FORHP HRSA-22-115 (UK9) RMOMS FINAL.pdf

U.S. Department of Health and Human Services

Federal Office of Rural Health Policy

Community Based Division

Rural Maternity and Obstetrics Management Strategies Program Funding Opportunity Number: HRSA-22-115

Funding Opportunity Type: New

Assistance Listings (AL/CFDA) Number: 93.912

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2022

Application Due Date: April 5, 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: January 5, 2022

Victoria Tsai, MPH Public Health Analyst, Federal Office of Rural Health Policy Email: RMOMS@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C. § 254c(f) (§ 330A(e) of the Public Health Service Act) mailto:RMOMS@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 Rural Maternity and Obstetrics Management Strategies (RMOMS) program. The purpose of this program is to improve access to and continuity of maternal and obstetrics care in rural communities.

Funding Opportunity Title: Rural Maternity and Obstetrics Management Strategies Program

Funding Opportunity Number: HRSA-22-115

Due Date for Applications: April 5, 2022

Anticipated Total Annual Available FY 2022 Funding:

$5,000,000 subject to the availability of appropriated funds

Estimated Number and Type of Awards: Up to 5 cooperative agreements

Estimated Annual Award Amount: Up to $1,000,000 per award

Cost Sharing/Match Required: No

Period of Performance: September 1, 2022 through August 31, 2026 (4 years)

Eligible Applicants: • All public and private entities, nonprofit and for-profit, are eligible to apply. This includes, but is not limited to: faith-based and community-based organizations, federally recognized tribes, and tribal organizations.

• Shall be an entity with demonstrated experience serving, or the capacity to serve, rural underserved populations.

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• Shall represent a network composed of members – (i) that include at least three or more health care organizations (including the applicant organization).

• Shall not previously have received an award under this subsection for the same or similar project, unless the entity is proposing to expand the scope of the project or the area that will be served through the project.

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 Application Guide, available online, 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: 1 – 2 p.m. ET Call-In Number: 1-833-568-8864 Participant Code: 06048296 Weblink: https://hrsa-gov.zoomgov.com/j/1606904058?pwd=cWVmR2RaZm1UYnB5OGc0VFFiSGlsdz09

Webinar Recording: email RMOMS@hrsa.gov 24 hours after live event http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://hrsa-gov.zoomgov.com/j/1606904058?pwd=cWVmR2RaZm1UYnB5OGc0VFFiSGlsdz09 https://hrsa-gov.zoomgov.com/j/1606904058?pwd=cWVmR2RaZm1UYnB5OGc0VFFiSGlsdz09 mailto:RMOMS@hrsa.gov

HRSA-22-115 III

Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. Purpose

2. Background

II. AWARD INFORMATION

1. Type of Application and Award

2. Summary of Funding

III. ELIGIBILITY INFORMATION

1. Eligible Applicants

2. Cost Sharing/Matching

3. Other

IV. APPLICATION AND SUBMISSION INFORMATION

1. Address to Request Application Package

2. Content and Form of Application Submission

i. Project Abstract

NARRATIVE GUIDANCE

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: RMOMS PROGRAM GLOSSARY

APPENDIX B: RMOMS DATA REQUIREMENTS

APPENDIX C: RMOMS PROGRAM RESOURCES

HRSA-22-115 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Health Resources and Services Administration’s (HRSA) Rural Maternity and Obstetrics Management Strategies (RMOMS) program. The purpose of the RMOMS program is to improve access to and continuity of maternal and obstetrics care in rural communities.

The goals of the RMOMS program are to: (i) improve maternal and neonatal outcomes within a rural region; (ii) develop a sustainable network approach to increase the delivery and access of preconception, prenatal, pregnancy, labor and delivery, and postpartum services; (iii) develop a safe delivery environment with the support and access to specialty care for perinatal patients and infants; and (iv) develop sustainable financing models for the provision of maternal and obstetrics care in rural hospitals and communities. Applicants are encouraged to propose innovative ways to achieve these goals through an established or formal regional network structure.

The RMOMS program includes a robust independent evaluation and analysis effort that will rely on validated clinical data from each RMOMS award recipient and their appropriate network member in order to quantify the impact of this program investment.

