FORHP HRSA-24-083 (G59) Rural NBR Outreach_FINAL.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2024

Federal Office of Rural Health Policy

Community-Based Division

Rural Northern Border Region Outreach Program

Funding Opportunity Number: HRSA-24-083

Funding Opportunity Type(s): New

Assistance Listing Number: 93.912

Application Due Date: June 25, 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: April 26, 2024

Maribel Nunez

Public Health Analyst, Federal Office of Rural Health Policy

Call: 301-443-0466

Email: MNunez@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C. 254c(e) (§ 330A(e) of the Public Health Service Act) mailto:MNunez@hrsa.gov

HRSA-24-083 RNBR-OP 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 Northern Border Region Outreach Program

Funding Opportunity Number: HRSA-24-083

Assistance Listing Number: 93.912

Due Date for Applications: June 25, 2024

Purpose: The purpose of this program is to promote the delivery of health care services to rural underserved populations in the rural Northern

Border Regional Commission (NBRC) Region of

Maine, New Hampshire, New York, and Vermont.

Program Objective(s): • Expand the delivery of new and enhanced health care services exclusively in the

Northern Border rural communities;

• Deliver health care services through a strong consortium, in which every consortium member organization is actively involved and engaged in the planning and delivery of services;

• Utilize community engagement and evidence-based or innovative, evidence informed model(s) in the delivery of health care services; and

• Improve population health, and demonstrate health outcomes and sustainability

Eligible Applicants: • Shall be physically located within Maine, New Hampshire, New York, or Vermont (the

Northern Border Regional Commission

(NBRC) member states) and

HRSA-24-083 RNBR-OP ii

• Shall be a domestic public or private, non-profit or for-profit entity with demonstrated experience serving, or the capacity to serve rural underserved populations and

• Shall represent a consortium of participants

– (i) that include at least three or more health care provider organizations (including the applicant organization); and (ii) that may be rural, urban, nonprofit or for-profit entities, 1 and

• Shall not previously have received an award under this subsection for the same or similar project, unless the entity is proposing to expand the scope of the project or the area that will be served through the project.

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

Anticipated FY 2024 Total

Available Funding:

$3,000,000

Estimated Number and Type of

Award(s):

Up to 12 new grants total; at a minimum, approximately 1 grant will be awarded to an applicant located within each state of the Northern

Border Regional Commission (NBRC).

Estimated Annual Award

Amount:

Up to $250,000 per award, subject to the availability of appropriated funds

Cost Sharing or Matching

Required:

No

Period of Performance: September 30, 2024 through September 29, 2027

(3 years)

1For more information on HRSA-designated rural areas, visit the Rural Health Grants Eligibility Analyzer.

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

HRSA-24-083 RNBR-OP iii

Agency Contacts: Business, administrative, or fiscal issues:

Lissette Young Grants Management Specialist Division of Grants Management Operations, OFAM

Email: lyoung@hrsa.gov

Program issues or technical assistance:

Maribel Nunez

Public Health Analyst, Federal Office of Rural Health Policy

Email: MNunez@hrsa.gov

Application Guide

You (the applicant organization / agency) are responsible for reading and complying with the instructions included in this NOFO and in HRSA Application Guide (Application

Guide). Visit HRSA’s How to Prepare Your Application page for more information.

Technical Assistance

We have scheduled the following webinar:

Thursday, May 9, 2024

2:00 – 3:00 p.m. ET

Weblink: https://hrsa-gov.zoomgov.com/j/1605060753?pwd=SG45Zy9QSkRTTzNOOWVEdG56RWdEUT

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

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

Meeting ID: 160 506 0753

Passcode: 82446382

We will record the webinar. Playback information can be requested at

MNunez@hsa.gov.

mailto:lyoung@hrsa.gov mailto:MNunez@hrsa.gov http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://hrsa-gov.zoomgov.com/j/1605060753?pwd=SG45Zy9QSkRTTzNOOWVEdG56RWdEUT09 https://hrsa-gov.zoomgov.com/j/1605060753?pwd=SG45Zy9QSkRTTzNOOWVEdG56RWdEUT09 https://hrsa-gov.zoomgov.com/j/1605060753?pwd=SG45Zy9QSkRTTzNOOWVEdG56RWdEUT09 mailto:MNunez@hsa.gov

HRSA-24-083 RNBR-OP 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

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Attachments

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

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: PAGE LIMIT WORKSHEET

APPENDIX B: NORTHERN BORDER REGIONAL COMMISSION (NBRC) REGION 41

HRSA-24-083 RNBR-OP 1

I. Program Funding Opportunity Description

1. Purpose

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

Border Region Outreach Program (RNBR-OP).

