FORHP HRSA-24-004 (U1C) RHRC Final.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2024

Federal Office of Rural Health Policy

Policy Research Division

Rural Health Research Center Program

Funding Opportunity Number: HRSA-24-004

Funding Opportunity Type(s): Competing Continuation, New

Assistance Listing Number: 93.155

Application Due Date: May 23, 2024 Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

We will not approve deadline extensions for lack of registration.

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

Issuance Date: March 22, 2024

Karis Tyner Research Coordinator, Policy Research Division Federal Office of Rural Health Policy Call: 301-287-2615 Email: ktyner@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: Social Security Act §711(b) (42 U.S.C. 912(b)) mailto:ktyner@hrsa.gov

HRSA-24-004 RHRC Program i

508 COMPLIANCE DISCLAIMER

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.

SUMMARY

Funding Opportunity Title: Rural Health Research Center Program

Funding Opportunity Number: HRSA-24-004

Assistance Listing Number: 93.155

Due Date for Applications: May 23, 2024

Purpose: The purpose of this cooperative agreement is to support recipients as they develop high-quality, impartial, policy-relevant rural health services research to inform the improvement of health care in rural areas.

Program Objective(s): The objectives of research funded through this program will be:

1) to inform health care providers, administrators, policymakers, and other interested parties at the federal, state, and local levels of the challenges facing rural communities relating to health care, and

2) to inform policies designed to improve health care in rural areas.

Rural Health Research Center program recipients will conduct policy-oriented health services research, which may include the updating of trend analyses and existing research and conducting of literature reviews on rural issues.

Eligible Applicants: Eligible applicants include all domestic public and private, nonprofit, and for-profit organizations.

• Native American tribal governments are eligible.

HRSA--24-004 RHRC Program ii

• Native American tribal organizations are eligible.

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

Anticipated FY 2024 Total Available Funding:

$5,600,000

We’re issuing this notice to ensure that, should funds become available for this purpose, we can process applications and award funds appropriately. You should note that we may cancel this program notice before award if funds are not appropriated.

Estimated Number and Type of Award(s):

RHRC Program: Up to eight cooperative agreements

Optional RHRC Supplement: Up to eight supplements per year, subject to the availability of appropriated funds

Estimated Annual Award Amount:

RHRC Program: Up to $700,000 per award, subject to the availability of appropriated funds

Optional RHRC Supplement: Up to $250,000 per award, subject to the availability of appropriated funds

Cost Sharing or Matching Required:

No

Period of Performance: September 1, 2024, through August 31, 2028 (4 years)

Agency Contacts: Business, administrative, or fiscal issues:

Bria Haley Grants Management Specialist Division of Grants Management Operations, OFAM Email: Bhaley@hrsa.gov

Program issues or technical assistance:

Karis Tyner Research Coordinator, Policy Research Division Federal Office of Rural Health Policy Email: ktyner@hrsa.gov mailto:Bhaley@hrsa.gov

HRSA--24-004 RHRC Program iii

Application Guide

You (the applicant organization / agency) are responsible for reading and complying with the instructions included in this NOFO and in HRSA R&R Application Guide (R&R Application Guide). Visit HRSA’s How to Prepare Your Application page for more information.

Technical Assistance

We have scheduled the following webinar:

Wednesday, April 10, 2024 2 – 3 p.m. ET Weblink: https://hrsa-gov.zoomgov.com/j/1614185064?pwd=a1E4NjFqUGF3b3M2dHg2YjJKOXNUZz09

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

Call-In Number: 1 (833) 568-8864 Participant Code: 86556090

We will record the webinar.

https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-rr-app-guide.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-rr-app-guide.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-rr-app-guide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://hrsa-gov.zoomgov.com/j/1614185064?pwd=a1E4NjFqUGF3b3M2dHg2YjJKOXNUZz09 https://hrsa-gov.zoomgov.com/j/1614185064?pwd=a1E4NjFqUGF3b3M2dHg2YjJKOXNUZz09

HRSA-24-004 RHRC Program iv

Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING OR MATCHING

3. OTHER

4. MULTIPLE APPLICATIONS

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Justification Narrative

v. Attachments

3. UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT (SAM)

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX: PAGE LIMIT WORKSHEET

HRSA-24-004 RHRC Program 2

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Rural Health Research Center (RHRC) Program. The purpose of this cooperative agreement is to support recipients as they develop high-quality, impartial, policy relevant rural health services research to inform the improvement of health care in rural areas. Health services research is a “multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, and ultimately, our health and well-being.”1

The objectives of the health services research funded through this program are to inform health care providers, administrators, policymakers, and other interested parties at the federal, state, and local levels of the challenges facing rural communities relating to health care and to inform policies designed to improve access to rural health care.

