FORHP HRSA-23-033 (H3H) SHIP_FINAL.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2023

Federal Office of Rural Health Policy

Hospital State Division

Small Rural Hospital Improvement Program (SHIP)

Funding Opportunity Number: HRSA-23-033

Funding Opportunity Types: Competing Continuation, New

Assistance Listings Number: 93.301

Application Due Date: November 8, 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 10, 2022

Mx. Krista M. Mastel, MPH

Public Health Analyst

Federal Office of Rural Health Policy

Phone: (301) 443-0491

Email: kmastel@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: Section 1820(g)(3) of the Social Security Act (42 U.S.C. 1395i-4).

mailto:kmastel@hrsa.gov

HRSA-23-033 i

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 Small Rural Hospital Improvement Program (SHIP). The purpose of this program is to help small rural hospitals with 49 beds or fewer implement quality and operational improvement efforts to align with value-based care.

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. You should note that this program may be cancelled before award.

Funding Opportunity Title: Small Rural Hospital Improvement

Program

Funding Opportunity Number: HRSA-23-033

Due Date for Applications: November 8, 2022

Anticipated FY 2023 Total Available

Funding:

$20,734,674

Estimated Number and Type of Awards: Up to 46 grants

Estimated Annual Award Amount:

Up to $13,011 per hospital per year subject to the availability of appropriated funds

Cost Sharing/Match Required: No

Period of Performance: June 1, 2023 through May 31, 2028

(5 years)

Eligible Applicants:

The State Office of Rural Health (SORH) in each state will be the official award recipient of record, and will act as fiscal intermediary for all eligible small rural hospitals within the state.

HRSA-23-033 ii

Eligible hospitals within the territories that do not have access to a SORH must apply to the SHIP program individually.

Eligible “small rural hospital” is defined as a non-federal, short-term general acute care hospital that: (i) is located in a rural area as defined in 42 U.S.C. 1395ww(d) and (ii) has 49 available beds or fewer, as reported on the hospital’s most recently filed Medicare Cost Report.

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:

Day and Date: Wednesday, August 31, 2022

Time: 3 – 4 p.m. ET

Weblink: https://hrsa-gov.zoomgov.com/j/1619804226?pwd=MlVDb3ZPcTFSRFRpN01JbEtNSDNIdz09

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

Call-In Number: 1-833-568-8864

Meeting ID: 161 980 4226

Passcode: 41092373

HRSA will record the webinar:

Webinar Recording: https://www.ruralcenter.org/ship/events 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%2F1619804226%3Fpwd%3DMlVDb3ZPcTFSRFRpN01JbEtNSDNIdz09&data=05%7C01%7CKMastel%40hrsa.gov%7Cfe7937fc898c4ab6ee2708da2916a1de%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C637867474423972537%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=o6Z%2FkHU61CF0UMoE593KXQkKabax%2Be7zi%2FvybMm1oOk%3D&reserved=0 https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fhrsa-gov.zoomgov.com%2Fj%2F1619804226%3Fpwd%3DMlVDb3ZPcTFSRFRpN01JbEtNSDNIdz09&data=05%7C01%7CKMastel%40hrsa.gov%7Cfe7937fc898c4ab6ee2708da2916a1de%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C637867474423972537%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=o6Z%2FkHU61CF0UMoE593KXQkKabax%2Be7zi%2FvybMm1oOk%3D&reserved=0 https://www.ruralcenter.org/ship/events

HRSA-23-033 iii

Table of Contents

EXECUTIVE SUMMARY ..................................................................................................I

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. Purpose

2. Background

II. AWARD INFORMATION

1. Type of Application and Award

2. Summary of Funding

III. ELIGIBILITY INFORMATION

1. Eligible Applicants

2. Cost Sharing/Matching

3. Other

IV. APPLICATION AND SUBMISSION INFORMATION

1. Address to Request Application Package

2. Content and Form of Application Submission

PROGRAM-SPECIFIC INSTRUCTIONS

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Attachments

3. Unique Entity Identifier (UEI) and System for Award Management (SAM) ……………………………………………………………………………………….16

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

HRSA-23-033 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Small Rural

Hospital Improvement Program (SHIP). This program supports eligible small rural hospitals in meeting value-based payment and care goals for their respective organizations through purchases of hardware, software, and training. SHIP also assists such hospitals in participating in delivery system reforms such as to become or join a

Medicare Shared Savings Program or Accountable Care Organizations (ACOs), participate in other shared saving programs, and purchase health information technology (hardware/software), equipment, and/or training to comply with quality improvement activities such as advancing patient care information, promoting interoperability, and payment bundling.

