FORHP HRSA-22-117 Rural Public Health Workforce FINAL.pdf

U.S. Department of Health and Human Services

Federal Office of Rural Health Policy

Community-Based Division

Rural Public Health Workforce Training Network Program Funding Opportunity Number: HRSA-22-117

Funding Opportunity Type: New

Assistance Listings (AL/CFDA) Number: 93.912

NOTICE OF FUNDING OPPORTUNITY

Application Due Date: March 18, 2022

Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

HRSA will not approve deadline extensions for lack of registration.

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

Issuance Date: December 17, 2021

Amber Berrian, MPH Public Health Analyst, Federal Office of Rural Health Policy Email: RPHWTNP@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C. § 254c(f) (§ 330A(f) of the Public Health Service Act); Section 2501 of the American Rescue Plan Act of 2021 (P.L. 117-2) mailto:RPHWTNP@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 for the Rural Public Health Workforce Training Network Program. The purpose of this program is to expand public health capacity by supporting health care job development, training and placement in rural communities. HRSA will support rural health networks (which may be composed of, but are not limited to, minority-serving institutions, community colleges, technical colleges, rural hospitals, community health centers, nursing homes and substance use providers) to address the critical need for more trained health professionals, which has been amplified by the COVID-19 pandemic .

Funding Opportunity Title: Rural Public Health Workforce Training Network Program

Funding Opportunity Number: HRSA-22-117

Due Date for Applications: March 18, 2022

Anticipated Total Annual Available FY 2022 Funding:

$47,895,000

Estimated Number and Type of Awards: Up to 31 grants

Estimated Annual Award Amount:

Approximately $1,545,000 will be available for the three-year period of performance. Award recipients will receive the full award amount in the first year of the period of performance and are required to allocate funds across all three years.

Cost Sharing/Match Required: No

Period of Performance: August 1, 2022 through July 31, 2025

(3 years)

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Eligible Applicants: (A) Shall be a domestic public or private, non-profit or for-profit entity with demonstrated experience serving, or the capacity to serve, rural underserved populations. This includes faith-based, community-based organizations, tribes, tribal organizations; and

(B) Shall represent a network composed of participants – (i) that include at least three or more health care provider organizations (including the applicant organization); and (ii) that may be rural, urban, nonprofit or for-profit entities, with at least 66 percent (two-thirds) of network members located in a HRSA-designated rural area; and

(C) Shall not previously have received a grant 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.I 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, 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, January 5, 2022 Time: 1 – 2 p.m. ET Call-In Number: 1-833-568-8864 Participant Code: 86083981 Meeting ID: 161 940 7343 Weblink: https://hrsa-gov.zoomgov.com/j/1619407343?pwd=aW81ci9NRU5tbFBGYlkzUnFIT1Jydz09

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

https://hrsa-gov.zoomgov.com/j/1619407343?pwd=aW81ci9NRU5tbFBGYlkzUnFIT1Jydz09 https://hrsa-gov.zoomgov.com/j/1619407343?pwd=aW81ci9NRU5tbFBGYlkzUnFIT1Jydz09 mailto:RPHWTNP@hrsa.gov

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. Purpose

2. Background

II. AWARD INFORMATION

1. Type of Application and Award

2. Summary of Funding

III. ELIGIBILITY INFORMATION

1. Eligible Applicants

2. Cost Sharing/Matching

3. Other

IV. APPLICATION AND SUBMISSION INFORMATION

1. Address to Request Application Package

2. Content and Form of Application Submission

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Attachments

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

4. Submission Dates and Times

5. Intergovernmental Review

6. Funding Restrictions

V. APPLICATION REVIEW INFORMATION

1. Review Criteria

2. Review and Selection Process

3. Assessment of Risk

VI. AWARD ADMINISTRATION INFORMATION

1. Award Notices

2. Administrative and National Policy Requirements

3. Reporting

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: RURAL PUBLIC HEALTH WORKFORCE TRAINING NETWORK

GLOSSARY OF TERMS

APPENDIX B: RURAL PUBLIC HEALTH WORKFORCE TRAINING NETWORK

PROGRAM USEFUL RESOURCES

APPENDIX C: DRAFT RURAL PUBLIC HEALTH WORKFORCE TRAINING

NETWORK (RPHTWN) PROGRAM PERFORMANCE MEASURES

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Rural Public Health Workforce Training Network Program (RPHWTN).