Rural health services research addresses critical concerns facing rural communities in their efforts to secure adequate, affordable, and high-quality health services.

The four-year RHRC Program awards will support research centers with specific rural health research areas of concentration. The topic(s) of concentration must relate to policy issues intended to inform the improvement of health care in rural areas. The topic(s) of concentration must also be of enduring interest and importance to rural providers, rural stakeholders, policymakers, and/or rural communities. RHRC recipients will conduct policy-oriented health services research. In addition to primary and secondary research, the applicant may conduct literature syntheses and update existing research to produce timely and relevant information. The ratio of original research to other projects will be negotiated between the recipients and the Federal Office of Rural Health Policy (FORHP).

The recipients will synthesize findings into publicly available policy briefs accessible to a non-technical audience. Research findings will inform a wide audience of national, state, and local decisionmakers about health issues in rural communities. For example, research findings may illustrate opportunities for policy or programs to address barriers or challenges to providing or accessing health care in rural areas. Research funded under this cooperative agreement will be publicly available on the Rural Health Research Gateway at https://www.ruralhealthresearch.org.

This program will support health services research projects and will not support clinical and biomedical research or the delivery of health care services.

1 Stephens J, Levine R, Burling AS, Russ-Eft D. An Organizational Guide to Building Health Services Research Capacity. Final Report (Prepared by American Institutes for Research under contract 233-02- 0082). AHRQ Publication No. 11(12)-0095-EF. Rockville, MD: Agency for Healthcare Research and Quality; October 2011. https://www.ahrq.gov/funding/training-grants/hsrguide/hsrguide-main-page.html https://www.ruralhealthresearch.org/ https://www.ahrq.gov/funding/training-grants/hsrguide/hsrguide-main-page.html

HRSA-24-004 RHRC Program 3

You may apply for either the:

(1) RHRC Program (base award of up to $700,000 per year for 4 years) alone; or

(2) RHRC Program (base award of up to $700,000 per year for 4 years) and Optional RHRC Supplement (of up to $250,000) awarded no more than once per year for each year of the 4-year period of performance.

See Attachment 4 for guidance in applying for the “Optional RHRC Supplement.” Such supplemental funds will be:

• Awarded at HRSA’s discretion, based on the Optional RHRC Supplement review criteria in Section V.2 Review and Selection Process;

• Subject to the appropriation of funds for each year; and

• Subject to successful performance of the recipient on the base award.

2. Background

Section 711(b) of the Social Security Act (42 U.S.C. 912(b)) authorizes the Rural Health Research Center (RHRC) Program. The Health Resources and Services Administration’s (HRSA) Federal Office of Rural Health Policy (FORHP) is the focal point for rural health activities within the Department of Health and Human Services (HHS). By statute, FORHP advises the Secretary of HHS on the effects of current policies and proposed statutory, regulatory, administrative, and budgetary changes in Medicare and Medicaid programs on the financial viability of small rural hospitals, the ability of rural areas to attract and retain physicians and other health professionals, and access to and the quality of health care in rural areas. FORHP is also authorized to administer grants, cooperative agreements, and contracts to provide technical assistance and other activities as necessary to support activities related to improving health care in rural areas. For additional information about FORHP, please see https://www.hrsa.gov/rural-health.

FORHP accomplishes its mission through a broad range of policy and program activities. Policy relevant research enhances knowledge about rural health and rural health services.

II. Award Information

1. Type of Application and Award

Application type(s): Competing Continuation, New

We will fund you via a cooperative agreement.

A cooperative agreement is like a grant in that we award money, but we are substantially involved with program activities.

Aside from monitoring and technical assistance (TA), we also get involved in these ways:

• Participating in the planning and development of the RHRC’s annual research portfolio, including the final selection of projects.

https://www.hrsa.gov/rural-health

HRSA-24-004 RHRC Program 4

• Reviewing and commenting on the RHRC’s project design and methodology in the research proposals.

• Reviewing the RHRC’s products including the methodology, analysis, results, policy implications, format, and tone prior to public dissemination.

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

• Providing consultation with the RHRC to design strategies for disseminating the RHRC’s projects and findings to multiple audiences interested in rural health issues in the form of policy briefs, journal manuscripts, chart books, presentations to policy makers, responses to health policy programs and experts, and presentations at national, state, and regional conferences.

You must follow all relevant federal regulations and public policy requirements. Your other responsibilities will include:

• Following HRSA guidelines pertaining to acknowledgement and disclaimer on all products produced with HRSA award funds.

• Following accessibility requirements based on Section 508 of the Rehabilitation Act of 1973.

• Developing research projects that aim to produce new or updated information to inform the improvement of health care in rural areas.

