FORHP HRSA-24-112 RMH Data FINAL.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2024

Federal Office of Rural Health Policy

Policy Research Division

Rural Maternal Health Data Support and Analysis Program

Funding Opportunity Number: HRSA-24-112

Funding Opportunity Type(s): New

Assistance Listing Number: 93.155

Application Due Date: July 15, 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: May 24, 2024

Greta Stuhlsatz, PhD

Statistician, Policy Research Division

Call: 301-443-4274

Email: gstuhlsatz@hrsa.gov

See Section VII for a complete list of agency contacts.

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

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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 Maternal Health Data Support and Analysis

Program

Funding Opportunity Number: HRSA-24-112

Assistance Listing Number: 93.155

Due Date for Applications: July 15, 2024

Purpose: This program will fund one entity to provide data support to rural maternal health care networks to assist efforts to improve maternal health care at the community- and regional-levels. This program will also fund the use of data to inform the improvement of rural maternal health care nationwide.

Program Objective(s): The goal of the program is to:

▪ Increase capacity of rural maternal health care networks to: 1) collect and report data related to maternal health, obstetrics, and post-birth outcomes including infant health and 2) use this data to assess performance and identify promising practices in implementing sustainable models designed to improve health care during pregnancy, birth, and the postpartum period.

▪ Enhance public awareness and understanding, through data analysis and dissemination of findings, of: 1) the unique considerations associated with delivering prenatal, labor and delivery, and postpartum services to rural areas and 2) opportunities for improving rural maternal health care.

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

• Native American tribal governments are eligible.

• Native American tribal organizations are eligible.

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

FY 2024 Total Available

Funding:

$750,000

Estimated Number and Type of

Award(s):

Up to 1 new cooperative agreement

Estimated Annual Award

Amount:

Up to $750,000 per award

Cost Sharing or Matching

Required:

No

Period of Performance: September 30, 2024 through September 29, 2028

(4 years)

Agency Contacts: Business, administrative, or fiscal issues:

Marie Mehaffey

Grants Management Specialist Division of Grants Management Operations, OFAM

Email: mmehaffey@hrsa.gov

Program issues or technical assistance:

Greta Stuhlsatz Statistician Federal Office of Rural Health Policy

Email: gstuhlsatz@hrsa.gov mailto:mmehaffey@hrsa.gov

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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:

Tuesday, June 4, 2024

2 pm – 3 p.m. ET

Weblink: https://hrsa-gov.zoomgov.com/j/1600404115?pwd=aThkbUZjdWRsTUpKZ0N1TE9XLzlqUT09

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

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

Meeting ID: 160 040 4115

Passcode: 89202173

We will record the webinar. Please contact gstuhlsatz@hrsa.gov to request playback information 48 hours after the live event.

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/1600404115?pwd=aThkbUZjdWRsTUpKZ0N1TE9XLzlqUT09 https://hrsa-gov.zoomgov.com/j/1600404115?pwd=aThkbUZjdWRsTUpKZ0N1TE9XLzlqUT09

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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: PAGE LIMIT WORKSHEET

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I. Program Funding Opportunity Description

1. Purpose

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

Health Data Support and Analysis Program. This program will fund one entity to provide data support to rural maternal health care networks to assist them in their efforts to improve maternal health care at the community- and regional-levels. This program will also fund the use of data to inform the improvement of rural maternal health care nationwide.

National trends in maternal health have worsened over time, and rural residents have a

9 percent greater chance of experiencing severe maternal morbidity and mortality compared with urban residents.1 At the same time, rural residents are more likely to experience substance use disorder (SUD)-related deliveries than residents of urban areas.2,3 Over half of rural counties have no hospital-based obstetric services, and rural counties face greater risk of further loss of services compared to urban counties.4 To address serious disparities in rural maternal health care and outcomes, rural communities are implementing strategies through Federal Office of Rural Health Policy

(FORHP) funding (e.g., Rural Maternal and Obstetrics Management Strategies

Program, programs addressing substance use disorder during pregnancy in rural areas) and other resources.