The purpose of this program is to expand public health capacity by supporting health care job development, training and placement in rural and tribal communities. The expected impact of this program is to enhance clinical and operational capacity in order to adequately address the population health needs of rural communities affected by COVID-19, including those dealing with the effects of long COVID1. The RPHWTN program addresses the ongoing critical need in health care facilities for trained public health professionals serving rural communities. This is done through the establishment of networks to develop formal training/certification programs in order to help professionals in the following workforce training tracks:

Track #1 - Community Health Support Track #2 - Health IT and/or Telehealth Technical Support Track #3 - Community Para-Medicine Track #4 - Case Management Staff and/or Respiratory Therapists

One of the central elements of the RPHWTN Program is to create stronger linkages between training programs and the health care entities that will ultimately employ or rely on these public health professionals. The four tracks selected for this program focus on activities that have direct benefits to the participating hospitals and clinics. For example, this includes workforce training directly related to the institution’s operations. It also includes workforce training and support related to case management, care coordination and population health while also aligning with broader goals related to value-based care.

Economic and health disparities, in addition to inadequate availability of rural health professional training sites, make it challenging to maintain a strong health care workforce in rural communities. As such, another important element of the RPHWTN Program is to develop workforce training programs that will promote diversity and inclusion in the workforce, which can help advance health equity in the community.2,3

The RPHWTN Program goals are to:

1) Establish a strong network of local health care and social service providers and educational institutions to create training programs focused on addressing the rural workforce needs in four critical public health tracks.

1 www.cdc.gov/coronavirus/2019-ncov/long-term-effects.html (Accessed on 11/29/21) 2 https://www.nga.org/center/publications/creating-a-more-equitable-workforce-system-opportunities-for-governors-and-states/ Accessed on 10/6/21.

3 Achieving Equity in and Evolving Healthcare System: Opportunities and Challenges.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4724388/ Accessed on 10/6/21 http://www.cdc.gov/coronavirus/2019-ncov/long-term-effects.html https://www.nga.org/center/publications/creating-a-more-equitable-workforce-system-opportunities-for-governors-and-states/ https://www.nga.org/center/publications/creating-a-more-equitable-workforce-system-opportunities-for-governors-and-states/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4724388/

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2) Develop innovative workforce approaches to expand health care capacity affected by COVID-19 (including long COVID), such as cross-training (new and current) staff to help support business operations and equipping public health professionals with the skills to engage in population health.

3) Identify formal and sustainable pathways with rural health facilities to eventually employ or rely on the public health professionals who complete the RPHWTN funded training/education to obtain high-quality, good-paying jobs.

4) Design or expand culturally and linguistically appropriate workforce trainings that will enhance the competency of the rural health workforce in order to improve health care in rural communities.

5) Develop approaches in training current/existing staff to maximize their clinical/operational capacity.

Important: For more details, see Program Requirements and Expectations. This section contains additional information related to each track as well as general program requirements and expectations.

2. Background

This program is authorized under 42 U.S.C. § 254c(f) (§ 330A(f) of the Public Health Services Act) and funded by Section 2501 of Public Law 117-2 (American Rescue Plan Act of 2021).

This authority directs the Federal Office of Rural Health Policy (FORHP) to support awards for eligible entities to promote, through planning and implementation, the development of integrated health care networks that have combined the functions of the entities participating in the networks in order to (i) achieve efficiencies; (ii) expand access to, coordinate, and improve the quality of essential health care services; and (iii) strengthen the rural health care system as a whole.

