HRSA-24-121 TCLP Final version 7.1.24.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2024

Office for the Advancement of Telehealth

Telehealth Innovation and Services Division

Technology-enabled Collaborative Learning Program

Funding Opportunity Number: HRSA-24-121

Funding Opportunity Type(s): New

Assistance Listing Number: 93.211

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

We will not approve deadline extensions for lack of registration.

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

Issuance Date: July 1, 2024

Melody Williams, MPH Public Health Analyst, Office for the Advancement of Telehealth Telephone: (301) 287-2616 Email: mwilliams1@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C. § 254c -20 (§ 330N of the Public Health Service Act) mailto:mwilliams1@hrsa.gov

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508 COMPLIANCE DISCLAIMER

Persons using assistive technology may not be able to fully access information in this file. For assistance, email or call one of the HRSA staff listed in Section VII Agency Contacts.

SUMMARY

Funding Opportunity Title:

Technology-enabled Collaborative Learning Program (TCLP)

Funding Opportunity Number:

HRSA-24-121

Assistance Listing Number:

93.211

Due Date for Applications:

August 2, 2024

Purpose: The purpose of this program is to improve retention of health care providers and increase access to health care services in rural areas, frontier areas, health professional shortage areas, or medically underserved areas and for medically underserved populations or Native Americans.

Program Objective(s):

This program seeks to evaluate, develop, and, as appropriate, expand the use of technology-enabled collaborative learning and capacity building models for health care providers and other professionals to improve retention of health care providers and increase access to health care services

Eligible Applicants: Eligible applicants include entities that:

1. Provide, or support the provision of, health care services in rural areas, frontier areas, health professional shortage areas, or medically underserved areas, or to medically underserved populations or Native Americans, including Indian Tribes, Tribal organizations, and urban Indian organizations.

2. Are in the United States or are in Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, the U.S. Virgin Islands, the

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Federated States of Micronesia, the Republic of the Marshall Islands, or the Republic of Palau, and

3. Are public or private, non-profit or for-profit entities, domestic community-based or faith-based organizations, or Tribal (governments, organizations including urban Indian organizations)

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

Anticipated FY 2024 Total Available Funding:

$3,800,000

Estimated Number and Type of Award(s):

Up to 8 new cooperative agreements

Estimated Annual Award Amount:

Up to $475,000 per award, subject to the availability of appropriated funds

Cost Sharing or Matching Required:

No

Period of Performance:

September 30, 2024 through September 29, 2029 (5 years)

Agency Contacts: Business, administrative, or fiscal issues:

John B. Gazdik Grants Management Specialist Division of Grants Management Operations, OFAAM Telephone: (301) 443-6962 Email: jgazdik@hrsa.gov

Program issues or technical assistance:

Melody Williams, MPH Public Health Analyst, Office for the Advancement of Telehealth Telephone: (301) 287-2616 Email: MWilliams1@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.

mailto:jgazdik@hrsa.gov mailto:MWilliams1@hrsa.gov http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application

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Technical Assistance

We have scheduled the following webinar:

Monday, July 8, 2024 4:00 pm -5:00 pm. Eastern Time Web Link: https://hrsa-gov.zoomgov.com/j/1602798578

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

+16692545252,,1602798578# US (San Jose) +16468287666,,1602798578# US (New York) Or Telephone:

Dial(for higher quality, dial a number based on your current location):

+1 669 254 5252 US (San Jose) +1 646 828 7666 US (New York) +1 646 964 1167 US (US Spanish Line) +1 551 285 1373 US (New Jersey) +1 669 216 1590 US (San Jose) +1 415 449 4000 US (US Spanish Line) 833 568 8864 US Toll Free Webinar ID: 160 279 8578

We will record the webinar.

https://hrsa-gov.zoomgov.com/j/1602798578

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING OR MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Attachments

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

4. INTERGOVERNMENTAL REVIEW

5. FUNDING RESTRICTIONS

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Technology-enabled Collaborative Learning Program (TCLP). The purpose of this program is to improve retention of health care providers and increase access to health care services, such as those to address chronic diseases and conditions (including Alzheimer’s disease), infectious diseases, mental health and substance use disorders, prenatal and maternal health, pediatric care, pain management, palliative care, and other specialty care in rural areas, frontier areas, health professional shortage areas, or medically underserved areas and for medically underserved populations or Native Americans.1

Recipients will evaluate, develop, and, as appropriate, expand the use of technology-enabled collaborative learning and capacity building models. In this NOFO, the term "technology-enabled collaborative learning and capacity building model" means a distance health education model that connects health care professionals, and particularly specialists, with multiple other health care professionals through simultaneous interactive videoconferencing for the purpose of facilitating case-based learning, disseminating best practices, and evaluating outcomes.