• Participating in the planning and development of the RHRC’s annual research portfolio, including the final selection of research projects.

• Responding to FORHP requests (including the potential execution of short-term qualitative or quantitative analyses to inform emerging policy questions as they may relate to the RHRC’s research), comments, and questions in a timely manner.

• Submitting projects to FORHP in a timely manner.

• Conducting policy-oriented health services research on rural issues and synthesizing the results into policy briefs easily understood by a non-technical audience.

• Updating preexisting research and conducting literature reviews or syntheses as part of the research portfolio, as appropriate in consultation with FORHP, for the purpose of informing the improvement of rural health care.

• Sharing research findings (e.g., policy briefs, chartbooks) for FORHP review before dissemination.

• Submitting all finalized research products to the Rural Health Research Gateway (https://www.ruralhealthresearch.org) and RHRC websites for publication.

• Designing and implementing dissemination strategies for your research results to multiple audiences interested in rural health issues in the form of policy briefs, journal manuscripts, presentations to policymakers, responses to health policy programs and experts, and presentations at national, state, and regional conferences.

• Attending annual RHRC meetings.

HRSA-24-004 RHRC Program 5

2. Summary of Funding

We estimate $5,600,000 will be available each year to fund 8 recipients. You may apply for a ceiling amount of up to $700,000 annually (reflecting direct and indirect costs). In addition, you may also apply for optional supplemental funding up to $250,000 annually (reflecting direct and indirect costs).

The period of performance is September 1, 2024, through August 31, 2028 (4 years).

This program notice depends on the appropriation of funds. If funds are appropriated for this purpose, we will proceed with the application and award process.

Support beyond the first budget year will depend on:

• Appropriation

• Satisfactory progress in meeting the project’s objectives

• A decision that continued funding is in the government’s best interest

45 CFR part 75 - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards applies to all HRSA awards.

If you’ve never received a negotiated indirect cost rate, you may elect to charge a de minimis rate of 10 percent of modified total direct costs (MTDC)*. You may use this for the life of the award. If you choose this method, you must use it for all federal awards until you choose to negotiate for a rate. You may apply to do so at any time. See Section 4.1.v. Budget Justification Narrative in the R&R Application Guide.

*Note: One exception is a governmental department or agency unit that receives more than $35 million in direct federal funding.

III. Eligibility Information

1. Eligible Applicants

You can apply if your organization is in the United States, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, Guam, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, or the Republic of Palau, and is a public or private, nonprofit, or for-profit organization. Native American tribal governments and tribal organizations are eligible to apply.

2. Cost Sharing or Matching

Cost sharing or matching is not required for this program.

3. Other

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

• Exceeds the funding ceiling amount https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75

HRSA-24-004 RHRC Program 6

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

4. Multiple Applications

We will only review your last validated application before the Grants.gov due date.

IV. Application and Submission Information

1. Address to Request Application Package

We require you to apply online through Grants.gov. Use the SF-424 Research and Related (R&R) workspace application package associated with this notice of funding opportunity (NOFO). Follow these directions: How to Apply for Grants. If you choose to submit using an alternative online method, see Applicant System-to-System.

Form Alert: For the Project Abstract Summary, applicants using the SF-424 R&R Application Package are encountering a “Cross-Form Error” associated with the Project Summary/Abstract field in the “Research and Related Other Project Information” form, Box 7. To avoid the “Cross-Form Error,” you must attach a blank document in Box 7 of the “Research and Related Other Project Information” form, and use the Project Abstract Summary Form in workspace to complete the Project Abstract Summary. See Section IV.2.i Project Abstract for content information.

Note: Grants.gov calls the NOFO “Instructions.”

Select “Subscribe” and enter your email address for HRSA-24-004 to receive emails about changes, clarifications, or instances where we republish the NOFO. You will also be notified by email of documents we place in the RELATED DOCUMENTS tab that may affect the NOFO and your application. You’re responsible for reviewing all information that relates to this NOFO.

2. Content and Form of Application Submission

Application Format Requirements Submit your information as the R&R Application Guide and this program-specific NOFO state. Do so in English and budget figures expressed in U.S. dollars. There’s an Application Completeness Checklist in the R&R Application Guide to help you.

Application Page Limit The total number of pages that count toward the page limit shall be no more than 80 pages when we print them. We will not review any pages that exceed the page limit.

Using the pages within the page limit, HRSA will determine eligibility using Section III.

Eligibility Information of the NOFO.