On March 11, 2021, the President signed into law the American Rescue Plan Act of 2021 (P.L. 117-2). The Act provides additional relief to address the continued impact of the Coronavirus Disease 2019 (COVID-19) pandemic on the economy; public health;

state, tribal, local, and territorial (STLT) governments; individuals; and businesses.

To support the COVID-19 response, this program will train a range of health care workers to fill in-demand professions affected by the pandemic.4

COVID-19 has changed the way health care is being delivered. For example, when telehealth flexibilities were granted at the beginning of the COVID-19 pandemic, providers and care teams increasingly turned to telehealth as a way to deliver both

4 https://www.whitehouse.gov/briefing-room/statements-releases/2021/08/13/fact-sheet-biden-administration-takes-steps-to-address-covid-19-in-rural-america-and-build-rural-health-back-better/, Accessed on 9/7/2021 https://www.whitehouse.gov/briefing-room/statements-releases/2021/08/13/fact-sheet-biden-administration-takes-steps-to-address-covid-19-in-rural-america-and-build-rural-health-back-better/ https://www.whitehouse.gov/briefing-room/statements-releases/2021/08/13/fact-sheet-biden-administration-takes-steps-to-address-covid-19-in-rural-america-and-build-rural-health-back-better/

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clinical and non-clinical services. As those telehealth efforts increase, there is a need to have staff available to support the technology and to work with patients and care teams to troubleshoot issues and ensure the best leveraging of this technology.5

Community paramedicine has also emerged as a way to help fill a gap left in rural health care due to the pandemic. When the FORHP funded a Rural Community Paramedicine Summit in February 2021, participants shared that there were opportunities for community paramedicine to provide care such as medication and home safety checks.6 However, in the absence of proper staff training and actual staff to fill such roles, it will be challenging to expand this model’s potential to enhance rural public health capacity.

With higher rates of chronic disease and lack of access to care in rural communities, community health workers (CHWs) have also helped address gaps in the wake of the pandemic7. Additionally, CHWs have helped improve community health outcomes and lower costs for patients and health systems.8 By cross-training CHWs into areas that link to key business and clinical operations, this strategy can help lead to more impactful ways to serve the rural communities.

COVID-19 has had a considerable effect on social determinants of health.9 Understanding the social needs is critical because of the health disparities associated with larger prevention and treatment efforts. By focusing on case management, this strategy can help mitigate the impacts of social determinants of health as well align with larger value-based care efforts that seek to better manage the broader needs of patients that go beyond the clinic walls.

Rural communities are more likely to face workforce shortages and challenges.10 Over the next decade, it is projected that the demand for allied health workers, for example, will continue to increase, which will necessitate a workforce that is trained and prepared to meet these needs.11 The majority of rural areas do not have the adequate workforce supply to meet their population needs, especially in health care facilities. This lack of access to care has played a key role in the growing health inequities that result in a disproportionate increase in disease and death rates among minority populations in rural communities.12 Additionally, rural Americans face more health disparities and are

5 https://pubmed.ncbi.nlm.nih.gov/25066067/ (accessed on 11/30/21) 6 National Rural Health Resource Center, Implementing and Sustaining Rural Community Paramedicine, https://www.ruralcenter.org/resource-library/implementing-and-sustaining-rural-community-paramedicine, Accessed on 9/6/2021 7 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7764816/ (accessed on 11/30/21) 8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5767191/ (accessed on 11/30/21) 9 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7234789/ (accessed on 11/30/21) 10 National Rural Health Association (NRHA) policy brief Health Care Workforce Distribution and Shortage Issues in Rural America, Accessed on 9/6/2021 11 Health Resources and Services Administration, Bureau of Health Workforce, Allied Health Workforce Projections, 2016-2030: Community Health Workers.2019. https://bhw.hrsa.gov/data-research/projecting-health-workforce-supply-demand/allied-health 12 https://www.hrsa.gov/sites/default/files/hrsa/advisory-committees/graduate-medical-edu/publications/cogme-rural-health.pdf, Accessed on 9/7/2021 https://pubmed.ncbi.nlm.nih.gov/25066067/ https://www.ruralcenter.org/resource-library/implementing-and-sustaining-rural-community-paramedicine https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7764816/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5767191/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7234789/ https://www.ruralhealthweb.org/getattachment/Advocate/Policy-Documents/HealthCareWorkforceDistributionandShortageJanuary2012.pdf.aspx?lang=en-US https://www.ruralhealthweb.org/getattachment/Advocate/Policy-Documents/HealthCareWorkforceDistributionandShortageJanuary2012.pdf.aspx?lang=en-US https://www.hrsa.gov/sites/default/files/hrsa/advisory-committees/graduate-medical-edu/publications/cogme-rural-health.pdf https://www.hrsa.gov/sites/default/files/hrsa/advisory-committees/graduate-medical-edu/publications/cogme-rural-health.pdf

