FORHP HRSA-23-030 (D06) Rural Health Network Development_FINAL.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2023

Federal Office of Rural Health Policy

Community Based Division

Rural Health Network Development Program Funding Opportunity Number: HRSA-23-030

Funding Opportunity Type: New

Assistance Listings Number: 93.912

Application Due Date: November 22, 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: August 22, 2022

Jillian Causey, MHA Public Health Analyst, Federal Office of Rural Health Policy Phone: (301) 443-1493 Email: JCausey@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) mailto:JCausey@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, 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) 2023 Rural Health Network Development program. The purpose of this program is to support integrated health care networks that collaborate to achieve efficiencies; expand access to, coordinate, and improve the quality of basic health care services and associated health outcomes; and strengthen the rural health care system as a whole. More specifically, the program supports networks as they address gaps in service, enhance systems of care, and expand capacity of the local health care system.

This notice is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds appropriately.

Funding Opportunity Title: Rural Health Network Development

Program

Funding Opportunity Number: HRSA-23-030

Due Date for Applications: November 12, 2022

Anticipated FY 2023 Total Available Funding:

$13,200,000

Estimated Number and Type of Award(s): Up to 44 grants

Estimated Annual Award Amount:

Up to $300,000 per award subject to the availability of appropriated funds

Cost Sharing/Match Required: No

Period of Performance: July 1, 2023 through June 30, 2027 (4 years)

Eligible Applicants: To be eligible to receive a grant, an entity

(A) Shall be a domestic public or private, non-profit or for-profit entity with demonstrated experience http://www.hrsa.gov/

HRSA-23-030 ii serving, or the capacity to serve, rural underserved populations; and

(B) Shall represent a network composed of participants – (i) that includes at least three or more health care provider organizations, and (ii) that may be non-profit or for-profit entities; and

(C) Shall not previously have received a grant under subsection 330A(f) of the Public Health Service Act (other than a grant for planning activities) 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 this NOFO and in HRSA’s SF-424 Application Guide. Visit HRSA’s How to Prepare Your Application page for more information.

Technical Assistance

HRSA has scheduled the following webinar:

Wednesday, September 7, 2022 2 – 3:30 p.m. ET Weblink: https://hrsa-gov.zoomgov.com/j/1607076643?pwd=b3Flc0lUdHBVYVRoZHVPeTNzS21wdz09 http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fhrsa-gov.zoomgov.com%2Fj%2F1607076643%3Fpwd%3Db3Flc0lUdHBVYVRoZHVPeTNzS21wdz09&data=05%7C01%7CJCausey%40hrsa.gov%7Ca0fe6d4d44b94131f73e08da3cd09ad4%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C637889163891151343%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=f3%2BX7rspuBuxQZEE8KdI0WHoZtsBX%2FLRsiisvcDqMdk%3D&reserved=0 https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fhrsa-gov.zoomgov.com%2Fj%2F1607076643%3Fpwd%3Db3Flc0lUdHBVYVRoZHVPeTNzS21wdz09&data=05%7C01%7CJCausey%40hrsa.gov%7Ca0fe6d4d44b94131f73e08da3cd09ad4%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C637889163891151343%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=f3%2BX7rspuBuxQZEE8KdI0WHoZtsBX%2FLRsiisvcDqMdk%3D&reserved=0

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Attendees without computer access or computer audio can use the dial-in information below.

Call-In Number: 1-833-568-8864 Meeting ID: 14653038

HRSA will record the webinar. Playback information can be requested at JCausey@hrsa.gov mailto:JCausey@hrsa.gov

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

1. TYPE OF APPLICATION AND AW ARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

FOR MORE DETAILS, SEE PROGRAM REQUIREMENTS AND EXPECTATIONS

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. UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AW ARD MANAGEMENT (SAM)

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AW ARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: PERFORMANCE MEASURES

APPENDIX B: RURAL HEALTH NETWORK DEVELOPMENT PROGRAM

DEFINITIONS

APPENDIX C: LEGISLATIVE AIMS DESCRIPTION AND EXAMPLE ACTIVITIES ... 47

APPENDIX D: USEFUL RESOURCES

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Rural Health Network Development (RHND) Program. The purpose of the RHND Program is to support integrated health care networks who collaborate to achieve efficiencies; expand access to, coordinate, and improve the quality of basic health care services and associated health outcomes; and strengthen the rural health care system as a whole.