This cooperative agreement aligns with HRSA’s goals of promoting a health care workforce to address current and emerging needs, improving access to quality health services, achieving health equity2, and enhancing population health. The development and acquisition of instructional programming by the TCLP will increase access to quality care using telehealth and innovative technology solutions. The TCLP will also provide training for health care providers and other professionals that provide or assist in the provision of services, including training on best practices for data collection and evaluation activities to study the impact on patient outcomes and health care providers.

For more details, see Program Requirements and Expectations.

1 In this NOFO, the term “rural area” means a geographic area designated by HRSA as rural in accordance with the Rural Health Grants Eligibility Analyzer at https://data.hrsa.gov/tools/rural-health.

The term “frontier area” means a frontier county, as defined in 42 U.S.C. 1395ww(d)(3)(E)(iii)(III). The term "health professional shortage area" means a health professional shortage area designated under 42 U.S.C. 254e. The term "medically underserved population" has the meaning given the term in 42 U.S.C.

254b(b)(3). The term "Native Americans" has the meaning given the term in 42 U.S.C. 293 and includes Indian Tribes and Tribal organizations. The terms "Indian Tribe" and "Tribal organization" have the meanings given the terms "Indian tribe" and "tribal organization" in 25 U.S.C. 5304. The term “urban Indian organization” has the meaning given the term in 25 U.S.C. 1603.

2 Office of Health Equity, Health Resources and Services Administration (HRSA), U.S. Department of Health & Human Services (2020).

https://www.hrsa.gov/about/organization/bureaus/ohe/index.html#:~:text=What%20is%20health%20equit y%3F,disease%2C%20disability%2C%20or%20mortality https://data.hrsa.gov/tools/rural-health https://www.hrsa.gov/about/organization/bureaus/ohe/index.html#:%7E:text=What%20is%20health%20equity%3F,disease%2C%20disability%2C%20or%20mortality https://www.hrsa.gov/about/organization/bureaus/ohe/index.html#:%7E:text=What%20is%20health%20equity%3F,disease%2C%20disability%2C%20or%20mortality

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2. Background

This program is authorized by the 42 U.S.C. § 254c -20 (§ 330N of the Public Health Service Act). The Office for the Advancement of Telehealth (OAT) serves as the operational focal point for coordinating and advancing the use of telehealth technologies across all HRSA’s programs including, but not limited to, the provision of health care at a distance (telemedicine), distance-based learning to improve the knowledge of HRSA award recipients and others, and improved information dissemination to both consumers and providers about the latest developments in telemedicine.

In February 2019, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) published a Report entitled, “Impact of Participation in Technology-Enabled Collaborative Learning and Capacity Building (ECHO) Models on Provider Retention.”3 This report describes collaborative learning and capacity building models as “ECHO and ECHO-like models” (EELM) and finds an association between ECHO participation and retention in Health Professional Shortage AreasAreasHPSAs.

There are approximately 3,442 designated Medically Underserved Areas and Populations in the US and 7,481 Primary Medical Health Professional Shortage Areas.4 While substantial progress has been made in improving the health and well-being of all Americans, health disparities between population groups and geographic areas continue to persist. More specifically, “chronic diseases, risk factors for chronic disease, and COVID-19 all tend to disproportionately affect people of lower socioeconomic status and certain racial and ethnic minority populations. Disparities are found in a number of health indicators, including infant mortality, life expectancy, cardiovascular disease, cancer, diabetes, Chronic Obstructive Pulmonary Disease (COPD) HIV/AIDS, health care access and utilization, health insurance, disability, mental health, preventive health services such as cervical and colorectal cancer screening, smoking, obesity, substance use, suicide, homicide, and unintentional injuries.5 Additionally, these disparities are characterized by the differences in risks for Alzheimer’s and other dementias as studies have shown Black and Hispanic older adults have an increased incidence of the disease occurrence relative to older White adults6. American Indian and Alaska Native (AI/AN) people, in particular, experience higher disease burden because of inadequate education, disproportionate poverty, discrimination in the delivery of health services, and cultural differences. Additionally, AI/ANs continue to die at higher rates than other