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at greater risk of death from the five leading causes than urban Americans13. Although a broad array of factors contributes to health inequities and disparities, increasing rural workforce capacity and improving job quality to address recruiting and retention is one strategy to bridge this gap.

In order to address this growing rural health workforce disparity, this program is an opportunity for organizations to come together and utilize a network approach to bridge a workforce need. HRSA has funded networks as a strategy to bring rural health community partners together to address local challenges, and help rural partners achieve greater collective capacity to overcome challenges related to limited economies of scale for individual hospitals, clinics or other key rural health care stakeholders.

By using a network approach, the RPHWTN Program aims to bring together different sectors to leverage their collective strengths to target four key critical workforce training tracks. Additionally, this program supports the training and placement of public health professionals in critical administrative and health care roles and creates multiple pathways for students/trainees/professionals to eventually work at rural health care facilities in their new/expanded role(s).

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 $47,895,000 in FY 2022 to fund 31 award recipients.

The period of performance is August 1, 2022 through July 31, 2025. You may apply for a ceiling amount of up to $1,545,000 total cost to cover three years (includes both direct and indirect, facilities and administrative costs).

This a one-time funding opportunity with no expectation of additional federal funds after the performance period ends.

Award recipients will receive the full award amount in the first year of the three-year period of performance, and must allocate the award funding across each of the three years. Additionally, recipients must submit a budget and budget narrative for each of the three years of the period of performance. While you must distribute the funding across each of the three years, the budget does not need to be evenly split across the three-year period of performance, and can vary based on your community’s needs.

13 https://www.cdc.gov/ruralhealth/about.html

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Applicants should ensure that they also budget appropriate amounts to ensure collection of performance data that will be used to quantify the impact of the program.

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.

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

See HRSA Grants Policy Bulletin 2017-03 Indirect Cost Rate Agreements in the NOFO.

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

Applicant Organization Requirements:

Eligible applicant organizations shall be domestic public or private, non-profit or for-profit entities, including faith-based, community-based, tribes and tribal organizations.

The applicant organization may be located in a rural or urban area, but must have demonstrated experience serving, or the capacity to serve, rural underserved populations. 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.

To ascertain rural service areas, please refer to https://data.hrsa.gov/tools/rural-health.

This webpage allows you to search by county or street address and determine rural eligibility.

http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 https://sharepoint.hrsa.gov/ofam/dgp/PolicySOP/Grants%20Policy%20Bulletin%202017-03%20Indirect%20Cost%20Rate%20Agreements%20in%20the%20NOFO.pdf https://data.hrsa.gov/tools/rural-health

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The applicant organization shall represent a network composed of three or more health care provider organizations, including the applicant organization. Urban applicants should ensure a collaborative network with shared local control from the partnering rural communities. HRSA requires at least sixty-six percent (66%), or two-thirds of the consortium composition involved in the proposed project be located in a HRSA-designated rural area, as defined by the Rural Health Grants Eligibility Analyzer. When the applicant organization and consortium members are located in an urban area, the activities and services of the consortium must be provided in a non-metropolitan county or rural census tract. Proposed rural counties should be fully rural. For partially rural counties, please include the rural census tract(s) in the Project Abstract.