HRSA intends for the RHND Program to address gaps in service, enhance systems of care, and expand capacity of the local rural health care system.

The RHND program was created in response to the need for rural providers to address changes taking place in the health care sector in order to better serve their rural communities. Furthermore, integrated health care networks are an important component of health care service delivery and system reform. Many rural providers have historically worked together to address these challenges by creating networks that foster collaboration and coordination, and address structural challenges inherent in rural health care delivery, resulting in reduced burden and costs on the rural health care system.

The RHND Program will focus on the following four program domains:

I.) Improve access: by addressing gaps in care, workforce shortages, better workflows and/or improving the quality of health care services

II.) Expand capacity and services: by creating effective systems through the development of knowledge, skills, structures, and leadership models

III.) Enhance outcomes: by improving patient and/or network development outcomes through expanding or strengthening the network’s services, activities or interventions

IV.) Sustainability: by positioning the network to prepare for sustainable health programs through value-based care and population health management.

The RHND Program encourages innovative strategies to address health care needs identified by local communities and supports rural communities in preparing for changes within the evolving health care landscape. The program creates an opportunity for rural health networks to work collaboratively to adapt to the emerging trends in rural healthcare, and meet the unique needs of the rural communities they serve. While the RHND Program provides the opportunity for community specific programs, applicants should consider addressing the key priorities of the U.S. Department of Health and

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Human Services (HHS) within their programs: readiness for the next public health emergency, health equity, mental health, and value-based care.1

The program encourages applicants to include populations that have historically suffered from poorer health outcomes, health disparities, and other inequities, as compared to the rest of the rural population. Examples of these populations include, but are not limited to, racial and ethnic minorities, homeless populations, pregnant women, disabled individuals, youth and adolescents, etc.

HRSA recommends your network members consist of a broad array of organizations from both traditional and non-traditional health care entities. Diverse network members may include cross-sector entities such as behavioral health organizations, critical access hospitals, rural health clinics, community-based and social service organizations, colleges and universities and tribal organizations. Using the strength of diverse membership, the network should consider its service delivery approach to addressing pertinent rural health issues, such as hospital bypass rates and value-based care, in order to meet the program domains and effect long-term change.

Systems of Care Approach

One way applicants can improve access and enhance outcomes is through creating a systems of care approach. For the purposes of this program, systems of care is defined as a service delivery approach that uses community partnerships to create a coordinated array of broad and flexible services. The network, led by a core set of principles and values, will work together with the community to create or improve upon equitable systems, workflows and strategies to improve health outcomes (more information can be found in the background section.2 3

2. Background

The Rural Health Network Development Program is authorized by Section 330A(f) of the Public Health Service Act (42 U.S.C. 254c(f)), which contemplates award of rural health network development grants to eligible entities to plan, develop, and implement integrated health care networks that collaborate in order to (i) achieve efficiencies; (ii) expand access to, coordinate, and improve the quality of basic health care services and associated health outcomes; and (iii) strengthen the rural health care system as a whole (See Appendix C for more details on legislative aims).

1 Assistant Secretary for Planning and Evaluation (ASPE). (2022, March 25). Strategic Plan FY 2022 – 2026. HHS.Gov. https://www.hhs.gov/about/strategic-plan/2022-2026/index.html 2 Stroul, B., Blau, G., & Friedman, R. (2010). Updating the system of care concept and philosophy.

Washington, DC: Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children’s Mental Health.

3 Systems of Care. (2022, February 25). Casey Family Programs. Retrieved June 2, 2022, from https://www.casey.org/can-you-tell-us-about-a-few-agencies-that-have-systems-of-care/ https://www.casey.org/can-you-tell-us-about-a-few-agencies-that-have-systems-of-care/

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Rural areas face a range of challenges in the provision of health care services that networks can work to address. While rural providers and organizations may understand the needs of the community and gaps in service, it is often difficult to address these needs due to workforce shortages and limited resources, both monetarily and in-kind (i.e., time). Between competing priorities, and rural providers and administrators filling multiple roles, 4 individual organizations that serve rural communities may be limited in their ability to expand capacity/services and create better systems of care. As noted above in the purpose section, with the many health challenges rural communities’ face, the importance of integrated health care networks cannot be understated as they provide an opportunity for rural providers to collaborate and enhance the long-term health outcomes of the local community.