2. Background

SHIP is authorized by Section 1820(g)(3) of the Social Security Act (42 U.S.C. 1395i-4).

This program was first authorized by the Balanced Budget Act of 1997, an amendment to the Social Security Act, to help small rural hospitals implement data systems required by the Medicare Prospective Payment System (PPS). The initial funding for this program was provided by the Departments of Labor, Health and Human Services, and

Education, and Related Agencies Appropriations Act, 2002.

The reauthorization of the program through the Patient Protection and Affordable Care

Act expanded SHIP to support eligible hospitals in meeting value-based purchasing goals for their respective organizations and to enable small rural hospitals to become or join a Medicare Shared Savings Program or ACOs and purchase health information technology, equipment (hardware and software), and/or training to comply with meaningful use, ICD-101 standards, and payment bundling.

II. Award Information

1. Type of Application and Award

Types of applications sought: Competing Continuation, New

HRSA will provide funding in the form of a grant.

1 https://www.cms.gov/Medicare/Coding/ICD10/index.html https://www.cms.gov/Medicare/Coding/ICD10/index.html

HRSA-23-033 2

2. Summary of Funding

HRSA estimates approximately $20,734,674 to be available annually to fund approximately 1,600 hospitals, consolidated under 46 state recipients with award amounts of approximately $13,011 per hospital. 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 $13,011 total cost (includes both direct and indirect

(facilities and administrative) costs) per hospital 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 June 1, 2023 through May 31, 2028 (5 years). Funding beyond the first year is subject to the availability of appropriated funds for SHIP in subsequent fiscal years, satisfactory progress, and a decision that continued funding is in the best interest of the Federal Government.

All hospitals that meet the eligibility requirements and propose to use funds for allowable activities will receive funding through this program and will be allocated funds equally from the SORH.

All HRSA awards are subject to the Uniform Administrative Requirements, Cost

Principles, and Audit Requirements at 45 CFR part 75.

Indirect Costs Rate

Applicants are encouraged to limit Indirect Costs to the lesser of:

(i) 15 percent of the amount of the award for administrative expenses; or

(ii) the applicant organization’s federally negotiated indirect rate for administering the grant.

The applicant must have a current indirect cost rate agreement at the time of application.

III. Eligibility Information

1. Eligible Applicants

Eligible applicants include states that are current SHIP recipients, as well as states and territories with hospitals that meet eligibility requirements that have not been previously funded. The SORH will be the official award recipient acting as fiscal intermediary for all eligible hospitals within its state. Each SORH submits an application to HRSA on behalf of the eligible hospital applicants in its state. The SORH receives the federal funds, verifies hospital eligibility utilizing the Rural Health Grants Analyzer http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

HRSA-23-033 3

(https://data.hrsa.gov/tools/rural-health), makes awards to eligible hospitals, and ensures appropriate use of funds. At the end of the budget period, each SORH submits a financial report documenting reporting expenditure activity to HRSA.

Eligible small rural hospitals are non-federal, short-term general acute care facilities that are located in a rural area of the U.S. and the territories, including faith-based hospitals.

For the purpose of this program:

1) “eligible small rural hospital” is defined as a non-federal, short-term general acute care hospital that: (i) is located in a rural area as defined in 42 U.S.C. 1395ww(d) and (ii) has 49 available beds or fewer, as reported on the hospital’s most recently filed Medicare Cost Report;

2) “rural area” is defined as either: (1) located outside of a Metropolitan Statistical

Area (MSA); (2) located within a rural census tract of a MSA, as determined under the Goldsmith Modification or the Rural Urban Commuting Areas (RUCAs) or (3) is being treated as if being located in a rural area pursuant to 42 U.S.C.

1395(d)(8)(E); and,

3) Eligible small rural hospitals may be for-profit or not-for-profit, including faith-based. Hospitals in U.S. territories as well as tribally operated hospitals under

Titles I and V of P.L. 93-638 are eligible to the extent that such hospitals meet the above criteria.

Individual hospitals can find the SORH contact in their state at:

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

Eligible hospitals within the territories that do not have access to a SORH must apply to the SHIP program individually and should contact the SHIP Program Coordinator. See

Section VII for a complete list of agency contacts.

