FORHP HRSA-24-014 RCORP-Impact.pdf

Notice of Funding Opportunity

Application due May 6, 2024

Rural Communities Opioid Response Program

Rural Communities Opioid Response Program - Impact Opportunity number: HRSA-24-014

Contents Before you begin 3

Step 1: Review the Opportunity 4

Basic information 5

Eligibility 6

Program description 8

Funding policies & limitations 21

Step 2: Get Ready to Apply 23

Get registered 24

Find the application package 24

Application writing help 24

Step 3: Write Your Application 25

Application contents & format 26

Step 4: Learn About Review & Award 39

Application review 40

Award notices 47

Step 5: Submit Your Application 48

Application submission & deadlines 49

Application checklist 51

Learn What Happens After Award 52

Post-award requirements & administration 53

Contacts & Support 56

Appendices 62

Endnotes 68

Contents 2

Before you begin If you believe you are a good candidate for this funding opportunity, secure your SAM.gov and Grants.gov registrations now. If you are already registered, make sure your registration is active and up-to-date.

SAM.gov registration (this can take several weeks) You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI).

See Step 2: Get Ready to Apply

Grants.gov registration (this can take several days) You must have an active Grants.gov registration. Doing so requires a Login.gov registration as well.

See Step 2: Get Ready to Apply

Apply by May 6, 2024 Applications are due by 11:59 p.m. Eastern Time on May 6, 2024.

Before you begin 3 https://sam.gov/ https://grants.gov/

Jump to a step

1. Review 2. Get ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 5

Eligibility 6

Program description 8

Funding policies & limitations 21

Basic information Federal Office of Rural Health Policy

Rural Communities Opioid Response Program

Have questions?

Go to Contacts & Support.

Key facts

Opportunity name:

Rural Communities Opioid Response Program - Impact

Opportunity number:

HRSA-24-014

Federal Assistance Listing:

93.912

Statutory authority:

42 U.S.C. 912(b)(5) (§ 711(b)(5) of the Social Security Act)

Key dates

Application deadline:

May 6, 2024

NOFO issue date:

March 6, 2024

Expected award date:

by September 1, 2024

Expected start date:

September 1, 2024

Summary The purpose of RCORP – Impact is to improve access to integrated, coordinated treatment and recovery services for substance use disorder (SUD), including opioid use disorder (OUD), in rural areas. Ultimately, RCORP-Impact aims to address the SUD/OUD crisis in rural communities and promote long-term, sustained recovery.

Funding detail Application type: New

Expected total available FY 2024 funding: $12,000,000

Expected number and type of awards: Up to 16 Grants

Funding range per award: up to $750,000 per year

The program and estimated awards depend on the future appropriation of funds and are subject to change based on the availability and amount of appropriations.

We plan to fund awards in four 12-month budget periods for a four-year period of performance of September 1, 2024 – August 31, 2028.

To help you find what you need, this NOFO uses internal links. In Adobe Reader, you can go back to where you were by pressing Alt + Left Arrow (Windows) or Command + Left Arrow (Mac).

Step 1: Review the Opportunity 5

Eligibility Who can apply

Eligible applicants All domestic public or private, non-profit, and for-profit, entities are eligible to apply.

This includes:

Institutions of higher education

• Public institutions of higher education

• Private institutions of higher education

Nonprofit entities

• Nonprofits having a 501(c)(3) IRS status

• Nonprofits with an IRS status other than 501(c)(3)

Private for-profit entities

• For-profit organizations

• Small businesses

Public entities

• State governments, including the District of Columbia, domestic territories, and freely associated states

• County governments

• City or township governments

• Special district governments

• Independent school districts

Tribes & tribal organizations

• Native American tribal governments

• Native American tribal organizations

Note: “Domestic” means the fifty States, the District of Columbia, 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.

Step 1: Review the Opportunity 6

Other eligibility criteria To be reviewed and scored, your application must:

• Specify a target rural service area that contains only counties and/or census tracts that are designated rural per the Rural Health Grants Eligibility Analyzer.

• Specify the RCORP-Impact supported direct treatment and/or recovery services that your network will deliver in every rural and partially rural county included in your target rural service area.

• Specify (in Attachment 2) at least four separately owned entities (three entities plus the applicant organization) that will serve as members of your Network.

• Demonstrate that at least 50% of the Network members are located within the target rural service area.

• Be complete, including all required attachments and narrative sections.

• Include MOUD as an RCORP-Impact supported direct treatment service.

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

• Exceeds the funding ceiling amount ($750,000 per year)

• Fails to satisfy the deadline requirements.

Cost sharing This program has no cost-sharing requirement. If you choose to share in the costs of the project, we will not consider it during merit review. We will hold you accountable for any funds you add, including through reporting.

1. Review 2. Get ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 7 https://data.hrsa.gov/tools/rural-health

Program description Purpose The purpose of RCORP – Impact is to improve access to integrated and coordinated treatment and recovery services for substance use disorder (SUD), including opioid use disorder (OUD), in rural areas. Ultimately, RCORP-Impact aims to address the SUD/OUD crisis in rural communities and promote long-term, sustained recovery.