Below, HRSA highlights historical challenges rural networks face. These challenges are not a requirement for applicants to address in their proposed projects, but rather provide addition context to consider when crafting your application.

Hospital Bypass

Many rural communities are working to reduce the percentage of rural residents who bypass their local rural hospital or other clinical providers. According to a 2020 study done by the Centers for Medicare and Medicaid Services, hospital bypass rates over the last 25 years range from 25 percent to 70 percent, and “rural patients cite limited services and lack of specialty care as reasons for bypassing their local rural hospitals”.5 Networks should consider including local rural hospitals as members in order to build and or/expand capacity, services, and infrastructure to increase access to care and ultimately, reduce systems costs and improve health outcomes.

Value-Based Care and Population Health

Networks may consider addressing program sustainability through creating value-based care and population health programs. Public and private health care payers are increasingly focused on the need for value-based care and population health. This focus is affecting payment models for reimbursement (e.g., value-based payments, capitated payments, etc.) and will require a focus on improving health outcomes and demonstrating quality improvement across diverse clinical and community sectors.

Rural health care providers are increasingly being asked to focus on new approaches to lower costs and improving outcomes for patients, demonstrating greater patient satisfaction scores for providers, and better cost control and reduced risk for third-party payers.6 Applicants should consider how their proposed activities will help network member organizations adapt to these larger health system dynamics. Definitions for

4 Centers for Medicare & Medicaid Services (CMS). (2018). CMS Rural Health Strategy. Www.Cms.Gov.

Retrieved May 25, 2022, from https://www.cms.gov/About-CMS/Agency- Information/OMH/Downloads/Rural-Strategy-2018.pdf 5 CMS Office of Minority Health. Examining Rural Hospital Bypass for Inpatient Services. Baltimore, MD:

Centers for Medicare & Medicaid Services; December 2020.

6 Teisberg, E., Wallace, S., & O'Hara, S. (2020). Defining and Implementing Value-Based Health Care: A Strategic Framework. Academic medicine: journal of the Association of American Medical Colleges, 95(5), 682–685. https://doi.org/10.1097/ACM.0000000000003122 https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/Rural-Strategy-2018.pdf https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/Rural-Strategy-2018.pdf https://doi.org/10.1097/ACM.0000000000003122

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payment models for reimbursement are in Appendix B. The applicant organization and their network member organizations are encouraged to position themselves for this change while addressing the local health care need supported by the statutory charges (i, ii, and iii), outlined in the authorizing legislation.

Consolidation in Rural Communities

In rural communities, providers play a central role in practice transformation and hospital sustainability.7 Providers are able to understand the needs of their patients and readily identify an organization or local community’s gaps in service. While there is increasing consolidation in the larger health care system, there is still a need for providers across the spectrum of services to work together to improve access and coordination of services. While the current health care environment veers towards a number of network participants owned by a single entity; for the purposes of this program, HRSA highly encourages applicants to have a broad array of member organizations. Where possible, these organizations should not be affiliated with or acquired by the applicant organization (or applicant parent organization) and should be separate organizations, forging relationships with new entities the applicant organization has not previously worked with. These separate organizations will provide distinctive expertise, which will help the network better address gaps in care, assist their organizations in acclimating to the evolving health care environment and improve social determinants of health by addressing relevant health care needs identified by the rural community.

The RHND program will also enable rural health networks to continue to be a locus of innovation and to maximize limited rural health resources in times of economic hardship and decreased access to health care services. Programs created through this funding are intended to be replicable in other rural communities. The RHND Program supports and encourages creative projects that aim to confront key public health crises that address the needs of a wide range of population groups including, but not limited to, low-income populations, the elderly, pregnant women, infants, adolescents, rural Black, Indigenous, and people of color populations, and rural populations with special health care needs. Each population faces different and unique challenges, and residents in rural communities often experience multiple social determinants of health, often presenting complexities in addressing these challenges. Networks should use the benefits and resources of their collaboration to identify and address these intersectionalities.