Understanding the rural maternal health landscape and the impact of various interventions is crucial to informing efforts to reduce disparities between rural and urban areas. Rural providers, policymakers, and the public need high-quality data and analysis to understand what works in rural maternal health care to improve pregnancy- and birthing- outcomes in rural communities nationwide. A comprehensive approach to data is particularly important to coordinate across the multiple entities involved in maternal health care including clinicians, hospitals, outpatient clinics, academic medical centers, payers, social service providers, and more. However, “data collection on maternal health risks, services, outcomes in the United States continues to be fragmented, 1 Kozhimannil K, Interrante J, Henning-Smith C, Admon K. Rural-Urban Dif ferences in Severe Maternal Morbidity and Mortality in the US, 2007-2015. Health Af fairs. 2019; 38 (12): 2077-2085. Available at:

https://www.healthaf fairs.org/doi/10.1377/hlthaf f .2019.00805 2 Soni et al (2019), “Obstetric Delivery Inpatient Stays Involving Substance Use Disorders and Related Clinical Outcomes, 2016” AHRQ Healthcare Cost and Utilization Project, https://www.hcupus.ahrq.gov/reports/statbriefs/sb254-Delivery-Hospitalizations-Substance-Use-Clinical- Outcomes2016.pdfhttps://hcup-us.ahrq.gov/reports/statbriefs/sb254-Delivery-Hospitalizations-Substance- Use-Clinical-Outcomes-2016.jsp 3 Jarlenski M and Krans E. Co-occurring substance use disorders identif ied among delivery hospitalizations in the United States. J Addict Med. 2021 Nov-Dec; 15(6): 504–507. Available at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166954/ 4 Kozhimannil KB, Interrante JD, Tuttle MKS, Henning-Smith C. Changes in Hospital-Based Obstetric Services in Rural US Counties, 2014-2018. JAMA. 2020;324(2):197. Available at:

https://jamanetwork.com/journals/jama/fullarticle/2768124 https://www.hrsa.gov/rural-health/grants/rural-community/rmoms https://www.hrsa.gov/rural-health/grants/rural-community/rmoms https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00805 https://hcup-us.ahrq.gov/reports/statbriefs/sb254-Delivery-Hospitalizations-Substance-Use-Clinical-Outcomes-2016.jsp https://hcup-us.ahrq.gov/reports/statbriefs/sb254-Delivery-Hospitalizations-Substance-Use-Clinical-Outcomes-2016.jsp https://hcup-us.ahrq.gov/reports/statbriefs/sb254-Delivery-Hospitalizations-Substance-Use-Clinical-Outcomes-2016.jsp https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166954/ https://jamanetwork.com/journals/jama/fullarticle/2768124

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unstandardized, nontransparent, and irregular,” according to the White House Blueprint for Addressing the Maternal Health Crisis.5

Considering these issues, a key component of this program will include technical assistance (TA) to rural maternal health care networks to support improvements in data collection. TA shall include activities such as, but not limited to, reporting and collection of quantitative and qualitative data, maintenance of datasets, and assessment of data to support rural maternal health care networks in reaching their maternal health goals.

Focusing on TA to rural maternal health care networks supports a holistic approach to data, considering the various components affecting maternal health care in rural areas at the community- and regional-levels. Another major objective of this program is to fund the analysis of rural maternal health data and the dissemination of findings for a broad, public audience to illustrate issues at the national level.