Program Goals Goal 1: Service Delivery Establish and/or expand coordinated and comprehensive substance use disorder (SUD) treatment and recovery services.

Goal 2: Workforce Develop a responsive SUD workforce, which includes both peers and clinical providers with diverse scopes of practice.

Goal 3: Supportive Services Establish and/or enhance coordination with supportive social services to ensure that rural individuals and families impacted by SUD have the greatest opportunity possible for sustained, long-term recovery.

Goal 4: Sustainability Develop innovative, multi-sectoral approaches to ensure the continued availability of RCORP-Impact supported services in the target rural service area.

Target Population The target population for RCORP-Impact includes:

• Individuals living in HRSA-designated rural areas who are:

◦ At risk for SUD.

◦ Experiencing symptoms of SUD.

◦ In treatment for SUD.

◦ In recovery for SUD.

• Their families and/or caregivers.

• Impacted community members who reside in HRSA-designated rural areas.

Step 1: Review the Opportunity 8

Program Highlights

• You are required to provide Medication for Opioid Use Disorder (MOUD) as a part of your RCORP-Impact project.

• You cannot require abstinence or detoxification as a prerequisite for MOUD treatment except as medically necessary according to evidence-based approaches. You cannot limit the duration of MOUD treatment.

• You must deliver RCORP-Impact supported direct treatment and/or recovery services in every rural and partially rural county included in your target rural service area.

◦ These services must be physically located in every rural and partially rural county included in the target rural service area.

◦ Across your entire service area, you must provide both direct treatment and recovery services.

• You must have a mechanism in place to engage individuals in RCORP-Impact funded treatment, recovery, and supportive social services.

• You must work towards engaging Peer Recovery Specialists to support service delivery in your program.

• You are expected to account for populations within your target rural service area that have historically suffered from poorer health outcomes, health disparities, and other inequities as compared to the rest of the population.

• We strongly encourage you to incorporate at least one data focus area(s) into your approach and work plan.

◦ The data focus areas for RCORP-Impact include justice-involved populations, children and adolescents, and evolving/emerging threats related to SUD/OUD (e.g., fentanyl and xylazine).

• You must collaborate with a network of at least 4 organizations that represent different aspects of SUD care, including your organization.

◦ At least 50% of the organizations in the network must have a physical presence in the target rural service area.

• If awarded, you will participate in the RCORP-Impact learning collaborative, facilitated by the RCORP technical assistance provider.

• Required staff roles include a project director, data coordinator, healthcare navigator, and learning collaborative point of contact.

Additionally, FORHP strongly encourages applicants to consider implementing innovative activities in the following areas:

Step 1: Review the Opportunity 9

• Achieving sustainability, including through utilizing new reimbursement mechanisms (e.g., Incident-to billing to support services provided by non-physician providers).

• Securing meaningful employment for people in recovery.

• Establishing new access points for SUD treatment and recovery services, where none previously existed.

Background The Rural Communities Opioid Response Program (RCORP) is a multi-year Health Resources and Services Administration (HRSA) initiative aimed at reducing disease and death related to substance use disorder (SUD), including opioid use disorder (OUD), in high-risk rural communities.

The RCORP initiative has supported over 1,900 rural communities across 47 states and 2 territories. In 2021 alone, RCORP provided services to over 2 million individuals.

RCORP is administered through HRSA’s Federal Office of Rural Health Policy, which is charged with supporting activities related to improving health care in rural areas.

RCORP also supports the President’s National Mental Health Strategy.

According to the National Institute on Drug Abuse, more than 106,000 persons in the U.S. died from drug-involved overdose in 2021, including illicit drugs and prescription opioids. This represents a 14% increase in overdose deaths from the previous year. Of these overdose deaths, over 75% involved an opioid.[1]

From 2020 to 2021, overdose deaths were slightly lower in rural areas compared to urban areas (29.4 vs. 32.6 deaths per 100,000). However, drug overdose deaths increased at a faster rate in rural areas (67.6% increase in rural vs. 54.2% increase in urban).[2] Compounding the challenge, rural counties are nearly 3 times more likely than metropolitan counties to be a low-dispensing county for naloxone[3]. Additional challenges associated with SUD/OUD program delivery in rural areas include facility limitations, greater distances to care, and transportation coordination.[4]

Strong evidence and multiple clinical guidelines support treatment that includes access to medication for opioid use disorder (MOUD)[5]. Despite the effectiveness of MOUD, a recent study found that only 1 in 5 adults with OUD in the past year received any MOUD. The study found that those in nonmetropolitan areas were significantly less likely to receive MOUD.[6] Another recent study found that, compared to more urban counties, counties with a higher percentage of residents in rural areas were less likely to have an opioid treatment clinic that accepted Medicare - even though the SUPPORT for Patients and Communities Act generally mandated that all states cover Opioid Treatment Programs (OTP) in their Medicaid programs effective October 1, 2020. The

Step 1: Review the Opportunity 10 estimated average drive time to an OTP for people living in rural areas is 6 times greater than for those living in urban areas.[7]

Program Guidance General Project Requirements All services supported by RCORP-Impact must be:

• Responsive to the needs of the target rural service area, as they relate to the purpose of RCORP-Impact.