These items do not count toward the page limit:

• Standard OMB-approved forms you find in the NOFO’s workspace application package

• Abstract (standard form (SF) “Project_Abstract Summary”) https://www.grants.gov/ https://www.grants.gov/applicants/grant-applications/how-to-apply-for-grants https://www.grants.gov/system-to-system/applicant-system-to-system/

HRSA-24-004 RHRC Program 7

• Indirect Cost Rate Agreement

• Proof of non-profit status (if it applies)

Attachment 4, Optional RHRC Supplement, DOES count towards the 80-page limit. Attachment 4 must not exceed 5 pages. If there are other items that do not count toward the page limit, we’ll make this clear in Section IV.2.vi Attachments.

If you use an OMB-approved form that is not in the HRSA-24-004 workspace application package, it may count toward the page limit.

Applications must be complete and validated by Grants.gov under HRSA-24-004 before the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

• When you submit your application, you certify that you and your principals2 (for example, program director, principal investigator) can participate in receiving award funds to carry out a proposed project. That is, no federal department or agency has debarred, suspended, proposed for debarment, claimed you ineligible, or you have voluntarily excluded yourself from participating.

• If you fail to make mandatory disclosures, we may take an action like those in 45 CFR § 75.371. This includes suspending or debarring you.3

• If you cannot certify this, you must include an explanation in Attachment 5: Other Relevant Documents.

(See Section 4.1 viii “Certifications” of the R&R Application Guide)

Program-Specific Instructions Include application requirements and instructions from Section 4 of the R&R Application Guide (budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract). Also include the following:

i. Project Abstract

Use the Standard OMB-approved Project Abstract Summary Form that you’ll find in the workspace application package. Don’t upload the abstract as an attachment or it may count toward the page limit. See Form Alert in Section IV.1 Application Package. For information you must include in the Project Abstract Summary Form, see Section 4.1.ix of the R&R Application Guide.

NARRATIVE GUIDANCE

The following table provides a crosswalk between the narrative language and where each section falls within the review criteria. Make sure you’ve addressed everything. We

2 See definitions at eCFR :: 2 CFR 180.995 -- Principal. and eCFR :: 2 CFR 376.995 -- Principal (HHS supplement to government-wide definition at 2 CFR 180.995).

3 See also 2 CFR parts 180 and 376, 31 U.S.C. § 3354, and 45 CFR § 75.113.

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 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 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180/subpart-I/section-180.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376 https://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-prelim-title31-chapter33&edition=prelim https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-B/section-75.113

HRSA-24-004 RHRC Program 8 may consider any forms or attachments you reference in a narrative section during the merit review.

Narrative Section Review Criteria

Introduction Criterion 1: NEED

Organizational Information Criterion 5: RESOURCES/CAPABILITIES

Need Criterion 1: NEED Criterion 2: RESPONSE Criterion 4: IMPACT

Approach Criterion 1: NEED Criterion 2: RESPONSE Criterion 4: IMPACT Criterion 5: RESOURCES/CAPABILITIES

Work Plan Criterion 2: RESPONSE Criterion 4: IMPACT

Resolution of Challenges Criterion 2: RESPONSE

Evaluation and Technical Support Capacity

Criterion 3: EVALUATIVE MEASURES Criterion 5: RESOURCES/CAPABILITIES

Budget Justification Narrative Criterion 6: SUPPORT REQUESTED

ii. Project Narrative

This section must describe all aspects of the proposed project. Make it brief and clear.

Provide the following information in the following order. Please use the section headers.

This ensures reviewers can understand your proposed project.

Introduction – Corresponds to Section V’s Review Criterion #1(Need) Propose at least one area of concentration that the RHRC will focus on throughout the 4-year period of performance and briefly explain how the chosen topic(s)addresses emerging and historic health policy issues and how this relates to the improvement of health care in rural areas. You may propose to focus your work around one area of concentration for the entire RHRC or propose to include multiple areas of concentration that draw on the varied expertise of your key personnel. The topic(s) of concentration must be policy relevant and of enduring interest and importance to rural providers, rural stakeholders, policymakers, and/or the health of rural communities. HRSA is particularly interested in areas of concentration that inform payment and policy related to hospitals, primary care, post-acute care, quality and value-based care, health workforce, Medicare (including Medicare Advantage) and Medicaid, private insurance, maternal health, HRSA-24-004 RHRC Program 9 pharmacy and prescription drugs, ambulance and emergency medical services (EMS), behavioral health, health care access, and how these areas may intersect with health equity and health disparities. State whether you are also applying for the Optional RHRC supplement in the introduction. If you wish to apply for the optional supplement, include the supplement application materials in Attachment 4.