The purpose of this program is to promote the delivery of health care services to rural underserved populations in the rural Northern Border Regional Commission (NBRC)

Region of Maine, New Hampshire, New York, and Vermont. Through a consortia of local health care and social service providers, communities can develop innovative approaches to challenges related to specific health needs that expand clinical and service capacity.

The overarching goals for the RNBR Outreach Program are to:

• Expand the delivery of health care services to include new and enhanced services exclusively in the Northern Border rural communities;

• Deliver health care services through a strong consortium, in which every consortium member organization is actively involved and engaged in the planning and delivery of services;

• Utilize community engagement and evidence-based or innovative, evidence informed model(s) in the delivery of health care services; and

• Improve population health and demonstrate health outcomes; and

• Increase financial sustainability.

This Program allows the applicant the flexibility to determine your unique community needs and focus area(s), based on historical health care context, expertise, and relevant data sources in the community. As such, applicants are expected to propose projects that:

• Clearly identify a health care focus area(s) that your grant activities will address.

• Describe how rural communities participated in the identification of the grant project focus area indicated.

• Emphasize how the project will benefit the rural community or communities.

• How your proposed grant activities and identified focus area(s) will improve health equity.

Examples of health care focus areas include (but are not limited to): mental/behavioral health, healthcare workforce development; community health workers, addressing health disparities, rural hospital financial and operational improvement; impacts of rural hospital closure; care coordination; patient engagement, data analytics/health information technology; and telehealth.

https://www.nbrc.gov/

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For more details, see Program Requirements and Expectations.

2. Background

The Rural Northern Border Region Outreach Program (RNBR-OP) is authorized by 42

U.S.C. 254c(e) (§ 330A(e) of the Public Health Service Act). This program aims to help rural communities in the Northern Border Regional Commission (NBRC) Region better address their health care needs.

The NBRC is a federally established commission with a defined region (see 40 USC

Subtitle V). The NBRC is a federal-state partnership for economic and community development in Maine, New Hampshire, New York, and Vermont. See Appendix B:

NBRC Region.

The 60 counties located in the NBRC Region are some of the most distressed counties in the four northeastern border states.2 56 of these counties are considered rural (non-metropolitan area) and are home to approximately 3,414,300 residents.3

A landscape assessment of the NBRC Region showed several poor health outcomes that include:

• Higher suicide rates compared to the national average,

• Higher drug overdose rates compared to the national average, and

• Higher rates of mental distress, cancer, and excessive drinking3

The landscape assessment also showed that most NBRC Region counties are in some classification of a shortage area:

• 55 of 60 NBRC counties are designated as a partial primary care health professional shortage area,

• 46 of 60 counties are designated as a partial mental health professional shortage area, and

• 46 of 60 counties are designated as a partial dental health region professional shortage area3

The RNBR-OP encourages creative projects that aim to work on key public health issues. RNBR-OP encourages evidence-based projects that address the needs of wide range population groups including but not limited to, low-income populations, the elderly, pregnant women, infants, adolescents, rural minority populations, and rural populations with special health care needs.

To view abstracts of projects in the NBRC, visit HRSA’s Data Workhouse and/or https://www.ruralhealthinfo.org/search?q=northern+border+region.

2 Northern Border Regional Commission. www.nbrc.gov 3 Rural Health Grants Eligibility Analyzer. HRSA, https://data.hrsa.gov/tools/rural-health file:///C:/Users/klloyd/Downloads/HYPERLINK%23AppendixA file:///C:/Users/klloyd/Downloads/HYPERLINK%23AppendixA https://www.ruralhealthinfo.org/search?q=northern+border+region http://www.nbrc.gov/

HRSA-24-083 RNBR-OP 3

II. Award Information

1. Type of Application and Award

Application type: New

We will fund you via a grant.

2. Summary of Funding

We estimate up to $3,000,000 will be available each year to fund up to 12 recipients.