In alignment with FORHP’s statutory authorization, funds under this award shall support activities related to improving health care in rural areas. For the purposes of this award, we consider rural areas to be those that conform with the definition of rural that FORHP maintains at its Defining Rural Population website available at:

https://www.hrsa.gov/rural-health/about-us/what-is-rural. Therefore, this award will support only TA to maternal health care networks providing services in rural areas.6

Further, for the purposes of this award, the term “maternal health care networks” refers to groups of health care providers that deliver health care services focused on pre-natal care, labor and delivery, and postpartum care in collaboration with other organizations supporting the delivery of maternal health care that may include, but are not limited to, payers, clinical experts at academic medical centers, and community-based organizations. Expected outcomes include:

• Increased capacity of rural maternal health care networks to: 1) collect and report data related to maternal health, obstetrics, and post-birth outcomes including infant health, and 2) use this data to assess performance and identify promising practices in implementing sustainable models designed to improve health care during pregnancy, birth, and the postpartum period.

• Enhanced public awareness and understanding, through data analysis and dissemination of findings, of: 1) the unique considerations associated with delivering prenatal, labor and delivery, and postpartum services to rural areas and 2) opportunities for improving rural maternal health care.

5 White House Blueprint for Addressing the Maternal Health Crisis . June 2022. Available at:

https://www.whitehouse.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf 6 To determine whether an area is considered rural, please visit the Rural Health Grants Eligibility Analyzer at: https://data.hrsa.gov/tools/rural-health https://www.whitehouse.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf https://www.whitehouse.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf https://www.hrsa.gov/rural-health/about-us/what-is-rural https://www.whitehouse.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf https://data.hrsa.gov/tools/rural-health

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2. Background

Section 711(b) of the Social Security Act (42 U.S.C. 912(b)) authorizes the Rural

Maternal Health Data Support and Analysis Program. The Health Resources and

Services Administration’s (HRSA) Federal Office of Rural Health Policy (FORHP) is the focal point for rural health activities within the Department of Health and Human

Services (HHS). By statute, FORHP advises the Secretary of HHS on the effects of current policies and proposed statutory, regulatory, administrative, and budgetary changes in Medicare and Medicaid programs on the financial viability of small rural hospitals, the ability of rural areas to attract and retain physicians and other health professionals, and access to and the quality of health care in rural areas. FORHP is also authorized to administer grants, cooperative agreements, and contracts to provide technical assistance and other activities as necessary to support activities related to improving health care in rural areas. For additional information about FORHP, please see https://www.hrsa.gov/rural-health.

FORHP accomplishes its mission through a broad range of policy and program activities. Program- and policy-relevant data and analysis enhances knowledge that supports the improvement of health care in rural areas.

II. Award Information

1. Type of Application and Award

Application type(s): New

We will fund you via a cooperative agreement.

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

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

• Consulting in the planning, development, and implementation of technical assistance (TA) provided to rural maternal health care networks to support the collection, use, and assessment of qualitative and quantitative data.

• Providing technical assistance to the recipient, upon request, on processes for the identification or selection of rural maternal health care networks to receive direct data support TA under this award.

• Reviewing and commenting on project design and methodology for collecting and analyzing quantitative and qualitative data in work plan proposals.

• Consulting in the planning and development of the annual work plan, including consulting in the data analysis projects and rapid data analyses.

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

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• Facilitating the use of HRSA and FORHP-supported communications resources as needed to support the cooperative agreement.

• Reviewing and providing feedback and recommendations on data TA and analysis work products, including but not limited to presentations, program documents (e.g., program plans, work plans, budget, contracts, key personnel), reports, briefs, and manuscripts, prior to implementation or dissemination.

• Consulting in the planning and implementation of any meetings, webinars, or work groups conducted by the award recipient during the period of performance.

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

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

• Following accessibility requirements based on Section 508 of the Rehabilitation

Act of 1973.

• Providing direct data support TA to rural maternal health care networks. TA provided will include assistance in how to collect, report, and use data on rural maternal health and birth outcomes including infant health.

• Maintaining and analyzing data from rural maternal health care networks, along with other rural maternal health data sources, and disseminating findings to rural maternal health care networks, interested parties, and the public as appropriate.

• Working closely with FORHP in the planning, development, and implementation of activities under this award. This includes FORHP review of methods for TA and data collection, maintenance of data, and data analysis.