The applicant organization should have the staffing and infrastructure necessary to oversee program activities, serve as the fiscal agent for the award, and ensure that local control for the award is vested in the targeted 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. The applicant organization must have demonstrated experience serving, or the capacity to serve, rural underserved populations, and describe the experience and/or capacity in the Project Abstract.

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

The applicant organization shall be part of a group of entities that have committed to forming a network or are part of an established network (see below for network specification requirements).

NOTE: If the applicant organization shares the same EIN as its parent organization or organizations within the same network are proposing different projects, and the applicant is eligible, then the applicant may request an exception in Attachment 12.

Please see Exceptions section for additional details.

Network Specification Requirements:

For the purposes of this program, a network is defined as an organizational arrangement among at least three separately owned, non-profit and for-profit, public or private health care providers in which each member has its own EIN number and has a substantial role in the project. The network must maintain at least three separate and different health care provider organizational members throughout the entire period of performance. For large health systems that share an EIN across multiple rural and/or urban sites, you must request an exception in Attachment 12.

While network members may be located in rural or urban areas, we recognize that rural-urban partnerships can sometimes lead to the underrepresentation of rural needs.

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Therefore to encourage rural issues to remain programmatic priorities, HRSA requires that at least sixty-six percent (66%), or two-thirds of the consortium composition involved in the proposed project be located in a HRSA-designated rural area, as defined by the Rural Health Grants Eligibility Analyzer.

Each consortium member must demonstrate substantial involvement in the project and contribute significantly to the goals of the project.

Given the complex and multifaceted nature of this program, network members should come from multiple sectors and disciplines. Examples of potential network members include, but are not limited to:

• Health care providers, such as:

o Critical access hospitals or other hospitals;

o Rural health clinics;

o Local or state health departments;

o Federally qualified health centers; and o Nursing homes.

• Educational Institutions

• Community Action Agencies, Chambers of Commerce, Health Equity Councils, and other community groups

• Labor unions

• Worker organizations

• State or Local Workforce Development Boards

• Area Health Education Centers

• State Offices of Rural Health

• State Rural Health Associations

• Temporary Assistance for Needy Family Administering Offices and/or Recipients

NOTE: Special consideration will be given to applicants that have a signed Memorandum of Agreement or Understanding (MOA/U) with all network partners at the time of application; additional information can be found in Section V.2. An MOA/U helps to clearly identify and outline each network partner’s responsibilities and expectations to achieve already identified and agreed upon project/work plan objectives. As noted in a recent publication, establishing formal partnerships through an MOA/U helps to ensure

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that collaboration and coordination efforts withstand potential organizational changes.14 Given the specialized nature of workforce development, training and placement, network partnership, active engagement and support from all partners will be critical to the long-term success of the program and may also provide opportunities to achieve increased economies of scale. For those applicants who cannot obtain a signed MOU/A from all network partners at the time of application, a letter of commitment is required to be submitted in order for the applicant organization to be considered for this award. If funded, award recipients who submitted a letter of commitment with their application will be expected to submit an MOA/U within six months of the project period.

Geographic Requirements:

Network members may be located in urban or rural areas, but all activities supported by this program must exclusively be implemented in HRSA-designated rural counties or rural census tracts in urban counties and the network overall must be representative of rural entities. Please check HRSA's Rural Health Grants Eligibility Analyzer tool to see if a county/tract is considered rural.

Exceptions:

Tribal exception: HRSA is aware that tribes and tribal governments may have an established infrastructure without separation of services recognized by filing for EINs. In case of tribes and tribal governments, only a single EIN located in a HRSA-designated rural area is necessary to meet the consortium requirements. Tribes and tribal entities under the same tribal governance must still meet the consortium criteria of three or more entities committed to the proposed approach, as evidenced by a signed letter of commitment that delineates the expertise, roles and responsibilities in the project, and commitments of each consortium member. Please refer to Attachment 12 for additional information on this exception.