You may apply for a ceiling amount of up to $250,000 annually (reflecting direct and indirect costs).

The period of performance is September 30, 2024 through September 29, 2027 (3 years).

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 Narrative in the Application Guide.

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

Due to the NBRC Region’s limited geographic area, at a minimum, approximately one applicant will be awarded from each of the following NBRC Region states: Maine, New

Hampshire, New York and Vermont. Funding will support RNBR-OP activities to promote the delivery of health care services to rural underserved populations across the

NBRC Region.

III. Eligibility Information

1. Eligible Applicants

You can apply if your organization meets all three of the following criteria:

https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 https://www.hrsa.gov/sites/default/files/hrsa/grants/sf424-application-guide.pdf

HRSA-24-083 RNBR-OP 4

1. You can apply if your organization is in the United States and is:

• Public or private, non-profit or for-profit

• Community-based

• Tribal (governments, organizations)

2. You can apply if your organization meets the following geographic requirements:

• You are an organization physically located within Maine, New Hampshire, New York, or Vermont (NBRC member states) Appendix B.

• You are an organization with demonstrated experience serving, or the capacity to serve, rural underserved populations located in the NBRC Region

(see Appendix B).

3. You can apply if your organization meets the following consortium requirements:

• You are an organization representing a consortium composed of three or more health care provider organizations, including the applicant organization, with at least 66 percent (two-thirds) of consortium members located in a

HRSA-designated rural area, as defined by the Rural Health Grants Eligibility

Analyzer.

Applicants will be deemed non-responsive and will not be considered for this funding opportunity if the applicant:

• is located outside of Maine, New Hampshire, New York, or Vermont;

• submits an application to serve populations outside of HRSA designated rural counties or rural census tracts in the NBRC Region (see Appendix B); and

• submits more than one application.

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

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

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

• Fails to satisfy the deadline requirements referenced in Section IV.4 https://data.hrsa.gov/tools/rural-health https://data.hrsa.gov/tools/rural-health.

HRSA-24-083 RNBR-OP 5

Multiple Applications

You may submit multiple applications under the same Unique Entity Identifier (UEI), if each proposes distinct projects. We will only review your last validated application before the Grants.gov due date. See below ‘Exception Request’ for more information.

Exception Request

A. Multiple EIN exception: Multiple applications associated with the same UEI

(previously DUNS) number and/or EIN are not allowable. However, HRSA recognizes a growing trend towards greater consolidation within the rural health care industry and the possibility that multiple organizations may share an EIN and/or UEI with its parent organization. As a result, at HRSA’s discretion, separate applications associated with a single UEI number and/or EIN are allowable, as long as the applicants provide HRSA with all of the information requested in Attachment 9.

NOTE: Single organizations (e.g., a parent organization/headquarters) cannot submit multiple applications, even if the proposed projects are different. If the parent organization applies using the legal and/or “doing business as” name of the parent or satellite sites, for the purposes of this program, it is still considered an application submitted by the parent organization and thus, multiple applications are not allowed.

Applications associated with the same UEI number and EIN should be independently developed and written. HRSA reserves the right to deem applications that provide insufficient information in Attachment 9, or are nearly identical in application content, to be ineligible. In this instance, assuming all other eligibility criteria are met, HRSA will only accept the last submitted application for HRSA-24-083 associated with the EIN or

DUNS number.

B. Tribal exception: HRSA is aware that tribes and tribal organizations may have an established infrastructure without separation of services recognized by filing for EINs and/or UEI. In case of tribes and tribal governments, only a single EIN or

UEI located in a HRSA-designated rural area is necessary to meet the network requirements. Tribes and tribal entities under the same tribal governance must still meet the network criteria of three or more entities under the single EIN and/or

UEI are committed to the proposed approach as evidenced by a signed Letter of

Commitment. Please refer to Attachment 9 for additional information on how to request this exception.

HRSA-24-083 RNBR-OP 6

IV. Application and Submission Information

1. Address to Request Application Package

We require you to apply online through Grants.gov. Use the SF-424 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.

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

Select “Subscribe” and enter your email address for HRSA-24-083 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 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 Application Guide to help you.