• Culturally and linguistically appropriate for the target rural population that you will serve.

• Easily accessible and available to the target rural population, for example offering extended treatment hours (e.g., nights and weekends), or providing transportation to appointments.

• Available to all individuals regardless of ability to pay. You may not deny services due to an inability to pay.

• Integrated and coordinated.

◦ We strongly encourage you, if possible, to establish services in a “one stop shop” model, or otherwise ensure that a variety of services are easily accessible from each location where care is provided through RCORP-Impact funding. Additional guidance can be found in the Six Levels of Collaboration/ Integration.

• Comprehensive, meaning your project should take a “whole person” approach to care.

◦ You should provide a complete suite of services to meet the needs of the target population and provide the best opportunity for long-term, sustained recovery.

◦ We strongly encourage you to coordinate with other local resources and service providers to achieve this comprehensive approach.

• Scoped to align with your budget.

Additionally, you must:

• Address all 4 RCORP-Impact goals.

• Have a mechanism in place to engage individuals in treatment, recovery, and supportive social services.

◦ This may include, but is not limited to, engaging patient navigators, conducting street-outreach, and providing active follow-up and reminders about appointments.

1. Review 2. Get ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 11 https://www.thenationalcouncil.org/wp-content/uploads/2020/01/CIHS_Framework_Final_charts.pdf?daf=375ateTbd56 https://www.thenationalcouncil.org/wp-content/uploads/2020/01/CIHS_Framework_Final_charts.pdf?daf=375ateTbd56

While your project should take a comprehensive approach to SUD-related treatment and recovery in your target rural service area, we strongly encourage you to incorporate at least one data focus area into your project approach. See Performance Reporting for more details.

Target rural service area requirements RCORP-Impact supported services may only be delivered in HRSA-designated rural counties and rural census tracts, as defined by the Rural Health Grants Eligibility Analyzer. Within partially rural counties, services supported by this award may only be delivered within HRSA-designated rural census tracts. If your target rural service area contains any counties or census tracts that are NOT designated rural per the Rural Health Grants Eligibility Analyzer, your application will not be reviewed or scored.

RCORP evaluation data indicates that programs are more successful when individuals can access services locally. To this end, you must provide RCORP-Impact supported treatment and/or recovery services in every rural and partially rural county you select.

Do not select a county/partially rural county as part of your target rural service area if you do not plan to provide RCORP-Impact services there. If you include any rural or partially rural counties in your service area where you will NOT be delivering RCORP- Impact supported services, your application will not be reviewed or scored.

Requirements for achieving RCORP Impact goals

Goal 1: Service Delivery Establish and/or expand coordinated and comprehensive substance use disorder (SUD) treatment and recovery services.

Overall guidance

• Establish new and/or significantly expand SUD treatment and recovery service line(s) in the target rural service area.

◦ You must provide direct treatment and/or recovery services in every individual rural county included within your target rural service area.

◦ Across the entire target rural service area, you must provide both direct treatment and recovery services (e.g., you may provide treatment services in one rural county and recovery services in another rural county, but you cannot only provide treatment services or only recovery services.)

• All services must target opioid use disorder and may also address other substance use disorders where there is demonstrated need.

• Services should be operational as soon as possible, ideally within the first year of the program.

1. Review 2. Get ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 12 https://data.hrsa.gov/tools/rural-health https://data.hrsa.gov/tools/rural-health

• Throughout the remainder of the period of performance, you must increase the number of individuals receiving each service. You may also, but are not required to, expand the scope of SUD services you are providing, for example:

◦ Adding locations where individuals can receive MOUD or recovery support services.

◦ Coordinating with primary care providers to offer SUD services in their practices.

◦ Performing minor renovations on an existing space to accommodate more providers and patients.

Guidance for Delivery of Treatment Services

• RCORP-Impact supported treatment services must be evidence-based and include Medication for Opiate Use Disorder (MOUD).

• You must provide MOUD as a part of your RCORP-Impact project.

◦ If you do not include MOUD in your approach and work plan, your application will be considered non-responsive, and it will not be reviewed or scored.

• Treatment services must include a shared decision-making process for all individuals with SUD, including those who are pregnant or have chronic medical conditions, about receiving MOUD.

• For patients who choose MOUD, you must make all reasonable efforts to provide access to, at a minimum:

◦ Methadone and/or buprenorphine

◦ Injectable naltrexone

• Please note that Buprenorphine is available for purchase in the 340B Drug Pricing Program by eligible covered entities.

• You cannot require abstinence/detoxification as a prerequisite for MOUD treatment except as medically necessary according to evidence-based approaches.

