FORHP HRSA-24-120 Delta Maternal FInal for posting.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

Delta Region Maternal Care Coordination Program Funding Opportunity Number: HRSA-24-120

Funding Opportunity Type(s): New

Assistance Listing Number: 93.912

Application Due Date: August 2, 2024 Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

We won’t approve deadline extensions for lack of registration.

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

Issuance Date: June 25, 2024

Nikita Patel Public Health Analyst, Federal Office of Rural Health Policy Call: 301-594-3288 Email: DeltaMCCProgram@hrsa.gov

See Section VII for a complete list of agency contacts.

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

HRSA-24-120 Delta MCC 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: Delta Region Maternal Care Coordination Program

Funding Opportunity Number: HRSA-24-120

Assistance Listing Number: 93.912

Due Date for Applications: August 2, 2024

Purpose: Improve and expand access to and coordination of perinatal health care services in the Delta Regional Authority’s Region (Delta Region).

Program Objective(s): 1. Use care coordination strategies to enhance and expand access to and coordination of perinatal services in the Delta Region through a strong network of entities that represent the spectrum of care during and after pregnancy;

2. Utilize evidence-based, promising practice and/or value-based care model(s) in the planning and delivery of perinatal services;

3. Identify barriers to providing maternal health care in the region and strategies for addressing such barriers; and

4. Develop and implement deliberate and sustainable strategies of care coordination into policies, procedures, staffing, services, and communication systems.

Eligible Applicants: To be eligible to receive a cooperative agreement under this program, an entity:

(A) Shall be a domestic public or private, nonprofit or for-profit entity located in the Delta region, with demonstrated experience serving, or the capacity https://dra.gov/map-room/

HRSA-24-120 Delta MCC ii to serve, rural and underserved populations.

Applicants must be located in the Delta Region.

The Delta Region includes 252 counties and parishes located across eight states - Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee.

(B) Must represent a network that includes the following – (i) at least three or more healthcare providers and (ii) that may be rural, urban, non-profit, or for-profit entities, and

(C) Must not previously have received a grant under 42 U.S.C. 254c(e) (other than a grant for planning activities) 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:

$1,800,000

Estimated Number and Type of Award(s):

Up to four new cooperative agreements

Estimated Annual Award Amount:

Up to $450,000 per award, subject to the availability of appropriated funds

Cost Sharing or Matching Required:

No

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

Nikita Patel mailto:Mmehaffey@hrsa.gov

HRSA-24-120 Delta MCC iii

Public Health Analyst Federal Office of Rural Health Policy Email: DeltaMCCProgram@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:

Tuesday, July 9, 2024 3 – 4 p.m. ET Weblink: https://hrsa-gov.zoomgov.com/j/1602332988?pwd=eEtwelJid1ZXSDlJUitZd2liU1lBUT09

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

Call-In Number: 1-833-568-8864 Meeting ID: 44025214

We will record the webinar. Provide information on where to find the webinar recording.

mailto:DeltaMCCProgram@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/1602332988?pwd=eEtwelJid1ZXSDlJUitZd2liU1lBUT09 https://hrsa-gov.zoomgov.com/j/1602332988?pwd=eEtwelJid1ZXSDlJUitZd2liU1lBUT09

HRSA-24-120 Delta MCC 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

3. REVIEW AND SELECTION PROCESS

• 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: RURAL COUNTIES WITH MCTA SCORES GREATER THAN 20

APPENDIX B: DELTA REGION MATERNAL HEALTH NETWORK PARTNERS

APPENDIX C: COMMON DEFINITIONS

APPENDIX D: PROGRAM RESOURCES

APPENDIX E: PAGE LIMIT WORKSHEET

HRSA-24-120 Delta MCC 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Delta Region Maternal Care Coordination Program (Delta MCC). The purpose of this program is to improve and increase access to care for pregnant women and new mothers during and after pregnancy.

