FY 16 Sustainability FOA 12.17.15.pdf

DEPARTMENT OF HEALTH AND HUMAN SERVICES

AGENCY: Office of the Secretary, Office of the Assistant Secretary for Health, Office of

Population Affairs

FUNDING OPPORTUNITY TITLE: Announcement of Anticipated Availability of Funds for Ensuring Access to Quality Family Planning Services

ACTION: Notice

ANNOUNCEMENT TYPE: Limited Competition Grant

FUNDING OPPORTUNITY NUMBER: PA-FPH-16-023

CFDA NUMBER: 93.217

CFDA PROGRAM: Family Planning Services

DATES: Non-binding letters of intent are due February 29, 2016, 5:00pm ET

Your application is due March 31, 2016 by 5 p.m. Eastern Time. To receive consideration, your application must be received electronically via Grants.gov by the HHS Office of the

Assistant Secretary for Health (HHS/OASH), Office of Grants Management (OGM) no later than this due date and time. If your application does not meet the specified deadline it will be returned to you unread. You must submit electronically via Grants.gov unless you obtain a written exemption from this requirement 2 business days in advance of the deadline from the Director, HHS/OASH Office of Grants Management. To obtain an exemption, you must request one via email from the HHS/OASH Office of Grants Management, and provide details as to why you are technologically unable to submit electronically through the Grants.gov portal. Your request should be submitted at least 4 business days prior to the application deadline to ensure your request can be considered prior to 2 business days in advance of the deadline. If you request an exemption, include the following in your e-mail request: the HHS/OASH announcement number;

your organization's DUNS number; your organization’s name, address and telephone number;

the name and telephone number of your Authorizing Official; the Grants.gov Tracking Number

(GRANTXXXX) assigned to your submission; and a copy of the "Rejected with Errors" notification from Grants.gov. Send the request with supporting documentation to ogm.oash@hhs.gov. Note: failure to have an active System for Account Management (SAM) registration will not be grounds for receiving an exemption to the electronic submission requirement.

The HHS/OASH Office of Grants Management will only accept applications via alternate methods (hardcopy paper via US mail or other provider or PDF via email) from applicants obtaining prior written approval. The application must still be submitted by the deadline. Only applications submitted through the Grants.gov portal or alternate format

(hardcopy paper via US mail or other service or PDF via email) with an approved written exemption will be accepted. See Section D.7. (“Other Submission Requirements”) for information on application submission mechanisms.

Executive Order 12372 comment due date: The State Single Point of Contact (SPOC) has 60 days from the application due date to submit any comments. For more information on the

SPOC see section D.4 Intergovernmental Review.

To ensure adequate time to successfully submit your application, HHS/OASH recommends that you register as early as possible in Grants.gov since the registration process can take up to one month. For information on registering for Grants.gov, refer to mailto:ogm.oash@hhs.gov http://www.grants.gov or contact the Grants.gov Contact Center 24 hours a day, 7 days a week

(excluding Federal holidays) at 1-800-518-4726 or support@grants.gov.

Your organization is strongly encouraged to register multiple authorized organization representatives in Grants.gov to ensure someone is available to submit your application.

Technical Assistance: A technical assistance webinar for potential applicants will be held on

February 2, 2016 from 3:00pm ET to 4:30pm ET. Webinar information follows below:

Conference Dial in:

Dial in: 888-942-8387

Passcode; 7883022

Online Webinar (to view the presentation):

URL: https://www.mymeetings.com/nc/join/

Conference number: PW6473655

Audience passcode: 7883022

Participants can join the event directly at:

https://www.mymeetings.com/nc/join.php?i=PW6473655&p=7883022&t=c

EXECUTIVE SUMMARY: The Office of Population Affairs announces the availability of funds for Fiscal Year (FY) 2016 for a limited competition under the authority of Title X of the

Public Health Service Act, 42 U.S.C. 300 et seq. This notice solicits applications from Title X grantees who have a current grant, or have applied for funding, as of April 1, 2016. Grantees with an active grant as of July 1, 2016, may be funded. Note that a grantee is defined as an entity http://www.grants.gov/ mailto:support@grants.gov https://www.mymeetings.com/nc/join/ https://www.mymeetings.com/nc/join.php?i=PW6473655&p=7883022&t=c that receives funding directly from the Office of Population Affairs. Funding received under this announcement may be used to ensure access to quality family planning services in Title X by addressing one of the following priority areas: 1) improving health information technology systems; 2) enrolling clients into health insurance programs; 3) partnering with, or enhancing integration of family planning with primary care services; 4) improving financial systems to optimize revenue; or 5) outreach to low income men and women of reproductive age in need of family planning services.

Awards will be for one year. Grantees may submit multiple applications but each application should only address ONE priority area. Multiple service sites can be included in the ONE priority area.