All network members, regardless of ownership status, will be required to collect and share clinical data. This program intends to demonstrate the impact on access to and continuity of maternal and obstetrics care in rural communities through testing models that address the following RMOMS Focus Areas:

1) Rural Hospital Obstetric Service Aggregation and Approaches to Risk Appropriate Care

2) Network Approach to Coordinating a Continuum of Care

3) Leveraging Telehealth and Specialty Care

4) Financial Sustainability

For more details, see Program Requirements and Expectations..

2. Background

RMOMS is authorized by 42 U.S.C. § 254c(f) (§ 330A(e) of the Public Health Services Act) to “promote rural health care services outreach by improving and expanding the delivery of health care services to include new and enhanced services in rural areas, through community engagement and evidence-based innovative, evidence- informed models.”

National trends in maternal health have worsened over time and a key indicator is the pregnancy-related mortality ratio. The ratio is an estimate of the number of pregnancy-related deaths for every 100,000 live births. The pregnancy-related mortality ratio

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increased from 7.2 deaths per 100,000 live births in 1987 to 17.3 deaths per 100,000 live births in 2017.1 Similarly, Severe Maternal Morbidity (SMM) is steadily increasing and affected more than 50,000 women in the United States in 2014.2 SMM includes unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health.3 Reasons for the overall increase in pregnancy-related mortality and morbidity rates are unclear; however, it is known that risk from maternal mortality is especially unevenly distributed across African Americans, American Indian/Alaskan Natives, low-income persons, and rural residents.

Recent data at the national level describing the rural and urban differences for maternal morbidity and mortality rates show rural residents have a 9 percent greater chance of experiencing severe maternal morbidity and mortality compared with urban residents.4 At the same time, considerable racial and ethnic disparities in pregnancy-related mortality persist with mortality rates for African American and American Indian/Alaskan Native women two to three times higher than White women.5 These differences are contextualized by declining access to obstetric services in rural areas. As of 2014, more than half of all rural U.S. counties were without hospital obstetric services.6 Furthermore, rural obstetric unit closures are more common in smaller hospitals and communities with a limited obstetric workforce.7 These trends in the decreasing availability of obstetric units in rural areas indicate growing challenges in gaining access to care. For example, when comparing rural U.S. counties not adjacent to urban areas that had a loss of hospital-based obstetric services to counties with continuous services, there was an increase in out-of-hospital and preterm births and births in hospitals without obstetric units in the following year.8 Rural counties had higher infant, neonatal, and post-neonatal mortality rates than large urban counties.9

1 Centers for Disease Control and Prevention. Pregnancy Mortality Surveil lance System.

www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm. Accessed 9/13/21 2 Centers for Disease Control and Prevention. Severe Maternal Morbidity in the United States.

https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html Accessed on 9/13/2021.

3 Centers for Disease Control and Prevention. Severe Maternal Morbidity in the United States.

https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html Accessed on 9/13/2021.

4 Kozhimannil K, Interrante J, Henning-Smith C, Admon K. Rural-Urban Differences in Severe Maternal Morbidity and Mortality in the US, 2007-2015. Health Affairs. 2019; 38 (12): 2077-2085. doi: 10.1377/hlthaff.2019.00805 5 Centers for Disease Control and Prevention. Infographic: Racial/Ethnic Disparities in Pregnancy –Related Deaths – United States 2007-2016. https://w ww.cdc.gov/reproductivehealth/maternal-mortality/disparities-pregnancy-related-deaths/infographic.html. Accessed on 9.13.2021.

6 Hung P, Henning-Smith C, Casey M, Kozhimannil K. Access to Obstetric Services in Rural Counties Stil l Declining, with 9 Percent Losing Services, 2004-14. Health Affairs. 2017; 36 (9): 1663-1671. doi:

10.1377/hlthaff.2017.0338 7 Hung P, Kozhimannil K, Casey M, Moscovice I. Why Are Obstetric Units in Rural Hospitals Closing Their Doors? Health Services Research. 2016; 51: 1546-1560. doi: 10.1111/1475-6773.12441 8 Kozhimannil K, Hung P, Henning-Smith C, Casey M, Association Between Loss of Hospital-Based Obstetric Services and Birth Outcomes in Rural Counties in the United States. JAMA. 2018 online.

