There is extensive documentation regarding the distress of the counties and parishes in the DRA region for both health and economic conditions. The population in the DRA region has been decreasing, and 20 percent of the region’s population has income below the poverty rate, compared with the national rate of 14 percent. Further, poverty is much more persistent in the DRA region than nationally.5 Rural (non-metropolitan) counties with a high incidence of poverty are largely concentrated in the Southern region, with the most severe poverty found in the historically poor areas such as the DRA region.6

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

4 Delta Regional Authority, www.dra.gov.

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

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

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

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

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Approximately 13 percent of the rural hospitals that closed between 2010 and 2020 are located in a Delta county or parish.7 Recent analysis found that multiple DRA states are among those determined to have the highest number of rural hospitals at risk of financial distress.8 Findings from HRSA’s Delta Region Community Health Systems Development Program, which provides in-depth technical assistance to rural healthcare facilities in the DRA region, show that trained administrative support professionals9 (i.e., staff specializing in billing/coding, claims processing, data analysis, and clinical documentation) are necessary for hospitals to meet key performance indicators around financial and quality improvement. These staff play a key role in increasing hospital revenue and therefore a hospital’s financial stability, which is key to improving health care in the rural communities they serve.

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

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

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

• Health Information Management

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

• Insurance Claims Processing

• Clinical Documentation Improvement

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

https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/ 8 Thomas, S, et al. Geographic Variation in the 2019 Risk of Financial Distress among Rural Hospitals, April 2019.

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

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

https://www.ruralhealthresearch.org/publications/1251 https://www.ahima.org/certification-careers/certifications-overview/career-tools/career-pages/health-information-101/ https://www.ahima.org/certification-careers/certifications-overview/career-tools/career-pages/health-information-101/

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

• Supply Chain and Materials Management

II. Award Information

1. Type of Application and Award

Type of applications sought: New

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA estimates approximately $1,400,000 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. Funding amounts will be based on the service areas included in the Eligibility section of this NOFO. The funding amount for each service area is based upon natural geographic boundaries and rural population size.

For the Central Service Area, you may apply for a ceiling amount of up to $600,000 total cost (includes both direct and indirect, facilities and administrative costs) per year. For the Northern Service Area, you may apply for a ceiling amount of up to $500,000 total cost (includes both direct and indirect, facilities and administrative costs) per year. For the Eastern Service Area, 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. The specific counties and rural population for each service area are listed under the Service Area Requirements section below. 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 September 1, 2022 through August 31, 2026 (4 years).

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

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

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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Limitations on indirect cost rates

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

III. Eligibility Information

1. Eligible Applicants

Eligible applicants include domestic public, private, and non-profit organizations, including tribes and tribal organizations, faith-based and community-based organizations, and accredited domestic institutions of higher education including public or private non-profit educational entities, such as four-year colleges and universities, community colleges, technical colleges, vocational schools, Historically Black Colleges and Universities (HBCUs), Hispanic Serving Institutions (HSIs), and Tribal Colleges and Universities (TCUs) located in one of the eight states in the DRA region.

Eligible entities must be located in the DRA region. The DRA region includes 252 counties and parishes located across eight states - Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee. To view service area maps for each state, visit https://dra.gov/about-dra/map-room/. Applicants do not need to be located in a rural DRA region county or parish, but training must be provided to the rural counties and parishes listed in the Service Area Requirements section below.

Accreditation/Approval Documentation

Strategic Network members providing academic training must be accredited by a nationally recognized accrediting agency, and provide a copy of their active accreditation or active approval from state government as Attachment 7, as specified by the U.S. Department of Education.

HRSA may consider any application that fails to attach a copy of the required accreditation or related documentation as Attachment 7 to be non-responsive and may not consider it for funding under this notice. Applicants are required to maintain their accreditation or state approval status, as appropriate, throughout the period of performance and to notify HRSA of change in status.

Strategic Network Requirements

Applicants are required to create a Strategic Network of partnerships that must meet the following requirements:

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Develop a Strategic Network that is composed of at least four separate organizations, which each have their own EIN number. These members may be for-profit or non-profit and may be in a rural or urban area. All partners must be located in one of the eight states in the DRA region. Note: the award will be made to only one member of the Strategic Network, the applicant organization, which will serve as the recipient of record.