A. PROGRAM DESCRIPTION:

This funding opportunity announcement (FOA), issued by the Office of Population

Affairs (OPA), invites applications from Title X grantees who have a current grant, or have applied for funding, as of April 1, 2016. Grantees with an active grant as of July 1, 2016, may be funded. Applicants may only propose a project in ONE of the following priority areas (further information below), but may submit multiple applications:

1) Improving health information technology systems;

2) Enrolling clients into health insurance programs;

3) Partnering with, or enhancing integration of family planning with primary care services;

4) Improving financial systems to optimize revenue; and,

5) Outreach to low income men and women of reproductive age in need of family planning services.

The applicant should clearly identify which priority area it is addressing and be responsive to the specific requirements within each topic area detailed below. Applicants must identify specific service sites within the grantee network where project activities will occur.

Project activities may be proposed in more than one service site per application, but only ONE priority area may be addressed. Multiple applications per grantee are allowed.

BACKGROUND

The Title X program is designed to provide comprehensive family planning and related preventive health services with priority for services to persons from low income families. Based on the most recent Family Planning Annual Report (2014 FPAR),1 eighty-nine percent of the 4.1 million clients served at 4,127 Title X family planning centers have family incomes at or below

200 percent of the Federal Poverty Level (FPL).

The healthcare landscape has changed as a result of the Patient Protection and Affordable

Care Act (P.L. 111-148), as amended by the Health Care and Education Reconciliation Act (P.L.

111-152) (collectively known as the Affordable Care Act, or ACA), and Title X-funded centers need to invest in infrastructure and operational improvements in order to ensure continued access to high quality family planning services, and to remain financially sustainable.

With a changing healthcare landscape, OPA encourages Title X providers to recognize practices that will increase their long-term sustainability and ensure continued ability to provide access to needed services. The Family Planning National Training Center (FPNTC) funded by

OPA has developed a framework for health center sustainability that includes practices on a

1 Fowler, CI, Gable, J, Wang, J, and McClure, E. (2014). Family Planning Annual Report: 2014 National Summary.

Research Triangle Park, NC: RTI International. Available at: http://www.hhs.gov/opa/title-x-family-planning/research-and-data/fp-annual-reports/ http://www.hhs.gov/opa/title-x-family-planning/research-and-data/fp-annual-reports/ continuum from unsustainable to cutting edge. This framework is available on the FPNTC website, and we encourage applicants to use this framework to develop their applications:

http://fpntc.org/training-and-resources/achieving-the-triple-aim-better-care-better-health-and-lower-cost-a-guide-for.

PRIORITY AREAS:

1) Improving health information technology systems

The effective use of health information technology (HIT) now plays a critical contributing role in improving care quality, reducing costs, and improving the patient experience of care. The Federal Health IT Strategic Plan 2015-20202 identifies the mission of health IT systems as one that “improves the health and well-being of individuals and communities through the use of technology and health information that is accessible where and when it matters most.” It is becoming more important than ever to collect electronic information that can be transformed into data that are actionable for dynamic uses in public health. HIT systems are also necessary to support new payment models.

While most hospitals and private clinics have largely transitioned from paper to

Electronic Health Record (EHR) systems, driven by efforts to comply with the Meaningful

Use program (see https://www.cms.gov/Regulations-and-

Guidance/Legislation/EHRIncentivePrograms/Getting_Started.html), many public health agencies have experienced a slower rate of adoption and implementation. One aim of the

Federal Health IT Strategic Plan is to facilitate the creation of “bi-directional interfaces [that

2 The Office of the National Coordinator for Health Information Technology (ONC) Office of the Secretary United States Department of Health and Human Services. Available at: https://www.healthit.gov/sites/default/files/9-5-federalhealthitstratplanfinal_0.pdf or http://healthit.gov http://fpntc.org/training-and-resources/achieving-the-triple-aim-better-care-better-health-and-lower-cost-a-guide-for http://fpntc.org/training-and-resources/achieving-the-triple-aim-better-care-better-health-and-lower-cost-a-guide-for https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Getting_Started.html https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Getting_Started.html https://www.healthit.gov/sites/default/files/9-5-federalhealthitstratplanfinal_0.pdf https://www.healthit.gov/sites/default/files/9-5-federalhealthitstratplanfinal_0.pdf http://healthit.gov/ will] enable unencumbered provider reporting to public health entities and allow seamless feedback and decision support from public health to clinical providers relevant to chronic health and emergent threats.”3

Currently, Title X grantees and their affiliated service sites use a variety of HIT systems to support the delivery of clinical services and to collect data to meet the requirements laid out in the Family Planning Annual Report (FPAR). However, some grantee networks still rely heavily on paper-based systems, siloed practice management software, and/or analytical programs in order to generate their FPAR data. A survey of 1,700 Title X agencies fielded in spring 2015 found that only a third of the health departments who participated reported using an EHR system and only 11% of respondents were connected to a health information exchange. OPA is currently in the process of redesigning the FPAR from a static, aggregate data reporting system to FPAR 2.0, an encounter-level data collection system that will generate clinical performance data for use in driving quality improvement. Optimal participation in the FPAR 2.0 data collection system will require that a grantee’s network of sites use EHR systems that have been designed for future interoperability and possess

Meaningful Use Stage 2 certification, at a minimum. Title X grantees and their affiliated service sites will not be able to participate fully in the standards-based future of healthcare interoperability if the basic technologies and infrastructures are not in place. More information regarding FPAR 2.0 can be found on http://opahit.sites.usa.gov/.