Organizational Information – Corresponds to Section V’s Review Criterion #5 (Resources/Capabilities)

Organizational Structure of the Proposed RHRC A single entity or a consortium of organizations may operate the proposed RHRC;

however, the applicant retains sole responsibility for administration of the cooperative agreement, including administering Federal funds in a manner consistent with underlying agreements, program objectives, and the terms and conditions of the Federal award. The RHRC must have its own identity including name, organizational structure, and dedicated website. This discussion should include at minimum:

o The identity of the proposed RHRC and its relationship to its operating organization(s). If a consortium operates the RHRC, you must provide this information for each organization in the consortium.

o Relevant resources (e.g., personnel, computer facilities, dedicated office space, technical or analytic support) that will support the RHRC in conducting the proposed research.

o Description of the library of data sets currently maintained by the applicant that will support rural health research, including information on the types of geo-codes on files for different definitions of rural. Indicate any plans for purchasing data sets to keep these libraries up to date, especially data files relevant for the proposed area(s) of concentration. Applicant must provide rural relevant examples (one example at a minimum) of demonstrated experience working with each data set listed. Additionally, applicant must provide proof that they have access to the geographic variables necessary to conduct rural/urban research.

Staffing Plan and Personnel Requirements Applicants must present a staffing plan and provide a justification for that plan that includes education and experience qualifications and rationale for the time being requested for each staff position. RHRC leadership must include either:

• A Principal Investigator (i.e., the Project Director) and Deputy Principal Investigator (i.e., Deputy Project Director) or

• Two Co-Principal Investigators (i.e., Co-Project Directors)

Staff of the RHRC must include:

HRSA-24-004 RHRC Program 10

Core Research Staff Technical Writer/Editor Project Manager

Except for the Principal Investigator and Deputy Principal Investigator or Co- Principal Investigators, multiple staff roles may be filled by the same person (e.g., a member of the core research staff can also fill the role of the project manager).

Include a staffing plan that presents the number of hours of FTE devoted to the proposed RHRC for each staff member and the total number of hours or FTE for all staff members, as well as job descriptions for all staff that include roles and responsibilities (Attachment 1). Provide supporting information to demonstrate the qualifications of proposed project staff through their biographical sketches (Attachment 2).

The Principal Investigator or Co-Principal Investigators must devote a substantial portion of their time to the RHRC.

If using the Principal Investigator and Deputy model, the Principal Investigator must devote at least 25 percent of their time and the Deputy at least 20 percent of their time to the RHRC.

If using the Co-Principal Investigator model, each person must devote at least 20 percent of their time to the RHRC and aggregated together they must devote the equivalent of at least 45 percent of one person’s time to the RHRC.

The Principal Investigator(s) leads the development and realization of the RHRC’s research portfolio and is the lead author on at least two of the applicant’s proposed research projects. They are responsible for the administrative aspects of the RHRC and reviewing all draft research products. They should also have a substantial number of rural health publications (at least ten) related to a proposed concentration of the RHRC, a minimum of ten years of work experience specific to rural health research, and a doctoral degree.

Describe the following regarding the Principal Investigator or the Co-Principal Investigators as applicable:

Evidence of successfully managing a research team and conducting and disseminating policy relevant rural health research.

Experience informing and educating national, state, and community decisionmakers about health and access issues for rural populations.

How they will supervise staff.

If not using the Co-Investigator model, we expect you to have a Deputy Principal Investigator. Describe the following regarding the Deputy Principal Investigator:

Experience, including roles and responsibilities in organizational lines of authority, conducting, and disseminating policy relevant rural health research.

HRSA-24-004 RHRC Program 11

Experience informing and educating national, state, and community decisionmakers about health and access issues for rural populations.

Process to assume the duties of the Principal Investigator when the Principal Investigator is on short-term (e.g., vacation) and extended (e.g., sabbatical) leave.

Strong RHRCs most often have the core research staff within the same organization and lead all projects from within that organization. The core research staff should be multi-disciplinary and have the educational and professional experience necessary to conduct research proposed by the RHRC. This may include both social science (sociology, epidemiology, demography, economics, organizational behavior, statistics, public health, political science, and/or geography) and clinical backgrounds. Describe the following:

How the disciplines of the core research staff relate to the RHRC’s topic(s) of concentration.

How the skills of the core research staff relate to implementation and execution of a rural health services research project or the dissemination of policy relevant research.

An editor or technical writer must also be included on staff whose responsibility should be to review drafts of studies prior to FORHP submission to ensure high quality and readability. This individual should be identified in the staffing plan and in the line-item budget.

A project manager will be responsible for tracking the progress of each research project from inception to completion and monitoring timeliness of submissions. The project manager should be able to provide timely information to FORHP staff on the status of each research project. This individual may also fill another role (i.e., Deputy Director or Administrative Assistant) in the proposed RHRC. This individual should be identified in the staffing plan and in the line-item budget.