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.

https://data.hrsa.gov/tools/rural-health https://nosorh.org/nosorh-members/nosorh-members-browse-by-state/

HRSA-23-033 4

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically. HRSA encourages you to apply through

Grants.gov using the SF-424 workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at Grants.gov: HOW TO

APPLY FOR GRANTS. 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-23-033 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 the HRSA SF-424 Application

Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in 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 size of all uploaded files included in the page limit shall be no more than the equivalent of 50 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.vi 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-23-033, it will count against the page limit.

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

HRSA-23-033 5

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 of 50 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-23-033 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 10: Other Relevant Documents.

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

Program-Specific Instructions In addition to application requirements and instructions in Section 4 of HRSA’s SF-424

Application Guide (including the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract), include the following:

i. Project Abstract

Use the Standard OMB-approved Project Abstract Summary Form that is included in the workspace application package. 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.

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.

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

HRSA-23-033 6

Narrative Section Review Criteria

Introduction (1) Need

Needs Assessment (1) Need

Methodology (2) Response and (4) Impact

Work Plan (2) Response

Resolution of Challenges (2) Response

Evaluation and Technical Support

Capacity

(3) Evaluative Measures

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:

o INTRODUCTION -- Corresponds to Section V’s Review Criterion (1) Need

This section should briefly describe the purpose of the proposed goals supported by SHIP funding including any new policies, collaborations and/or administrative changes. Please include the vision of your SHIP and highlight the goals for the five-year period of performance. Indicate which program areas from the SHIP

Allowable Investments (https://www.ruralcenter.org/ship/allowable-investments) you will be addressing.

o NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criterion (1) Need

This section provides an overview of the needs of small rural hospitals as they relate to the purpose of the SHIP program. The needs assessment should demonstrate an understanding of your state’s small rural hospital landscape. The assessment will inform and set priorities for the objectives and activities described within each program area in the methodology and work plan sections. The assessment should answer the following questions:

What is the current status and/or trends for small rural hospitals in your state? Include the total number of small rural hospitals in your state and note any newly certified small rural hospitals or small rural hospitals that closed or converted to a different facility type within the past year.

https://www.ruralcenter.org/ship/allowable-investments

HRSA-23-033 7

What are the challenges that impact the ability of small rural hospitals to provide quality care to communities?

What other stakeholders are engaged in supporting small rural hospital efforts?

What are the gaps in data related to small rural hospitals?

What underserved communities2, if any, are served by small rural hospitals in your state?

Clearly identify data sources and associated dates to show that the needs and trends are outlined.

o METHODOLOGY -- Corresponds to Section V’s Review Criteria (2) Response and

(4) Impact o Overview: Describe the proposed methods by which the state SHIP

Director will:

Collect, compile, and report information

Disburse funds

Lead or plan any activities (if applicable)

Communicate with hospital staff to monitor progress

Provide technical assistance if necessary

Monitor for fidelity including ensure hospital eligibility, compliance, and appropriate expenditure of funds

Work with any consultants or technical assistance providers

Activities, programs, and initiatives (i.e., trainings, formation of networks/consortia, or group purchasing) should be specific, realistic, measurable, and achievable within a specified timeframe.

SORHs are strongly encouraged to assist hospitals form networks/consortia on an intra- or inter-state basis to purchase hardware, software, and/or training.

SHIP Funding Priorities: Provide a plan for monitoring the progress of the participating hospital(s) for programmatic and spending progress.

Additionally, Describe any activities that may be best practices or innovations (replicable, measurable, demonstrated impact) including network/consortia, as applicable. SORHs will also include details about the engagement of hospital administrators, staff and community

2 Black, Latino, and Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons; persons with disabilities; and persons otherwise adversely affected by persistent poverty or inequality as defined by Executive Order 13985:

https://www.federalregister.gov/documents/2021/01/25/2021-01753/advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government https://www.federalregister.gov/documents/2021/01/25/2021-01753/advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government https://www.federalregister.gov/documents/2021/01/25/2021-01753/advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government

HRSA-23-033 8

representatives, program collaborators, and other stakeholders whose efforts support process improvements.

SHIP funds should be prioritized by participating Critical Access

Hospitals (CAH) in the following manner, one or both, in no particular order:

1) Hospitals must meet MBQIP (see https://www.hrsa.gov/rural-health/rural-hospitals/mbqip and https://www.ruralcenter.org/resource-library/mbqip-measures) participation requirements in order to improve hospital quality outcomes. Non-federal tribal hospitals may use another culturally sensitive federally managed measure of hospital quality outcomes.