• You cannot limit the duration of MOUD treatment.

◦ Long-term retention in MOUD treatment is a measure of success for RCORP- Impact and is part of the required performance reporting for award recipients.

• Examples of establishing new and/or significantly expanding SUD/OUD treatment services include, but are not limited to:

◦ Purchasing a mobile health unit to provide SUD treatment (including MOUD) at easily accessible locations or after work hours.

1. Review 2. Get ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 13 https://www.hrsa.gov/opa https://www.hrsa.gov/opa

◦ Performing minor renovations to an existing structure to create space for a new access point that provides SUD treatment. Note: please reference the Minor Alteration and Renovation (A/R) Costs section of the NOFO for more information about minor renovations.

◦ Expanding the capacity of a primary care practice to provide MOUD.

Guidance for Delivery of Recovery Services

• Ensure coordination between recovery services and other services supported by RCORP-Impact, including treatment and supportive social services.

• Whether or not an individual is receiving MOUD cannot impact their being considered for recovery services.

• Examples of establishing new and/or significantly expanding SUD/OUD recovery services include, but are not limited to:

◦ Working with local businesses to create meaningful, supportive employment opportunities for individuals in recovery.

◦ Renovating an existing structure to create a new recovery home.

◦ Establishing a new recovery community organization to provide support to individuals in recovery.

Goal 2: Workforce Develop a responsive SUD workforce, which includes both peers and clinical providers with diverse scopes of practice.

• Plan activities related to recruiting, hiring, training, and retaining an SUD workforce in the target rural service area.

• Your specific activities should reflect the SUD workforce needs in your target rural service area.

• As a part of this goal, you will work with the RCORP technical assistance provider to ensure that local clinicians are able to connect with their peers for support related to treating individuals with SUD.

• You must work towards engaging Peer Recovery Specialists to support service delivery. RCORP evaluation data indicates that the use of Peer Recovery Specialists improves MOUD delivery.

• You may use RCORP-Impact funding to help qualify rural clinical locations for loan repayment programs, such as HRSA’s Substance Use Disorder Treatment and Recovery Loan Repayment Program (STAR LRP) or National Health Service Corps Rural Community Loan Repayment Program (NHSC).

• Examples of activities under Goal 2 include, but are not limited to:

1. Review 2. Get ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 14 https://nhsc.hrsa.gov/sites/eligibility-requirements https://bhw.hrsa.gov/funding/apply-loan-repayment/star-lrp https://bhw.hrsa.gov/funding/apply-loan-repayment/star-lrp https://nhsc.hrsa.gov/loan-repayment/nhsc-rural-community-loan-repayment-program

◦ Hiring a new provider through STAR LRP or NHSC to provide SUD treatment services, including MOUD.

◦ Training primary care providers to offer MOUD and providing access to peer clinical mentorship.

◦ Working with a behavioral health practice to integrate peer recovery specialists into provision of SUD treatment services.

Goal 3: Supportive Services Establish and/or enhance coordination with supportive social services to ensure that rural individuals and families impacted by SUD have the greatest opportunity possible for sustained, long-term recovery.

• Establish new supportive social services and/or collaborate with existing social services that are not currently connected with SUD treatment services.

◦ Food access, housing support and employment training and opportunities are all examples of new supportive services you can establish.

◦ An example of collaborating with existing social services is coordinating with an existing transportation company to offer rides to and from appointments.

• You must ensure that supportive social services directly address the needs of the target rural population and are easily accessible and integrated with RCORP- Impact supported SUD services.

• Examples of activities under Goal 3 include, but are not limited to:

◦ Working with local transportation resources to provide free transport to SUD treatment appointments and recovery services.

◦ Coordinating with childcare providers to offer childcare for parents and caregivers, so that they can attend treatment appointments.

◦ Coordinating with a local food bank to ensure that individuals impacted by SUD have consistent and reliable access to healthy food.

• You may also include evidence-based services to prevent individuals from beginning substance use in the first place.

◦ Prevention services are notrequired as part of RCORP-Impact but are allowable if they are evidence based and there is a specific need in the target rural service area.

• Examples of allowable prevention services may include (but are not limited to):

◦ Implementing an evidence-based prevention curriculum in local schools.

◦ Training providers on non-opioid pain management approaches.

◦ Providing mental health services.

◦ Developing infrastructure for sustainable and strategic naloxone distribution

Step 1: Review the Opportunity 15

Goal 4: Sustainability Develop innovative, multi-sectoral approaches to ensure the continued availability of RCORP-Impact supported services in the target rural service area. It is critical to ensure that all grant-funded services (established under Goals 1, 2, and 3) remain available after RCORP-Impact funding ends, so that individuals impacted by SUD can continue receiving treatment, recovery, and social services support.

• Throughout the period of performance, you should work with your network (see Network Requirements) to make RCORP-Impact supported services sustainable.

• You must engage a Healthcare Navigator to help enroll eligible individuals into health insurance and maximize opportunities for your network to bill for services.

