HRSA-25-016 -PDF final.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2025

Bureau of Primary Health Care

Health Center Program

Service Area Competition Funding Opportunity Number: HRSA-25-016

Funding Opportunity Type(s): Competing Continuation, Competing Supplement, New

Assistance Listing Number: 93.224

PHASE 1: Application Due Date in Grants.gov: October 15, 2024

PHASE 2: Supplemental Information Due Date in HRSA EHBs: November 14, Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

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

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

Issuance Date: August 15, 2024

Ashley Vigil & Julia Tillman Public Health Analysts, Office of Policy and Program Development Bureau of Primary Health Care Call: 301-594-4300 Contact: BPHC Contact Form Service Area Competition technical assistance webpage

See Section VII for a complete list of agency contacts.

https://www.hrsa.gov/about/contact/bphc.aspx https://bphc.hrsa.gov/program-opportunities/sac

Authority: 42 U.S.C. § 254b (Title III, § 330 of the Public Health Service (PHS) Act) http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim https://www.govinfo.gov/app/collection/comps/p

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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: Service Area Competition

Funding Opportunity Number: HRSA-25-016

Assistance Listing Number: 93.224

Due Date for Applications – Grants.gov:

Phase 1: October 15, 2024 (11:59 p.m. ET)

Due Date for Supplemental Information – HRSA Electronic Handbooks (EHBs):

Phase 2: November 14, 2024 (5 p.m. ET)

Purpose: To ensure continuity of affordable, accessible, and high-quality primary health care in the communities and populations currently served by the Health Center Program.

Program Objective(s): 1. Improve the health of underserved populations, including individuals and families experiencing homelessness, migratory and seasonal agricultural workers, and residents of public housing by delivering comprehensive, culturally competent, high-quality primary health care and supportive services.

2. Provide services regardless of the patient’s ability to pay.

Eligible Applicants: Your organization must be a private, non-profit entity or public agency in the United States or its territories. Tribes, tribal or community-based organizations may apply.

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

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Anticipated Available Funding: Approximately $244,461,600

We’re issuing this notice to ensure that, should funds become available for this purpose, we can process applications and award funds appropriately. You should note that we may cancel this program notice before award if funds are not appropriated.

Estimated Number and Type of Award(s):

Up to 88: competing continuation, competing supplement, and new awards

Estimated Annual Award Amount:

Varies

Cost Sharing or Matching Required:

No

Period of Performance: May 1, 2025 through April 30, 2028 (up to 3 years)

Agency Contacts: Business, administrative, or fiscal issues:

Joi Grymes-Johnson Grants Management Specialist Division of Grants Management Operations, OFAM Health Resources and Services Administration Call: 301-443-2632 Email: jgrymes@hrsa.gov

Program issues or technical assistance:

Ashley Vigil & Julia Tillman Public Health Analysts Attn: Service Area Competition Bureau of Primary Health Care Health Resources and Services Administration Call: 301-594-4300 Contact: BPHC Contact Form

• Under Funding, select Applications for Notice of Funding Opportunities

• Select Service Area Competition Web: Apply for SAC mailto:jgrymes@hrsa.gov https://www.hrsa.gov/about/contact/bphc.aspx https://bphc.hrsa.gov/funding/funding-opportunities/service-area-competition

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Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in this NOFO and the HRSA Two-Tier Application Guide. Visit HRSA’s How to Prepare Your Application page for more information.

Technical Assistance

The Health Center Program Compliance Manual explains the Health Center Program requirements. You need to understand the requirements and show how you meet them in your application.

The SAC TA webpage (https://bphc.hrsa.gov/program-opportunities/sac) includes:

• Application resources, such as sample forms, attachments, and instructions.

• Answers to frequently asked questions.

• Applicant TA webinar and slides.

• Contact information for questions.

The HRSA-supported Health Center Resource Clearinghouse includes links to many health center resources.