In alignment with both the goals of FPAR 2.0 and the Federal Health IT Goals cited below, applicants may propose projects that improve the grantee’s health IT infrastructure and/or that of its affiliated sub-recipients and service sites through any of the following activities:

http://opahit.sites.usa.gov/

1. Purchase of, or upgrade to, a Meaningful Use Stage 2-certified EHR system. (Aligns with Federal Health IT Goal 2 - Objective 2A, Strategy 1.)

The Office of the National Coordinator (ONC) maintains a list of certified EHR systems at http://oncchpl.force.com/ehrcert?q=chpl. Proposed projects should purchase or upgrade to Meaningful Use Stage 2-certified EHR system.

Note: While Electronic Practice Management (EPM) systems provide important electronic functionality such as appointment booking and collection of demographic data which may be used to support current FPAR data collection, OPA encourages service sites to adopt certified clinical EHR systems to ensure the long-term sustainability of the investment and prepare clinical sites to be able to meet and comply with evolving interoperability standards.

2. Investment in health IT systems hardware or improvements to existing EHR systems and/or related IT systems that enable participation in a data warehouse or participation in a local or state-based health information exchange (HIE) including:

A) Investment in broadband or wireless internet services for clinics or local health departments lacking modern capabilities (aligns with Goal 4 - Objective 4E);

B) Purchase of updated equipment to support modern health IT software including computers and peripherals, supporting applications, and supportive hardware

(e.g., integration engines) (supports deployment of Goal 4 Objectives);

C) Modifications to update the capabilities of existing EHR systems to perform more accurate or more sophisticated data extraction, reporting and analytics (aligns with Goal 2 - Objective 2A, Strategy 6);

http://oncchpl.force.com/ehrcert?q=chpl

D) Development of a new, or enhancement of an existing, central data repository at the grantee or state level (a host location for access and sharing of data to monitor and track health outcomes of Title X clients effectively) or streamline workflows for data capture during a client visit (aligns with Goal 2 - Objective 2A, Strategy

6);

E) Development of infrastructure or applications that provide the necessary capabilities to enable effective participation in a health information exchange, including adoption of common interoperability standards or pilot tests of standards implementation (aligns with Goal 4 - Objective 4C).

3. In alignment with Federal Health IT Goal 3 - Objective 3A and Goal 4 - Objective

4B, and in preparation for the anticipated privacy and security requirements of FPAR

2.0, perform a k-anonymity analysis. This analysis will help OPA determine whether the grantee’s current health IT system(s) could adequately perform the recommended de-identification algorithms on a representative sample of Title X client visits for

FPAR 2.0 data collection in order to sufficiently reduce the risk of re-identification of an individual in the sample data, and if not, identify which data elements must be either further restricted or de-identified. The recommended algorithms are outlined in the Family Planning Profile De-Identification supplement and White Paper which can be found at www.ihe.net, with additional information available on OPA’s Health IT blog: http://opahit.sites.usa.gov/.

4. Other improvements to health IT systems that seek to improve patient care quality and experience or to support best practices in revenue cycle management.

http://opahit.sites.usa.gov/

2. Enrolling clients into health insurance programs

Fifty-four percent of all Title X clients are uninsured and 69 percent are under the age of

30 (FPAR, 2014). The ACA includes a variety of provisions designed to promote accountability, affordability, quality, and accessibility in the health care system. The ACA requires most health coverage to include coverage for certain recommended preventive services without cost sharing. Specifically included among the recommended preventive services is coverage for FDA-approved contraception and related patient education and counseling for women with reproductive capacity, which most plans must pay for without cost sharing. Current and potential Title X clients need information and assistance to understand available opportunities to identify and obtain the affordable health coverage that best meets their needs. Under 42 CFR §59.5(b)(3), service centers should “inform the community of the availability of services,” which includes health coverage enrollment assistance activities for current and potential Title X clients. For Title X centers that serve a disproportionate number of uninsured individuals, assisting individuals with obtaining health coverage will help clients better access family planning and related preventive health services, which will further the Title X programs’ goals in helping individuals determine “the number and spacing of their children”( 42 CFR §59.1). In addition, increased revenue through third party reimbursements may allow Title X centers to remain sustainable and provide services to additional clients.