◦ This will help ensure the sustainability of clinical services after the RCORP- Impact project ends.

• Examples of activities under Goal 4 include, but are not limited to:

◦ Leveraging other funding streams available within the community to enhance and sustain SUD services.

◦ Ensuring effective and efficient billing for third party reimbursement (see Appendix B for Third Party Payor guidance).

◦ Assisting individuals with health insurance enrollment and providing benefits counseling.

◦ Demonstrating the collective impact of the network to secure durable community buy-in.

◦ Establishing new partnerships beyond the network to further support RCORP-Impact services.

• You will also receive personalized technical assistance throughout your project, to help plan for the sustainability of RCORP-Impact funded services.

Network requirements Individuals often need access to a variety of different resources and services to successfully enter long-term recovery from SUD. This can be especially challenging in rural communities where such resources and services may be less available or separated by significant distances. Therefore, you must implement your RCORP-Impact project as part of a network of organizations that represent different aspects of SUD care.

Network-specific guidance

• You must specify the organizations that will be in your network. Your network must consist of at least 4 separately owned entities (your organization plus 3 additional organizations).

Step 1: Review the Opportunity 16

• Your network must represent a diversity of sectors relevant to SUD in your target rural service area.

• Applications with fewer than 4 network members, including the applicant organization, will be deemed non-responsive and will not be reviewed or scored.

• Additionally, at least 50% of your network members must have a physical location (either a headquarters or a satellite site) within the target rural service area. If you don’t meet this requirement, we will deem your application non-responsive and it will not be reviewed or scored.

• Each member of your network must be fully integrated into the RCORP-Impact project and have clear roles and responsibilities in your work plan.

• At a minimum, network members should commit to:

◦ Meeting regularly (at least once a quarter).

◦ Coordinating with other network members on RCORP-Impact activities.

◦ Sharing aggregate data for performance reporting to HRSA.

◦ Sustaining services after the period of performance ends.

◦ Developing approaches to ensure continuity of operations to minimize the impact of potential service disruptions such as staffing changes, clinician turnover, public health emergencies, severe weather.

• We strongly encourage you to consider engaging at least some the following sectors in your network, as well as any sectors relevant to your Data Focus area, if applicable:

◦ Primary Care

◦ Crisis Care (including first responders and hospital emergency departments)

◦ Mental Health Care

◦ Pharmacy

◦ Justice-Involved

◦ Transportation

◦ Education

• We strongly encourage you to consider budgeting RCORP-Impact funds to support network members’ participation in the project.

• You must provide a letter of support from each organization that will participate as a member of your network (see Attachment 3).

◦ If awarded, you must submit a single letter of commitment signed by each network member within 90 days of the project start date.

Step 1: Review the Opportunity 17

Learning Collaborative If awarded, you will participate in the RCORP-Impact learning collaborative, facilitated by the HRSA-funded RCORP technical assistance provider. The learning collaborative will offer the opportunity to network, share best practices, address challenges, and receive targeted technical assistance for your project.

• You must designate one individual to serve as the point of contact for the learning collaborative.

• We anticipate that the Learning Collaborative will begin meeting no later than 6 months into the period of performance.

Performance Reporting As a requirement of RCORP-Impact, you will report annually on a variety of broad, community-based performance measures to track your progress towards achieving the RCORP-Impact goals. In addition, you will also report on performance measures in the following Data Focus Areas, if applicable:

Data Focus #1: Justice-Involved Populations Brief Background: Compared to the general population, in the 2 weeks after release from incarceration, individuals are 129 times more likely to overdose, and 13 times more likely to die from an overdose.[8] Providing access to medication for opioid use disorder during incarceration reduces the risk of opioid overdose upon release.

Measures: You will report on 1 – 3 measures that reflect delivery of services to individuals at risk of incarceration, currently incarcerated, or recently released from incarceration. Measures have not been finalized, but will likely reflect the number of individuals in this population receiving services, the types of services being provided, etc.

Data Focus #2: Children and Adolescents Brief Background: According to the 2021 National Survey of Children’s Health, 23.3% of children aged 3-17 have experienced a mental, emotional, developmental, or behavioral health problem.[9] Moreover, in 2020, 546 adolescents aged 12-17 died of a drug overdose – nearly double the number of deaths in 2019.[10]

Measures: You will report on 1 – 3 measures that reflect delivery of services to children and adolescents ages 5 – 17. Measures have not been finalized, but will likely reflect the number of individuals in this population receiving services, the types of services being provided, etc.

Step 1: Review the Opportunity 18

Data Focus #3: Evolving and emerging threats related to

SUD & OUD

Brief Background: From 2012 through 2019, rates of drug overdose deaths involving psychostimulants with abuse potential (drugs such as methamphetamine, amphetamine, and methylphenidate) were 1.4 times higher in rural counties than in urban counties.[11] In April 2023, the Biden-Harris administration designated fentanyl adulterated or associated with xylazine as an “emerging threat to the United States.”[12]

Measures: You will report on 1 – 3 measures that reflect delivery of services related to substances other than opioids. Measures have not been finalized but will likely reflect your network’s needs and activities around non-opioid substances of concern in your community.