doi:10.1001/jama.2018.1830 9 Ely D, Hoyert D. Differences Between Rural and Urban Areas in Mortality Rates for the Leading Causes of Infant Death: United States, 2013-2015. NCHS Data Brief No. 300. 2018.

https://w ww.cdc.gov/nchs/data/databriefs/db300.pdf . Accessed on 9/13/2021.

http://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm.

https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00805 https://www.cdc.gov/reproductivehealth/maternal-mortality/disparities-pregnancy-related-deaths/infographic.html https://www.cdc.gov/reproductivehealth/maternal-mortality/disparities-pregnancy-related-deaths/infographic.html https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0338 https://dx.doi.org/10.1111%2F1475-6773.12441 https://jamanetwork.com/journals/jama/fullarticle/2674780 https://www.cdc.gov/nchs/data/databriefs/db300.pdf

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Rural communities face distinct and varied challenges in light of the current negative trends in maternal health outcomes. Many factors affect the sustainability of rural obstetric care, including obstetric workforce recruitment and skill maintenance10, birth volume, financial viability, resources, and infrastructure of prenatal and postnatal services, among others. In 2018, Medicaid paid for slightly less than half of all births nationally and covered a greater share of births in rural areas.11

An important element of rural health care coordination is the distance traveled to receive needed health care services. Research findings show patients who had to travel more than 30 miles to a labor and delivery location had fewer prenatal visits and infants with a lower birth weight and gestational age.12 Telehealth can be an important tool for improving access to quality health care, especially for underserved and economically or medically vulnerable populations. Applicants who propose a telehealth component to their work plan are encouraged to reach out to one of the 12 HRSA-supported regional Telehealth Resource Centers that provide technical assistance to organizations and individuals who are actively providing or interested in providing telehealth services to rural and/or underserved communities.

II. Award Information

1. Type of Application and Award

Type of applications sought: New

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

HRSA program involvement will include:

• Providing common measures and data elements that must be reported by all recipients (See Appendix B);

• Participating in the planning and development of the baseline data and data collection methods (See Appendix B);

10 Hung P, Kozhimannil K, Casey M, Henning-Smith C, Prasad S. State Variations in the Rural Obstetric Workforce. Rural Health Research Center Policy Brief. 2016. http://rhrc.umn.edu/w p-content/uploads/2016/05/State-Variations- in-the-Rural- Obstetric-Workforce.pdf . Accessed on 9/13/2021.

11 Medicaid and CHIP Payment and Access Commission. (2020). Medicaid’s Role in Financing Maternity Care [Fact Sheet]. ]. https://www.macpac.gov/wp-content/uploads/2020/01/Medicaid%E2%80%99s-Role-in-Financing-Maternity- Care.pdf 12 Hamlin L. Obstetric Access and the Community Health Imperative for Rural Women. Family and Community Health. 2018; 41(2): 105-110. doi: 1 0 .10 97 /FCH.0 00 00 00 00 000 01 92 http://www.telehealthresourcecenter.org/ http://rhrc.umn.edu/wp-content/uploads/2016/05/State-Variations-in-the-Rural-Obstetric-Workforce.pdf http://rhrc.umn.edu/wp-content/uploads/2016/05/State-Variations-in-the-Rural-Obstetric-Workforce.pdf http://rhrc.umn.edu/wp-content/uploads/2016/05/State-Variations-in-the-Rural-Obstetric-Workforce.pdf https://www.macpac.gov/wp-content/uploads/2020/01/Medicaid%E2%80%99s-Role-in-Financing-Maternity-Care.pdf https://www.macpac.gov/wp-content/uploads/2020/01/Medicaid%E2%80%99s-Role-in-Financing-Maternity-Care.pdf https://doi.org/10.1097/fch.0000000000000192

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• Reviewing and providing recommendations on the implementation period work plan;

• Reviewing award activities on an ongoing basis and providing input on strategies or approach;

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

• Providing consultation with the maternal and obstetrics services rural health network, as appropriate, in outreach and dissemination activities.