2) ICD-113 coding readiness and/or implementation activities.

If a CAH has implemented both MBQIP and ICD-11 activities, then that hospital may select a different activity listed on the SHIP Allowable

Investments (https://www.ruralcenter.org/ship/allowable-investments), contained within the hospital application.

If a CAH is currently using all hardware, software, equipment, and/or trainings listed on the SHIP Allowable Investments

(https://www.ruralcenter.org/ship/allowable-investments), the hospital may select other hardware, software, equipment, and/or training provided:

1) the purchase will optimally affect the hospital’s ability to transform its practice and participate in a Medicare Shared Savings Program or an

ACO, increase value based purchasing objectives, aid in the adoption of ICD-11, and/or support care transitions/coordination. Hospitals are encouraged to align SHIP purchases in ways that ensure the consistent and systematic fair, just, and impartial treatment4 of all patients by addressing Social Determinants of Health5 (SDOH) to improve the quality of healthcare provided; and

2) The hospital receives permission from both its SORH SHIP Director if in a state and the state’s SHIP Director’s FORHP Project Officer for an activity not listed on the Allowable Investments website.

3 See https://www.who.int/standards/classifications/classification-of-diseases and https://icd.who.int/en 4 As defined by Executive Order 13985: https://www.federalregister.gov/documents/2021/01/25/2021- 01753/advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government 5 Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality -of-life outcomes and risks. https://health.gov/healthypeople/priority-areas/social-determinants-health https://www.hrsa.gov/rural-health/rural-hospitals/mbqip https://www.hrsa.gov/rural-health/rural-hospitals/mbqip https://www.ruralcenter.org/resource-library/mbqip-measures https://www.ruralcenter.org/resource-library/mbqip-measures https://www.ruralcenter.org/ship/allowable-investments https://www.ruralcenter.org/ship/allowable-investments https://www.who.int/standards/classifications/classification-of-diseases https://icd.who.int/en https://health.gov/healthypeople/priority-areas/social-determinants-health

HRSA-23-033 9

SHIP funds for non-CAHs should be prioritized in the following manner:

1) ICD-11 coding readiness and/or implementation activities

If a Prospective Payment System hospital has implemented ICD-11 activities then that hospital may select a different activity on the SHIP

Allowable Investments (https://www.ruralcenter.org/ship/allowable-investments).

If a non-CAH is currently using all hardware, software, equipment, and/or trainings listed on the SHIP Allowable Investments

(https://www.ruralcenter.org/ship/allowable-investments), the hospital may select an alternative hardware, software, equipment, and/or training provided:

1) the purchase will optimally affect the hospital’s ability to transform its practice and participate in a Medicare Shared Savings Program or an

ACO, increase value based purchasing objectives, aid in the adoption of ICD-11, and/or support care transitions/coordination. Hospitals are encouraged to align SHIP purchases in ways that ensure the consistent and systematic fair, just, and impartial treatment6 of all patients by addressing Social Determinants of Health7 (SDOH) to improve the quality of healthcare provided; and

2) The hospital receives permission from both its SORH SHIP Director if in a state and the state’s SHIP Director’s FORHP Project Officer.

SHIP Hospital Applications: All hospitals must complete the Hospital

Application. The suggested application templates are available at https://www.ruralcenter.org/ship/grant-guidance. All hospitals must have their CEOs and the individual(s) responsible for SHIP-funded purchase(s) and/or project(s) sign the SHIP hospital applications in ink or electronically. These signatures will attest to the accuracy of each hospital’s prioritized purchase(s), certifying each hospital’s engagement in MBQIP or ICD-11, or other activity. Note that allowable activities categories are broad and specific activities may fall into more than one category. Hospitals within the states must send the application to the state SHIP Director. SORHs must collect and store the hospital applications. Hospitals in the territories without a SORH must complete the application and submit as Attachment #7. FORHP

Program Staff may request hospital applications from the SORH as

6 As defined by Executive Order 13985: https://www.federalregister.gov/documents/2021/01/25/2021- 01753/advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government 7 Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. https://health.gov/healthypeople/priority-areas/social-determinants-health https://www.ruralcenter.org/ship/allowable-investments https://www.ruralcenter.org/ship/allowable-investments https://www.ruralcenter.org/ship/allowable-investments https://www.ruralcenter.org/ship/grant-guidance https://health.gov/healthypeople/priority-areas/social-determinants-health

HRSA-23-033 10

part of program monitoring to ensure appropriate spending and satisfactory progress.