Multiple EIN exception: In general, multiple applications associated with the same DUNS number and/or EIN are not allowable. However, HRSA recognizes a growing trend towards greater consolidation within the health care industry and the possibility that health care organizations may share the same EIN as its parent organization. As a result, at HRSA’s discretion, multiple health care organizations that share the same EIN as its parent organization or, organizations within the same consortium who are proposing different projects are eligible to apply by requesting an exception. Please refer to Attachment 12 for information on how to request an exception to this policy.

14 U.S. Department of Health and Human Services, Health Resources and Services Administration, A Guide for Rural Health Care Collaboration and Coordination.

https://www.hrsa.gov/sites/default/files/hrsa/ruralhealth/reports/HRSA-Rural-Collaboration-Guide.pdf, Published August, 2019.

https://www.hrsa.gov/sites/default/files/hrsa/ruralhealth/reports/HRSA-Rural-Collaboration-Guide.pdf

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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.

Notifying your State Office of Rural Health

By statute, all applicants are required to notify their State Office of Rural Health (SORH) or equivalent (state appropriate entity) of their intent to apply to this program. A list of the SORHs can be accessed at: https://nosorh.org/nosorhmembers/nosorh-members-browse-by-state/. Applicants must include in Attachment 1 a copy of the letter or email sent to the SORH, and any response received to the letter, which was submitted to the SORH describing their project.

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 consortiums, 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.

Applicants located in Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, or the Republic of Palau that do not have the functional equivalent of a SORH are nevertheless eligible to apply.

SORHs responding to this notice as the applicant organization must provide an attestation in Attachment 1 that there is no conflict of interest and other applicants were not prejudiced. This attestation must clearly show 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.

https://nosorh.org/nosorhmembers/nosorh-members-browse-by-state/ https://nosorh.org/nosorhmembers/nosorh-members-browse-by-state/

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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.

Form Alert: For the Project Abstract Summary, applicants using the SF-424 R&R Application Package are encountering a “Cross-Form Error” associated with the Project Summary/Abstract field in the “Research and Related Other Project Information” form, Box 7. To avoid the “Cross-Form Error”, you must attach a blank document in Box 7 of the “Research and Related Other Project Information” form, and use the Project Abstract Summary Form 2.0 in workspace to complete the Project Abstract Summary.

See Section IV.2.i Project Abstract for content information.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-22-117 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 R&R 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 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 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.

https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html https://www.govinfo.gov/content/pkg/GPO-STYLEMANUAL-2016/pdf/GPO-STYLEMANUAL-2016.pdf 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 http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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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-22-117, 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-22-117 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 13: Other Relevant Documents.

See Section 4.1 viii of HRSA’s SF-424 R&R 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 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.

https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx

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Program Requirements and Expectations:

Workforce Training Tracks:

(A) Applicants must select at least one workforce training track and can select additional workforce training track(s) as long as they can demonstrate the need and have the capacity to do so.

(B) Applicants must establish a network to develop and implement workforce activities that will directly impact at least one of the following four workforce training tracks and respective area(s) of need.

Track #1 - Community Health Support:

For the purposes of the RPHWTN program, track #1 is limited to “Community Health Workers (CHW)”, which is defined15 broadly to include additional disciplines (See Appendix A: Glossary for ‘CHW’ definition). Proposed projects in Track #1 must meet this CHW definition. This track is not intended for training individuals who are seeking or already have a doctoral or graduate degree.

Area of workforce training need: HRSA requires that proposed projects in Track #1 must focus on cross-training in high value areas to improve operational and clinical capacity. Cross training must be focused in coding and billing, serving as an electronic health record scribe/chart support, health and human service coordination, peer recovery support, crisis intervention services, benefits counseling and health promotion.

Other areas of cross-training may be considered as long as it still meets the intent of demonstrating value back to the clinical organization.