The RCORP Evaluation Provider will provide guidance and support for data collection and reporting. We strongly encourage you to incorporate at least one of the data focus areas into your project approach, and to include organizations in your network that represent your chosen data focus area(s).

Staffing Requirements To achieve RCORP-Impact goals and meet the program requirements, you must include the following roles in your project. Individuals may fulfill more than one role:

Project Director

• Primary point of contact and leadership for the award.

• Directs project activities.

• Makes staffing, financial, or other adjustments to align project activities with the project outcomes.

• Engages community members and key stakeholders to implement project activities.

• Must attend monthly calls with HRSA program staff and the HRSA-funded RCORP technical assistance team.

• You may decide the job qualifications and percentage of effort needed to effectively fulfill these duties, but we strongly recommend a minimum time commitment of at least .25 FTE for the Project Director.

• List the designated Project Director in Box 8f of the SF-424 Application Page.

Step 1: Review the Opportunity 19

Healthcare Navigator

• Helps enroll eligible individuals into health insurance to maximize opportunities to bill for services.

• Assists with post-enrollment activities, such as requesting pre-authorization for services, appealing coverage decisions, etc.

• You may decide the job qualifications and percentage of effort needed to effectively fulfill these duties.

Learning Collaborative Point of Contact

• Participates in monthly learning collaborative meetings.

• Should be a key staff member with the authority to speak on behalf of your project.

• You may decide the job qualifications and percentage of effort needed to effectively fulfill these duties.

Data Coordinator

• Coordinates with your network members to collect, aggregate, track, and report quantitative and qualitative data and information to fulfill HRSA’s reporting requirements.

• You may decide the job qualifications and percentage of effort needed to effectively fulfill these duties.

Diversity, Equity, and Inclusion You are expected to account for populations within your target rural service area that have historically suffered from poorer health outcomes, health disparities, and other inequities as compared to the rest of the population.

Examples of these populations include, but are not limited to, racial and ethnic minorities, LGBTQ+ individuals, socioeconomically disadvantaged populations, new immigrants, people who are homeless, and individuals with disabilities.

Upon award, the HRSA-funded RCORP technical assistance provider and your project officer will provide guidance on identifying these populations and incorporating them into your work plan. However, we encourage you to consider these populations as you write your application.

Step 1: Review the Opportunity 20

Funding policies & limitations Policies

• We will only make awards if this program receives funding. If Congress appropriates funds for this purpose, we will move forward with the review and award process.

• Support beyond the first budget year will depend on:

◦ Appropriation of funds

◦ Satisfactory progress in meeting the project’s objectives

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

• We may reduce funding or take other actions after the first year if you are not making reasonable progress on achieving the goals of your application.

• See Appendix B for guidance and requirements on Third Party Payor Guidance.

Limitations

• For guidance on some types of costs we do not allow or restrict, see Budget in section 4.1.iv of the Application Guide. You can also see 45 CFR part 75, General Provisions for Selected Items of Cost.

• For-profit organizations cannot earn profit from the federal award. See 45 CFR 75.216(b).

You cannot use funds under this notice for the following:

• To acquire real property.

• To purchase syringes.

• For construction, except minor alteration and renovation as described in Minor Alteration and Renovation (A/R) Costs.

• To pay for any equipment costs not directly related to the purposes for which this grant is awarded.

• To pay down bad debt. Bad debt is debt that has been determined to be uncollectible, including losses (whether actual or estimated) arising from uncollectible accounts and other claims. Related collection and legal costs arising from such debts after they have been determined to be uncollectible are also unallowable.

1. Review 2. Get ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 21 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR5d90ba314caea08 https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR5d90ba314caea08 https://www.ecfr.gov/current/title-45/part-75#p-75.216(b) https://www.ecfr.gov/current/title-45/part-75#p-75.216(b)

• To pay the difference between the cost to a provider for performing a service and the provider’s negotiated rate with third-party payers (i.e., anticipated shortfall).

• To supplant any services/funding sources that already exist in the service area(s).

See Manage Your Grant for other information on costs and financial management.

Indirect costs Indirect costs are those incurred for a common or joint purpose across more than one project and that cannot be easily separated by project (like utilities for a building that supports multiple projects). Learn more at 45 CFR 75.414, Indirect Costs.

You determine indirect costs using one of two methods:

Method 1 – Approved rate. You currently have an indirect cost rate approved by your cognizant federal agency at the time of award.

Method 2 – De minimis rate. Per 45 CFR 75.414(f), if you have never received a negotiated indirect cost rate, you may elect to charge a de minimis rate.

This rate is 10% of modified total direct costs (MTDC). See 45 CFR 75.2 for the definition of MTDC. You can use this rate indefinitely. If you use this rate, you must use it for all federal awards unless you negotiate a rate.

Program income Program income is money earned as a result of your award-supported project activities. You will have to use those funds to add to approved project activities. Find more about program income at 45 CFR 75.307.