• Utilizing HRSA and FORHP-supported communications resources as needed to support the cooperative agreement.

• Sharing resources and materials developed under this award for FORHP review prior to implementation or public dissemination.

• Assessing and measuring the impact of your activities under this award, in consultation with FORHP.

• Responding to FORHP requests (including the potential execution of short-term qualitative or quantitative analyses to inform emerging rural maternal health questions arising out of work under this award), comments, and questions in a timely manner.

• Submitting required reports, projects, or other work products to FORHP in a timely manner.

• Attending FORHP rural maternal health program meetings as applicable.

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2. Summary of Funding

We estimate $750,000 will be available each year to fund 1 recipient. You may apply for a ceiling amount of up to $750,000 annually (reflecting direct and indirect costs).

The period of performance is September 30, 2024, through September 29, 2028

(4 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

HRSA may reduce funding or take other actions after the first year if the recipient of this award does not achieve their application goals.

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.

III. Eligibility Information

1. Eligible Applicants

You can apply if your organization is in the United States, the Commonwealth of Puerto

Rico, the Northern Mariana Islands, American Samoa, Guam, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, or the

Republic of Palau, and is one of the following:

• Public or private (nonprofit or for-profit) organizations

• Native American tribal governments

• Native American tribal organizations, nonprofit or for-profit

2. Cost Sharing or Matching

There is no cost sharing or matching requirement for this program.

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

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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

Multiple Applications

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

IV. Application and Submission Information

1. Address to Request Application Package

We require you to apply online through Grants.gov. Use the SF-424 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-24-112 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 80 pages when we print them. We will not review any pages that exceed the page limit.

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

Eligibility Information of the NOFO.

These items do not count toward the page limit:

• Standard OMB-approved forms you find in the NOFO’s workspace application package https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/s2s/applicant-system-to-system.html

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• 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-24-112 workspace application package, it may count toward the page limit.

Applications must be complete and validated by Grants.gov under HRSA-24-112 before the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

• When you submit your application, you certify that you and your principals7 (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.8

• If you cannot certify this, you must include an explanation in Attachments 6-15:

Other Relevant Documents.

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

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

▪ Applicant Organization Name

▪ Organization Address

7 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).

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

https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180/subpart-I/section-180.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376 https://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-prelim-title31-chapter33&edition=prelim https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-B/section-75.113

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▪ Project Director Name

▪ Project Director E-mail Address and Phone Number

▪ Organization website (if applicable)

▪ Consortium members (if applicable)

Abstract Body Content

▪ Brief overview of the project including a description of organizational capabilities of the applicant organization, consortium members, or other collaborators (if applicable).

▪ Brief overview of the methods for carrying out the proposed project.

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 4: IMPACT

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.

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▪ Introduction – Corresponds to Section V’s Review Criterion #1 NEED

Briefly describe the purpose of the proposed project and identify specific goals, objectives, and expected outcomes. Summarize how the proposed project will support the ability of rural maternal health care networks to collect, report, and interpret maternal health related data. Describe how the proposed project will use these data and other local, regional, and national data to illustrate for the public the unique challenges to and opportunities for the provision of maternal health care in rural areas. This description should demonstrate that the applicant has a strong understanding of the rural maternal health landscape.

▪ Organizational Information -- Corresponds to Section V’s Review Criterion #5

RESOURCES/CAPABILITIES

This section should describe the capacity of your organization to provide technical assistance (TA) to rural maternal health care networks for the collection and assessment of data. This section should also describe your organizational capacity to maintain datasets, analyze data, and publish analytical findings. This includes information about your organization’s structure and staffing plan and your experience and expertise.