The cooperative agreement recipient’s responsibilities will include:

• Adhering to HRSA guidelines pertaining to acknowledgement and disclaimer on all products produced by HRSA award funds;

• Complying with program terms and reporting requirements detailed in the notice of award;

• Completing activities included in the final implementation period work plan, specifically data collection and active participation in HRSA-funded efforts to contribute to the rural maternal health evidence base;

• Timely development of a data collection strategy and infrastructure to satisfy network- and patient-level data requirements (see Appendix B) in the planning period (year 1) and throughout implementation (years 2-4);

• Cooperating with a HRSA-funded technical assistance provider and evaluator during the period of performance (and potentially share project updates and information with them after the period of performance ends). HRSA will provide additional guidance on the technical assistance and evaluation components of the project throughout the period of performance;

• Participating in conference calls and/or meetings with HRSA;

• Responding timely to requests for information, including requests for data submissions from HRSA; and

• Establishing relationships and collaborations to leverage other federal and state supported Maternal and Child Health programs and state Medicaid agencies.

2. Summary of Funding

HRSA estimates approximately $5,000,000 to be available annually to fund up to five 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 $1,000,000 total cost (includes both direct and indirect, facilities and administrative costs) per year.

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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 RMOMS 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.

III. Eligibility Information

1. Eligible Applicants

Applicant Organization Specifications:

Eligible applicants shall be domestic public or private, non-profit or for-profit, entities, including faith-based and community-based organizations, tribes, and tribal organizations. The applicant organization may be located in an urban or rural area and must have demonstrated experience serving, or the capacity to serve, rural underserved populations; represent a network of members that include three or more health care providers; and shall not previously have received an award under this subsection for the same or similar project, unless the entity is proposing to expand the scope of the project or the area that will be served through the project.

Please reference the Program Requirements and Expectations section for additional guidance.

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 RMOMS Program must exclusively occur in HRSA-designated rural areas. Please reference the Program Requirements and Expectations section for additional guidance.

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

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• Applicant organization fails to demonstrate that it is part of a network comprised of at least three or more health care organizations (including the applicant organization), and includes the six required network partner types defined in the glossary. Please reference the Program Requirements and Expectations section for additional guidance.

Multiple Applications

Multiple applications from an organization with the same DUNS number or Unique Entity Identifier (UEI) are allowable if the applications propose separate and distinct projects.

Applications associated with the same DUNS number or EIN should be independently developed and written. HRSA reserves the right to deem applications that provide insufficient information in Attachment 3 or are nearly identical in content, to be ineligible. In this instance, assuming all other eligibility criteria are met, 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.

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

You are required to notify the State Office of Rural Health (SORH) of your intent to apply to this program. A list of the SORHs can be accessed at:

https://nosorh.org/nosorhmembers/nosorh-members-browse-by-state/. You must include in Attachment 4 a copy of the letter or email sent to the SORH describing your project, and any response received to this letter.

Each state has a SORH, and HRSA recommends making every effort to contact the SORH entity early in the application process to advise them of your intent to apply. The SORH may be able to provide consultation to you regarding model programs, data resources, and technical assistance for networks, evaluation, partner organizations, or support of information dissemination activities. If you do not receive a response, please include the original letter of intent requesting the support.

If you are 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, you do not have a https://www.gsa.gov/about-us/organization/federal-acquisition-service/office-of-systems-management/integrated-award-environment-iae/iae-information-kit/unique-entity-identifier-update https://www.gsa.gov/about-us/organization/federal-acquisition-service/office-of-systems-management/integrated-award-environment-iae/iae-information-kit/unique-entity-identifier-update https://nosorh.org/nosorhmembers/nosorh-members-browse-by-state/

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designated SORH. By statute, all applicants are required to consult with their respective SORHs or other appropriate state entities in Attachment 4. However, if an applicant from these territories does not have a SORH equivalent or other appropriate governmental entity, this requirement does not apply and the applicant is still eligible to apply.

SORHs responding to this announcement as the applicant organization must provide an attestation in Attachment 4 that their application was independently developed and written and that they have not knowingly duplicated efforts or project ideas of non- SORH applicants within their state.

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.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-22-115 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.

https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html http://www.grants.gov/applicants/apply-for-grants.html 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 https://www.hrsa.gov/sites/default/files/hrsa/HRSA-strategy-intimate-partner-violence.pdf

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Application Page Limitation

The total size of all uploaded files included in the page limit shall be no more than 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- 22-115, it may count against the page limit. Therefore, we strongly recommend you only use Grants.gov workspace forms associated with this NOFO to avoid exceeding the page limit. Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limit. It is therefore important to take appropriate measures to ensure your application does not exceed the specified page limit. Any application exceeding the page limit of 80 will not be read, evaluated, or considered for funding.