The ACA has created a private health insurance Marketplace, called the Health Insurance

Marketplace (also referred to as the “Marketplace” or “Exchange”), that provides millions of individuals, families, and small businesses with access to affordable health insurance coverage. Through the Marketplace, eligible individuals and families can receive premium tax credits and cost-sharing reductions to help with the cost of insurance coverage and covered services. Individuals and families can apply for health insurance through the

Marketplace during an open enrollment period or, if they experience certain circumstances during the year, during a special enrollment period. The open enrollment period for the

Marketplace is anticipated to begin in November 2016 for coverage beginning in 2017.

Medicaid and CHIP enrollment is ongoing. The ACA also gives states the opportunity to expand their Medicaid programs with significant funding support from the Federal government. Most individuals under 65 years of age with incomes below 133 percent of the federal poverty level (FPL) will be eligible for Medicaid in states that participate in this expansion.

The purpose of this funding priority area is to support service delivery sites in raising awareness of affordable health coverage options and to provide enrollment assistance to current and potential Title X clients in their approved service areas who do not have coverage. Providing enrollment assistance will help individuals access high quality family planning services in order to determine the number and spacing of their children as authorized under the Title X statute and regulations. Additionally, increased revenue through third party reimbursements will enable services to be provided to additional clients in need.

The requirements set forth in this FOA are specific to the Title X program. Although language in this FOA may be similar to language applicable to other HHS or State-based

Marketplace enrollment assistance programs, this FOA is independent of any other HHS enrollment assistance programs (such as the CMS Marketplace Navigator Program) and does not seek to duplicate or replace any other such program.

Applicants may propose projects to initiate or expand onsite health coverage enrollment services that:

a) Increase the service site’s current enrollment assistance capacity by expanding hours of existing enrollment workers or by hiring new staff to assist clients with signing up for health insurance programs.

b) Allow health centers to conduct “in reach” with currently uninsured Title X clients

(for example by contacting currently uninsured patients to explore options); and outreach to clients in an approved service area that need family planning and health insurance enrollment services, so that they can have better access to Title X family planning and related preventive health services..

3. Partnering with, or enhancing integration of family planning services with primary care services

The majority (92%) of family planning users are women who, for those with coverage through Medicaid or a non-grandfathered health insurance plan or policy, have access to a broad range of preventive services as a result of the ACA. Six out of ten women who use publicly funded family planning centers cite the family planning center as their usual source of medical care.3 Title X family planning providers have always been required to provide referrals to other healthcare providers, including primary care providers (42 CFR 59.5 (b)(1) and (8)) and Title X providers are encouraged to have formal documented linkages (e.g., with memoranda of understanding) with primary care providers. However, with the increase in the number of individuals insured, and the trusted nature of Title X providers, there are

3 Gold RB et al., Next Steps for America’s Family Planning Program: Leveraging the Potential of Medicaid and Title X in an Evolving Health Care System, New York: Guttmacher Institute, 2009.

opportunities to integrate more formally with primary care providers to ensure optimal care for clients. This funding opportunity can be used to enhance linkages and integration with primary care providers in the local area. The OPA-funded FPNTCs have a number of resources on how to partner with primary care providers on the following website:

www.fpntc.org (then search for “primary care”). Further, the recent recommendations for the provision of Quality Family Planning services (QFP)4 provide guidelines for related preventive health services.

Applicants may propose projects to formalize partnerships with, or better integrate services with primary care providers through:

1) Increasing the clinical services provided onsite, consistent with the QFP recommendations;

2) Formal partnerships or co-location with local primary care providers; and,

3) Integration with local primary care providers.

Applicants should be specific in their proposed activities and include measurable outcomes for the proposed activities.

4. Improving financial systems to optimize revenue

At the national level, 39 percent of Title X revenue for grantees comes from Medicaid, 8 percent from private sources, 20 percent from Title X Federal funding and 4 percent from client fees. 5 In order to thrive in the current healthcare landscape and ensure that Title X clinics are sustainably financed, it is essential that all health centers receiving Title X funding

4 Gavin, L, Moskosky S, Carter M, et al. Providing Quality Family Planning Services; Recommendations of CDC and the U.S Office of Population Affairs. MMWR 2014;63 5 Fowler, CI, Gable, J, Wang, J, and McClure, E. (2014). Family Planning Annual Report: 2014 National Summary. Research Triangle Park, NC: RTI International. Available at: http://www.hhs.gov/opa/title-x-family-planning/research-and-data/fp-annual-reports/ http://www.fpntc.org/ monitor fiscal performance measures at the individual health center level and establish benchmarks and goals for improvement. Key performance indicators (KPI) may include (but are not limited to):

• Net collection rate

• Accounts Receivable Aging

• Days in Accounts Receivable

• Utilization or client volume

• Payer Mix

• Net Program Income

• Months Cash on Hand

All of these financial metrics can be tracked using a financial dashboard that’s available in the sustainability community of practice on the FPNTC website.6

Title X sites are required to bill third party payers (42 CFR 59.5(a)(9)), however many private insurance plans require participation in their provider network to reimburse for services provided.