To support this purpose, the objectives for the Delta MCC are to:

1. Use care coordination strategies to enhance and expand access to perinatal services in the Delta Region through a strong, diverse network of entities that represent the spectrum of care during and after pregnancy;

2. Utilize evidence-based, promising practices and/or value-based care model(s) in the planning and delivery of perinatal services;

3. Identify barriers to providing maternal health care in the region and strategies for addressing such barriers; and

4. Develop and implement deliberate and sustainable strategies of care coordination into policies, procedures, staffing, services, and communication systems (including but not limited to billing for appropriate services and partnering private and public payers).

Applicants are encouraged to consider innovative strategies to meet the needs of and support pregnant women and new mothers. Some examples of activities that can be provided include:

• Provide outreach and education to pregnant women and new mothers on healthy nutrition to reduce risk of hypertension

• Provide screening and referral of mental health issues such as depression and anxiety including HRSAs Maternal Mental Health Hotline (1-833-TLC-MAMA)

• Refer pregnant women and new mothers to online or local support groups

• Recruitment of doula and midwifery services, community health workers, and/or maternal fetal specialist services

• Support patient care through telehealth

• Support travel costs, as necessary, of maternal health specialist to travel to pregnant woman

• Provide education and social support for pregnant women through the development of centering pregnancy (group prenatal care) visits;

HRSA-24-120 Delta MCC 2

• Provide resources and education to support in-home hypertension management and blood pressure self-monitoring and reporting;

• Support mobile prenatal and postpartum care visits for pregnant women and new mothers;

• Utilize development dyad models (mother and infant) to support combined postpartum and infant checkup visits;

• Support childcare for pregnant women and new mothers during prenatal and postpartum care visits;

Applicants are encouraged to consider innovative strategies. Applicants are encouraged to propose ways to achieve these goals through the establishment or continuation of collaborative networks/consortiums of providers and services who support pregnant women and new mothers through pregnancy and post-partum. The networks will focus on reducing risk factors for pregnant women during and after pregnancy through screening and referral to needed services and interventions.

HRSA recommends your members consist of a broad array of organizations from both traditional and non-traditional health care entities. Network members may include cross-sector entities such as health care providers, key services for supporting infant and child health, quality program providers, and insurers. See Appendix B for examples of the types of network members.

This program funding should be used to complement the work of other organizations and should not duplicate or supplant activities that are funded through other federal mechanisms.

The Delta MCC is a four-year program with year one (September 30, 2024 – September 29, 2025) a planning year and years two, three, and four (September 30, 2025 – September 29, 2028) focused on program implementation.

For more details, see Program Requirements and Expectations.

2. Background

The Delta MCC is authorized by 42 U.S.C. § 254c(e) (§ 330A(e) of the Public Health Service Act).

Trends in maternal health have worsened over time1 and the risk from maternal death is unevenly distributed across African Americans, American Indian/Alaskan Natives, low-income persons, and rural residents. Rural residents have a 9 percent greater chance of experiencing severe maternal morbidity, defined as potentially life-threatening complications or the need to undergo a lifesaving procedure during or immediately

1 Centers for Disease Control and Prevention. Pregnancy Mortality Surveillance System.

https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm

HRSA-24-120 Delta MCC 3 following childbirth, and maternal death compared with urban residents.2 However, data that is broken out specific to the Delta Region indicates that odds of maternal death in Delta counties are 1.39 times higher compared with non-Delta counties.3 While this program is intended to address maternal death specifically, the goals of the program aim to support building systems of coordinated care that reduce risk for maternal death and improve health outcomes and disparities in this Region.

Delta Region Definition

The Delta Region includes 252 counties and parishes located across eight states – Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee.

To view maps of the counties and parishes in each state that are in the Delta Region, visit https://dra.gov/map-room/. To determine if a county or parish in the Delta Region is rural visit https://www.ruralhealthinfo.org/am-i-rural.

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) provided directly to the award recipients, we also get involved in these ways:

• Providing a list of common measure and data elements that must be reported on by all recipients;

• Participating in the planning and development of the qualitative and quantitative data collection measures;

• Reviewing award activities on an ongoing basis and providing guidance in planning and implementation activities; and

• Providing consultation with the funded network, as appropriate, in outreach and dissemination activities.

2 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.