7 Mahoney, M. M. R. D. B. (2021). The Key Role of Advanced Practice Providers in Today’s New Normal.

Www.Physicianleaders.Org. https://www.physicianleaders.org/news/the-key-role-of-advanced-practice-providers-in-todays-new-normal https://www.physicianleaders.org/news/the-key-role-of-advanced-practice-providers-in-todays-new-normal https://www.physicianleaders.org/news/the-key-role-of-advanced-practice-providers-in-todays-new-normal

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II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA estimates approximately $13,200,000 to be available annually to fund 44 recipients. The actual amount available will not be determined until enactment of the final FY 2023 federal appropriation. You may apply for a ceiling amount of up to $300,000 annually (reflecting direct and indirect, facilities and administrative costs) per year. This program notice is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds appropriately.

The period of performance is July 1, 2023 through June 30, 2027 (4 years). Funding beyond the first year is subject to the availability of appropriated funds for the Rural Health Network Development program in subsequent fiscal years, satisfactory progress, and a decision that continued funding is in the best interest of the Federal Government.

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

III. Eligibility Information

1. Eligible Applicants

Eligible applicants include 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. The applicant organization should describe in detail their experience and/or capacity to serve rural populations in the Project Abstract section of the application.

The applicant organization may not previously have received an RHND award (other than a grant for planning activities) for the same or a similar project. However, existing recipients that (1) seek to expand services or expand their service areas, (2) include new or additional network member organizations, or (3) target a new population or new focus area are eligible to apply.

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

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For more details, see Program Requirements and Expectations.

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 funding ceiling amount

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

NOTE: Multiple applications from an organization are not allowed. HRSA will only accept and review your last validated electronic submission before the Grants.gov application due date. Please see exception request information below.

Exceptions Request

Multiple EIN Exception

In general, multiple applications associated with the same UEI (previously DUNS) number and/or EIN are not allowable. However, HRSA recognizes a growing trend towards greater consolidation within the rural health care industry and the possibility that multiple 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 network who are proposing different projects are eligible to apply by requesting an exception. Please refer to Attachment 14 for information on how to request an exception to this policy.

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 network requirements. Tribes and tribal entities under the same tribal governance must still meet the network 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 network member organization. Please refer to Attachment 14 for additional information on this exception.

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Notifying your State Office of Rural Health

By statute, all applicants are required to consult with their State Office of Rural Health (SORH) or another appropriate state entity. Consequently, HRSA requires applicants to notify their 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-bystate/. 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 networks, evaluation, network member organizations, or support of information dissemination activities. If you do not receive a response, please include in your application 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, and the Republic of Palau do not have a designated SORH. Therefore, applicants from these areas must provide a copy of an email or letter confirming they have contacted the National Organization of State Offices of Rural Health (NOSORH). The email address is: donnap@nosorh.org.

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.

For more information on how SORHs can be helpful in supporting rural community organizations, please visit the NOSORH Website and check out the Community Based Division (CBD) Factsheet and community organization collaboration video highlight.

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 https://nosorh.org/nosorhmembers/nosorh-members-browse-bystate/ mailto:donnap@nosorh.org https://nosorh.org/ https://nosorh.org/wp-content/uploads/2018/01/SORH-CBD-Factsheet-Final.pdf https://nosorh.org/wp-content/uploads/2018/01/SORH-CBD-Factsheet-Final.pdf https://www.youtube.com/watch?v=Tk3hGs6Btpc https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html

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APPLY FOR GRANTS. If you use an alternative electronic submission, see Grants.gov:

APPLICANT SYSTEM-TO-SYSTEM.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-23-030 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, and certifications. You must submit the information outlined in 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 this NOFO and HRSA’s SF-424 Application Guide. 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 to assist you in completing your application.

Application Page Limit The total of uploaded attachment pages that count against the page limit shall be no more than the equivalent of 80 pages when printed by HRSA. Standard OMB-approved forms included in the workspace application package do not count in the page limit. The abstract is the standard form (SF) "Project_Abstract Summary.” If there are other attachments that do not count against the page limit, this will be clearly denoted in Section IV.2.v Attachments.