At a minimum, the SHIP Hospital Application must include:

Hospital Name

CMS Certification Number (CCN)

Number of beds per line 14 of the most recently filed

Medicare Cost Report

Participation in the following CMS programs (yes/no):

Medicare Shared Savings Program

Other ACO Program (e.g., Medicaid ACO, private payer ACO)

Hospital Inpatient Quality Reporting (IQR)

Program

Care Compare (formerly Hospital Compare)

Medicare Hospital VBP Program (PPS hospitals only)

Other Value Based Care Models or Alternative

Payment Models

Allowable Investment Activities by category and a description of the activity, in table format

The amount and percent of funding requested by category

If a competing continuation hospital applicant, also include:

Anticipated FY22 funding expenditure

Activity and progress by category

Lessons learned

If a new hospital applicant, also include:

Hospital former name (if applicable)

Hospital address

Hospital Administrator/CEO contact information

Hospital SHIP Project Director (PD) contact information

CAH (yes/no)

Tribally operated under Titles 1 and V and P.L. 93-

638 (yes/no)

FY23 Network/Consortium information (if applicable)

Hospital Administrator/CEO signature and date

Hospital SHIP PD signature and date

FY23 SHIP Hospital Funding Spreadsheet: For this NOFO, all applicants must submit a FY23 SHIP Hospital Funding Spreadsheet.

HRSA-23-033 11

The suggested template is available at:

https://www.ruralcenter.org/ship/grant-guidance. Complete the spreadsheet and submit as Attachment #8.

At a minimum, the FY23 SHIP Hospital Funding Spreadsheet must include the following for every hospital:

CCN

Hospital Name

Address

Administrator/CEO name and email

Hospital SHIP PD name and email

CAH (Y/N)

Tribally operated under Titles I and V of P.L. 93-638? (Y/N)

Bed size (must be 49 or fewer)

CMS program/model participation, or other VBP programs, models, or initiatives: (yes/no)

Medicare Shared Savings Program

Other ACO Program (e.g., Medicaid ACO, private payer

ACO)

Hospital IQR Program

Care Compare (formerly Hospital Compare)

Medicare Hospital VBP Program

Other Value Based Care Models or Alternative Payment

Models

Indicate VBP Investment Activities selection(s):

Quality Reporting

MBQIP data collection process/related training

Efficiency or Quality Improvement (QI) training

Provider-Based Quality Measures education

Alternative Payment Model and Quality Payment

Program training/education

Indicate ACO Investment Activities selection(s):

Computerized Provider Order Entry

Pharmacy services training, hardware/software, and/or machines

Population Health or Disease Registry training and/or software/hardware

SDOH screening software and training

Efficiency or QI training/project

System Performance training

Telehealth/mobile health

Community Paramedicine

Health Information Technology training for value and

ACOs

HRSA-23-033 12

Indicate Payment Bundling or PPS Investment Activities selection(s):

ICD-11 software

ICD-11 training

Efficiency or QI training

S-10 Cost Reporting training

Price Transparency training

Investment Budget Request

VBP amount

ACO/Shared Savings amount

Payment Bundling/PPS amount

Total funding request

Network/Consortium Expenditures

Will FY23 funds be allocated to a SHIP network/consortium of hospitals to complete SHIP allowable activities (Y/N)?

Will FY23 funds be allocated to any other network/consortium of hospitals to complete SHIP allowable activities? (Y/N)

Fund Distribution

If a SORH, indicate in which of the following ways funds will be allocated for each hospital: direct to hospital; to network (whether partially or fully); or released by SORH

Percent requested per investment area

VBP

ACO/Shared Savings Program

Payment Bundling/PPS o WORK PLAN -- Corresponds to Section V’s Review Criterion (2) Response

Describe the activities or steps to achieve each of the objectives proposed by the state (or individual hospital) as outlined in the Methodology section during the entire period of performance. As appropriate, identify meaningful support and collaboration with key stakeholders in planning, designing, and implementing all activities, including developing the application.

Provide a summary of the proposed activities of the hospital applicants, and how the program funds will be used regarding the identified needs of the SHIP, within the Allowable Investments (https://www.ruralcenter.org/ship/allowable-investments) categories: 1) Value-Based Purchasing, 2) ACOs/Shared Savings

Program, and 3) Payment Bundling/PPS.