3 Smith BL, Sandlin, AT, Bird, TM, Steelman, SC. Maternal mortality in the Mississippi Delta region.

Southern Medical Journal. 2014; 107(5): 275-9.

https://www.ruralhealthinfo.org/am-i-rural

HRSA-24-120 Delta MCC 4

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

• Adhering to HRSA guidelines pertaining to acknowledgement and disclaimer on all products with HRSA award funds;

• Participating in conference calls and/or meetings with HRSA;

• Working collaboratively with HRSA and responding to HRSA requests, comments, and questions on a timely basis;

• Cooperating with HRSA-funded Technical Assistance partners during the period of performance (and potentially share project updates and information with them after the period of performance ends);

• Establishing relationships and collaborations to leverage other complementary federal and state Maternal and Child Health programs and federally funded health centers while ensuring that there is no duplication of effort;

• Establishing a shared network governance model that incorporates perspectives from all members in its decision-making and resource allocation to meet program goals while ensuring and demonstrating high-level engagement from every member. The shared governance model structure should provide safeguards to ensure a collaborative decision-making process that empowers all network members to address program goal; and

• Adjusting approach based on HRSA’s feedback and priorities.

2. Summary of Funding

We estimate $1,800,000 will be available each year to fund 4 recipients. You may apply for a ceiling amount of up to $450,000 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

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 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75

HRSA-24-120 Delta MCC 5 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 meets all three of the following criteria:

1. Your organization is in the United States and is:

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

2. Your organization meets the following geographic requirements:

• You are an organization physically located in the Delta Region

• You are an organization with demonstrated experience serving, or the capacity to serve, rural underserved populations located within the Delta Region; and

• Your organization proposes a project serving the rural Delta region.

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

• Is located outside of the Delta Region;

• Submits an application to serve populations outside of HRSA designated rural counties or rural census tracts in the Delta Region, and

• Submits more than one application.

For more details, see Program Requirements and Expectations.

2. Cost Sharing or Matching

Cost sharing or matching is not required for this program.

3. Other

To be considered for funding, your organization must represent a network/consortium composed of three or more health care providers and health care organizations, including the applicant organization, with at least 66 percent (two-thirds) of

HRSA-24-120 Delta MCC 6 network/consortium members located in a HRSA-designated rural area, as defined by the Rural Health Grants Eligibility Analyzer.

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

Consulting your State Office of Rural Health

By statute, all applicants are required to consult their State Office of Rural Health (SORH) or equivalent (appropriate state entity) regarding their intent to apply to this program.

HRSA strongly recommends applicants contact their SORH before applying. The SORHs have expertise in FORHP programs specifically as well as rural health generally, and there may be opportunities to utilize SORH expertise in ways to that enhances applications. For example, the SORH may be able to provide information regarding model programs, data resources, and technical assistance for networks/consortiums, evaluation, partner organizations, or support of information dissemination activities. For this program especially, the SORH can play a vital role as a network/consortium partner in both the application phase and if awarded, the planning and implementation phases of this program. If you do not receive a response, please include the original letter of intent requesting the consultation as part of Attachment 8

SORHs responding to this notice as the applicant organization must provide an attestation in Attachment 7 that there is no conflict of interest and other non-SORH applicants were not prejudiced. This attestation must clearly show that the SORH application was independently developed and written and that they have not knowingly duplicated efforts or project ideas of non-SORH applicants within their state.

Each state has a SORH, and a list of the SORHs can be accessed at:

https://nosorh.org/nosorhmembers/nosorh-members-browse-bystate/. All applicants must include in Attachment 7 a copy of the letter or email sent to the SORH, and any response received to the letter, which was submitted to the SORH describing their project.

Multiple Applications

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

Exceptions

Multiple Application Exception

Multiple applications associated with the same UEI (previously DUNS) number and/or EIN are not allowable. HRSA also recognizes a growing trend towards greater https://data.hrsa.gov/tools/rural-health https://nosorh.org/nosorhmembers/nosorh-members-browse-bystate/

HRSA-24-120 Delta MCC 7 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, Exceptions Request. HRSA expects applications with the same UEI number and EIN providing the requested information for Attachment 9 Exception Request with their application are 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-24-120 associated with the EIN or DUNS number.