1. The Strategic Network must include at least one institution of higher education located in one of the eight states in the DRA region, such as four-year colleges and universities, community colleges, technical colleges, vocational schools, Historically Black Colleges and Universities (HBCUs), Hispanic Serving Institutions (HSIs), and Tribal Colleges and Universities (TCUs).

2. The Strategic Network must include at least one rural-serving community-based organization located in the DRA region to assist in addressing the social needs of the students enrolled in the proposed training program.

3. The Strategic Network must include at least two rural community-based healthcare entities located in the DRA region to support placement opportunities for trainees. Partnerships can include entities such as critical access hospitals, small rural hospitals, rural health clinics, federally qualified health centers, and tribal healthcare facilities. Applicants are strongly encouraged to include the healthcare facilities participating in the Delta Region Community Health Systems Development Program.

4. Strategic Networks that include a four-year college or university must include at least one additional institution of higher education located in the DRA region such as community colleges, technical colleges, and vocational schools to broaden the reach of the proposed training program in the region.

5. All applicants are encouraged to include additional institutions of higher education located in one of the eight states in the DRA region, such as four-year colleges and universities, community colleges, technical colleges, vocational schools, Historically Black Colleges and Universities (HBCUs), Hispanic Serving Institutions (HSIs), and Tribal Colleges and Universities (TCUs) to broaden the reach of training programs throughout the DRA region.

A list of Minority Serving Institutions, including HBCUs, HSIs, and TCUs can be found here (also available on Grants.gov in the Related Documents Tab):

https://www.minorityhealth.hhs.gov/assets/PDF/2020_Minority_Serving_Institutio ns.pdf

6. Applicants are encouraged to form partnerships with appropriate state and regional-level entities in order to support the development of training programs that are responsive to rural communities. Partnerships can include entities such as CareerOneStop Centers, State Workforce Agencies, State or Local Workforce Boards, Local Economic Development Organizations (which can include Chambers of Commerce), Community Action Agencies, Primary Care Associations, Primary Care Organizations, State Offices of Rural Health, Area Health Education Centers, and State Education Agencies.

https://www.minorityhealth.hhs.gov/assets/PDF/2020_Minority_Serving_Institutions.pdf https://www.minorityhealth.hhs.gov/assets/PDF/2020_Minority_Serving_Institutions.pdf

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7. Each member of the Strategic Network must sign a Memorandum of Agreement or a Memorandum of Understanding (MOA/MOU) submitted in Attachment 4.

The purpose of this document is to signify the formal commitment of Strategic Network members. The MOA/MOU must describe the Strategic Network’s purpose. It must also describe each member’s expertise relevant to the goals of the Strategic Network and the member’s responsibilities in terms of financial contribution, participation and membership benefits.

8. Applicants must notify DRA early in the process of their intent to submit an application.

Service Area Requirements

Applicants are required to identify which of the following service areas the proposed training program will cover. Applicants must identify one of the proposed services areas.

These service areas are based upon natural geographic boundaries and rural population size. Due to the lack of proximity to the other DRA region states, Alabama has a single service area that encompasses all of the rural DRA counties in the state.

Based on the rural population size of each service area, the following award ceiling amounts will apply:

• Northern Service Area: $500,000 per year

• Central Service Area: $600,000 per year

• Eastern Service Area: $300,000 per year

Service areas only include rural counties and parishes in the DRA region of the states listed. Counties and parishes outside of the DRA region will not be considered for funding. HRSA intends to fund one recipient for each service area- the highest ranked application for each service area will receive consideration for award.

Northern Service Area:

State DRA region counties included Estimated Rural

Population10 Illinois Alexander, Franklin, Gallatin, Hamilton, Hardin, Jackson, Johnson, Massac, Perry, Pope, Pulaski, Randolph, Saline, Union, White

258,321

Kentucky Ballard, Caldwell, Calloway, Carlisle, Christian, Crittenden, Fulton, Graves, Hickman, Hopkins, Livingston, Lyon, Marshall, McCracken, McLean, Muhlenberg, Todd, Trigg, Union, Webster

443,406

10 All population estimates based on 2020 estimates from ESMI. Obtained from Delta Regional Authority, February 25, 2021.