1. Review 2. Get ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 22 https://www.hrsa.gov/grants/manage-your-grant https://www.ecfr.gov/current/title-45/section-75.414 https://www.ecfr.gov/current/title-45/part-75#p-75.414(f) https://www.ecfr.gov/current/title-45/part-75#p-75.2(Modified%20Total%20Direct%20Cost) https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.307

Step 2:

Get Ready to Apply

In this step

Get registered 24

Find the application package 24

Application writing help 24

Get registered SAM.gov You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI). SAM.gov registration can take several weeks. Begin that process today.

To register, go to SAM.gov Entity Registration and click Get Started. From the same page, you can also click on the Entity Registration Checklist for the information you will need to register.

Grants.gov You must also have an active account with Grants.gov. You can see step-by step instructions at the Grants.gov Quick Start Guide for Applicants.

Find the application package The application package has all the forms you need to apply. You can find it online. Go to Grants Search at Grants.gov and search for opportunity number HRSA-24-014.

After you select the opportunity, we recommend that you click the Subscribe button to get updates.

Application writing help Visit HHS Tips for Preparing Grant Proposals.

Visit HRSA’s How to Prepare Your Application page for more guidance.

Join the webinar For more information about this opportunity, join the webinar on March 21, 2024, at 1pm ET. You can join the webinar through HRSA’s Zoom.

If you are not able to join through your computer, you can call in at 833-568-8864 with meeting ID 82197459.

We will record the webinar. If you are not able to join live, you request a recording by emailing ruralopioidresponse@hrsa.gov .

Need Help? See Contacts & Support.

1. Review 2. Get ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 2: Get Ready to Apply 24 https://sam.gov/content/entity-registration https://grants.gov/applicants/applicant-registration http://www.grants.gov/quick-start-guide/applicants https://www.grants.gov/search-grants https://www.hhs.gov/grants-contracts/grants/get-ready-for-grants-management/tips-for-preparing-grant-proposals/index.html https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://hrsa-gov.zoomgov.com/j/1607379691?pwd=SG9hOXdxNmUyc3lYN0gvaGh3ZHFwdz09 mailto:ruralopioidresponse@hrsa.gov

Step 3:

Write Your Application

In this step

Application contents & format 26

Application contents & format Applications include 5 main components. This section includes guidance on each.

There is a 60 page limit for the overall application.

Submit your information in English and express budget figures using U.S. dollars.

Make sure you include each of these:

Components Submission Format Included in the page limit?

Project abstract Use the Project Abstract Summary form No

Project narrative Use the Project Narrative Attachment form Yes

Budget narrative Use the Budget Narrative Attachment form Yes

Attachments Insert each in the Other Attachments form. Yes, unless otherwise marked.

Other required forms Upload using each required form. No

Required format You must format your narratives and attachments using our required formats for fonts, size, margins, etc. See the formatting guidelines in section 4.2 of the Application Guide.

Project abstract Complete the information in the Project Abstract Summary Form. Include a short description of your proposed project. Include the needs you plan to address, the proposed services, and the population groups you plan to serve. For more information, see section 4.1.ix of the Application Guide.

Project narrative In this section, you will describe all aspects of your project.

Use the section headers and the order below.

1. Review 2. Get ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Write Your Application 26 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf

Background See merit review criterion 1: Background

• State the objective(s) of your proposed project.

• Briefly describe the target rural service area.

• Briefly describe target rural population.

• Briefly summarize the needs you are planning to address with your project.

• State the data focus area(s) that you are addressing in your project, if applicable.

Organizational information See merit review criterion 2: Organizational information

Overview

• Describe how the mission of your organization and the scope of current organizational activities align with the purpose and goals of RCORP-Impact.

• Describe your organization’s connections and partnerships within the target rural service area and target rural population.

• Describe how the leadership of your organization will support the implementation of your proposed RCORP-Impact project.

• Describe how the different components of your organization, apart from leadership, will support the implementation of your proposed RCORP-Impact project and the effective management of HRSA funds.

• Describe how you will ensure that implementation of the project can begin on the project period start date.

• Describe how your organization will work with your network to manage staff and clinician turnover and ensure continuity of the project’s operations and services.

• In Attachment 8, provide an organizational chart.

Staffing Plan

• Describe how you will manage your proposed project and ensure that the work plan is implemented effectively.

• Provide a high-level summary of your proposed staffing plan.

• For positions that are currently vacant, describe how you will quickly fill the position if awarded, to avoid any delays in implementing the work plan.

• In Attachment 5, provide a staffing plan.

Step 3: Write Your Application 27

Staff Biosketches

• For each staff member reflected in the staffing plan, provide a brief biographical sketch in Attachment 6 that clearly demonstrates the staff member has appropriate and applicable experience for their role on the project.

◦ If an individual is fulfilling multiple roles in the proposed project, you may use a single biographical sketch to address their qualifications for each role.