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/consortium requirements. Tribes and tribal entities under the same tribal governance must still meet the network/consortium 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.

To request for a Tribal Exception and/or Multiple EIN Exception, the following must be included in Attachment 9:

• Names, titles, email addresses, and phone numbers for points of contact at each of the applicant organizations and the parent organization;

• Proposed project focus and service area for each applicant organization with the same EIN or UEI (these should not overlap);

• Justification for why each applicant organization must apply to this funding opportunity separately as the applicant organization, as opposed to serving as network member organizations on other applications;

• Assurance that the applicant organizations will each be responsible for the planning, program management, financial management, and decision making of their respective projects, independent of each other and/or the parent organization; and

• Signatures from the points of contact at each applicant organization and the parent organization.

HRSA-24-120 Delta MCC 8

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-24-120 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 50 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

If there are other items that do not count toward the page limit, we’ll make this clear in Section IV.2.vi Attachments.

If you use an OMB-approved form that is not in the HRSA-24-120 workspace application package, it may count toward the page limit.

Applications must be complete and validated by Grants.gov under HRSA-24-120 before the deadline.

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

HRSA-24-120 Delta MCC 9

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 11:

Other Relevant Documents.

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

Program Requirements and Expectations Applicants for the Delta MCC must meet all the requirements stated under section III.

Eligibility Information. Applicant organizations are also expected to meet the requirements outlined below. Failure to respond to these requirements may impact your application’s score.

Applicant Organization Requirements

A. The applicant organization must be in an established or formal network/consortium partnership that can provide care during and after pregnancy. Please see Appendix C for the definition of established/formal networks, the definition of health care provider organizations and examples of types of partnership organizations.

B. The applicant organization must have the staffing and infrastructure necessary to oversee program activities and financial management for the award. As such, HRSA strongly recommends the project director allot adequate time (at least 1 FTE) to the program and has management experience involving multiple organizational arrangements. HRSA highly recommends your staffing plan should include supporting and key personnel that total at least one full time- FTE at the time of application.

Network/Consortium Requirements

A. You must specify the organizations that will be in the network consortium. Your network consortium partners must consist of at least 3 separately owned entities (your organization plus 2 additional organizations). Each applicant organization and network member must have its own EIN number unless an exception is requested (see details above in Section III.3).

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.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-24-120 Delta MCC 10

B. The network must represent a consortium composed of three or more health care provider organizations, including the applicant organization, with at least 66 percent (two-thirds) of network consortium members located in a HRSA-designated rural area, as defined by the Rural Health Grants Eligibility Analyzer.

HRSA requires an attestation that at least sixty-six percent (66%), or two-thirds of consortium members (members with signed Letters of Commitment or Memorandum of Understanding) of the proposed project are physically located in a HRSA-designated rural area. See Attachment 1. The network/consortium must represent a diversity of health professionals relevant to coordinating care for maternal prenatal and perinatal services in the target rural service area. This would include, but not limited to:

• Rural and tribal hospitals

• Primary Care Providers including Federally Qualified Health Centers, Medicare-certified Rural Health Clinics, and Indian Health Service Clinics

• Healthy Start Awardees

• Maternal, Infant, and Early Childhood Home Visiting Program Awardees

• Level II facilities with the capability to provide specialty care to maternal health patients (see Appendix B)

• Tertiary hospitals that can provide high-risk obstetric care, such as Level III and Level IV facilities (see Appendix B)

• Insurers (Medicaid, Children’s Health Insurance Program, Private Insurers)

C. Each network/consortium partner must demonstrate substantial involvement in the project and contribute significantly to the goals of the project, including how members will share information across the network and plans for shared governance in how the network will operate on behalf of all members.

D. If you are an established network/consortium with formal existing network members established through signed network member agreements, please include a summary, no longer than one page, detailing your network’s history of working together and highlighting your network’s products, services, and sources of sustainability as Attachment 2.