Application Page Limit

The total number of pages that count toward the page limit shall be no more than 40 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”)

• Indirect Cost Rate Agreement

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

If there are other items that do not count toward the page limit, we’ll make this clear in

Section IV.2.v Attachments.

If you use an OMB-approved form that is not in the HRSA-24-083 workspace application package, it may count toward the page limit.

Applications must be complete and validated by Grants.gov under HRSA-24-083 before the deadline.

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-24-083 RNBR-OP 7

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

• When you submit your application, you certify that you and your principals4 (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.5

• If you cannot certify this, you must include an explanation in Attachment 10-15:

Other Relevant Documents.

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

Program Requirements and Expectations

Successful applicants are required to:

• Provide all funded RNBR-OP activities and services only within HRSA designated rural counties or rural census tracts located in the NBRC Region.

▪ NOTE: To confirm eligible HRSA designated rural counties or rural census tracts, please refer to https://data.hrsa.gov/tools/rural-health. See also

Appendix B: NBRC Service Areas for a list of all NBRC Region counties.

▪ Proposed grant activities may serve multiple rural counties or rural census tracts within the NBRC Region, including rural counties or census tracts across NBRC Region states.

• Represent a consortium that includes one or more member partners with experience working on health care issues in HRSA designated rural counties and/or rural census tracts the proposed project will serve.

▪ At least 66% (two-thirds) of consortium member partners must be located in a HRSA designated rural county or rural census tract. To meet this requirement, the applicant must be able to demonstrate that each consortium member partner has their own Employee Identification Number

(EIN) or Unique Entity Identifier (UEI), unless otherwise included in the exception outlined below.

▪ See Section 3 (Multiple EIN/UEI Exception) and/or Attachment 9 if member partners within your consortium share the same EIN and/or UEI. Please refer to Attachment 6 for information required from each consortium member.

• Ensure a high degree of local rural control in the project by incorporating and actively engaging local rural organizations into the consortium and implementing a

4 See def initions at eCFR :: 2 CFR 180.995 -- Principal. and eCFR :: 2 CFR 376.995 -- Principal (HHS supplement to government-wide def inition at 2 CFR 180.995).

5 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.hrsa.gov/sites/default/files/hrsa/grants/sf424-application-guide.pdf https://data.hrsa.gov/tools/rural-health 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-24-083 RNBR-OP 8

shared decision-making structure that includes local rural consortium members’ ongoing contribution to project decisions for the duration of the funded project period.

Program-Specific Instructions Include application requirements and instructions from Section 4 of the 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. Do not upload the abstract as an attachment or it may count toward the page limit. For information you must include in the Project Abstract

Summary Form, see Section 4.1.ix of the Application Guide.

ABSTRACT HEADING CONTENT

Application Organization Information

• Organization Name,

• Address (street, city, state, ZIP code),

• Facility/Entity Type (SORH, CAH, FQHC, Community based organization, health department, etc.) and;

• Website Address (if applicable)

Designated Project Director and Other Key Personnel Information

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

• Key Staff Name & Title, Contact Phone Number(s), and E-Mail Address

Rural Northern Border Region Outreach Program

• Project Title

• Project Goal

• Project Objectives

Proposed Service Area (e.g., Name of NBRC Region states and counties). NOTE: Proposed rural counties should be fully rural. For partially rural counties, include rural census tract(s).

ABSTRACT BODY CONTENT

Target Population Brief description of the target population group(s) to be served

Focus Area

• Identify the project health care focus area(s) that your proposed project activities will address (e.g., project will focus on mental and behavioral health)

Consortium Member Partnerships Provide the full list of organization names and facility/entity type of partner(s) organizations comprising the consortium members who have signed a Letter(s) of

Agreement or Memoranda of Understanding to implement the proposed project.

• HRSA requires at least one member partner to have experience working on health care issues in the NBRC Region the project proposes to serve.

https://www.hrsa.gov/sites/default/files/hrsa/grants/sf424-application-guide.pdf

HRSA-24-083 RNBR-OP 9

• HRSA requires an attestation that at least sixty-six percent (66%), or two-thirds of consortium members (members with signed Letters of Agreement(s) or Memoranda of Understanding) of the proposed project are physically located in a HRSA-designated rural area, as defined by the Rural Health Grants Eligibility Analyzer.