OPTIONAL: Expert Work Group The applicant may choose to appoint and convene an Expert Work Group (EWG) comprised of national and regional experts in its proposed area(s) of concentration. The EWG may meet with the RHRC virtually or in-person; however, no more than $7,000 of the annual budget may be spent on this activity (including travel, per diem, and honorarium). Note: The EWG is not a requirement. HRSA leaves it to the discretion of each applicant to decide whether an EWG will strengthen its products. If you choose to include an EWG, you are encouraged to include a diverse group of rural health stakeholders (e.g., State Offices of Rural Health, health care providers, health care organizations, patients, and/or community organizations).

Need–Corresponds to Section V’s Review Criterion #1 (Need,), #2 (Response), and #4 (Impact)

The RHRCs will analyze the possible effects of policy on the 61 million residents of rural communities in the United States. Use this section to demonstrate how your

HRSA-24-004 RHRC Program 12 proposed area(s) of concentration and proposed research studies will fill information gaps and inform rural health policy to improve health care in rural areas. You must demonstrate a comprehensive understanding of the needs of the rural population as they pertain to health and health care services. Also, you must demonstrate a strong understanding of the unique characteristics of rural communities from a health care service, payment, and provider point of view as well as why rural residents are considered an underserved population. You should clearly articulate the issues and challenges facing rural communities and health care providers, as well as the associated factors that contribute to those challenges. This section will help reviewers understand whom you will serve with the proposed project.

Approach – Corresponds to Section V’s Review Criteria #1 (Need), #2 (Response), #4 (Impact), and #5 (Resources/Capabilities) In this section, you must include specific information about the proposed research projects for the first budget year. You should propose projects that would produce findings with a high likelihood of having meaningful applications that advance RHRC program goals. Propose four projects. We will identify four final projects in collaboration with each award recipient, which may align with priorities of HHS/HRSA. Competing continuation applicants must propose research projects that are not duplicative of past projects, but they may propose projects that build on or update previously funded work. Post award, HRSA and the successful applicants will collaboratively define these projects. This process may include additional input from HRSA on possible alternative projects and/or suggested project modifications, depending on policy issues at that time as they relate to the improvement of health care in rural areas. After a consultation, we will ask the awarded applicants to submit revised project proposals and a revised budget.

Your proposals must be national in scope and cannot be single state or regional studies in the first budget period; we may consider state/regional studies on a limited basis in years two through four.

You must avoid duplication with research that is already underway or recently completed by the currently funded centers. Look at the Rural Health Research Gateway to identify projects previously funded and currently underway. Projects must not duplicate or overlap with work conducted by the Flex Monitoring Team, which analyzes and presents Critical Access Hospital (CAH) data and captures best practices to inform improvement efforts and efficiently target limited resources in CAHs.

We expect that you will complete all research products proposed for the first year within the 12-month budget period.

Present four research proposals using the format outlined below. Limit each research proposal to a maximum of six pages.

https://www.ruralhealthresearch.org/ https://www.flexmonitoring.org/

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Proposal Summary

• Project title

• Lead author information (name, degree, email address)

• Two sentence project description

Research Proposal

• Statement of the problem/issue and policy relevance: Clearly state the purpose of the research. Identify the gaps in existing knowledge that the research intends to fill. State the relevance of the research and its implications for rural health policy from the perspectives of national, state, and local stakeholders and policymakers. Emphasize its potential value for members of rural communities. State how the proposed research will contribute to the current literature and how it is likely to advance the understanding of problems faced by rural communities and to have meaningful applications to improve rural health care access and population health.

• Geographic Coverage: Describe the geographic coverage and any sub-populations of focus for the research and assess how generalizable the results will be for the purpose of informing policymaking. Studies must be nationally representative or have implications for the design or implementation of national policies. Describe the ability of the data to represent varying levels of rurality. The research must include rural versus urban analyses and may include analyses by level of rurality to capture results across the rural continuum.

• Hypotheses, Design, and Analysis: State the hypothesis(es) or research questions for the research project. Thoroughly describe the project design you will use to accomplish the specific aims of the proposed study. All studies should have a quantitative component. Qualitative work should not be the foundation for a study. Include a discussion of any anticipated limitations of the study design.

• Methods and Data Sources: Identify proposed methods and data sources.

Include information on data availability, acquisition cost, and a time schedule for obtaining and preparing the data for analysis. If you plan to collect and use primary data, discuss the data collection plan including sampling methods, estimated sample size, expected response rate, data collection schedule, etc.

You must show that that the primary data collection is realistic with a high likelihood of success given available time and resources.