Applicants may propose projects that:

1) Increase contracts with private health plans or Medicaid Managed Care Organizations

(MCOs);

2) Analyze financial performance metrics for individual health centers in their network and strategically plan to increase the financial performance of selected health centers;

or, 6 Available at: http://fpntc.org/cop/sustainability http://fpntc.org/cop/sustainability

3) Invest in infrastructure to optimize claims processing.

5. Outreach to low income men and women of reproductive age in need of family planning services.

According to the Guttmacher Institute, there were 20.1 million US women in need of publicly funded family planning services in 2013.7 The changing dynamics of the health care system, including: increasing numbers of individuals with insurance, increasing numbers of adolescents remaining on their parent’s health insurance plans until the age of 26, and changing social attitudes towards contraception and the terminology around contraception, provide an opportunity for Title X centers to enhance outreach services to reach populations in need that are not currently accessing family planning services. Title X grantees are already required to “provide for informational and educational programs designed to achieve community understanding of the objectives of the program; inform the community of the availability of services; and promote continued participation in the project by persons to whom family planning services may be beneficial” (42 CFR 59.5(b)(3)), but the breadth of such outreach varies by health center. Community education and community engagement activities can have positive outcomes, such as increased awareness of family planning services.8,9 There are opportunities for Title X centers to partner with other programs serving low income and vulnerable populations, such as the WIC program, corrections and juvenile

7 Guttmacher Institute. Contraceptive Needs and Services, 2013 Update. Available at:

http://www.guttmacher.org/pubs/win/contraceptive-needs-2013.pdf 8 Carter MW, Tregear ML, Moskosky S. Community Education for family Planning in the US. A systematic review. American Journal of Preventive Medicine 2015;49(2S1):S107–S115.

9 Carter MW, Tregear ML, Lachance, C. Community Engagement in family Planning in the US. A systematic review. American Journal of Preventive Medicine 2015;49(2S1):S116–S123.

http://www.guttmacher.org/pubs/win/contraceptive-needs-2013.pdf justice system, job corps, community colleges, school-based health services, services for the homeless, and many others. Applicants may propose projects to:

1) Conduct assessments in areas where there is high need but low clinic volume to understand why clients are not accessing services;

2) Create outreach campaigns to populations in need of Title X services;

3) Create evidence- informed messaging for local populations to educate them about the availability of Title X services in the area; and/or

4) Partner with community organizations to reach currently unserved low income individuals of reproductive age in the community.

Note: Applicants should select ONE priority area per application. ONE priority area may include multiple service sites. Applicants are allowed to submit more than one application.

AUTHORITY: Section 1001 of the Public Health Service (PHS) Act

B. FEDERAL AWARD INFORMATION

The Office of Population Affairs intends to make available approximately $1,000,000 for competing grants. The actual amount available will not be determined until enactment of the FY

2016 federal budget. This program announcement is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, applications can be processed, and funds can be awarded in a timely manner.

We will fund grants in annual increments (budget periods) and generally for a project period of up to one year, although we may approve shorter project periods. Funding for all approved budget periods beyond the first year of the grant is generally level with the initial award amount and is contingent upon the availability of funds, satisfactory progress of the project, and adequate stewardship of Federal funds.

Award Information

Estimated Funds Available for Competition: $1,000,000

Anticipated Number of Awards: 7-10

Range of Awards: $25,000 to $150,000 per budget period

Anticipated Start Date: 07/01/2016

Period of Performance: Not to exceed 1 year

Budget Period Length: 12 months

Type of Award: Grant

Type of Application Accepted: Electronic via Grants.gov ONLY unless an exemption is granted

C. ELIGIBILITY INFORMATION

1. Eligible Applicants.

Eligible applicants are Title X grantees who have a current grant, or have applied for funding, as of April 1, 2016. Grantees with an active grant as of July 1, 2016, may be funded.

Sub-recipient agencies seeking funds for the activities supported under this announcement must apply through the Title X grantee. Each Title X grantee may submit multiple applications that may include activities/products benefiting multiple sub-recipients and/or service sites, but each application must focus on only ONE priority area.

2. Cost Sharing or Matching

The following cost sharing requirements apply to the overall Title X grantee agency funding levels. Applicants are not required to demonstrate specific cost sharing for this FOA as long as the grantee’s overall Title X project (including the funding from this FOA) meets the requirements below (see example at the end).

Program regulations at 42 CFR §59.7(c) stipulate that, “No grant may be made for an amount equal to 100 percent of the project’s estimated costs.” Also, 42 CFR § 59.7(b) states that, “No grant may be made for less than 90 percent of the project’s costs, as so estimated, unless the grant is to be made for a project that was supported, under section 1001, for less than 90 percent of its costs in fiscal year 1975. In that case, the grant shall not be for less than the percentage of costs covered by the grant in fiscal year 1975.”