• Provide information on your organization’s current mission and structure, including an applicant organizational chart (Attachment 1), staffing plan and job descriptions for key personnel (Attachment 2), and biographical sketches of key personnel (Attachment 3). Describe how this aligns with the scope of the proposed activities. If you are applying on behalf of a consortium, you (the applicant organization) must serve as the lead organization. This means the applicant retains responsibility for administration of the cooperative agreement, including administering federal funds in a manner consistent with underlying agreements. If a consortium operates the program, you must:

o Describe the capabilities and roles of each member organization as part of the proposed project, including capabilities evidenced by relevant activities/products including completed or current research on rural maternal health care or specific engagements providing TA on data issues to rural maternal health care organizations.

o Discuss the capability of the applicant organization to provide overall program management.

o Submit a complete list of consortium members in Attachment 5.

o Ensure that the organizational chart in Attachment 1 shows that the applicant organization is responsible for the overall management of the program and the relationship of all other involved member organizations.

o In Attachment 4, provide any Letters of Agreement or Memoranda of

Understanding that document the commitment of member organizations in a consortium model.

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• Succinctly describe the capacity of your organization (including the consortium, as applicable) to effectively manage the programmatic, fiscal, and administrative aspects of the proposed project.

• Demonstrate your organization’s significant experience conducting similar work

(from any funder). Include specific examples of the following, as applicable:

o Experience providing TA to rural health care organizations focused on supporting data collection, reporting, and using data to demonstrate impact.

o Experience providing data TA on a national scale to rural health care organizations, including networks of rural health care organizations focused on maternal health care.

o Experience collecting and maintaining qualitative and quantitative data from rural health care organizations, particularly small health care organizations with limited capacity to collect and report data.

o Past publications or data analyses on maternal health or obstetrics that were national in scope and contained rural-centric or rural-urban comparisons as part of the analysis. Additionally, discuss experience with analyses completed in a three-to-six-month period.

o Work communicating complex maternal health care policy issues and data analyses to varied audiences in ways that identify key rural concerns.

o Substantial experience working with large, national data sets including

Medicaid claims data, as well as experience working with data sets with small sample sizes.

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

The needs assessment must demonstrate an understanding of the challenges rural maternal health care networks face in collecting and utilizing maternal health data to meet organizational and programmatic objectives focused on improving maternal health care in rural areas. Further, the needs assessment must demonstrate a clear understanding of the role of technical assistance (TA) in addressing these data challenges and helping rural maternal health care networks meet their objectives and demonstrate the impact of their efforts as they relate to improving maternal health care in rural areas. Additionally, the needs assessment must demonstrate an understanding of how improved data capacity at the organizational-level and increased awareness of the issues on a broader, national-level can lead to improvements in rural maternal health care.

Underpinning the challenges rural maternal health care networks face related to maternal health data, the needs assessment must demonstrate a strong understanding of the issues affecting the ability to provide high-quality, sustainable maternal health care services to those living in rural areas. This should include a description of the larger contextual issues influencing rural maternal health care access and outcomes (e.g., loss of obstetric care in rural areas, financing and reimbursement challenges, maternal morbidity and mortality including issues such as

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SUD). You must use and cite data whenever possible to support the information provided.

▪ Approach – Corresponds to Section V’s Review Criterion #2 RESPONSE

Propose an overall strategic vision to provide data support on a national scale (not limited to specific states/regions) to rural maternal health care networks.

1. Providing data support technical assistance (TA) to rural maternal health care networks. In describing the approach to TA, the application should:

• Present a plan to identify rural maternal health care networks to receive TA under this award. Explain how you will ensure that the selection of rural maternal health care networks to receive TA under this award is consistent with the program objectives.

• Discuss how you would assist rural maternal health care networks in identifying needs and resources (e.g., processes and technology) to collect and report accurate patient-level data to compile as aggregate, de-identified measures.

• Indicate how you would provide TA to correct issues identified in the data collection and reporting processes for current and future submissions.

• Discuss how you would review qualitative information from rural maternal health care networks collected through means such as work plans, logic models, annual reports and provide feedback to rural maternal health care networks.

• Detail a plan to support continuity of data collection from various rural maternal health care networks over time for robust analyses now and in the future.