• Human Subjects Research: Answer the questions below.

o Are human subjects involved? If you plan for activities involving human subjects at any time during the proposed research project, indicate YES even if the proposed project is exempt from Regulations for the Protection of Human Subjects. Indicate NO if you do not plan for

HRSA-24-004 RHRC Program 14 activities involving human subjects and skip to the Staff Qualifications and Staff-loading Chart section of the NOFO.

o If the answer was YES, indicate if the Institutional Review Board (IRB) review is pending. If you have IRB approval, enter the approval date.

o If exempt from IRB approval enter the exemption numbers and a short description corresponding to one or more of the exemption categories.

See:

http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.html#46.101(

b) for a list of the six categories of research that qualify for exemption from coverage by the regulations as defined in the Common Rule for the Protection of Human Research Subjects.

o For the Human Subject Assurance Number provide the IRB approval number or the approved Federal Wide Assurance (FWA), Multiple Project Assurance (MPA), Single Project Assurance (SPA) or Cooperative Project Assurance Number (CPA) that the applicant has on file with the Office of Human Research Protections, if available.

o If the IRB has not yet reviewed and you believe your research is exempt, provide a justification for the exemption(s) with sufficient information about involvement of human subjects to allow a tentative conclusion by HRSA staff that the claimed exemption(s) seems appropriate.

o Note you cannot conduct non-exempt research involving human subjects under an HHS-sponsored award unless your organization provides verification of the justification of the exemption per HHS regulations. You must send documentation of IRB review when completed, and its exemption or approval, to the Project Officer. This IRB certification must include the grant number, the title of the project, name of the appropriate IRB that has reviewed and exempted or approved, the proposed activity, name of the lead author, date of IRB exemption or approval, and appropriate signatures.

• Staff-loading Chart: Identify the lead author and other senior staff involvement.

Include a staff-loading chart that presents the number of hours devoted to the project for each staff member and the total number of hours for each activity (e.g., data cleaning, mapping, analysis). Indicate the relevant expertise and experience of the staff.

• Timetable: Provide a schedule for the project work. You should include deliverable due dates for each project. Gantt charts are not necessary. Dates should reflect time required for data acquisition, IRB approval, etc.

• Literature Citations: Provide citations to published literature relevant to this proposal.

http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.html#46.101(b) http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.html#46.101(b)

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Work Plan – Corresponds to Section V’s Review Criteria #2 (Response) and #4 (Impact)

In this section you must describe the activities or steps proposed to complete your research projects and your dissemination plan. This discussion must include the following:

• Explanation of quality control processes, including data quality and the quality of the written products produced under this cooperative agreement.

Include plans to comply with accessibility requirements based on Section 508 of the Rehabilitation Act of 1973.

• Explanation of how you will communicate research findings in a writing style that is accessible to a nontechnical audience.

• Project management plan that will ensure each funded activity stays on track throughout the first 12-month budget period.

• A general Work Plan for budget period two through four. This SHOULD NOT include specific research projects that you will conduct during those years but should highlight activities that will span all four years of the period of performance.

• Plan for the Principal Investigator(s) to review all draft reports to assure their policy relevance, quality, and readability.

• Tracking method that allows you to respond to HRSA within a timely manner.

• Plan for reporting the number of downloads and/or views for each research product posted on the RHRC’s website as well as a plan to track journal citations, conference presentations and posters, speaking engagements (including webinars), and press inquiries and communications.

• Plan for disseminating the research products (e.g., policy briefs) produced under this cooperative agreement. At a minimum, this plan should include a strategy to:

o Develop and/or maintain a website dedicated to RHRC research that will house completed research projects.

o Provide the Rural Health Research Gateway with links to completed research products housed on the RHRC’s individual website.

o Alert users to new research products through multiple channels of communication and target dissemination to State Offices of Rural Health, policymakers, and other relevant rural stakeholders.

HRSA-24-004 RHRC Program 16

Resolution of Challenges – Corresponds to Section V’s Review Criterion #2 (Response) Discuss challenges (data authorization, accessibility, cost, etc.) that you are likely to encounter in designing and implementing the research projects proposed in the Approach section as well as the activities described in the Work Plan. Explain the approaches that you will use to resolve these challenges.

Evaluation and Technical Support Capacity – Corresponds to Section V’s Review Criterion #3 (Evaluative Measures) and Criterion #5 (Resources/Capabilities)

We will collect measures annually within the Non-Competing Continuation Application and 30 days after the end of the program year. This may not be a comprehensive list of all the necessary tracking measures, and the Notice of Award may include additional elements.

• Describe your plan for notifying HRSA prior to any public release of research directly or indirectly funded by HRSA (for instance, a courtesy copy of manuscripts submitted to HRSA prior to journal acceptance, advance notice of a presentation at a conference and any accompanying slides or materials, etc.).