The intent with this cross-training approach is to show value back to the participating hospitals and clinics by linking to activities that either assist the financial operations of the facility (e.g., enhancing coding and billing, ensuring that more uninsured patients obtain coverage) or improve the hospitals and clinics ability to focus on population health by meeting the broader human and social service needs of their patients, especially those impacted by long COVID-19. This would also have the effect of aligning with value-based health care models. In both of those cases, the intent is to enhance the likelihood of developing sustainable workforce models. HRSA encourages innovative approaches to integrate these traditional CHWs into more formal parts of the health care workforce through cross-training in multiple areas in order to improve operational and clinical capacity.

15 For the purposes of the RPHWTN program – Track #1, Community Health Workers include: 1) individuals who are lay members of the community who work with the local health care system and share similarities ad experiences with the community members they serve – they have been identified by many titles such as ‘promotores(as) and community health advisors; or 2) individuals from the following disciplines: doulas, peer recovery specialists, behavioral health technicians, medical assistants and/or dental assistants/hygienists.

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Doulas’ areas of need: With higher infant mortality rates and limited access to obstetric and maternal services in rural areas, HRSA encourages applicants to consider strategies to incorporate doulas into rural maternal care; for example, how doulas’ role can be utilized in high-risk pregnancies and how they can be leveraged to help link pregnant patients to broader social and mental health services to encourage enhanced outcomes. Doula-assisted mothers were four times less likely to have low birth weight baby and two times less likely to experience a birth complication.16

Required cross-training activities (at a minimum) and allowable costs include, but are not limited to:

• Designing and conducting training to provide benefits counseling (e.g., helping to assess whether the patients they work with are eligible for either Medicaid, the Children’s Health Insurance Program (CHIP), or private-sector Marketplace plans). By increasing the number of clients who move from being uninsured to insured, this effort would reduce patients who are self-pay or indigent, which increases the financial viability of the clinical partners in the Network.

• Designing and conducting training in medical coding and billing, helping support the financial operations of the clinical partners and also creating a potential job ladder for broader employment.

• Designing and conducting training to provide service coordination. As clinical partners increasingly understand the challenges of addressing social determinants of health, there is a need to link patients to available services (e.g., housing, healthy food, job training, day care, oral health services, transportation, and elder care). CHWs that could add case management skills can help ensure that clinical partners are helping to address the populations’ social determinants of health (including crisis intervention services).

• Developing tailored/customized trainings/certificate programs/curriculums.

Applicants are strongly encouraged to utilize existing training curriculums/ certifications/models, where appropriate. While seeking formal accreditation/credentialing for any training curriculums/certifications/ models that are developed through the RPHWTN program is allowed, HRSA highly encourages applicants not to allocate substantive parts of their budget to seeking formal accreditation/credentialing.

• Supporting operational costs in establishing and/or maintaining workforce development training.

Please note the following for Track #1 applicants:

1. For applicant organizations receiving federal support for CHW workforce development programs (including the HRSA forecasted funding opportunity for the Community Health Worker and Paraprofessional Training Program (CHWPTP)), must not duplicate activities and personnel supported under this award.

2. Applicants who select Track #1 can choose to focus on any of the groups listed under the RPHWTN definition of CHW (See Appendix A: Glossary for ‘CHW’ definition). If an applicant chooses to focus on multiple groups (e.g., CHWs and

16 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647727/

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Medical Assistants) they should discuss the need and capacity to do so in the “Project Narrative.”

3. Applicants must consider including robust, comprehensive and tailored work-based learning strategies for new or existing staff. This includes on-the-job training and customized training/certificate programs. Applicants are encouraged to work with employer partners to develop workforce training activities to create career pathways for new or existing staff. For example, applicants could look at career paths for CHWs to progress from nurse aides to LPN to Associate’s Degree in Nursing (ADN).

4. Applicants in Track #1 are encouraged to draw from existing models for sustaining CHWs including the Pathways Hub model and draw from examples of negotiated per member/per month agreements with managed care organizations and insurance payers. Applicants should align and leverage training opportunities for CHWs with the primary actions of state and/or local public health led efforts to address the underlying conditions and/or environments within rural communities.