Applications must be complete, within the maximum specified page limit, and validated by Grants.gov under HRSA-22-115 before the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) You certify on behalf of the applicant organization, by submission of your proposal, that neither you nor your principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

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

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachment 16: Other Relevant Documents.

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

Temporary Reassignment of State and Local Personnel during a Public Health Emergency

Section 319(e) of the Public Health Service (PHS) Act provides the Secretary of the Department of Health and Human Services (HHS) with discretion upon request by a state or tribal organization to authorize the temporary reassignment of state, tribal, and local personnel during a declared federal public health emergency. The temporary reassignment provision is applicable to state, tribal, and local public health department or agency personnel whose positions are funded, in full or part, under PHS programs and allows such personnel to immediately respond to the public health emergency in 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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the affected jurisdiction. Funds provided under the award may be used to support personnel who are temporarily reassigned in accordance with § 319(e). Please reference detailed information available on the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) website.

Program Requirements and Expectations Note that failure to meet the below program requirements, in addition to the criteria outlined in the Eligibility section, may result in HRSA deeming your application nonresponsive.

Network Specifications:

For the purposes of the RMOMS program, HRSA is employing a network model to encourage a broad range of clinical and administrative partners who will work together in a collective manner and play a key role in providing maternal and obstetric services.

The applicant organization must be part of a group of entities that are either an established or a formal network, which may need to be expanded to meet this program’s network definition. A network is defined as an organizational arrangement among three or more separately owned domestic public and/or private health care organizations, including the applicant organization. For the purposes of this program, the applicant must have a network composition that includes: 1) at least two rural hospitals or Critical Access Hospitals (CAH); 2) at least one health center under section 330 of the Public Health Service Act (Federally Qualified Health Center [FQHC] or FQHC look-alike; see Appendix C);

3) at least one Medicare certified Rural Health Clinic (RHC), to the extent which these entities are in the network service area and engaged in maternal and obstetrics care (see Appendix C); 4) at least one Level III and/or Level IV facility13;

5) regionally and/or locally available social services in the continuum of care (i.e., state Home Visiting and Healthy Start Programs to the extent which these resources are available in the service area; see Appendix C); and 6) the state Medicaid agency.

Partnership with the state Medicaid agency is beneficial as rural populations have a large share of Medicaid recipients and networks are to plan for financial sustainability.

Accordingly, applicants are required to obtain at least a letter of commitment from the state Medicaid agency at the time of application. Special consideration will be given to applicants that have a signed Memorandum of Agreement or Understanding (MOA/U)

13 Level III (Subspecialty Care) and Level IV (Regional Perinatal Health Care Centers) facil ities are defined by Levels of Maternal Care. Obstetric Care Consensus No. 9. American College of Obstetricians and Gynecologists. American Journal of Obstetrics and Gynecology 2019;134:e41e55. doi:

10.1016/j.ajog.2019.05.046.

http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx https://doi.org/10.1016/j.ajog.2019.05.046

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with the state Medicaid agency at the time of application; additional information can be found in Section V.2. Review. To obtain an award under this funding opportunity, networks are required to obtain a MOA/U with the state Medicaid agency. Given the specialized nature of maternal health, network members should be equipped to manage and coordinate care throughout preconception, pregnancy, labor, delivery, and postpartum periods. Medicaid covers nearly 50 percent of all births nationally and the engagement, expertise, and support of state Medicaid agencies will be critical to the long-term success of the program and may also provide opportunities to achieve long-term savings.14 Networks should include upstream tertiary partners (i.e., Level III and/or Level IV facilities as documented in Attachment 11) to provide enhanced case management of high-risk deliveries while also providing access to specialist, including leveraging telehealth to support care delivery and clinician support in rural communities.