Project Activities Brief description of the proposed activities and/or services

Expected Outcomes Brief description of the proposed project’s expected outcomes

Capacity to Serve Rural Underserved Populations in the NBRC Region Please describe your capacity to serve rural underserved populations in the NBRC Region. Examples to show this capacity may include, but is not limited to, a history or ability to:

• Identify formal partnerships/formalize MOUs with rural health care organizations (if applicable)

• Identify the target rural population and service area, including counties and rural census tract(s) the project will serve in the NBRC Region

• Identify activities that build, strengthen, and maintain the necessary competencies and resources needed to sustain or improve health services delivery in rural NBRC Region populations

• Discuss organizational expertise and capacity as it relates to the scope of work proposed. Include a brief overview of the organization’s assets, skills and qualifications to carry on the project.

• Describe current experience, including member partnerships, activities, program implementation and previous work of a similar nature.

• Discuss the effectiveness of methods and/or activities employed to improve health care services in rural communities.

You must describe your geographic relationship to the proposed rural service population as well as your plans to ensure that rural populations are served. You should also describe how you will ensure a high degree of local rural control in the project.

Funding Opportunity Notification Briefly describe how the applicant organization learned about this funding opportunity.

Select one: State Office of Rural Health, HRSA News Release, Grants.gov, HRSA Project Officer, HRSA Website, Technical Assistance Provider, State/Local Health Department, or Other (please explain)

Funding Preference

• Applicants must explicitly document a qualifying funding preference and cite the qualification that is being met (see 42 U.S.C. 254c(h)(3)) to receive a funding preference. HRSA highly recommends you include concise language making it clear to HRSA which funding preference you qualify for.

If you do not qualify for a funding preference, please state that you do not qualify.

• If applicable, you need to provide supporting documentation in Attachment

10. Please refer to Section V.2 for further information.

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

HRSA-24-083 RNBR-OP 10

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 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

Approach Criterion 2: RESPONSE

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 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

Briefly describe the purpose or the overall aim of the proposed project. Describe how the proposed project aligns with the RNBR-OP goals listed in the “Purpose” section. Summarize your project’s focus area(s), service area(s), goals, and expected outcome(s). Describe the evidence-based or promising practice model the proposed project will adopt and/or adapt to meet your community’s need.

▪ Organizational Information – Corresponds to Section V’s Review Criterion 5:

Resources/Capabilities

Please use the following sub-headings in responding to this section:

▪ Application Organization

▪ Project Staffing

HRSA-24-083 RNBR-OP 11

▪ Consortium Composition and Involvement

Application Organization

• Briefly describe your mission, structure, and scope of current activities.

Explain how these elements all contribute to the organization’s ability to carry out the program requirements and meet program expectations.

Include a project organizational chart.

• Discuss how you’ll follow the approved plan, account for federal funds, and record all costs to avoid audit findings.

• Describe your location relative to the targeted rural service area.

• Describe how you’ll assess and improve the unique needs of the people who live in the community you serve.

• Describe your organization’s demonstrated experience serving rural underserved populations located in the NBRC Region (if applicable, applicant organization should describe existing or prior collaboration and/or working experience within the targeted rural area).

Project Staffing

• Identify the project director, as well as key personnel on the award, in the

Project Abstract and Attachment 2. Include information on the individual who will serve as the project director (or interim), as well as if they serve as the project director on any other federal awards. If you have an interim project director or have not yet hired a person to serve as the project director, discuss the process and timeline for hiring a permanent project director for this project.

• We recommend the project director allot 1.0 FTE to the program and has management experience involving multiple organizational arrangements. In-kind contributions, the value of non-cash contributions (for example, property or services) that benefit a federally assisted project or program, should be included in the staffing plan. All staffing information should be included in Attachment 2.

• Describe key personnel roles and how they relate to the proposed project.

Key personnel are individuals who would receive funds by this award or person(s) conducting activities central to this program (Attachment 2).

Describe the degree to which the consortium members are ready to integrate their functions.

Consortium Composition and Involvement

• Provide information on each of the consortium members and their experience serving and working with rural underserved populations in the

NBRC Region.