3 Office of the Assistant Secretary for Planning and Evaluation (ASPE). Impact of Participation in Technology-Enabled Collaborative Learning and Capacity Building (ECHO) Models on Provider Retention (Sept 22,2019). https://aspe.hhs.gov/reports/report-congress-current-state-technology-enabled-collaborative-learning-capacity-building-models 4 Health Resources and Services Administration (HRSA), U.S. Department of Health & Human Services (2024). https://data.hrsa.gov/topics/health-workforce/shortage-areas 5 Office of Health Equity, Health Resources and Services Administration (HRSA), U.S. Department of Health & Human Services (2020). Health Equity Report 2019-2020: Special Feature on Housing and Health Inequalities.

https://www.hrsa.gov/sites/default/files/hrsa/health-equity/HRSA-health-equity-report-printer.pdf 7 Indian Health Service (IHS). Indian Health Disparities Factsheet.

https://www.ihs.gov/newsroom/factsheets/disparities/ https://aspe.hhs.gov/reports/report-congress-current-state-technology-enabled-collaborative-learning-capacity-building-models https://aspe.hhs.gov/reports/report-congress-current-state-technology-enabled-collaborative-learning-capacity-building-models https://data.hrsa.gov/topics/health-workforce/shortage-areas https://www.hrsa.gov/sites/default/files/hrsa/health-equity/HRSA-health-equity-report-printer.pdf https://www.ihs.gov/newsroom/factsheets/disparities/

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Americans in many categories.7 HRSA anticipates the program will enable providers to continue pursuing improvements, in particular, to address the socioeconomic and cultural barriers that may impede patient access to effective multidisciplinary care.

Through this opportunity, HRSA will support innovative technology-enabled collaborative learning and capacity building models that connect health care professionals, and particularly specialists, with other health care professionals to serve the target populations. Program results will include expansion of service areas/settings and capacity of existing models, developing innovative technological strategies, methods, or tools, to incorporate emerging telehealth-based treatments for diseases listed above, and include the goal of publishing research articles based on data resulting from this funding support.

Applicants are also encouraged to look at the National Consortium of Telehealth Resource Centers in order to reach out to their regional Telehealth Resource Center (TRC) and the two National TRCs. Applicants can also contact the HRSA Telehealth Centers of Excellence at University of Mississippi Medical Center or at the Medical University of South Carolina. They serve as national clearinghouses for telehealth research and resources, including Technical Assistance (TA). Another resource to support the implementation and evaluation of telementoring programs for rural and remote health care workers is the Rural Telementoring Training Center (RTTC).

II. Award Information

1. Type of Application and Award

Application type(s): New

We will fund you via a cooperative agreement.

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

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

• Ongoing review of award activities and input on content or approach;

• Participating in conference calls or meetings with award recipients;

• Reviewing and providing recommendations on the final work plan;

• Providing guidance and assistance to TCLP recipients, upon request, on the process for identifying key academic medical centers and other centers of excellence through which to share freely accessible resources and tools;

• Providing common measures that must be reported by all recipients;

7 Indian Health Service (IHS). Indian Health Disparities Factsheet.

https://telehealthresourcecenter.org/ https://telehealthresourcecenter.org/ https://www.umc.edu/Research/Centers-and-Institutes/Centers/Telehealth_Center_of_Excellence/Home.html https://muschealth.org/medical-services/telehealth/about/coe https://muschealth.org/medical-services/telehealth/about/coe https://ruraltelementoring.org/

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• Participating, as appropriate, in the planning and implementation of any meetings, training activities or workgroups conducted during the period of performance for the cooperative agreement;

• Providing assistance in identifying opportunities for disseminating information about TCLP programs nationally that coordinate both health and human services;

and

• Reviewing, providing comments, and recommendations for documents, curricula, etc. prior to printing, dissemination, or implementation.