Include the FY 2023 Work Plan template found here:

https://www.ruralcenter.org/ship/grant-guidance as Attachment #5 that specifies each activity and identifies responsible staff.

https://www.ruralcenter.org/ship/allowable-investments https://www.ruralcenter.org/ship/allowable-investments

HRSA-23-033 13

o At a minimum, the work plan must include the following for each objective; table format is recommended:

Activity

Anticipated Completion Date/Timeline

Staff and Entity

Progress/Process Measures

Outcome/Impact o RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review Criterion

(2) Response

Discuss challenges anticipated in designing and implementing the activities described in the SHIP work plan and approaches used to resolve such challenges. Include any anticipated problems with implementation of hospital activities (e.g., selection of measures) and/or network development. Challenges can be fiscal or operational.

EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to

Section V’s Review Criterion (3) Evaluative Measures

Describe the plan for the program performance evaluation that will contribute to continuous quality improvement. The program performance evaluation should monitor ongoing processes and the progress towards the goals and objectives of the project. Provide evaluative measures to monitor SHIP investment and its impact. Include descriptions of the inputs (e.g., organizational profile, collaborators, key staff, budget, and other resources), key processes, contractor monitoring (as applicable), and expected outcomes of the funded activities

(including improved quality, improved operational efficiencies, or cost savings).

ORGANIZATIONAL INFORMATION -- Corresponds to Section V’s Review

Criterion (5) Resources/Capabilities

Provide information on the applicant organization’s current mission and structure, scope of current activities, and provide an organizational chart (Attachment #6).

iii. Budget

The directions offered in the SF-424 Application Guide may differ from those offered by

Grants.gov. Follow the instructions in Section 4.1.iv of HRSA’s SF-424 Application

Guide and the additional budget instructions provided below. A budget that follows the

Application Guide will ensure that, if HRSA selects your application for funding, you will have a well-organized plan and, by carefully following the approved plan, may avoid audit issues during the implementation phase.

Reminder: The Total Project or Program Costs are the total allowable costs (inclusive of direct and indirect costs) you incur to carry out a HRSA-supported project or activity.

Total project or program costs include costs charged to the award and costs borne by you to satisfy a matching or cost-sharing requirement, as applicable.

HRSA-23-033 14

As required by the Consolidated Appropriations Act, 2022 (P.L. 117-103), Division H, §

202, “None of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of

Executive Level II.” See Section 4.1.iv Budget – Salary Limitation of HRSA’s SF-424

Application Guide for additional information. Note that these or other salary limitations may apply in the following fiscal years, as required by law.

iv. Budget Narrative

See Section 4.1.v. of HRSA’s SF-424 Application Guide.

In addition, SHIP requires the following:

Total budget should not exceed $13,011 per hospital.

Budget justifications should specifically describe how each item supports the achievement of proposed objectives, activities, programs, and initiatives. The budget period is for one year. However, one-year budgets for each of the subsequent budget periods within the requested period of performance must be submitted with the application. Line item information provided should explain the costs entered in the SF-424A.

Personnel costs are only for the oversight of the award and do not include hospital personnel costs.

“Travel,” “Supplies,” “Construction,” and “Other” are not allowable expenses.

A SORH is encouraged to request the lesser of 15 percent of the award total or their indirect cost rate. The current indirect cost rate agreement must be included

(Attachment #1) and will not count toward the page limit.

v. Attachments

Provide the following items in the order specified below to complete the content of the application. Unless otherwise noted, attachments count toward the application page limit. Your indirect cost rate agreement and proof of non-profit status (if applicable) will not count toward the page limit. Clearly label each attachment. You must upload attachments into the application. HRSA and the objective review committee will not open/review any hyperlinked attachments.

Attachment 1: Indirect Cost Rate Allocation Agreement or Plan

Provide the current federally negotiated indirect cost rate agreement used to substantiate indirect costs in the proposed budget. Not counted in the page limit.

Attachment 2: Staffing Plan

Applicants must include a staffing plan and provide a justification for the plan that includes education, experience qualifications, and rationale for requested time

(percent of Full Time Equivalent [FTE]) for each staff position. If a staff member works on other federal awards, include the program name and FTE. Note that http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

HRSA-23-033 15

staff cannot be compensated with award funds for more than 100 percent of their time across all federal awards (45 CFR 75.430). Briefly include a statement outlining your organization's succession planning process to ensure continuity of operations and grant activity oversight and management.

Attachment 3: Job Descriptions for Key Personnel

Keep each job description to one page in length as much as is possible. Include the role, responsibilities, and qualifications of proposed project staff.