5. Applicants could also focus on home-support services for higher-risk populations, which could be either through traditional home health services or through similar less formal home-support services. In particular, this could help with care transitions (e.g., hospital or skilled nursing facility to home, etc.).

Track #2 - Health IT / Telehealth Technical Support:

Areas of workforce training need: HRSA requires that proposed projects in Track #2 must train new staff or enhance skills of existing staff to meet the increasingly demanding skillsets needed to maintain and fully leverage electronic health records and also ensure that health information technology/telehealth systems are being optimally and accurately utilized by clinical staff and providers and patients. See Appendix A:

Glossary for ‘telehealth’ definition.

HRSA encourages innovative projects that may be able to consolidate staff who work on health IT functions and those who work on telehealth. Blending these roles in particularly small clinical settings may help with business operations. Additionally, network partners may be able to use a regional shared staffing approach to meet their health IT needs. Given that many of the participating hospitals and clinics will be small entities, they may not have the resources to support a full-time IT support position.

Shared staffing models where the aggregate needs of several participating hospitals or clinics would result in enough demand to support these positions and make this regionalized approach more financially sustainable could be employed.

Required activities (at a minimum) and allowable costs include, but not limited to:

• Training new staff to fill these positions or enhance skills of existing staff to meet the increasingly demanding need to maintain and fully leverage electronic health records, ensure that telehealth systems are working properly, and help clinicians and patients in troubleshooting challenges. This would include working with existing vendors, developing enhanced skills in contract specification reviews and oversight, training clinical staff in the use of new technologies and overseeing hardware and software upgrades.

https://www.ruralhealthinfo.org/toolkits/services-integration/2/care-coordination/community-hub

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• Designing training and placement programs that reflect varying degrees of health IT/telehealth functions. In some clinical settings, the staff who work on health IT functions such as electronic health records and those who work on telehealth may be two different roles with different skills and backgrounds.

Networks can design training and placement programs that reflect that orientation. For Networks focusing on training staff to support telehealth efforts, there are available courses to consider.

• Training to maintain broader health IT efforts such as home monitoring and working with patients and clinical staff on the expanding use of personalized e-health efforts enabled through mobile phones and the sharing of information between patients and clinicians.

• Building on existing resources developed by HHS. Applicants focused on the more traditional health IT programs at an Associate’s Degree level may benefit from building on existing resources.

• Aligning and leveraging training opportunities for health IT and telehealth staff with the primary actions of state and/or local public health led efforts to address the underlying conditions and/or environments within rural communities. See Appendix B for additional resources.

• Training and training-related costs. Funds can also be used to address state-level certification issues. See Appendix B for additional resources.

• Training and skill development costs related to addressing cyber security (hacking, privacy compliance, etc.).

Please note the following for Track #2 applicants:

• RPHWTN grant funds cannot be used to purchase or upgrade electronic health record systems and/or other health information technology.

• Applicants must consider including robust, comprehensive and tailored work based learning strategies for new or existing staff. This includes on-the-job training and customized training/certificate programs. Applicants are encouraged to work with employer partners to develop workforce training activities to create career pathways for new or existing staff.

Track #3 - Community Paramedicine:

Areas of workforce training need: HRSA requires that proposed projects in Track #3 must develop new community paramedicine models or expand existing paramedicine models by leveraging and/or building on existing resources and platforms. Support can be extended to Community Emergency Medical Technicians who have limited clinical capacity but can still perform a range of activities to support community and public health. HRSA encourages projects that leverage EMTs and paramedics to be equipped with the skills and knowledge to focus on population health.

Required activities (at a minimum) and allowable costs include, but not limited to:

• Supporting mobile integrated healthcare and community paramedicine (MIH-CP) training and placement. The term mobile integrated healthcare (MIH) is often used interchangeably with community paramedicine, particularly outside of the…