◦ The names reflected in the staffing plan must align with the names identified in the biographical sketches.

Network

• Describe how the network will be structured and managed.

• Describe how you will engage network members to ensure effective and productive collaboration.

• Describe how the network members represent the sectors that are necessary to support a coordinated, comprehensive, and sustainable approach to SUD services in the target rural service area.

• Describe how you will ensure that all network members have the capability and agree to share aggregate data to meet HRSA performance reporting requirements.

• In Attachment 2, include information for all organizations that will serve in the network.

• In Attachment 3, include a letter of support from each individual network member.

• In Attachment 7, attest that the network will meet at least quarterly.

Approach See merit review criterion 3: Approach

Goal 1: Service Delivery Establish and/or expand coordinated and comprehensive substance use disorder (SUD) treatment and recovery services.

Justification of Need

• Use recent, reliable quantitative data to justify the need for new or expanded SUD treatment and recovery services in the target rural service area.

• Describe how the target population is currently accessing SUD treatment and recovery services (both within and outside of the target rural service area) and why these services are insufficient to meet the need and demand.

Step 3: Write Your Application 28

• Demonstrate that the estimated number of individuals in need of treatment and recovery services is proportional to the scope of treatment and recovery services you plan to implement.

Approach PART A: SUD Treatment and Recovery Services As a reminder, you must provide direct treatment and/or recovery services in every county/partially rural county included within your target rural service area. You must provide both treatment and recovery services across the entire target rural service area.

• Describe in detail how you will establish new SUD treatment service lines and/or significantly expand existing SUD treatment service lines.

• For each proposed SUD treatment service line:

◦ Describe in detail the treatment service(s) you will provide with RCORP- Impact funds. Include the physical address(es) where you will provide the treatment service(s), and the specific population that you anticipate will receive the treatment service(s).

◦ State whether the treatment service(s) is being newly established, or significantly expanded.

▪ For new treatment service(s), provide an estimate of the number of individuals you expect to serve with each service.

▪ For expanding existing treatment services, describe in detail the scope of the expansion, including the current capacity of the service, the magnitude of your planned expansion, and the number of additional individuals you plan to serve.

• Describe how you will increase the number of individuals receiving the RCORP- Impact treatment service(s) throughout the project period.

• Describe in detail how you will establish new SUD recovery service lines and/or significantly expand existing SUD recovery service lines in the target rural service area.

• For each proposed SUD recovery service line:

◦ Describe in detail the recovery service(s) you will provide with RCORP-Impact funds. Include the physical address(es) where you will provide the recovery service(s), and the specific population that you anticipate will receive the recovery service(s).

◦ State whether the recovery service(s) is being newly established, or significantly expanded.

▪ For new recovery service(s), provide an estimate of the number of individuals you expect to serve with each service.

Step 3: Write Your Application 29

▪ For expanding existing recovery services, describe in detail the scope of the expansion, including the current capacity of the service, the magnitude of your planned expansion, and the number of additional individuals you plan to serve.

• Describe how you will increase the number of individuals receiving the RCORP- Impact supported recovery service(s) throughout the project period.

• In Attachment 4, include information about each physical location where you will deliver RCORP-Impact supported treatment and/or recovery services.

PART B: Access to SUD Treatment and Recovery Services

• Describe how you will ensure that the RCORP-Impact supported treatment and recovery services are integrated, coordinated, comprehensive, and easily accessible.

• Describe how you will engage individuals in the RCORP-Impact supported treatment and recovery services described above and ensure they are supported in accessing these services over the long term.

• Describe how you will ensure that RCORP-Impact supported treatment and recovery services are culturally and linguistically appropriate for your target rural population.

◦ Include how you will work to make services accessible to populations in the target service area that have historically suffered from poorer health outcomes, health disparities, and other inequities as compared to the rest of the population.

In Attachment 7, attest that:

• You will not require abstinence/detoxification as a prerequisite for RCORP-Impact supported MOUD treatment except as medically necessary according to evidence-based approaches.

• You will not limit the duration of MOUD treatment.

• For patients who choose MOUD, you will make all reasonable efforts to provide access to, at a minimum both:

◦ Methadone and/or buprenorphine

◦ Injectable naltrexone

• No individuals will be denied services due to an inability to pay.

• You will work with the HRSA-funded RCORP-TA coordinator to identify populations in the target service area that have historically suffered from poorer health outcomes and incorporate them into your work plan.

Step 3: Write Your Application 30

Goal 2: Workforce Develop a responsive SUD workforce, which includes both peers and clinical providers with diverse scopes of practice.

Justification of Need

• Use recent, reliable quantitative data to specifically describe the SUD workforce needs in the target rural service area.

• Include a description of the existing SUD workforce in your target rural service area, its current capacity to serve individuals impacted by SUD, and why this is not sufficient to meet the need and demand.

Approach

• Describe in detail how you will develop a responsive SUD workforce in your target rural area.

◦ Include how you will engage and support both peer recovery specialists and clinical providers with diverse scopes of practice to ensure…