For example, Applicant XYZ was awarded $1,000,000 under the Title X service delivery grant and had committed $100,000 in cost sharing for their Title X project. Applicant XYZ is applying for $200,000 under this FOA. They should propose $20,000 in cost sharing to meet the

10% minimum matching for their overall Title X project.

3. Other Eligibility Information

Application Responsiveness Criteria

We will review your application to determine whether it meets the following responsiveness criteria. If your application does not meet the responsiveness criteria, we will eliminate it from the competition and it will not be reviewed.

The applicant appears to have demonstrated:

• The application addresses only one priority area, which is identified clearly in the following application sections: Project Abstract and Project Narrative Section I:

Statement of Need, Priority Areas Addressed, and Sites Selected.

Note: Each Title X grantee organization may submit multiple applications, but may address only one priority area per application submitted.

Application Screening Criteria

If your application is appropriately submitted, it will be screened to assure a level playing field for all applicants. If duplicate applications from the same organization for the same project are successfully submitted, only the last application received by the deadline will be reviewed. If your application fails to meet the screening criteria described below it will not be reviewed and will receive no further consideration.

1. Your application must be submitted electronically via www.grants.gov (unless an exemption was granted 2 business days prior to the deadline) by March 31, 2016 by 5 p.m. Eastern

Time.

2. Your Project Narrative section of the application must be double-spaced, on the equivalent of

8 ½ ” x 11” inch page size, with 1” margins on all sides (top, bottom, left and right) and font size not less than 12 points.

3. Your Project Narrative must not exceed 30 pages. NOTE: The following items do not count toward the page limit: all required forms, including SF-424, SF-424A, SF-424B, SF-LLL, Project Abstract Summary, and Budget Narrative (including budget tables).

http://www.grants.gov/

4. Your total application, including the Project Narrative plus Appendices, must not exceed 50 pages. NOTE: items noted in #3 above do not count toward total page limit.

5. Your proposed budget does not exceed the maximum indicated in Range of Awards.

6. Your application meets the Application Responsiveness Criteria outlined above.

D. APPLICATION AND SUBMISSION INFORMATION

1. Address to Request Application Package

You may obtain an application package electronically by accessing Grants.gov at http://www.grants.gov/. You can find it by searching on the CFDA number shown on page 1 of this funding opportunity announcement. If you have problems accessing the application or difficulty downloading, contact:

Office of Grants Management

Phone: 240-453-8822

Email: ogm.oash@hhs.gov

2. Content and Form of Application Submission

i. Letter of Intent –Requested.

If you plan to apply for this funding opportunity, you should submit a letter of intent as early as possible, but no later than the deadline indicated on page 1 of this announcement. Although you are not required to submit a letter of intent, the information that it contains allows

HHS/OASH to estimate the potential review workload and plan the review. A letter of intent is not binding, and does not enter into the review of a subsequent application. Your letter of intent should include a descriptive title of your proposed project, the name, address and telephone mailto:ogm.oash@hhs.gov number for the designated authorized representative of your organization, the FOA number and title of this announcement, and the priority area you will be addressing. If you are submitting multiple applications, your letter of intent should state this. Your letter of intent should be sent to the address listed under the AGENCY CONTACTS section G.

ii. Application Format

Your application must be prepared using the forms and information provided in the online grant application package.

The Project Narrative, and total application including appendices, must adhere to the page limit indicated in Application Screening Criteria listed in Section C.

You must double-space the Project Narrative pages.

You should use an easily readable typeface, such as Times New Roman or Arial. You must use 12-point font. You may single-space tables or use alternate fonts but you must ensure the tables are easily readable. The page limit does not include the Budget Narrative (including budget tables), required forms, assurances, and certifications as described in Application

Screening Criteria. Please do not number pages or include a table of contents. Our grants management system will generate page numbers once your application is complete.

If your application exceeds the specified page limits for the Project Narrative or Project

Narrative plus Appendices when printed on 8.5” X 11” paper by HHS/OASH/OGM, it will not be considered. We recommend you print out your application before submitting electronically to ensure that it is within the page limits and is easily readable.

Appendices

Your Appendices should include any specific documents outlined in Section D.2.iii., under the heading “Appendices” in the Application Content section of this funding opportunity announcement. You should not include brochures and bound materials. If you create Appendices specifically for this application, you should use the same formatting required for the Project

Narrative, including double-line spacing. However, if you include appendix documents that were not created directly in response to this funding announcement, especially those imported from other sources and documents (e.g., organizational structure), you may retain the original formatting, but the pages must be easily readable.

Project Abstract

You must complete the Project Abstract Summary form provided in the application package.

The abstract will be used to provide reviewers with an overview of the application and will form the basis for the application summary in grants management and program summary documents.

HHS/OASH may publish your abstract if your project is funded; therefore, it should not include sensitive or proprietary information.