The abstract is no longer an attachment that counts in the page limit. Additionally, Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limit. However, if you use an OMB-approved form that is not included in the workspace application package for HRSA-23-030, it will 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.

It is important to take appropriate measures to ensure your application does not exceed the specified page limit. Any application exceeding the page limit will not be read, evaluated, or considered for funding.

http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/s2s/applicant-system-to-system.html https://www.grants.gov/web/grants/s2s/applicant-system-to-system.html https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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Applications must be complete, within the maximum specified page limit, and validated by Grants.gov under HRSA-23-030 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 15: 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 the affected jurisdiction. Funds provided under the award may be used to support personnel who are temporarily reassigned in accordance with § 319(e), which sunsets / terminates on September 30, 2023. Please reference detailed information available on the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) website.

Program Requirements and Expectations Service Area Requirements

a. Applicants must list the rural counties that will be served. Proposed counties must be fully rural, but if counties are partially rural counties, please include the rural census tract(s) in the Project Abstract. It is imperative 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 grant funding.

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 http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx

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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.

b. Each applicant organization and network member organization must have its own EIN number unless an exception is requested (see details below under ‘Exceptions Request’).

c. 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.

Network Requirements

Applicants must meet the following network requirements:

a. Network member organizations may be located in rural or urban areas and can include all domestic public or private, non-profit or for-profit entities including faith-based, community-based organizations, tribes, and tribal organizations. We recognize that rural-urban networks can sometimes lead to the underrepresentation of rural needs. Therefore, HRSA requires at least sixty-six percent (66%), or two-thirds of network member organizations (organizations with signed Memorandum of Agreement (MOU), Memorandum of Understanding (MOU) or other formal collaborative agreements, including signed and dated by-laws) of the proposed project be located in a HRSA designated rural area, as defined by the Rural Health Grants Eligibility Analyzer. This means that if a network is composed of three member organizations, at least two organizations must be located in a HRSA designated rural area. The applicant organization must verify and indicate the rural or urban eligibility of each network member organization in Attachment 7.

b. Applicant organizations located in urban areas are required to ensure a collaborative network, with shared local control (see definition in Appendix B) from the participating rural counties. Activities and services of the network must be provided in a non-metropolitan county or rural census tract. Proposed rural counties must be fully rural. For partially rural counties, please include the rural census tract(s) in the Project Abstract.

c. Network member organization must have extensive experience collaborating with one another, with each network member organization having demonstrated experience serving, or the capacity to serve, rural underserved populations.

Network member organizations must prioritize addressing gaps in care and expand capacity to create long-term systems-based changes, resulting in practice transformation.

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

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d. The applicant organization is required to have the staffing and infrastructure necessary to oversee program activities. 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.

e. The network must have a permanent network director (i.e., network executive director) or have established an interim network director capable of overseeing the network’s administrative, fiscal, and business operations at the time an award is made. HRSA strongly recommends the network director role be 1.0 FTE.

HRSA prefers that the network director role is different from the project director role.

Programs are encouraged to utilize evidence-based practices or models to promote successful program implementation. See the Project Narrative section for additional information.

When writing, please keep in mind the network definitions for an integrated health network, a Memorandum of Agreement (MOA) / Memorandum of Understanding (MOU), and a Governing Body as defined in Appendix B and guidelines above in this section.

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

i. Project Abstract Do not upload the abstract as an attachment or it may count toward the page limit. For information required in the Project Abstract Summary Form, see Section 4.1.ix of HRSA’s SF-424 Application Guide.

Abstract Heading Content Applicant Organization Information Organization Name, Address (street, city, state, zip code), Facility/Entity Type (FHQC, RHC, public health department, etc.) and Website Address (if applicable) Designated Project Director & Designated Network Director Information

• Project Director Name & Title, Contact Phone Number(s), and E-mail Address

• Key Staff Names & Titles, Contact Phone Number(s), and E-mail Address

• Network Director Name & Title, Contact Phone Number(s), and E-mail Address (if different from project director)

Rural Health Network Development Project Project Title, and Goal http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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Focus Area(s) (e.g., behavioral health, cardiac rehabilitation) Abstract Body Content Target Patient Population Brief description of the service area and target patient population the project proposes to serve and track (2-3 sentences max) Network Members o Network Name o Total number of member organizations and facility/entity type of organizations

Network Project Activities/Services Brief description of the proposed project activities and/or services provided through the network collaboration Expected Outcomes Brief description of the proposed project expected outcomes. Clearly label and organize these expected outcomes by the Rural Health Network Development program domains: i) improve access, ii) expand capacity and services iii) enhance outcomes, iv) sustainability.