An example network composition:

• Rural Hospital 1: the obstetrics delivery site with telehealth and prenatal care

• Rural Hospital 2: maternal and obstetric case management with telehealth, prenatal, and postnatal care

• CAH 3: maternal and obstetric case management with telehealth, prenatal, and postnatal care

• FQHC 1: maternal and obstetric case management with telehealth, prenatal, and postnatal care

• FQHC 2: maternal and obstetric case management with telehealth, prenatal, and postnatal care

• Rural Health Clinic (RHC)

• Public Health: well-baby care, screenings, etc.

• Healthy Start Award Recipient: connecting patients to services; providing clinical support

• Home Visiting Award Recipient: supporting at-risk new mothers and babies

• Level IV Regional Perinatal Health Care Centers linked by telehealth

• Other local providers (nurse midwives, private practice clinicians, social workers, case managers)

• State Medicaid Agency: committed to work with the providers for reimbursement

Other potential partners include, but are not limited to:

• Accredited birth centers

• Health Center Controlled Networks

• Primary care providers/offices

• Primary care associations

14 Rossier Markus A, et al. Medicaid Covered Births, 2008 Through 2010, in the Context of the Implementation of Health Reform. Women's Health Issues. 2013; 23 (5): e273-e280. DOI: 10.1016/j.w hi.2013.06.006 https://doi.org/10.1016/j.whi.2013.06.006

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• State Offices of Rural Health

• Emergency medical services entities

• Community organizations

Include the signed MOA/U that defines the roles and responsibilities for network partners 1-5: (1) at least two rural hospitals or Critical Access Hospitals (CAH); 2) at least one health center under section 330 of the Public Health Service Act (Federally Qualified Health Center (FQHC) or FQHC look-alike, see Appendix C); 3) at least one Medicare certified Rural Health Clinic (RHC, to the extent which these entities are in the network service area and engaged in maternal and obstetrics care; see Appendix C) 4) at least one Level III and/or Level IV facility15; 5) regionally and/or locally available social services in the continuum of care (i.e., state Home Visiting and Healthy Start Programs to the extent which these resources are available in the service area); and include at least a letter of commitment from partner 6) the state Medicaid agency as Attachment 1. If you are an established network, please include a summary, no longer than one page, detailing your network’s history of working together and highlighting your network’s products, services, and sources of sustainability as Attachment 2. If you are an existing RMOMS network, please also detail how you are proposing to expand the scope of the project or the area that will be served through the project in Attachment 2.

Note: Each network member must demonstrate involvement in the project and contribute to the project goals, including integrating data sharing and reporting capabilities (See Appendix B). The roles and responsibilities of each network member must be clearly defined in the MOA/U. The MOA/U must be signed by all network members at the time of application with the exception of the state Medicaid agency. A letter of commitment from the state Medicaid agency must be submitted at the time of application and included in Attachment 1. Upon receipt of award, networks are required to obtain a MOA/U with the state Medicaid agency.

Geographic Requirements:

The applicant organization, along with each network member who will receive any of the awarded funds, must have separate and different Employer Identification Numbers (EINs).

At least one network member must be located in a HRSA-designated rural county or rural census tract in an urban county; however, the applicant organization may be located in an urban area. All individuals served and all activities supported by this

15 Level III (Subspecialty Care) and Level IV (Regional Perinatal Health Care Centers) facilities are defined by Levels of Maternal Care. Obstetric Care Consensus No. 9. American College of Obstetricians and Gynecologists. American Journal of Obstetrics and Gynecology 2019;134:e41e55. doi: 10.1016/j.ajog.2019.05.046.

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program must exclusively target populations residing in HRSA-designated rural counties or rural census tracts in urban counties.

RMOMS Focus Areas:

Applicants are required to incorporate all four of the RMOMS Focus Areas in their proposals. Additionally, applicants are required to address the focus-specific prompts listed below as they prepare a response. Responses do not have to be limited to these items and may include additional information related to the RMOMS Focus Areas.

Rural Hospital Obstetric Service Aggregation and Approaches to Risk Appropriate Care

• Demonstrate how a regional network with several rural hospitals that are facing challenges in providing obstetric services could aggregate obstetric services to a targeted rural hospital or Critical Access Hospital (CAH) within the rural region to revive or sustain rural obstetric and maternal services. For example, volume may be too low at an individual rural hospital or CAH in the network; however, if deliveries were aggregated at one of the rural hospitals the financial viability of rural obstetric services in the rural region could be increased.