Budget Narrative

The Budget Narrative text should use the formatting required of the Project Narrative for the explanatory text. Budget tables may be single-spaced but should be laid out in an easily-readable format and within the printable margins of the page.

iii. Application Content

Successful applications will contain the following information:

Project Narrative

The Project Narrative is the most important part of the application, since it will be used as the primary basis to determine whether or not your project meets the minimum requirements for a grant under this announcement. The Project Narrative should provide a clear and concise description of your project. HHS/OASH recommends that your project narrative include the following components:

1. Statement of Need, Priority Areas Addressed, and Sites Selected

2. Goals and Objectives

3. Proposed Intervention

4. Project Evaluation

5. Project Management and Organizational Capability

Statement of Need, Priority Areas Addressed, and Sites Selected. This section should indicate the need for the priority areas chosen and the specific need in the sites selected for the intervention or activities. Include relevant data from selected service sites that indicates the need for improvement in the priority area selected and expected outcomes. Data or information on the anticipated impact if funding is received to address the priority area should also be included.

At a minimum, information specific to the identified priority area should be provided for each health center where project activities will be conducted or implemented:

Priority Area 1: Improving health information technology systems:

• Description of the current EHR and/or other data collection system(s) in use and justification for why new systems, software or upgrades need to be made.

• Description of any assessments conducted with available data demonstrating the need and readiness of the selected entities to adopt, implement, and use the proposed technology solution(s) before the end of the proposed project period. Desired outcomes and a process for measuring them should also be proposed.

• Description of the procurement process or other relevant processes of the organizations purchasing equipment, systems or services (if applicable).

For Part 3 of Priority Area 1:

• A detailed description justifying that the applicant possesses a sufficient amount of the desired encounter-level data as well as the scientific expertise with which to successfully execute the k-anonymity analysis or other equivalent statistical analysis to determine re-identifiability of a de-identified data set.

• A detailed description of the resulting product that will be shared with OPA for future use in planning the deployment of the Family Planning Profile and

FPAR 2.0.

Priority Area 2: Enrolling clients into health insurance programs:

• The geographic area(s) that will be served.

• Partnerships with existing enrollment workers (navigators, certified application counselors, etc.).

Priority Area 3: Partnering with, or enhancing integration with primary care services:

• Description of the existing linkages with primary care providers.

• Analysis of the potential demand for family planning integrated with primary care services.

• Potential new services that will be available to Title X clients through partnerships/referrals/integration.

Priority Area 4: Improving systems to optimize revenue:

• Current or baseline financial data such as payer mix, net collection rate, etc.

• Description of the current systems to collect and process claims.

Priority Area 5: Outreach to low income men and women of reproductive age in need of family planning services:

• Description of the unmet need in the local area.

• Description of potential partnerships or other resources that can be leveraged to reach underserved populations.

• Description of the approach to be used to reach underserved populations.

Goals and Objectives. This section should consist of a description of the project’s goal(s) and major objectives. There should be at least one measurable goal or objective for each service site that can be evaluated at the end of the project.

The objectives should lead to clearly stated outcomes that will have meaningful impact to the service sites proposed and can be evaluated (further instructions are in the evaluation section).

Proposed Intervention. This section should provide a clear and concise description of the intervention you are proposing to use to address the need. For each service site, the applicant should detail the nature of the activities to be undertaken, how they address system gaps and identified issues, and how the intervention will achieve the overall project goals and objectives.

Clarification should be provided as to why these specific activities were selected as appropriate

(i.e., has this approach been successful in similar settings? Does the research suggest this direction?). Identify any anticipated barriers and how the project will be able to overcome those barriers.

Project Evaluation. This section should describe the methods you will use to evaluate whether or not the proposed intervention achieves its measurable outcome(s) and assess and evaluate the impact of activities for which you are applying. You should describe what outcome(s) will be produced by the project and how the outcome(s) will be measured and reported. You should describe the quantitative and qualitative tools and techniques that you will employ to measure the outcome(s) and how you will identify and document the “lessons learned.”

Note: The project narrative must clearly identify the measurable outcome(s) that will result from your project. HHS/OASH will not fund any project that does not include measurable outcomes. A “measurable outcome” is an observable end result that describes how a particular intervention benefits program participants. It demonstrates the “impact” of the intervention. For example, a percent change in a health center’s financial performance measure.

Your application will be scored on the clarity and nature of your proposed outcomes, not on the number of outcomes cited. In many cases, it is very appropriate for a project to have only

ONE outcome that it is trying to achieve through the intervention reflected in the project’s design.

Section V: Project Management and Organizational Capability

The organizational capability statement should describe how the applicant agency (or the particular division of a larger agency which will have responsibility for this project) is organized, the nature and scope of its work, and the capabilities it possesses. This description should cover capabilities of the applicant agency not included in the program narrative, such as any current or previous relevant experience and/or the record of the project team in completing similar work. If appropriate, include an organization chart showing the relationship of the project to the current organization.