• Indicate how you would help rural maternal health care networks understand how they can use data on rural maternal health care and birth outcomes, including infant health, to demonstrate the impact of their efforts.

2. Establishing and maintaining a data repository of rural maternal health relevant datasets. In describing the approach to data collection and maintenance, the application should:

• Discuss your approach for collecting quantitative and qualitative data from rural maternal health care networks including, but not limited to, primary data collection (e.g., patient-level data, interviews) and secondary data on rural maternal health topics of nationwide interest (e.g., access to obstetric care, maternal health, birth, and infant outcomes).

• Indicate how you would ensure rural maternal health care networks have a standardized structure (e.g., templates, data dictionary) and system (e.g., data reporting processes, mechanisms, and timelines) for reporting both patient-level data and deidentified, aggregate data to the recipient of funding under this award.

• Discuss how you may develop datasets from data received from rural maternal health care networks and perform quality checks and cleaning of data received.

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• Detail your process to identify data elements to collect and maintain under this award and the rural maternal health care networks that may provide data.

3. Conducting data analyses to quantify and describe the impact of strategies and interventions undertaken by rural maternal health care networks as they relate to access to and the quality of maternal health care in rural areas. In describing the approach to data analysis, the application should:

• Discuss how you would conduct a combination of planned and rapid response data analyses, including studies and analyses of interventions undertaken by rural maternal health care networks.

o Topics for analysis may include quantitative studies on the impact of rural maternal health strategies and interventions on cost, utilization, and quality of care, and qualitative analyses (e.g., analysis of interviews) of rural maternal health care provider experiences. Topics for analysis may also include, but are not limited to, issues of nationwide concern related to rural maternal health care (e.g., tracking obstetric unit closures).

o Data sources may include, but are not limited to, T-MSIS Medicaid claims, CDC National Vital Statistics System (NVSS), and rural maternal health care network-reported data including patient-level and performance data.

• Detail your process to adjust plans for analysis in year one as needed and develop plans for analysis in subsequent years, including the review of any briefs or other resources developed through this funding.

4. Disseminating resources and information targeted to rural maternal health care networks and a more general, public audience, as appropriate. In describing the approach to information dissemination, the application should:

• Discuss how you would disseminate tools and resources, analytical findings, and data to the public for the purposes of informing the improvement of rural maternal health care.

• Indicate how you would utilize existing FORHP-sponsored resources whenever possible including publication of information on sites including the RHIhub and Rural Health Research Gateway.

▪ Work Plan -- Corresponds to Section V’s Review Criteria #2 RESPONSE and #4

IMPACT

Describe how you’ll achieve each of the objectives during the period of performance.

You find these in the Approach section. Use a timeline that includes each activity and identifies who is responsible for each.

1. Technical Assistance Plan: Applicants should propose their plan for providing hands-on technical assistance (TA) to support rural maternal health care networks in the collection, reporting, and assessment of maternal health data.

TA may also include the development and implementation of tools and https://www.ruralhealthinfo.org/ https://www.ruralhealthresearch.org/

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resources (e.g., toolkits, data dictionary, templates) designed specifically for rural maternal health care networks. These tools and resources should support the collection and reporting of data on maternal health measures. Rural maternal health care networks should be able to use these tools and resources to assess care and outcomes in their communities. The work plan should include the process for identifying recipients of TA under this award consistent with the program objectives.

2. Data Management Plan: Applicants should propose their plan for developing and maintaining datasets compiling data from rural maternal health care networks. This may include, but is not limited to, quantitative data (e.g., de-identified patient-level data) and qualitative data (e.g., data collected through structured interviews). This also includes management of data and ensuring the quality of data provided by rural maternal health care networks. Datasets maintained under this award may also include compilations of publicly available data on rural maternal health issues of nationwide interest and presentation in formats for public use including spreadsheets and maps.

3. Analysis Plan: The applicant should propose two analytical studies for the first year of the award assessing barriers to and opportunities for providing rural maternal health care, at least one of which should include a specific focus on maternal health care networks providing services in rural areas. Use the format outlined below. Limit each research proposal to a maximum of six pages.