Attachment 4: Biographical Sketches of Key Personnel

Include biographical sketches for persons occupying the key positions described in Attachment 3, not to exceed two pages in length per person. In the event that a biographical sketch is included for an identified individual not yet hired, include a letter of commitment from that person with the biographical sketch.

Attachment 5: Work Plan

Provide a detailed summary at the state level regarding proposed applicant activities, how funds are to be used during each budget period, activities, and a timeline that describes funds disbursement (if a SORH) processes and the use of

SHIP hospital networks (if applicable). The suggested template and instruction is available here: https://www.ruralcenter.org/ship/grant-guidance

Attachment 6: Organizational Chart

Provide a one-page figure that depicts the organizational structure of the SHIP program within the SORH or the hospital.

Attachment 7: Hospital Application Form (only required for hospitals applying individually)

The suggested hospital application templates and instructions are available here:

Attachment 8: FY 2023 SHIP Hospital Funding Spreadsheet

Attach the completed FY 2023 SHIP Hospital Funding Spreadsheet. The suggested template and instruction is available here:

https://www.ruralcenter.org/ship/grant-guidance. Not counted in the page limit.

Attachment 9: 5th Year Budget

After using columns (1) through (4) of the SF-424A Section B for a 5-year period of performance, you will need to submit the budget for the 5th year as an attachment. Use the SF-424A Section B, which does not count in the page limit;

however, any related budget narrative does count. See Section 4.1.iv of HRSA’s

SF-424 Application Guide.

HRSA-23-033 16

Attachments 10–15: Other Relevant Documents

Include here any other documents that are relevant to the application, including letters of support. Letters of support must be dated and specifically indicate a commitment to the project/program (in-kind services, dollars, staff, space, equipment, etc.).

3. Unique Entity Identifier (UEI) and System for Award Management (SAM)

Effective April 4, 2022:

The UEI (SAM), a new, non-proprietary identifier assigned by SAM, has replaced the UEI Data Universal Numbering System (DUNS) number.

Register at SAM.gov and you will be assigned a UEI.

You must register with SAM and continue to maintain active SAM registration with current information at all times when you have: an active federal award, an active application, or an active plan under consideration by an agency (unless you are an individual or federal agency that is exempted from those requirements under 2 CFR §

25.110(b) or (c), or you have an exception approved by the agency under 2 CFR § 25.110(d)). For your SAM registration, you must submit a notarized letter appointing the authorized Entity Administrator.

If you are chosen as a recipient, HRSA will not make an award until you have complied with all applicable SAM requirements. If you have not fully complied with the requirements by the time HRSA is ready to make an award, you may be deemed not qualified to receive an award, and HRSA may use that determination as the basis for making an award to another applicant.

If you have already completed Grants.gov registration for HRSA or another federal agency, confirm that the registration is still active and that the Authorized Organization

Representative (AOR) has been approved.

The Grants.gov registration process requires information in two separate systems:

System for Award Management (SAM) (https://sam.gov/content/home | SAM.gov

Knowledge Base)

Grants.gov (https://www.grants.gov/)

For more details, see Section 3.1 of HRSA’s SF-424 Application Guide.

If you fail to allow ample time to complete registration with SAM or Grants.gov, you will not be eligible for a deadline extension or waiver of the electronic submission requirement.

https://sam.gov/content/home https://sam.gov/content/home https://www.fsd.gov/gsafsd_sp?id=gsa_kb_view2&kb_id=f66d8e6cdb76d4100d73f81d0f9619c6 https://www.fsd.gov/gsafsd_sp?id=gsa_kb_view2&kb_id=f66d8e6cdb76d4100d73f81d0f9619c6 https://www.grants.gov/

HRSA-23-033 17

4. Submission Dates and Times

Application Due Date

The application due date under this NOFO is November 8, 2022 at 11:59 p.m. ET.

HRSA suggests you submit your application to Grants.gov at least 3 calendar days before the deadline to allow for any unforeseen circumstances. See Section 8.2.5 –

Summary of emails from Grants.gov in HRSA’s SF-424 Application Guide for additional information.

5. Intergovernmental Review

SHIP is not subject to the provisions of Executive Order 12372, as implemented by 45

CFR part 100.

See Section 4.1 ii of HRSA’s SF-424 Application Guide for additional information.