This section should also include a clear delineation of the roles and responsibilities of project staff and sub-recipients and how they will contribute to achieving the project’s objectives and outcomes. It should specify who would have day-to-day responsibility for key tasks such as:

leadership of project; monitoring the project’s on-going progress, including the progress of sub-recipients; preparation of reports; and communications with other partners and

HHS/OASH. HHS/OASH expects that, throughout the grant period, the Project Director will have involvement in, and substantial knowledge about, all aspects of the project.

Biographical sketches for key project personnel should be included in the appendix.

These should be limited to 2 pages and only include relevant information.

Budget Narrative

You are required to submit a detailed Budget Narrative. Your Budget Narrative should detail all costs. Please be sure to carefully review Section D.6 Funding Restrictions for specific information on allowable, unallowable, and restricted costs. Staff should be listed by position with salary and percentage of full-time equivalent to be devoted to this project, and the percentage of salary to be charged to the project. Any participant incentives proposed to be provided should be fully justified and include a description of internal controls in place to verify proper use. Please Note: Because your proposal must demonstrate a clear and strong relationship between the stated objectives, project activities, and the budget, the Budget Narrative should describe the cost estimated per proposed project, activity, service delivered, and/or product. The

Budget Narrative should define the amount of work that is planned and expected to be performed and what it will cost with an explanation of how you expect this to be cost effective. The Budget

Narrative does not count toward your total application page limit.

Appendices

All items described in this section will count toward the total page limit of your application.

Work Plan. The project Work Plan should reflect, and be consistent with, the Project Narrative and Budget, and must cover the entire one year funding period. The Work Plan should include a statement of the project’s overall goal, anticipated outcome(s), key objectives, and the major tasks, action steps, or products that will be pursued or developed to achieve the goal and outcome(s). For each major task, action step, or product, the Work Plan should identify the timeframes involved (including start- and end-dates), and the lead person responsible for completing the task.

Letters of Commitment from Subrecipient Organizations and Agencies

Letters of Commitment are required for all organizations and entities that have been specifically named as a sub-recipient to carry out any aspect of the project. The signed letters of commitment must detail the specific role and resources that will be provided, or activities that will be undertaken, in support of the applicant. The organization’s expertise, experience, and access to the targeted population(s) should also be described in the letter of commitment.

Letters of commitment are not the same as letters of support. Letters of support are letters that are general in nature that speak to the writer’s belief in the capability of an applicant to accomplish a goal/task. Letters of support also may indicate an intent or interest to work together in the future, but they lack specificity. Applicants should NOT provide letters of support, and letters of support such as this will not be considered during the review.

Biosketches for Key Personnel

Biosketches of no more than 2 pages should be submitted for key personnel that demonstrate expertise in the priority area selected.

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

• You are required to provide a Dun and Bradstreet (D&B) Data Universal Numbering

System (DUNS) number when applying for Federal grants or cooperative agreements through Grants.gov. It is a unique, nine-digit identification number, which provides unique identifiers of single business entities. The DUNS number is free and easy to obtain.

• You will find instructions on the Grants.Gov web site as part of the organization registration process at http://www.grants.gov/web/grants/applicants/organization-registration.html.

• Your organization must register online in the System for Account Management (SAM).

Grants.gov will reject submissions from applicants with nonexistent or expired

SAM Registrations.

• A quick start guide for grant registrants is available at https://www.sam.gov/sam/transcript/Quick_Guide_for_Grants_Registrations.pdf. You should allow a minimum of five days to complete an initial SAM registration. Allow up to

10 business days after you submit your registration for it to be active in SAM.

• If your organization is already registered in SAM, you must renew your SAM registration each year. Organizations registered to apply for Federal grants through http://www.grants.gov will need to renew their registration in SAM.

• It may take 24 hours or more for SAM updates to take effect in Grants.gov, so if you plan to apply for this funding opportunity or think you might apply, you should check for active registration in SAM well before the application deadline.

• If you are successful and receive a grant award, you must maintain an active SAM registration with current information at all times during which your organization has an active award or an application or plan under consideration by an HHS agency.

HHS/OASH cannot make an award until you have complied with these requirements. In accordance with 2 CFR § 25.205, at the time an award is ready to be made, if you have not complied with these requirements, HHS/OASH:

http://www.grants.gov/web/grants/applicants/organization-registration.html http://www.grants.gov/web/grants/applicants/organization-registration.html https://www.sam.gov/sam/transcript/Quick_Guide_for_Grants_Registrations.pdf

• May determine that you are not qualified to receive an award; and

• May use that determination as a basis for making an award to another applicant.

Should you successfully compete and receive an award, all first-tier sub-award recipients must have a DUNS number at the time you, the recipient, make a sub-award.

4. Submission Dates and Times

You must submit your application for this funding opportunity by 5:00 p.m. Eastern Time on the date indicated in the DATES section on page 1 of this announcement. Your submission time will be determined by the date and time stamp provided by Grants.gov when you complete your submission.

If you fail to…