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

• Supporting collaboration with HRSA’s Telehealth Centers of Excellence, Telehealth Resource Centers, the Rural Telementoring Training Center and with the Telehealth Technology-Enabled Learning Program recipients;

• Planning and delivering training and Technical Assistance on TCLP activities to health care providers and ensuring that the use of technology-enabled collaborative learning and capacity building models are adapted to culturally and regionally diverse populations;

• Identifying opportunities and promoting best practices for TCLP programs to increase their viability in different areas by identifying successful models and administrative support strategies as well as disseminating information about technology-enabled collaborative learning and capacity building models that coordinate both health and human services;

• Identifying opportunities and promoting best practices for technology-enabled collaborative learning and capacity building programs to evaluate their impacts and improve their services and strategies over time;

• Providing health care providers and other professionals with tools for collecting and interpreting applicable data to support evaluation of technology-enabled collaborative learning and capacity building models;

• Adhering to HRSA guidelines pertaining to acknowledgement and disclaimer on all products produced by HRSA award funds, per Section 2.2 of the Application Guide (Acknowledgement of Federal Funding);

• Completing activities included in the final work plan, specifically information collection and evaluation activities to study the impact of such models on patient outcomes and health care providers, and to identify best practices for the expansion and use of such models.

• Actively participating in efforts to contribute to the evidence-base of technology-enabled collaborative learning and capacity building models;

• Networking with telehealth stakeholders;

• Engaging in webinars facilitated by HRSA program staff (e.g. program best practices, sustainability, etc.);

• Identifying professional opportunities to present, exhibit, or publish program findings that contribute to the technology-enabled collaborative learning and capacity building model evidence-base;

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• Collaborating with HRSA in ongoing review of activities and budgets;

• Identifying key organizations through which to share information on emerging policy issues related to technology-enabled collaborative learning and capacity building programs;

• Disseminating information on the impact of technology-enabled collaborative learning and capacity building models on patient outcomes and health care providers; identifying best practices for the expansion and use of such models that result from any meetings, training activities, or workgroups conducted during the period of performance for the cooperative agreement; and ensuring free public access to resources developed under the cooperative agreement;

• Adhering to all applicable HHS policies and federal law including Section 508 of the Rehabilitation Act of 1973, as amended; and

• Responding timely to requests for information, including requests for data submissions, from HRSA or the Telehealth-Focused Rural Health Research Center award recipient.

2. Summary of Funding

We estimate $3,800,000 will be available each year to fund 8 recipients. You may apply for a ceiling amount of up to $475,000 annually (reflecting direct and indirect costs).

The period of performance is September 30, 2024, through September 29, 2029 (5 years).

Support beyond the first budget year will depend on:

• Appropriation of funds for this purpose

• Satisfactory progress in meeting the project’s objectives

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

45 CFR part 75 - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards applies to all HRSA awards.

If you’ve never received a negotiated indirect cost rate, you may elect to charge a de minimis rate of 10 percent of modified total direct costs (MTDC)*. You may use this for the life of the award. If you choose this method, you must use it for all federal awards until you choose to negotiate for a rate. You may apply to do so at any time. See Section 4.1.v. Budget Narrative in the Application Guide.

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

III. Eligibility Information

1. Eligible Applicants

You can apply if your organization:

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

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• Provides, or supports the provision of, health care services in rural areas, frontier areas, health professional shortage areas, or medically underserved areas, or to medically underserved populations or Native Americans, including Indian Tribes, Tribal organizations, and urban Indian organizations, and

• Is in the United States or is in Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, or the Republic of Palau, and

• Is a public or private, non-profit or for-profit entity, a domestic community-based or faith-based organization, or Tribal (governments, organizations including urban Indian organizations).

2. Cost Sharing or Matching

Cost sharing or matching is not required for this program.

3. Other

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

• Exceeds the funding ceiling amount

• Fails to satisfy the deadline requirements referenced in Section IV.4

• Does not lead,, or is not capable of leading, a technology-enabled collaborative learning and capacity building model or engaging in technology-enabled collaborative training of participants in such model

Multiple Applications

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

IV. Application and Submission Information

1. Address to Request Application Package

We require you to apply online through Grants.gov. Use the SF-424 workspace application package associated with this notice of funding opportunity (NOFO). Follow these directions: How to Apply for Grants. If you choose to submit using an alternative online method, see Applicant System-to-System.