• Show how the network will ensure pregnant patients in the rural region receive care in a facility that best meets their needs and those of their neonates through appropriate risk stratification with lower-risk and routine pregnancies delivered in rural settings and higher-risk deliveries handled at a referral hospital in the network. Address how regions can approach care practices to prioritize referral to an appropriate facility during pregnancy rather than emergent transfer during labor.

• Address how rural regional risk appropriate care will improve health equity for rural residents including but 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.

Network Approach to Coordinating a Continuum of Care

• Demonstrate how the participating rural hospitals, community health centers, and other network partners focus on improving access along the continuum of care for preconception, pregnancy, labor and delivery, and postpartum health services.

• Identify and implement strategies to improve maternal and neonatal outcomes by developing more formal case management that includes rural hospitals and clinics working closely with existing HRSA award recipients, such as

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Community Health Centers, Maternal, Infant and Early Childhood Home Visiting (MIECHV) and Healthy Start programs (to the extent which these resources are available in the service area; see Appendix C).

Leveraging Telehealth and Specialty Care

• Show how rural networks collaborate with upstream tertiary providers (Level III and Level IV facilities16 as documented in Attachment 11) to enhance case management of higher-risk expectant patients living in geographically isolated areas.

• Illustrate how telehealth platforms can support rural clinicians and the obstetric patients they serve.

Financial Sustainability

• Show how rural networks, in partnership with Medicaid and other payers, can demonstrate improved outcomes and potential savings with the goal of providing the resources to ensure the ongoing support of the network once federal funding ceases.

The RMOMS program is funded via a cooperative agreement with HRSA, and may be built into an existing statewide or regional health network that supports obstetric and primary care services such that health care needs are addressed throughout preconception, pregnancy, labor and delivery, and postpartum periods. Applicants are required to develop their own strategies in response to all of the above listed RMOMS Focus Areas.

Award recipients will work with a HRSA-funded program evaluator to collect data from network members, and report network-level and patient-level data at baseline and throughout the course of the program. The purpose is for the network and the HRSA-funded evaluator to perform continuous quality improvement; identify gaps in the continuity of obstetric care and/or workforce and access to care within the targeted rural service area; leverage existing federal, state, and local maternal and obstetrics health resources; and to demonstrate the clinical and financial impact of the program. Data collection and reporting requirements, including anticipated measures, are detailed in Appendix B.

16 Level III (Subspecialty Care) or Level IV (Regional Perinatal Health Care Centers) facil ities are defined by Levels of Maternal Care. Obstetric Care Consensus No. 9. American College of Obstetricians and Gynecologists. American Journal of Obstetrics and Gynecology 2019;134:e41e55. doi: 10.1016/j.ajog.2019.05.046.

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Expected activities of award recipients include:

Year One (Planning Period)

a. Develop a model in alignment with RMOMS Focus Areas that supports the coordinated maternal care and delivery needs of a rural region and the necessary workforce training, services, equipment, and reimbursement needs to sustain the model.

b. Identify which small rural hospitals and/or CAHs will be part of the network, including which hospitals provide obstetric services and which do not. Address how the applicant will sustain existing services or offer new obstetric services in at least one rural hospital to ensure some level of obstetrics service in rural hospitals and/or CAHs in the service region while also identifying upstream tertiary providers (Level III and Level IV facilities1 as documented in Attachment 11) that will handle more complex deliveries as part of the network.

c. Coordinate with HRSA to establish a system to collect and store baseline network- and patient-level data across network partners during the planning period (year 1), which will serve as the baseline period. A data collection strategy must be finalized during year 1 for collecting and storing network- and patient-level data from network partners and reporting to the HRSA-funded program evaluator. This strategy will be utilized to continue data reporting throughout the implementation period (years 2-4) (see Appendix B).

d. Develop a work plan to implement the model in the target rural region during years 2, 3, and 4.

e. Engage in network capacity building and infrastructure development.

Years Two, Three, and Four (Implementation Period)

a. Implement and test model using the reviewed work plan.

b. Provide case management and coordinated care for pregnant patients, birth parents, and their infants across the continuum of care.

c. Ensure the ongoing and full participation of each network member in a shared governance model.

d. Collect data from network partners, report data to the HRSA-funded program evaluator, and adjust model based on evaluation findings.