Proposal Summary

a. Project Title

b. Project Director

c. Two Sentence Project Description

Study Proposal

a. Project Title

b. Statement of the Issue and Policy Relevance: Clearly state the purpose of the study. Identify the gaps in existing knowledge that the study intends to fill. State the relevance of the analysis and its implications for policy on rural maternal health from a national, state, and local perspective. Demonstrate how policymakers, health care providers, and the public may use the information to support the improvement of health care in rural areas. State how the proposed analysis will address gaps in current understanding.

c. Geographic Coverage: Describe the geographic coverage for the study and assess how generalizable the results will be for the purpose of informing policymaking. Studies should be nationally representative or have implications for the design or implementation of national policies. Describe the ability of the data to represent varying levels of rurality. The study should

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include rural versus urban analyses, as well as analyses by level of rurality as applicable.

d. Hypotheses, Design, and Analysis: State the hypothesis(es) or study questions for the analysis. Thoroughly describe the project design you will use to accomplish the specific aims of the proposed study (quantitative, qualitative, or mixed methods). Include a discussion of any anticipated limitations of the study design.

The work plan should document how the applicant plans to monitor progress towards completion of initial studies within a three-to-six-month timeframe.

Applicants should also propose how to incorporate rapid response analyses and associated resources (e.g., briefs, data tables, progress reports) into their work plans.

Post-award, the successful applicants may adjust the scope and details of proposed studies. This process may include technical assistance and additional input from FORHP on possible alternative projects and/or suggested project modifications. After receiving technical assistance, recipients may submit revised project proposals and a revised budget to align with any changes to project proposals. Your proposals must be national in scope and cannot be single state or regional studies in the first budget period.

4. Communications Plan: The applicant should propose how they would use a web-based platform (including FORHP-sponsored resources such as the RHIhub and Rural Health Research Gateway) to disseminate information associated with activities under this award. This may include, but is not limited to, the publication of data analysis findings; tools and resources to support the ability of rural maternal health care networks to collect, report, assess, and use data to inform the delivery and improvement of rural maternal health care; tools and resources to support greater public understanding and awareness of rural maternal health issues related to or illustrated by data; and presentations given in public settings including conferences and FORHP maternal health award recipient meetings.

▪ Resolution of Challenges – Corresponds to Section V’s Review Criterion #2

RESPONSE

Discuss internal and external barriers or challenges that you are likely to encounter in designing and implementing the activities described in the work plan in pursuit of program objectives. Illustrate approaches you will use to resolve such barriers and challenges. Include a specific discussion around challenges or difficulties that may arise from working with organizations with limited data experience and capacity.

Describe challenges in working with datasets involving small sample sizes and the need for rural and urban geographic indicators in datasets. Additionally, discuss challenges or difficulties that may arise in maintaining the confidentiality of data reported from rural maternal health care networks and steps to protect sensitive data, as applicable.

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▪ Evaluation and Technical Support Capacity – Corresponds to Section V’s Review Criteria #3 EVALUATIVE MEASURES and #4 IMPACT

Indicate how your organization will self-assess and track progress toward achievement of program objectives and the effectiveness and impact of the project.

Propose clearly defined, viable metrics, for the purpose of self-assessment including descriptions of the inputs (e.g., key personnel, consortium members, and other collaborators and resources), key processes, and meaningful project outcomes that you will use to measure the effectiveness of activities under this award including TA, data collection and maintenance, and data analysis and dissemination. Describe your plan for tracking the number of downloads/views of resources or other materials posted online and funded under this cooperative agreement to demonstrate the extent that resources developed are reaching a public audience. Demonstrate an understanding of how data collected and analyzed will inform the improvement of maternal health care in rural areas at various levels (e.g., organizationally, locally, regionally, nationally).

iii. Budget

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

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

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

Program Income

You must use any program income you generate from awarded funds for approved project-related activities. Use program income under the addition alternative (45 CFR §

75.307(e)(2)). Find post-award requirements for program income at 45 CFR § 75.307.