E. At a minimum, the network must have a Letter of Commitment from all network/ consortium partners submitted with this application. The Letter of Commitment must be signed and dated by all network/consortium partners/members, reflect the mutual commitment of each member partner to the Delta MCC and describe the extent of the anticipated involvement by each network partner. Include the Letter of Commitment as Attachment 1. If funded, award recipients who submitted a letter of commitment with their application will be expected to submit

HRSA-24-120 Delta MCC 11 a signed Memorandum of Agreement (MOA) within the planning year of the project period.

Service Area Requirements

A. Delta MCC supported services may only be delivered in HRSA-designated rural counties and rural census tracts within the Delta Region.

If your target rural service area contains any counties or census tracts that are NOT designated rural counties or rural census tracts within the Delta Region per the Rural Health Grants Eligibility Analyzer, your application will not be reviewed or scored.

B. The applicant organization must include a legible map that clearly shows the location of network/consortium partners, the geographic area(s) that will be served by the network/consortium, and any other information that will help visualize and understand the scope of the proposed project activities in Attachment 3.

Data Reporting Requirements

Delta MCC seeks to document and monitor progress on program goals through the collection of data from each award recipient and their network partners. Award recipients will work with a HRSA-funded data support provider to collect data from network partners and report data on a regular basis throughout the course of the program as determined by FORHP.

The purpose of the data collection and report is for the network and the HRSA-funded Data Support Provider to inform progress on the work plan; perform continuous quality improvement; and help to identify gaps in perinatal care within the targeted rural service area.

Examples of data to be collected across the network may include, but are not limited to:

• Number and name of counties served in project

• Number of people in the target population

• Number of unique individuals from your target population who received direct services during this reporting period

• Number of unique women from your target population who received direct services during this reporting period

• Number of pregnant women who receive a prenatal visit

• Number of new mothers who receive a postpartum visit

• Number of high-risk pregnancies

• Number of pregnant women and new mothers with hypertension

• Number of pregnant women and new mothers that received mental health screening

• Number of infants with low birth weight

• Number of pregnant women and new mothers screened for high blood sugar

HRSA-24-120 Delta MCC 12

• Number of pregnant women, new mothers, and their families screened for potential home visiting services

• Number of visits performed by clinicians travelling into the area and/or number of hours of mobile clinic services added in target counties

Please note that these are examples of the data elements that award recipients may be expected to collect and report; the final list of required data elements may differ from the list above. Additional information will be provided by the Federal Office of Rural Health Policy. Applicants should, however, build these risk-reduction efforts into their application work plan.

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.

In addition to the SF-424 Application Guide requirements, the project abstract must contain the following information below:

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.)

• Website Address (if applicable)

Project Overview

• Project Title

• Project Goal

• Project Objectives

Proposed Service Area (e.g., Delta Region states and counties).

NOTE: Proposed rural counties should be fully rural. For partially rural counties, include rural census tract(s).

HRSA-24-120 Delta MCC 13

ABSTRACT BODY CONTENT

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

Network/Consortium Partnerships Provide the full list of organization names and facility/entity type of partner(s) organizations comprising the network/consortium members who have signed a Letter(s) of Commitment, Memorandums of Agreement (MOA), or Business Associate Agreements (BAAs) to implement the proposed project.

• HRSA requires an attestation that at least sixty-six percent (66%), or two-thirds of consortium members (members with signed Letters of Commitment 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 Delta Region Please describe your capacity to serve rural underserved populations in the Delta Region. Examples to show this capacity may include, but is not limited to, a history or ability to:

• Identify existing formal partnerships (as applicable): If you are an established network/consortium, briefly summarize your network/consortium’s history of working together and highlighting your network/consortium’s products, services, and sources of sustainability.

• 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 promote rural health care services outreach by improving and expanding 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 direction and input from rural communities in the project.

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

Funding Priority Points Requested To receive a funding priority for delivering services in counties or parishes and census tracts with a maternity care health professional target area (MCTA) of 20 or higher, please include a statement in the abstract that you qualify for this funding priority.

HRSA highly recommends that the applicant use the language below to identify their funding priority request:

“[Applicant organization name] is requesting a funding priority. The proposed project will deliver coordinated perinatal health care services in the following counties or parishes and census tracts with a MCTA of 20 or higher based on designated geographic primary care HPSAs: [insert list of counties or parishes and census tracts with a MCTA of 20 or higher].”