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Missouri Butler, Carter, Crawford, Dent, Douglas, Dunklin, Howell, Iron, Madison, Mississippi, New Madrid, Oregon, Ozark, Pemiscot, Perry, Phelps, Reynolds, Ripley, Ste. Genevieve, St.

Francois, Scott, Shannon, Stoddard, Texas, Washington, Wayne, Wright

582,855

Total Rural Population

1,284,582

Central Service Area:

State DRA region counties included Estimated Rural

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

850,912

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

412,098

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

568,725

Total Rural

1,831,735

Eastern Service Area:

State DRA region counties included Estimated Rural

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

307,081

Total Rural

307,081

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2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

HRSA may not consider an application for funding if it contains any of the non-responsive criteria below:

• Exceeds the ceiling amount

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

NOTE: Multiple applications from an organization are not allowable.

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

Beneficiary Eligibility Requirements:

A student/trainee receiving support from award funds must be a citizen of the United States or a foreign national having in his/her possession a visa permitting permanent residence in the United States, or a non-citizen national. All students/trainees receiving support from award funds must formally commit to working in the DRA region upon completion of the program.

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically. HRSA encourages you to apply through Grants.gov using the SF-424 Research and Related (R&R) workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at 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-22-114 in order to receive notifications including modifications, clarifications, and/or republications of the NOFO on Grants.gov.

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

NOFO.

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

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2. Content and Form of Application Submission

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

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

Application Page Limitation The total size of all uploaded files included in the page limit shall be no more than the equivalent of 70 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-22-114, 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 70 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-22-114 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 8-15: Other Relevant Documents.

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

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

Program Requirements and Expectations Applicants will be required to facilitate the following program requirements:

1. Develop academic training programs focused on administrative support functions in healthcare facilities in the following areas: medical coding and billing, claims processing, information management, and clinical documentation, that lead to professional certification and academic degrees.

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

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

4. As part of the Strategic Network, establish or leverage partnerships with rural DRA region healthcare facilities to place participants/trainees for hands-on training and employment upon completion of the program.

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

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

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

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 R&R Application Guide.

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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 (4) Impact

Work Plan (2) Response

Resolution of Challenges (2) Response

Evaluation and Technical Support Capacity

(3) Evaluative Measures and

(4) Impact

Organizational Information (5) Resources/Capabilities

Budget Narrative (6) Support Requested

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

Use the following section headers for the narrative:

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

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

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

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

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

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

Include a clear description of the rural service area to be addressed by the proposed training program. Compare local data to state and federal data where possible to highlight the proposed service area’s unique need.

Identify key challenges and barriers to training, recruiting, and retaining administrative support or business operations professionals in healthcare facilities.

Describe how the target rural service area will benefit from the proposed training program.

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

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

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

Outline the specifics of the proposed training program and address the following questions:

a) From what populations will the Strategic Network recruit students into the training program?

b) How will the program ensure that students demonstrate a substantive commitment to working in rural communities in the DRA region upon completion of the training program?

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c) How will the Strategic Network address barriers and challenges to recruiting students into training and retaining students in and after training?

d) How will the program be advertised to local professionals already working in healthcare settings?

e) How will the program prioritize recruiting/accepting staff from facilities participating in the Delta Region Community Health Systems Development Program?

f) How will the program meet the unique needs of rural and underrepresented student populations – both from a recruitment and a retention standpoint?

g) What tools or resources will the program provide to all students to ensure successful completion of the program?

h) What specific tools or resources will the program provide to meet the unique needs of underrepresented students?

i) What various instruction modalities will the program offer to support students?

j) How will the Strategic Network actively place students in rural DRA region healthcare facilities to provide them hands-on experience?

k) How will the Strategic Network help place students in rural employment in the DRA region after completing the training program?

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

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

1. Recruitment

a) How the Strategic Network plans to sustain rolling recruitment of students for the program;

b) How the Strategic Network plans to disseminate information about the training program to members of the communities within the selected service area; and

c) How the Strategic Network will provide ongoing assessments of trainee and provider needs regarding administrative support workforce in the service area and recruitment barriers and challenges.

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2. Training

a) How the Strategic Network will provide trainees with peer support and services to support the needs of identified trainee population;

b) How the Strategic Network plans to sustain the hands-on training components of the program; and

c) How the Strategic Network plans to build diverse sources of network revenue to support ongoing training.