Specific Instructions

As required by the Further Consolidated Appropriations Act, 2024 (P.L. 118-47), Division D, Title II, § 202, “None of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of Executive Level II.” Effective January 2024, the salary rate limitation is

$221,900. As required by law, salary rate limitations may apply in future years and will be updated.

iv. Budget Narrative

See Section 4.1.v. of the Application Guide.

https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.307

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The budget justification narrative must describe all line-item federal funds (including subawards) proposed for this project for each year of the period of performance. The budget narrative does count towards the page limit.

If your program proposal includes hiring new personnel, awarding contracts, or making subawards, then you must consider the processes and time needed to put these parts of your plan in place. Recipients shall work to ensure that new hires are on-board within three months of the planned start date. If your program proposal includes using consultant services, list the total costs for all consultant services for each year. In the budget narrative, identify each consultant, the services they will perform the total number of hours, travel costs, and the total estimated costs

v. Attachments

Provide the following attachments in the order we list them.

Most attachments count toward the application page limit. Indirect cost rate agreement (if it applies) and biographical sketches of key personnel are the only exceptions. They will not count toward the page limit.

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

Attachment 1: Organizational Chart

Provide a one-page figure that depicts the organizational structure of the project.

Attachment 2: Staffing Plan and Job Descriptions for Key Personnel (see Section 4.1. of the Application Guide)

Keep each job description to one page as much as possible. Include the role, responsibilities, and qualifications of proposed project staff. Describe your organization’s timekeeping process. This demonstrates that you’ll comply with federal standards related to recording personnel costs.

Attachment 3: Biographical Sketches of Key Personnel (Do not count towards the page limit)

Include biographical sketches for people who will hold the key positions you describe in

Attachment 2. Keep it to two pages or less per person. Do not include potentially sensitive information such as personal addresses or social security numbers. If you include someone you have not hired yet, include a letter of commitment from that person with the biographical sketch.

Attachment 4: Letters of Agreement, Memoranda of Understanding (if applicable)

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

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Attachment 5: Consortium Member List (if applicable)

If applicable, provide a member list for the consortium. Provide the following information for each consortium member in a table format:

• Member Organization Name

• Member Organization Complete Address

• Primary Point of Contact Name, Title, E-mail Address, Phone Number

• Organization Employer Identification Number (EIN)

• Brief Description of Organization and Project Role

Note: If applicable, you must include any Letters of Agreement, MOU, etc., for all consortium members in Attachment 4.

Attachments 6–15: Other Relevant Documents (no more than 15)

Include any other documents that are relevant to the application.

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

A UEI is required to apply for this funding. You must register in the SAM.gov to receive your UEI.

You cannot use a DUNS number to apply. For more details, visit the following webpage:

General Service Administration’s UEI Update

After you register with SAM, maintain it. Keep your information updated when you have:

an active federal award, application, or plan that an agency is considering.9

When you register, you must submit a notarized letter naming the authorized Entity

Administrator.

We will not make an award until you comply with all relevant SAM requirements. If you have not met the requirements by the time we’re ready to make an award, we will deem you unqualified and award another applicant.

If you already registered on Grants.gov, confirm that the registration is active and that the Authorized Organization Representative (AOR) has been approved.

To register in Grants.gov, submit information in two systems:

• System for Award Management (SAM) (SAM Knowledge Base)

• Grants.gov

9 Unless 2 CFR § 25.110(b) or (c) exempts you f rom those requirements or the agency approved an exemption for you under 2 CFR § 25.110(d)).

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

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Effective March 3, 2023, individuals assigned a SAM.gov Entity Administrator role must be an employee, officer, or board member, and cannot be a non-employee. This change is to ensure entities are in control of who has permission to control roles within their entity.

Here’s what this means:

• Entity…