• Describe your plan for measuring the broader impact of your research findings.

iii. Budget

The R&R Application Guide directions may differ from those on Grants.gov.

Follow the instructions in Section 4.1.iv Budget of the R&R Application Guide and any specific instructions listed in this section. Your budget should show a well-organized plan.

Reminder: The total project or program costs are all allowable (direct and indirect) costs used for the HRSA activity or project. This includes costs charged to the award and non-federal funds used to satisfy a matching or cost-sharing requirement (which may include MOE, if applicable). Please see Attachment 4 for guidance on requirements for the Optional RHRC Supplement.

Program Income

You must use any program income you generate from awarded funds for approved project-related activities. Use program income under the addition alternative (45 CFR § 75.307(e)(2)). Find post-award requirements for program income at 45 CFR § 75.307.

As required by the Consolidated Appropriations Act, 2023 (P.L. 117-328), 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.” Effective January 2024, the salary rate limitation is $221,900. As required by law, salary rate limitations may apply in future years and will be updated.

https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.307 https://www.congress.gov/bill/117th-congress/house-bill/2617/text

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iv. Budget Justification Narrative

See Section 4.1.v. of the R&R Application Guide.

v. Attachments

Provide the following attachments in the order we list them.

Most attachments count toward the application page limit. Indirect cost rate agreement and proof of non-profit status (if it applies) are the only exceptions. They will not count toward the page limit.

Clearly label each attachment. Upload attachments into the application. Reviewers will not open any attachments you link to.

Attachment 1: Staffing Plan (see Section 4.1. of the R&R Application Guide)

Attach the staffing plan and job descriptions, including all relevant information requested in Section IV.2.ii. Organizational Information.

Attachment 2: Biographical Sketches

Biographical sketches should include the following information: name, position title, education/training, personal statement, positions/honors, contributions to science, and additional research support. In the personal statement you may wish to briefly describe why the individuals are well-suited for their role(s) in this project. Relevant factors may include aspects of training; previous work on this specific topic or related topics; technical expertise; and/or past performance in this or related fields. You may wish to briefly describe up to three of each individual’s most significant contributions to science, and to list ongoing and completed research projects from the past four years, describing the overall goals of the projects and your responsibilities.

Include rural-relevant briefs, peer-reviewed journal articles, and other written materials and presentations at national, state, and regional conferences. For published materials include the full citation in the first reference. For presentations include author(s), title, conference name, and date. If multiple key personnel are coauthors on a publication, you may include a single list of joint publications or condense the citations after the first mention.

The biographical sketches should not exceed three pages in length per person.

Note: Upload all biographical sketches of staff and key personnel in a single document in Attachment 2 using the Attachments Form in Grants.gov. Do not upload separate biographical sketches in the Biographical Sketch field in the RESEARCH & RELATED Senior/Key Person Profile Form. If you encounter an error when completing the Profile Form, attach a blank document when required on the Profile Form.

Attachment 3: Letters of Agreement, Consortium Arrangements, Memoranda of Understanding, and/or Description(s) of Proposed/Existing Contracts (project-specific)

HRSA-24-004 RHRC Program 18

Provide any documents that describe working relationships between your organization and other entities and programs cited in the proposal. Documents that confirm actual or pending contractual or other agreements should clearly describe the roles of the contractors and any deliverable. Make sure to sign and date any letters of agreement.

Attachment 4: Optional RHRC Supplement (not scored during the objective review)

Corresponds to Review Criteria within the Review and Selection Process section, on page 25. HRSA requires this attachment ONLY if you are requesting additional funding for the Optional RHRC Supplement. Applying for this supplement does not impact the RHRC base program application review score. HRSA staff will separately score the supplement proposals. HRSA may award supplements post-award after the period of performance begins, at HRSA’s discretion, based on the Optional RHRC Supplement review criteria in Section V.2. The supplement narrative must be no longer than five pages, inclusive of both the supplement research and budget narratives. The SF-424 R&R is not subject to the five-page limit.

Optional RHRC Supplement General Guidance:

• You must apply for the RHRC program base award to apply for this Optional RHRC Supplement.

• You may submit an Optional RHRC Supplement proposal including information on the potential project and budget.

• You may propose collaborations, however, the Optional RHRC Supplement award will be to the RHRC applicant organization, which will serve as the lead.

• HRSA may award optional supplements in any of the four budget periods, subject to the appropriation of funds for each year and successful performance of the recipient on the base award.

• The Optional RHRC Supplement proposal may fall within the proposed area(s) of concentration of the RHRC, build upon research projects proposed as part of the base award, or expand into additional areas. Proposal topics must relate to the improvement of health care in rural areas and may include any topic area mentioned elsewhere in this document.