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

Select “Subscribe” and enter your email address for HRSA-24-121 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.

https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/s2s/applicant-system-to-system.html

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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 60 pages when we print them. We will not review any pages that exceed the page limit.

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

Eligibility Information of the NOFO.

These items do not count toward the page limit:

• Standard OMB-approved forms you find in the NOFO’s workspace application package

• Abstract (standard form (SF) "Project Abstract Summary”)

• Indirect Cost Rate Agreement

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

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

If you use an OMB-approved form that is not in the HRSA-24-121 workspace application package, it may count toward the page limit.

Applications must be complete and validated by Grants.gov under HRSA-24-121 before the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

• When you submit your application, you certify that you and your principals8 (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.9

• If you cannot certify this, you must include an explanation in Attachment 8-14:

Other Relevant Documents.

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

8 See definitions at eCFR :: 2 CFR 180.995 -- Principal. and eCFR :: 2 CFR 376.995 -- Principal (HHS supplement to government-wide definition at 2 CFR 180.995).

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

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

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Program Requirements and Expectations You must evaluate, develop, and as appropriate, expand the use of a technology-enabled collaborative learning and capacity building model to improve retention of health care providers and increase access to health care services in a rural area, frontier area, health professional shortage area, or medically underserved area, or to a medically underserved population or Native Americans. You must develop instructional programming, and train health care providers and other professionals that provide or assist in the provision of services, such as training on best practices for data collection and leading or participating in such technology-enabled activities consistent with technology-enabled collaborative learning and capacity-building models (i.e., telementoring models such as Project ECHO, ECHO-like models, distance learning, clinical decision support, and other emerging models in the field). You must provide support for health care providers and other professionals that provide or assist in the provision of services through such models. You must perform information collection and evaluation activities to study the impact of such models on patient outcomes and health care providers, and to identify best practices for the expansion and use of such models.

You must address at least two of the following focus areas:

o Chronic diseases and conditions (including Alzheimer’s disease) o Infectious diseases o Mental health o Substance use disorders o Prenatal and maternal health o Pediatric care o Pain management o Palliative care o Other specialty care

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. Your Project Abstract must identify which focus areas from the Program Requirements and Expectations section that your project will address.

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NARRATIVE GUIDANCE

The following table provides a crosswalk between the narrative language and where each section falls within the review criteria. Make sure you’ve addressed everything. We may consider any forms or attachments you reference in a narrative section during the merit review.

Narrative Section Review Criteria

Introduction Criterion 1: NEED

Organizational Information Criterion 5: RESOURCES/CAPABILITIES

Need Criterion 1: NEED

Approach Criterion 2: RESPONSE

Work Plan Criterion 2: RESPONSE

Resolution of Challenges Criterion 2: RESPONSE

Evaluation and Technical Support Capacity

Criterion 3: EVALUATIVE MEASURES and

Criterion 4: IMPACT

Budget Narrative Criterion 6: SUPPORT REQUESTED

ii. Project Narrative

This section must describe all aspects of the proposed project. Make it brief and clear.

Provide the following information in the following order. Please use the section headers.

This ensures reviewers can understand your proposed project.

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

Succinctly (1-2 pages) describe the purpose of the technology-enabled collaborative learning and capacity building model proposed project. Include an overview of the partner site entities and plans for addressing the identified health care need in the target population in your proposed service area, including a list of the focus areas that will be offered. Clearly and succinctly, submit information on the collaborating partner site members, and expected program outcomes and community impact.

o Organizational Information -- Corresponds to Section V’s Review Criterion: 5 Resources and Capabilities

This section should describe your organization’s structure and the proposed staffing plan for activities conducted under this notice.

o Describe your organization’s history of ongoing federal support through the effective implementation of federally funded activities.