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 this capacity may include a history or ability to:

o Identify activities that build, strengthen, and maintain the necessary skills and resources needed to sustain or improve health services delivery in rural populations o Discuss 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 Describe current experience, including partnerships, activities, program implementation and previous work of a similar nature o Discuss the effectiveness of methods and/or activities employed to improve 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.

Funding Preference Applicants must explicitly document a qualifying funding preference and cite the qualification that is being met (see 42 U.S.C. 254c(h)(3)). HRSA highly recommends you include clear concise language making it clear to HRSA which funding preference you are choosing. If you choose not to select a funding preference, please use clear concise language making it clear to HRSA that you are not choosing a funding preference.

If applicable, you need to provide supporting documentation in Attachment 12. Please 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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Narrative Section Review Criteria

Introduction (1) Need

Needs Assessment (1) Need

Methodology (2) Response

Work Plan (2) Response and (4) Impact

Resolution of Challenges (2) Response

Evaluation and Technical Support Capacity

(3) Evaluative Measures

Organizational Information (5) Resources/Capabilities

Budget Narrative (6) Support Requested

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

Successful applications will contain the information below. Please use the following section headers for the narrative:

INTRODUCTION -- Corresponds to Section V’s Review Criterion 1: NEED

Briefly describe the purpose of the proposed project, how it supports legislative aims i, ii, and iii (please refer to Appendix C for a detailed explanation), and how it aligns with the four RHND program domains. Provide a description of how the project will meet the healthcare needs of the rural underserved population in the local community or region to be served. Include a brief description of the activities/types of services to be provided, collaborating network member organizations, expected program outcomes, and community impact. Where possible, you should explain how the proposed program and network collaboration will support population health management and value-based care.

The Introduction should be succinct, self-explanatory and well organized so that reviewers can understand the proposed project.

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

Outline the needs of the rural community and the applicant and network member organizations. Help reviewers understand the rural community and/or entities served by the proposed project. Address the following items within the needs assessment:

Healthcare Environment

a. Health care Service Needs. Provide evidence of the health care need(s) related to the specific healthcare activity that the network proposes to address, including quantifiable data on the lack of existing services, gaps in care, and/or programs within the targeted rural community. You must use appropriate data sources (e.g., local, state, federal) in your analysis of the environment in which the network project will be implemented, including:

Target populations. Provide information on the socio-cultural determinants of health and health disparities affecting the target population. Based on your target population, describe the extent to which the population you propose to serve includes subpopulations that have historically suffered from poorer health outcomes, health disparities, and other inequities compared to the rest of the target population. These populations may include, but are not limited to, homeless populations, racial and ethnic minorities, pregnant women, adolescents and youth, etc. In addition, discuss how this program and network collaboration ameliorate the disparities identified. You are encouraged to utilize the methods outlined in the National Culturally and Linguistically Appropriate Services Standards.

Rural Service Area. Include a map within the narrative that shows the location of network member organizations, the rural counties served by the network, and any other information that will help reviewers visualize and understand the scope of the proposed activities. The service area must be completely rural. If an organization is located in a rural census tract of an urban county, the rural census tract(s) must be clearly identified as well as the county and census tract(s) of the network member organizations. In Attachment 3, include a list of the impacted areas, counties and cities.

Impact of Network Collaboration

b. Impact. Describe the need for a network collaboration to address the population health of the target population (supported by the proposed health care activity) in a manner that individual facilities would not be able to do on their own.