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• Provide a one-page organizational chart, and accompanying one-page description, of the proposed partner/member organizations comprising the consortium who have signed a Letter(s) of Agreement or Memoranda of

Understanding to implement the proposed project. The organizational chart and description should clearly depict the relationship between the consortium members, including verification that at least 66 percent (two thirds) of consortium member partners are located in a HRSA designated rural area

1) A table may be used in the one-page description of each proposed member organization to present the following information: the organization name, address, primary contact person, current role in the community/region, proposed role in the consortium, and

Employer Identification Number (EIN) or Unique Entity Identifier

(UEI) must be provided for each consortium member. Indicate which consortium member has experience working on health care issues in rural counties and/or rural census track areas located in the NBRC

Region that the project proposes to serve. The organizational chart and one-page description should be included in Attachment 5.

• Clear description of how applicants will ensure a high degree of local rural control in the project. This should include a description addressing:

1) how the applicant organization will incorporate involvement and input from local rural consortia members on plans and activities for project implementation and

2) how shared decision-making is structured to remain inclusive of local rural consortia members for the duration of the proposed project.

• Discuss the strategies employed for creating and defining the consortium.

Explain why each of the consortium members are appropriate collaborators and, what expertise they bring to the project. Explain the capacity of each consortium member to commit to the three-year project.

• If applicable, describe the history of the consortium.

• Applicants must submit a Letter(s) of Agreement or Memoranda of

Understanding that are signed and dated by all consortium members as

Attachment 4.

• Provide details regarding how and when the consortium will regularly meet.

Explain the proposed process for soliciting and incorporating input from the consortium for decision-making, problem solving, and urgent or emergency situations. Provide a plan for communication and discuss how coordination will work with the consortium members. Indicators should be included to assess the effectiveness of the communication and coordination of the consortium and its timely implementation. Discuss potential challenges with

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the consortium (e.g., consortium disagreements, personnel actions, expenditure activities, etc.) and identify approaches that can be used to resolve the challenges.

• Address how communication and coordination will occur between the

Project Director/applicant organization and consortium members and how often communication is expected. Discuss how frequently project updates will be provided to the consortium members and the extent to which the project director will be accountable to the consortium. You should identify a process for periodic feedback and program modification as necessary.

• Describe the relationship of the consortium with the community/region it serves. If appropriate, describe the extent to which the consortium and/or its members engage the community in its planning and functions. You need to demonstrate how the rural underserved populations in the local community or region to be served will benefit from and be involved in the development, ongoing operations, and evaluation of the consortium.

▪ Need-- Corresponds to Section V’s Review Criterion 1: Need

This section outlines the community’s needs for the proposed project, and how the rural community or region to be served will be involved in the project. When addressing need, the applicant should keep in mind the selected focus area(s).

In order to design effective interventions that specifically address the underlying causes of poor health and disparities in a sustainable way, it is important to take into account how needs, in health status, as well as in the system of care and broader environment, have evolved over time. Descriptions of need in this section should reflect trends in available key data points over multiple years.

Please use the following sub-headings for this section:

• Target Population Details

• Program Development/Target Population Involvement

• Barriers/Challenges

• Health Care in Service Area

Target Population Details

• Describe the target population(s) the proposed project will serve.

• Describe how the population(s) you propose to serve includes subpopulations who have historically suffered from poorer health outcomes, health disparities, and other inequities among the target population.

• Identify and describe the presence of any racial and ethnic minority subpopulations. Explain how your project will address social determinants

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of health in order to meet the needs of these populations in terms of racial and ethnic health disparities and barriers (social, cultural, infrastructure etc.) that affect their health status.

If your service area does not include any racial and ethnic minority subpopulations, describe your population demographics and any unique disparities they face.

• Describe the target population(s) of the proposed project and the associated unmet health needs (if funded, this is the population that will be monitored and tracked). The population description may include information about the incidence and prevalence of specific conditions, such as chronic diseases, or about regarding age and socioeconomic status of the target population.

• Compare local data to state and federal data, where possible, in order to highlight the population’s unique needs. When possible, incorporate any national and/or local rankings data to aid in illustrating the community’s need. Cite data for factors that are relevant to the project.

Program Development/Target Population Involvement

• Describe how the needs of the target population(s) were identified (e.g., frequency of needs assessments, modes of data collection). Describe the involvement of the target population(s) in the project development and future plans to ensure the project is responding to the target population’s needs.

• Discuss the manner and degree to which the target population(s) was included in planning for the activities of the project. Describe how consortium/network members were involved in identifying the needs of the target population.