3. Retention

a) How the Strategic Network plans to continually retain graduates in rural DRA region communities via various strategies, such as developing career pathways, and how the Strategic Network plans to continually assess and address retention barriers and challenges;

b) How the Strategic Network plans to acquire sustained financial commitment from its members to support ongoing network activities; and

c) How the Strategic Network plans to identify additional DRA region partners.

Find additional rural-specific sustainability planning tools at:

https://www.ruralhealthinfo.org/sustainability

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

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

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

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

https://www.ruralhealthinfo.org/sustainability

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Year 1: Planning Year

• Month 3: By the end of Month 3, finalize all Strategic Network members;

clearly identify roles/responsibilities of each member; submit an updated MOU/MOA to HRSA, if needed.

• Month 6: By the end of Month 6, the formal recruitment process for trainees commences. Finalize plan to assess program performance.

• Month 12: By the end of Month 12, develop a strategic plan for remaining four years of the program.

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

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

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

EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to

Section V’s Review Criteria #3 Evaluative Measures and #4 Impact

1. Logic Model

Submit an “outcomes approach” logic model that clearly presents the conceptual framework for the proposed project and explains the links among program elements. The logic model should clearly provide a basis for the work plan.

For the purposes of this notice, the logic model must include and summarize the connections between the:

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

• 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);

• Short-Term Outcomes (i.e., the immediate results of a program, typically describing a change in knowledge, awareness, attitudes, skills, etc.);

• Long-Term Outcomes (i.e., the long-term results of a program, which may include changes in practice); and

• Impact (the overall results of a program, which often mirror the goals of the program).

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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/sites/default/files/documents/prep-logic-model-ts_0.pdf.

Include the logic model in Attachment 6.

2. Performance Evaluation Plan

To support the information included in the logic model, describe the plan for tracking, measuring and evaluating program performance. Explain any assumptions made in developing the logic model and discuss the anticipated outputs and outcomes of proposed activities. Both outcome and process measures may be used to evaluate the progress of the program.

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

• Number of trainees enrolled in training program, per year

• Number of trainees completing either a certificate or Associate Degree

• Number of trainees placed in a rural healthcare practicum site

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

Describe the process for collecting and analyzing data for these measures.

Discuss how the Strategic Network will track students after they complete training to determine employment and retention in rural areas of the DRA region.

Describe any potential obstacles for implementing the program performance evaluation and your plan to address those obstacles.

Discuss plans for dissemination of project results.

ORGANIZATIONAL INFORMATION -- Corresponds to Section V’s Review Criterion #5 Resources/Capabilities Succinctly describe the Strategic Network’s mission and structure, scope of current activities for each Strategic Network member, and ability of each member to meet program expectations.

Provide evidence of the applicant organization’s ability to collaborate with appropriate partners to carry out all the program requirements. Describe the relationship between the applicant organization and the other Strategic Network members. Explain why each of the Strategic Network members are appropriate collaborators and what expertise they bring to the network. Outline the roles and https://sharepoint.hrsa.gov/ofam/dgp/Shared%20Documents/FINAL%20FORHP%20HRSA-20-135%20Tribal%20COVID.pdf

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responsibilities of each Strategic Network member. Address each member’s capacity to meet program goals.

The network must have a Memorandum of Agreement or Memorandum of Understanding (MOA/MOU). The MOA/MOU must be signed and dated by all Strategic Network members and reflect the mutual commitment of each member to the program. Include the Strategic Network MOA/MOU as Attachment 4.

Include an organizational chart of the Strategic Network that depicts the relationship between the Strategic Network members as Attachment 5. Identify and describe each Strategic Network member and include each partner’s organization name, address, primary contact person, and current role in the DRA region. It is recommended that you use a table to present this information and include with Attachment 5.

Describe the relationship of each Strategic Network member within the DRA region. Describe the extent to which the Strategic Network will engage rural DRA communities in its planning.

Discuss how the Strategic Network will follow the approved work plan, as outlined in the application, properly account for the federal funds, and document all costs to avoid audit findings. Describe how you will routinely assess and improve the unique needs of target populations of the communities served.

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

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

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

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

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

As required by the Consolidated Appropriations Act, 2021 (P.L.