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o Describe your organization’s ability to integrate and implement a robust telementoring initiative at, or in collaboration with, an academic medical center.

o Describe your organization’s technology enabled delivery of evidence-based curricula, offering of practice based, culturally responsive care, and advancing the skill set of health care workers.

o Describe your organization’s experience (including materials published) successfully conducting work of a similar nature.

o Describe the governance of the technology-enabled collaborative learning and capacity-building models, including the ability of your organization to hold partner sites accountable for data delivery and other project deliverables; and o Describe how the information provided in the Project Organizational Chart (Attachment 5) contributes to the ability of the technology-enabled collaborative learning and capacity-building models to meet the program requirements and meet program expectations.

o In addition, each partner site within the project should:

o Have a clearly defined role and specific set of responsibilities for the project;

o Demonstrate clinician support from new and existing health care providers;

o Describe the commitment, involvement and support of senior management and clinicians in developing and operating the project; and o Demonstrate the clinicians’ understanding of the challenges in project implementation and their competence and willingness to meet those challenges.

o Describe how your model has the capacity, and collective mission and vision to collaborate effectively to achieve the goals of the TCLP program.

o Staffing needs should have a direct link to the activities proposed in the project narrative and budget portion of the application.

o HRSA recommends that you:

• devote at least 0.25 full-time equivalent (FTE) to the project director position.

• have at least one permanent staff at the time an award is made;

• have a minimum total equal to 2.0 FTE allocated for implementation of project activities, met across two or more staffing positions, including the project director position.

• if there will not be a permanent Project Director at the time of the award, recipients should make every effort to hire a Project Director in a timely manner and applicants should discuss the process and timeline for hiring.

• Project staff cannot bill more than 1.0 FTE across federal awards.

If the Project Director serves as a Project Director for other federal awards, please list the federal awards as well as the percent full-time equivalent (FTE) for that respective federal award.

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o Discuss how the organization will follow the approved work plan, as outlined in the application, adjust the work plan in consultation with HRSA, properly account for the federal funds, and document all costs to avoid audit findings. If you will make subawards or expend funds on contracts, describe how your organization will ensure proper documentation of funds.

o Provide evidence to demonstrate commitment and ability to form collaborative long-term relationships with key constituencies such as health care delivery sites, and academic medical centers. Provide evidence of an existing infrastructure and extensive past experience/track record of working with health care programs.

Describe relevant knowledge, skills, expertise and past successes with similar projects, particularly collaborative endeavors that involve building coalitions among health care delivery sites, academic medical centers, and other necessary stakeholders.

Biographical sketches must be included in Attachment 1 (Biographical Sketches for Key Personnel). The staffing plan and job descriptions for key faculty/staff must be included in Attachment 2 (Staffing Plan and Job Descriptions for Key Personnel).

Note: The application should demonstrate a broad range of expertise and experience in telehealth, technology-enabled collaborative learning and capacity building models, continuing training for health care staff and an extensive knowledge of policy and payment considerations affecting the viability and sustainability of such programs. The applicant organization serves as the awardee of record and coordinates all cooperative agreement activities. The applicant organization is a critical component to ensure the success of this project and should demonstrate a proven track record with extensive prior experience and results in working with entities developing technology-enabled collaborative learning and capacity building model opportunities.

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

This section outlines the needs of the health care providers and access to training and mentoring services. Describe and document the target population and its unmet health needs. Use and cite demographic data whenever possible to support the information provided. Discuss any relevant barriers in the service area that the project hopes to overcome. This section will help reviewers understand the target population that you will serve with the proposed project.

Please use the following sub-headings (1) Target Population Details, (2) Target Service Area Details, and (3) Technology-enabled Collaborative Learning and Capacity Building model Service Area Details.

Target Population Details:

o Describe the target population. Consider disparities based on gender identity, sexual orientation, geography, socioeconomic status, disability status, primary language, health literacy, and other relevant elements. You should also consider people with disabilities; non-English speaking populations; people with limited

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health literacy; or populations that may otherwise be overlooked when identifying target populations. The needs assessment should focus on technology-enabled collaborative learning and capacity building model needs in HRSA designated rural areas, frontier areas, health professional shortage areas, or medically underserved areas, or for medically underserved populations or Native Americans.

o Describe the associated unmet health needs of the target population of the proposed project (if funded, this is the population that you will monitor and track).