• Discuss the capacity of the target population(s) to be continuously involved in the proposed project.

Barriers/Challenges

• Discuss any relevant barriers in the service area that the project hopes to overcome.

• All projects that will primarily serve multiple ethnic or racial groups must describe specific plans for ensuring the services can be provided despite any cultural, linguistic, religious, or social difference that may exist.

Health Care in the Service Area

• Identify the target service area(s) for the proposed project.

• Describe any relevant geographical features of the service area(s) that impact access to health care services.

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• Describe the health care services available in or near the target service area(s). If applicable, be sure to identify factors associated with access to care and health care utilization among racial and ethnic minorities in the service areas as well.

• Describe the potential impact of the project on existing providers who are not part of the project (e.g., changes in referral patterns, practice patterns, provider reimbursement impact, etc.) and the community (e.g., economic impact etc.). Any potential adverse effect is particularly important, as well as estimates of how the project might augment and enhance any existing capabilities in the service area(s).

• Describe how this project will address a health gap in the community that would not otherwise have been addressed if it were not for this grant.

This section will help reviewers understand whom you will serve with the proposed project.

▪ Approach -- Corresponds to Section V’s Review Criterion 2: Response

In a narrative format, propose methods that will be used to meet each of the previously described program requirements and expectations in this NOFO.

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Please use the following sub-headings in responding to this section:

• Goals and Objectives

• Evidence-Based/Promising Practice Model

• Sustainability Approach

Goals and Objectives

• Define the specific goals and objectives of the proposed project. These goals and objectives should directly relate to the information presented in the “Needs Assessment” section. The stated goals and objectives should be specific, measurable, realistic, and achievable in a specific timeframe.

Evidence-Based/Promising Practice Model

You are required to propose a health service project based on an evidence-based or promising practice model(s) that has been shown to be effective in addressing gaps and needs in a community setting and improve the health status of participants.

You must include the following:

• The title and/or name of the evidence-based or promising practice model(s) that it will be adopting and/or adapting. You must cite the source of the evidence-based or promising practice model(s).

• A clear description of the evidence-based or promising practice model(s).

Include an explanation that clearly demonstrates how the evidence-based or promising practice model will be effective in meeting the target population’s need and how it will ultimately improve health status.

• A justification on how you selected the evidence-based practice or promising practice model(s). Include thorough rationale regarding how this framework is appropriate and relevant to the community’s need and target population. If applicable, explain the extent to how the model is tailored and/or modified to the proposed project. Describe how the tailored evidence-based or promising practice model can be effective in fulfilling the community’s unmet needs and improving health status.

Note: You can use either evidence-based or promising practice model(s).

Applications that propose a project based on an evidence-based practice model will not be scored higher than those that propose a project based on a promising practice model and vice-versa.

Sustainability Approach

• Describe a plan for sustaining the program funded by the RNBR-OP grant beyond the period of federal funding.

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• Consider how your project activities and/or services will be sustained beyond the 3-year performance period, if awarded. Describe the strategies that will be utilized to achieve the desired sustainability of the project.

• Most successful sustainability strategies include a variety of sources of support and do not depend on federal funding to maintain program activities. Describe some of the potential sources of support for achieving sustainability.

• We understand that the sustainability plan may evolve as the project is implemented. Describe how realistic and feasible the proposed sustainability plan is for your project.

Note: As part of receiving an award, the award recipient is required to submit a final sustainability plan during the third year of the performance period. Further information will be provided upon receipt of the award.

▪ Work Plan -- Corresponds to Section V’s Review Criterion 2: Response and

Criterion 4: Impact

Please use the following sub-headings in responding to this section:

• Work Plan

• Impact

• Replicability

• Dissemination Plan

Work Plan

A work plan is required as Attachment 1. You must submit a detailed work plan that describes the planned activities and steps necessary to accomplish each of the proposed project goals. It is recommended that the work plan be submitted in tabular format and includes the following:

• Illustrates the consortium’s goals, strategies, activities, and measurable progress and outcome measures.

• Outlines the individual or organization responsible for carrying out each activity and include a timeline for all three years of the award. We are aware that the work plan may change as the project is implemented.

• Uses a timeline that includes each activity and identifies the responsible staff and/or consortium member.