Describe the potential impact of the network’s activities on providers, programs, organizations and other network and non-network entities in the community.

https://thinkculturalhealth.hhs.gov/clas/standards https://thinkculturalhealth.hhs.gov/clas/standards

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METHODOLOGY -- Corresponds to Section V’s Review Criterion 2: RESPONSE

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

Methodology for Addressing Project Goals and Implementation

a. Project Goals. Define the specific goals and objectives of the proposed network program and the activities that the network will conduct to achieve these goals and objectives, and discuss how the project goals align with the four RHND program domains listed in the purpose section. Explain the network’s collaborative strategy to meet the goals and objectives. Goals and objectives should directly relate to the information presented in the Needs Assessment section and be aligned with the selected health care activity.

b. Promising Practices. Programs are encouraged to utilize evidence-based practices or models to promote successful program implementation. Models can be found at https://www.ruralhealthinfo.org/project-examples/evidence-levels/evidence-based. If portions of the proposed methodology that address a selected topic area(s) are based upon a project or program that was successful in another community or network, please describe that program and include an abstract of the program in Attachment 11. If applicable, describe why the selected approach will succeed in your community and how you will tailor your approach to meet the needs of your community.

Methodology for Meeting Rural Requirements

c. Local Rural Community. Describe how the local rural community or region served will be involved in the development and ongoing operations of the project. Describe how community involvement influences the program.

Applicants should describe how members of the network are composed of at least sixty-six percent (66%), or two-thirds of organizations who are located in HRSA designated rural areas.

Methodology for Addressing Systems of Care

d. Addressing Systems of Care. Describe your service delivery approach. Using the definition of Systems of Care in Appendix B, describe how the network will work together to create or improve equitable systems, workflows and strategies to enhance health outcomes and ready themselves for emerging payment models.

e. Sustainability. Demonstrate a cohesive plan for sustaining the project after federal funding has ended. This preliminary sustainability plan in Attachment 9 should detail how the network will document the value of the network programs and services to its member organizations and how the network plans to continue to work together and integrate the proposed program into the routine https://www.ruralhealthinfo.org/project-examples/evidence-levels/evidence-based https://www.ruralhealthinfo.org/project-examples/evidence-levels/evidence-based

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workflow of the network member organizations so that the project will sustain after the project period ends.

WORK PLAN -- Corresponds to Section V’s Review Criterion 2: RESPONSE and Criterion 4: IMPACT

This section should clearly demonstrate that the completion of work plan activities utilize a collaborative approach with all network member organizations. Describe the methodology for routine progress monitoring and how network member organizations will collectively decide upon new program strategies, if needed. Use a time line that includes completion dates for each activity and identifies responsible staff. This section should also provide clear evidence that the network has the capacity to begin the rollout and implementation of the proposed activities immediately.

Work Plan Information

Work Plan Table. Use of a tabular format that uses rows and columns to display information is strongly encouraged for effective organization of the work plan information and should be included in Attachment 4. The table should include, and clearly illustrate the:

Project goals, objectives, strategies, activities, outputs and outcomes, performance benchmarks for measuring progress of each activity and for measuring project outputs/outcomes;

Information on how project outputs will be measured;

Timeframes assigned for work plan execution for each year of the four-year period of performance, with appropriate timelines for project activity implementation for each year. The timeframes should be as specific as possible. All work plans should clearly and coherently align with the proposed project goals and objectives;

Key personnel and/or network member organizations responsible for implementing work plan project activities;

If an activity is a direct service activity, please explicitly write “direct service activity” next to the activity (definition of direct services can be found in Appendix B). Note: Direct service activities can account for no more than 30 percent of the award budget. Please see funding restrictions for additional information; and

All HRSA Reporting requirements. Please see “Reporting” under Section VI.

Award Administration Information, for more details.

Work Plan Narrative. Discuss how the implementation of the work plan activities will be a collaborative and sustainable effort across network member organizations.

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Describe the roles, shared responsibilities and collaboration across network member organizations in carrying out work plan activities;

Describe the integration of work plan activities into network member’s organizational activities;

Describe the frequency, communication plan, and method by which work groups will meet to track progress on work plan activities, as well as the mode of communication that will occur to report progress updates on work plan activities to the network.

Program Impacts

Impacts. Using the RHND program domains, include a description of the short term and long term impact that will result from the implementation of the proposed program and supporting work plan, including impacts on the target population, the community service area due to the network’s expanded capacity, system of care improvements and the anticipated economic impact, including any cost savings.

RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review Criterion 5:

RESPONSE

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