If applicable, you need to provide supporting documentation in Attachment 8. Please refer to Section V.2 for further information.

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

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Narrative Section Review Criteria

Approach Criterion 2: RESPONSE

Criterion 4: IMPACT

Work Plan Criterion 2: RESPONSE Criterion 4: IMPACT

Resolution of Challenges Criterion 2: RESPONSE

Evaluation and Technical Support Capacity

Criterion 3: EVALUATIVE MEASURES

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 o Briefly describe the purpose of the proposed project and clearly identify specific project goals, objectives, and expected outcomes. Summarize how the proposed project will address maternal prenatal and perinatal care, improve and expand care coordination services, and improve and expand access for the proposed target area(s).

Organizational Information -- Corresponds to Section V’s Review Criterion(a) # 5 Resources and Capabilities

In this section, you must demonstrate your organizational capacity and the network capacity to carry out the proposed project activities and ability meet program expectations.

Organization Information o Describe your organization’s current mission, structure, and scope of current activities, and how these elements all contribute to the organization’s ability to implement the Delta MCC requirements and expectations.

o Identify a Project Director, as well as key personnel on the award in the Project Abstract and Attachment 4. The Project Director will be responsible for project/program monitoring and carrying out the award activities as well as the overall network/consortium management.

HRSA-24-120 Delta MCC 16 o The applicant organization should identify a permanent Project Director prior to receiving award funds. If the applicant organization has a project director or has not yet hired a person to serve as the or Project Director, discuss the process and timeline for hiring a permanent individual for these positions.

o HRSA strongly recommends the Project Director allot adequate time and additional FTE support as needed for carrying out and managing network/consortium activities (1 FTE the Project Director is recommended).

o A staffing plan and job descriptions for key staff must be included in Attachment 4.

Network Information o Provide Letters of Commitment from each network/consortium member, in Attachment 1, delineating their expertise, roles and responsibilities, and commitments in the project.

o Include the applicant organization’s organizational chart and the network’/consortium’s organizational chart and list in Attachment 2. The network/consortium member list must contain the following information for each network/consortium member; it is recommended that this information is provided in a table format:

o Network/consortium member organization name o Network/consortium member organization street address and county o Network/consortium member primary point of contact (name, title, email) o Type of health care service and/or support services each network/consortium member provides (prenatal, labor and delivery, postpartum care, support service, etc.)

o Attestation if they are within a HRSA-designated rural area, as defined by the Rural Health Grants Eligibility Analyzer o Describe how your network/consortium includes a spectrum of health professionals and organizations relevant to coordinating care for maternal prenatal and perinatal services in your target rural service area.

o Describe how your network will establish a shared network governance model that incorporates perspectives from all members in its decision-making and resource allocation to meet program goals while ensuring and demonstrating high-level engagement from every member. Discuss how this structure will provide safeguards to ensure a collaborative decision-making process that empowers all network members to address program goals.

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

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

Target Population Details and Maternal Health Indicators o Identify and describe any national and/or local rankings data to include the number of maternal deaths or most recent maternal mortality ratio; social vulnerability index; or other maternal health indicators. When possible, disaggregate health indicators by race and ethnicity or other demographic characteristics and/or discuss and contextualize the target population with respect to racial and ethnic disparities or other demographic characteristics.

If the service area has a low population density where such data may impact patient privacy, please provide additional contextual information and the total population in the proposed service area.

Maternal Health Care Availability in Service Area o Describe the health care services available in or near the target service are and any gaps in services, including whether the service area is an identified maternity care health professional target area (MCTA) or health care professional shortage area (HPSA). Specifically detail the current prenatal and perinatal services available or not available in the area.

o Describe the need for coordinated maternal health care services in the target service area.

Approach -- Corresponds to Section V’s Review Criterion(a) #2 Response and #4 Impact

This section outlines, in a narrative format, the approach you will use to address and respond to the needs in your community and meet the goals of this program as outlined in the Purpose Section. It is anticipated that the first year is the planning year, although some implementation activities may occur during this timeframe. Approaches in future years may be adjusted based on additional information gathered during year one of the project.