When possible, incorporate any national and/or local rankings data to aid in illustrating the community’s need. Cite data for factors that are relevant to the project, such as: specific national, state, and regional health status indicators and unmet health need (as it relates to your primary focus area); percentage of target population with health insurance coverage and estimated proportion of major payers within this population (e.g., any commercial health plan, Medicare, Medicaid, dual Medicare-Medicaid, CHIP, TRICARE, Indian Health Service, uninsured/self-pay, etc.); percentage of target population without health insurance coverage that is likely eligible for health insurance coverage; and percentage of target population living below the federal poverty line, etc. Also, include information regarding the social determinants of health and health disparities affecting the population or communities served.

o Within your proposed service area, explain how your project will meet the needs of the target population in terms of health disparities and barriers (social, cultural, infrastructure etc.) that affect their health status.

Target Service Area Details:

o Identify the target service area(s) for the proposed project. Describe any relevant geographical features of the service area that affect access to health care services.

o Describe the health care services available in or near the target service area and any gaps in services.

o Describe the types of relevant health care providers that are located in and near the service area of the project as well as their relation to the project.

o Describe existing opportunities for mentoring and training to health care providers located in the service area.

o Describe the existing primary health care providers, home health agencies, or other health networks in the region that are serving the area that you are incorporating as a part of your proposed program. Detail how this project would foster or/and enhance collaboration.

o Provide details how the project will not compete with other regional health care service providers (e.g., changes in referral patterns, practice patterns, provider reimbursement impact, etc.).

o Provide a map (Attachment 7) that details the location of the learning community model partner sites and the area(s) that will be served by the program.

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Technology-Enabled Collaborative Learning and Capacity Building Model Service Area Details:

o Outline the needs and issues that affect the development of a technology-enabled collaborative learning and capacity building model and their ability to offer additional training/practicum to health care providers in the Technology- Enabled Collaborative Learning and Capacity Building Model Service area.

o Outline the challenges and barriers impacting the development and sustainability of technology-enabled collaborative learning and capacity building models and the communities they serve, as well as the larger contextual challenges facing the communities’ abilities to recruit, train, and retain health care professionals.

Use supporting data to provide context to the demand of technology-enabled collaborative learning and capacity building models. This section should also describe the significance of your organization to support the retention of health care providers and increase access to health care services.

o Identify key stakeholders that will serve the health care providers, discuss the impact of the project on interested stakeholders, and describe how stakeholder representatives are or will be involved in program planning. Cite demographic data whenever possible to support the information requested.

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

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

This section outlines the methods that the applicant organization will use to address the stated need and meet each of the previously described program requirements and expectations in this NOFO.

The following headings must be addressed within the approach sections. Please address these headings: “Methods for Fulfilling Goals and Objectives;” “Methods for Maintaining Stakeholder Commitment;” “Methods for Implementing a Promising Practice Model;” and “Methods for Sustaining Project Beyond the Period of Performance.”

Methods for Fulfilling Goals and Objectives:

o Define the specific goals and objectives.

o The stated goals and objectives should be measurable and align with the program intent and the period of performance.

o These goals and objectives should directly relate to the information presented in the prior section, or “Need.”

o The modality by which the technology-enabled collaborative learning and capacity building model will be delivered, including the required telecommunications infrastructure (e.g., equipment, bandwidth) required to support service delivery.

o Describe how the proposed project will promote the use of the technology-enabled collaborative learning and capacity-building models.

o Describe your experience in improving health inequities between population groups and geographic areas.

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o Propose methods to address disparities found in your targeted disease(s) for this proposal, or in one, or more, of the following health indicators: chronic diseases and conditions (including Alzheimer’s disease), infectious diseases, mental health, substance use disorders, prenatal and maternal health, pediatric care, pain management, palliative care, or other specialty care.

o Include a detailed and clear understanding of the intricacies of various technology-enabled collaborative learning and capacity-building models.

o Describe how you will work closely with HRSA to adapt the technology-enabled collaborative learning and capacity building model as needed in response to stakeholder feedback and changing priorities.

o Propose additional measures explaining how you will evaluate work and track progress through appropriate data collections.

Methods for Maintaining Stakeholder Commitment:

o Describe how your program will maintain partner site commitment throughout the period of performance.

o Describe how the program will build and maintain stakeholder involvement and commitment throughout period of performance.

o Demonstrate your experience in supporting the solicitation, review, selection, compilation and dissemination of best practices to medical educators and professionals for technology-enabled collaborative learning and capacity building models of care that will provide high quality continuing training.