6. Funding Restrictions

You may request funding for a period of performance of up to 5 years, at no more than

$13,011 per hospital per year (inclusive of direct and indirect costs). 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. Awards to support projects beyond the first budget year will be contingent upon Congressional appropriation, satisfactory progress in meeting the project’s objectives, and a determination that continued funding would be in the best interest of the Federal Government.

The General Provisions in Division H of the Consolidated Appropriations Act, 2022 (P.L.

117-103) apply to this program. See Section 4.1 of HRSA’s SF-424 Application Guide for additional information. Note that these and other restrictions will apply in following fiscal years, as required by law.

Federal funds provided through this program may only be used for purposes authorized in section 1820(g)(3) of the Social Security Act (42 U.S.C. 1395i-4), as amended.

You are required to have the necessary policies, procedures, and financial controls in place to ensure that your organization complies with all legal requirements and restrictions applicable to the receipt of federal funding including statutory restrictions on specific uses of funding. It is imperative that you review and adhere to the list of statutory restrictions on the use of funds detailed in Section 4.1 of HRSA’s SF-424

Application Guide. Like all other applicable grants requirements, the effectiveness of these policies, procedures, and controls is subject to audit.

Be aware of the requirements for HRSA recipients and subrecipients at 2 CFR §

200.216 regarding prohibition on certain telecommunications and video surveillance services or equipment. For details, see the HRSA Grants Policy Bulletin Number: 2021-

01E.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/manage/grants-policy-bulletin-2021.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/manage/grants-policy-bulletin-2021.pdf

HRSA-23-033 18

All program income generated as a result of awarded funds must be used for approved project-related activities. Any program income earned by the recipient must be used under the addition/additive alternative. You can find post-award requirements for program income at 45 CFR § 75.307.

V. Application Review Information

1. Review Criteria

HRSA has procedures for assessing the technical merit of applications to provide for an objective review and to assist you in understanding the standards against which your application will be reviewed. HRSA has critical indicators for each review criterion to assist you in presenting pertinent information related to that criterion and to provide the reviewer with a standard for evaluation.

These criteria are the basis upon which the reviewers will evaluate and score the merit of the application. The entire proposal will be considered during objective review.

Six review criteria are used to review and rank SHIP applications. Below are descriptions of the review criteria and their scoring points.

Criterion 1: NEED (20 points) – Corresponds to Section IV’s Introduction and Needs

Assessment

The extent to which the application:

Describes the purpose of the proposed goals supported by SHIP funding including any new policies, collaborations, and/or administrative changes.

Details the vision of your SHIP and highlight the goals for the five-year period of performance.

Demonstrates comprehensive knowledge and understanding of issues facing and unmet needs of small rural hospitals relating to the purpose of the SHIP program.

If a SORH, details how SHIP activities compliment other statewide work with small hospitals.

Demonstrates how comprehensive knowledge and understanding of issues and unmet needs of the health care landscape including underserved communities were obtained (i.e., research, annual assessments/surveys, etc.).

Criterion 2: RESPONSE (45 points) – Corresponds to Section IV’s Methodology, Work

Plan, and Resolution of Challenges

Methodology (20 points):

The extent to which the application clearly demonstrates:

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

HRSA-23-033 19

An approach to collect, compile, and report information as well as disburse funds, lead or plan activities, and work with consultants or technical assistance providers.

How expenditures will be prioritized according to the SHIP Funding

Priorities by participating hospitals.

How equipment or services will be provided.

If a SORH, how the SORH ensures receipt and accuracy of purchase from participating hospitals.

How the SORH will communicate with hospital staff to monitor progress, provide technical assistance if necessary, and ensure eligibility, compliance, and appropriate expenditure of funds.

Complete data and a summary pertaining to all hospital applicants, as detailed under Attachment #8 FY 2023 SHIP Hospital Funding

Spreadsheet including percentage or number of MBQIP and ICD-11 activities, number of CAH and PPS hospitals, and any particular needs hospitals may have and how they will be addressed.

Work Plan (20 points)

The extent to which the application clearly discusses:

Activities, goals, objectives, or steps taken during each budget period of the five (5) year period of performance.

Dates of initiation and completion (or anticipated) for each of the activities, goals, and/or objectives.

Number and type of staff (or responsible entity).

All evaluative measures (anticipated and/or actual).

All outcomes/impacts (anticipated and/or actual).

Format and use of networks/consortia (if applicable).

Proposing appropriate activities, in alignment with the SHIP Allowable

Investments.

Resolution of Challenges (5 points)

The extent to which the application clearly describes:

Potential barriers and challenges in designing and…