Define the specific goals and objectives of your proposed project. Propose methods that you will use to address the needs outlined in the Needs Assessment section and meet the five goals for the Delta MCC outlined in the Purpose section.

To address the five goals, you should consider:

• Using care coordination, community outreach and education, and provider training to address maternal health and infant health disparities; including the use of telehealth to increase access to services as necessary.

• Supporting rural hospital and rural clinic participation in AIM Safety Bundles and the state-wide Perinatal Quality Collaboratives.

https://saferbirth.org/patient-safety-bundles/ https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pqc-states.html

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• Using trained doulas, community health workers, and other qualified personnel to enhance coordination of services.

Applicants should also consider the following in their program planning and implementation:

• Develop a triage plan for various levels of risk during pregnancy;

• Reduce rates of hypertension for those identified for being at risk;

• Make referrals to services for appropriate counseling during the prenatal and postpartum periods;

• Monitor factors related to low birth weight;

• Make referrals for nutritional and clinical consultation to reduce the rate of gestational diabetes; and

• Make referrals for home-visiting services.

During year one, award recipients will engage in community asset mapping to strengthen their project. Additional instructions will be provided upon receipt of the award.

Describe how your strategies during the program years will lead to the capacity of the network/consortium to contribute the outcomes outlined in the Purpose section.

Describe how you will develop and implement sustainable strategies of care coordination into policies, procedures, staffing, services, and communication systems.

Describe how you will assess and address disparities in infant and maternal health outcomes, including among rural racial and ethnic minority and other underserved populations.

Briefly illustrate the level of collaboration of members in the network/consortium.

Describe each network/consortium members’ contribution to accomplish set program goals and how the network /consortium plans to implement shared governance. Describe the communication plan that will be used within the network/consortium and how frequently network/consortium meetings will be held.

Describe how the network/consortium partnerships and collaboration among entities that represent the spectrum of care during and after pregnancy will help identify barriers to providing maternal care and strategies for addressing barriers throughout the project.

Outline the specifics of the evidence-based, promising practice, and/or value-based care models for your strategies to address perinatal care.

Describe how you will build in strategies for sustainability so that the work can continue within the network/consortium after this grant ends.

https://www.ruralhealthinfo.org/toolkits/maternal-health https://www.ruralhealthinfo.org/topics/maternal-health/project-examples

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Work Plan -- Corresponds to Section V’s Review Criteria #2 Response and #4 Impact Provide a clear and detailed work plan in Attachment 6 that you will use to achieve each of the program goals listed under Section I.1 Purpose.

o Describe activities or steps you will use to achieve each of the program goals and objectives proposed during the entire period of performance identified in the “Introduction” section.

o Describe timeframes and deliverables and identify personnel, network/consortium members, and/or key collaborators responsible for executing each activity during the five-year period of performance. Identified key faculty/staff in the work plan must correspond with the staffing plan in Attachment 4.

o Describe the expected impact on the target population and the regional health landscape, including the expected or potential long-term changes and/or improvements and expansions in health care delivery due to implementation of care coordination strategies and innovation.

Resolution of Challenges -- Corresponds to Section V’s Review Criterion #2 Response

Discuss potential challenges and approaches to resolve those challenges. Include a discussion of:

o Maintaining network/consortium collaboration and involvement;

o Ensuring work and activities serve the target rural populations; and o Ensuring the services provided address the cultural, linguistic, religious, and social differences of the target population.

• Evaluation and Technical Support Capacity -- Corresponds to Section V’s Review Criterion # 3 Evaluative Measures

This section describes your proposed plan to monitor ongoing processes and progress towards meeting project goals, objectives and expected outcomes.

o Describe how you will engage network/consortium members to ensure effective and productive collaboration.

o Describe the capacity of network partners to collect and report data to you as the lead organization, including your capacity to oversee the data collection, cleaning, and reporting to HRSA.

iii. Budget

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

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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).

As required by the Consolidated Appropriations Act, 2024 (P.L. 117-328), Division H, § 2024, “None of the funds appropriated in this title shall be used to pay the salary of an…