Methods for Implementing an Evidence-Based or Promising Practice Model:

o Identify an evidence-based or promising practice model that has been shown to be effective in addressing modality by which the technology-enabled collaborative learning and capacity building models will serve the target population.

o Describe how the evidence-based or promising practice model is appropriate for your proposed project, and effective in meeting the target population’s need.

Methods for Sustaining Project Beyond the Period of Performance:

o Describe the methods by which you will sustain program activities and relationships beyond the period of performance.

o Describe some of the potential sources of support for achieving sustainability.

Sources of support could include but are not limited to financial, in-kind, or the absorption of activities by technology-enabled collaborative learning and capacity building models.

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

Describe the activities or steps that will be used to achieve each of the activities proposed during the entire period of performance in this section. Use a timeline that includes each activity and identifies responsible staff. As appropriate, identify meaningful support and collaboration with key stakeholders in planning, designing and

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implementing all activities. Provide a clear and coherent work plan that aligns with the project’s goals and objectives. Present a matrix that illustrates the project’s goals, strategies, activities, and measurable process and outcome measures (it is recommended to provide this information in a table format). The work plan must outline the individual and/or organization responsible for carrying out each activity and include a timeline for all five-years of the award. The applicant should include the work plan as Attachment 4.

Describe the following elements for your project model:

o The process to achieve the activities and implement a project as proposed in the methodology section. This section should provide clear evidence that you have a well-considered plan o to train health care providers and other professionals such as training on best practices for data collection and leading or participating in such technology-enabled activities consistent with technology-enabled collaborative learning and capacity-building models; and o to conduct information collection and evaluation activities to study the impact of such models on patient outcomes and health care providers, and to identify best practices for the expansion and use of such models;

o Describe the timeframes, deliverables, and key partners required during the cooperative agreement period of performance to establish the TCLP.

o Discuss how the TCLP plans to reach out, engage and promote freely accessible resources and tools to health care providers.

o Identify meaningful support and collaboration with key stakeholders in planning, designing and implementing all activities, including development of this application and, further, the extent to which these contributors reflect the cultural, linguistic and/or geographic diversity of the populations and communities served.

You may include but are not limited to the following examples: broadly accessible modalities such as webinars and meetings to increase collaboration with stakeholders.

o Explain how the work plan is appropriate for the program design and how the work plan targets fit into the overall timeline of implementation of the cooperative agreement.

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

Response o Describe barriers to developing technology-enabled collaborative learning and capacity building models for health care providers and how you will address these barriers. This description should include challenges developing new technology-enabled collaborative learning and capacity building programs, e.g., recruiting participants, creating partnerships, and expanding partnerships.

o Describe technological challenges, such as broadband access, software, and audio and video equipment, and how these challenges will be addressed.

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o Discuss any additional challenges both internal and external to the applicant organization that may directly or indirectly affect successful execution of the cooperative agreement and provide details and strategies for how these will be resolved.

o Evaluation and Technical Support Capacity -- Corresponds to Section V’s Review Criterion 3: Evaluation Measures and Criterion 4: Impact

Propose clearly defined, viable measurements of success in evaluation of a technology-enabled collaborative learning and capacity building model center of this scope, including process and outcome indicators for evaluating whether activities are being implemented as planned and whether the activities are achieving the expected effects/changes in the short and long-term.

o Describe current and past experience, skills, and knowledge, including individuals on staff, materials published, and previous work of a similar nature.

o Describe a plan for information collection and evaluation activities to study the impact of such models on patient outcomes and health care providers, and to identify best practices for the expansion and use of such models.

o Describe the strategy (including staffing and workflow) and the frequency to collect, analyze, and track data to measure process outcomes and impact outcomes, including, as appropriate, among different cultural groups (e.g., race, ethnicity, language) and explain how the data will be used to inform program development.

o Identify and present clear benchmarks of success for each year. Describe how the benchmarks to be applied to the project are industry standard from recognized sources, such as but not limited to the National Quality Forum (NQF), National Committee for Quality Assurance (NCQA), Centers for Medicare & Medicaid Services (CMS); or, describe and justify appropriate benchmarks if industry standards are not available.

o Describe your capacity to effectively manage the programmatic, fiscal, and administrative aspects of the proposed project. You must demonstrate knowledge, skills, and expertise required to run a technology-enabled collaborative learning and capacity building model and build coalitions with…