• As appropriate, identifies meaningful support and collaboration with key stakeholders in planning, designing, and implementing all activities, including development of the application and, further the extent to which

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these contributors reflect the cultural, racial, linguistic, and geographic diversity of the populations and communities served.

• Clearly and coherently aligns with the project’s goals and objectives. To accomplish this, you are strongly encouraged to present a table that illustrates the project’s goals, strategies, activities, and measurable process and outcome measures.

Impact

• Describe the expected impact on the target population(s) the proposed project plans to serve.

• Describe the potential impact of the selected evidence-based or promising practice model/s that was used in the design and development of the proposed project.

• Although we recognize the influence of external factors when attributing the effects of an activity or program to the long-term health outcome of a community, you should still describe the expected or potential long-term changes and/or improvements in health status due to the program.

Replicability

• Describe the expected impact from the project on the target population(s) and the extent of the project’s value to similar rural communities within the

NBRC Region with comparable needs. You must describe the extent to which project results may be national in scope. You must describe the degree to which the project activities are replicable to other rural communities with similar needs.

Dissemination Plan

• Describe the plans and methods for the dissemination of project results to the appropriate stakeholder(s). This description must include:

o A clear approach for widely disseminating information regarding results of your project (i.e., new services, resources, benefits, outcomes, challenges, or other innovative results).

o A plan that describes how the information collected throughout the project will be shared with varying stakeholders (i.e., policymakers, research community, local advocacy agencies or organizations, and/or at regional or national conferences, etc.).

o Outline of a dissemination plan describing strategies and activities for informing respective target audiences and stakeholders, including the general public about the results of your project and any relevant information that will help promote the delivery of health care services to rural underserved populations in rural counties and/or census

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tracts of Northern Border Regional Commission (NBRC) Regions states, Maine, New Hampshire, New York, and Vermont.

▪ Resolution of Challenges -- Corresponds to Section V’s Review Criterion 2:

Response

Describe any relevant barriers that the project hopes to overcome. Any pertinent geographic, socioeconomic, linguistic, cultural, ethnic, workforce, or other barrier(s) and a plan to overcome those barriers should be discussed in this section. All projects that will primarily serve multiple ethnic or racial groups must describe specific plans for ensuring the services provided address the cultural, linguistic, religious, gender and social differences of the target populations.

• Discuss challenges that are likely to be encountered in designing and implementing the activities described in the work plan, and approaches that will be used to resolve such challenges.

• Discuss any challenges that could be encountered with keeping the consortium actively engaged throughout the period of performance, and approaches that will be used to resolve such challenges.

• Discuss any challenges that could be encountered with staffing turnover and the approaches that will be used to ensure proper staff coverage in the interim.

• Include any challenges that are anticipated in making policy, systems or environmental changes and approaches that will be used to resolve such challenges.

• If applicable, non-rural applicant organizations should discuss any anticipated challenges related to working in a rural community or communities in the NBRC Region and approaches that will be used to resolve such challenges.

▪ Evaluation and Technical Support Capacity -- Corresponds to Section V’s Review

Criterion 3: Evaluative Measures and Criterion 5: Resources/Capabilities

Describe current experience, skills, and knowledge base, including individuals on staff, materials published, and previous work of a similar nature. As appropriate, describe the data collection strategy to collect, analyze, and track data to measure process, impact, and outcomes, with different groups (e.g., race, ethnicity, language) and explain how the data will be used to inform program development and service delivery.

Please use the following sub-headings in responding to this section:

• Project Monitoring

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Project Monitoring

• Describe measures to be implemented for assuring effective performance of the proposed award funded activities.

• Include outcome and process measures (including baseline measures) that will be tracked throughout the period of performance.

• Measures described must align with the goals and objectives of the proposed project and with the potential health impact. It is expected that recipients will be able to articulate the outcomes of the project justified by these measures at the end of the 3-year period of performance.

• Propose baseline health data metrics that can be monitored and tracked over the course of the 3-year period of performance. These metrics should be able to demonstrate the effectiveness of the intervention and determine potential replication of the project to other rural communities. Please consider the following when describing your project’s proposed baseline measures:

o Baseline measures are a subset of the process or outcomes measures, which need to be collected from the very start of the intervention.

o The need for baseline measures is one key…