Refer to the Project Narrative, Methodology section for more details on all activities in project years 1 – 4.

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

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i. Project Abstract

Use the Standard OMB-approved Project Abstract Summary Form 2.0 that is included in the workspace application package. Do not upload the abstract as an attachment 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. Applicants should list the rural areas (counties) that will be served. Proposed counties should be fully rural, but if counties are partially rural counties, please include the rural census tract(s) in the Project Abstract.

The applicant organization should also describe their experience and/or capacity serving rural populations in the Project Abstract section of the application. It is important that applicants list the rural counties (or rural census tract(s) if the county is partially rural) that will be served through their proposed project as this will be one of the factors that will determine the applicant organization’s eligibility to apply for this funding.

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.

ABSTRACT HEADER CONTENT

Applicant Organization Information Organization Name, Address (street, city, state, ZIP code), Facility/Entity Type (e.g., CAH, State Office of Rural Health, tribal organization, FQHC, RHC, public health department, etc.) and Website Address (if applicable) Designated Project Director Information Project Director Name & Title, Contact Phone Number and E-Mail Address RMOMS Project:

• Project Title and Goal(s)

• Requested award amount for each project year (1-4) http://www.usaspending.gov/

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ABSTRACT BODY CONTENT

Network Composition o Briefly describe the network, including name and goal(s). Indicate if you are a formal or established network, and if you expanded your network membership for this program, detail which network members were added.

o Indicate the number of network members involved in the project who have signed a MOA/U; indicate organization facility type (e.g., CAH, State Office of Rural Health, tribal organization, health center, RHC, public health department, etc.)

Target Service Area It is recommended that applicants provide this information in a table format.

o Entirely Rural Counties (list county name(s)) 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, please refer to https://data.hrsa.gov/tools/rural-health?tab=Address

Target Population Briefly describe the target population the project proposes to serve and track. Note: your network members are required to report patient-level clinical data on your defined target population.

Capacity to Serve Rural Underserved Populations

• Applicants must demonstrate their experience serving or the capacity to serve, rural underserved populations. Please describe your capacity to serve rural underserved populations. Examples to show a history or ability to serve in this capacity may include, but is not limited to:

o Identifying formal partnerships/formalize MOA/Us with rural health care organizations (if applicable).

o Identifying the target rural population and service area, including counties and rural census tract(s) the project will serve.

o Identifying activities that build, strengthen, and maintain the necessary competencies and resources needed to sustain or improve maternal and obstetrics health services delivery in rural populations.

o Discussing organizational expertise and capacity as it relates to the scope of work proposed. Include a brief overview of the organization’s assets, skills and qualifications to carry on the project.

o Describing current experience, including partnerships, activities, program implementation and previous work of a similar nature.

o Discussing the effectiveness of methods and/or activities employed to improve maternal and obstetrics health care services in rural communities.

• HRSA requires that urban applicants describe the geographic relationship to the proposed rural service population, as well as the plans to ensure that rural populations are served.

https://data.hrsa.gov/tools/rural-health?tab=Address

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Project Activities/Services Briefly describe the proposed project activities and/or services.

Expected Outcomes Briefly describe the proposed project’s expected outcomes.

Funding Preference Please place any request for funding preference at the bottom of the abstract. You must explicitly request a qualifying funding preference and cite the qualification that is being met (see 42 U.S.C. 254c(h)(3)); additional information can be found in Section V.2. Funding Preference. HRSA highly recommends that you include this language:

“(Your organization’s name) is requesting a funding preference based on qualification X. County Y is in a (designated HPSA; or in a MUC/MUP; or is focusing on primary care, and wellness and prevention strategies).”

If applicable, you need to provide supporting documentation in Attachment 13. Refer to Section V.2 for further information.

Special Consideration Please place any request for a special consideration at the bottom of the abstract.

HRSA recommends you include this language and/or combine with above funding preference language, if applicable:

“(Your organization’s name) is requesting special consideration based on the inclusion of a signed MOA/U with the state Medicaid agency included in Attachment 14.”

If applicable, you need to provide supporting documentation in Attachment 14. Refer to Section V.2 for further information.

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.

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