Summary of Changes Since the FY 2024 SAC Funding Opportunity

• The page limit is reduced to 90 pages. This does not include required forms or the following attachments: Attachment 1: Service Area Map and Table, Attachment 2:

Bylaws, Attachment 6: Co-Applicant Agreement, Attachment 9: Collaboration Documentation, Attachment 11: Evidence of Nonprofit or Public Center Status, or Attachment 13: Health Center Program Compliance.

• We moved elements of the Project Narrative related to compliance with Health Center Program requirements to Appendix A: Health Center Program Compliance.

• The Funding Reduction by Proposed Patients table has been updated to include a new funding request reduction scale.

• Patient targets have been updated to reflect the most recent total number of unduplicated patients reported in the 2023 Uniform Data System (UDS).

http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://bphc.hrsa.gov/compliance/compliance-manual/introduction https://www.healthcenterinfo.org/

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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. Program-Specific Forms

vi. Attachments

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

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: HEALTH CENTER PROGRAM COMPLIANCE

APPENDIX B: PAGE LIMIT WORKSHEET

HRSA-25-016 SAC 1

I. Program Funding Opportunity Description

1. Purpose

This Notice of Funding Opportunity (NOFO) announces the opportunity to apply for funding under the Health Center Program’s Service Area Competition (SAC). The purpose of this funding is to ensure continuity of care in the communities and populations currently served by the Health Center Program.

See Program Requirements and Expectations for more details.

2. Background

The Health Center Program is authorized by 42 U.S.C. § 254b (Title III, § 330 of the Public Health Service (PHS) Act).

Through the SAC, organizations compete for Health Center Program funding to provide comprehensive primary health care services in service areas and to patient populations already served by the Health Center Program.

Service areas and patient populations listed in the FY 2025 SAC Service Area Announcement Table (SAAT) are currently served by Health Center Program award recipients whose periods of performance end in FY 2025. Each announced service area has been assigned a unique Service Area Identification Number (SAC ID). You must enter the SAC ID on the Summary Page to identify the service area which you are proposing to serve. You must describe how you will make primary health care services accessible in an announced service area. This includes providing services to the SAAT Patient Target and population type(s) with available funding. Only one award will be made for each announced service area.

II. Award Information

1. Type of Application and Award

Application type(s): Competing Continuation, Competing Supplement, New

• Competing continuation – A current Health Center Program award recipient with a April 30, 2025 period of performance end date that will continue serving its current service area.

• Competing supplement – A current Health Center Program award recipient that will serve an announced service area by adding one or more new, full-time, permanent http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim https://www.govinfo.gov/app/collection/comps/p https://www.govinfo.gov/app/collection/comps/p https://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/sites/default/files/bphc/funding/summary-page.pdf

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service delivery sites within the announced service area in addition to its current service area.

• New – An organization that is not currently funded through the Health Center Program that will serve an announced service area through one or more permanent service delivery sites.1

If your application is successful, we will fund you via a grant.

2. Summary of Funding

HRSA estimates that $244,461,600 will be available to fund 88 recipients.

The period of performance is May 1, 2025 through April 30, 2028. You may receive funding for up to 3 years.

This program notice depends on the appropriation of funds. If funds are appropriated for this purpose, we will proceed with the application and award process.

Support beyond the first budget year will depend on:

• Appropriation

• Satisfactory progress in meeting the project’s objectives

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

You may apply for funding up to the Total Funding listed in the SAAT for the proposed service area.

You must propose to serve at least 75 percent of the SAAT Patient Target in calendar year 2026 (January 1 through December 31, 2026). If you propose to serve fewer patients than listed in the SAAT, your funding request must reflect the reductions noted below. If you do not reduce your funding request, HRSA will reduce the award accordingly. You can use the funding calculator to determine if a funding reduction is required.

Table 1: Funding Reduction by Proposed Patients

Patient Projections Compared to SAAT Patient Target

Funding Request Reduction

95-100% of patients listed in the SAAT No reduction

90-94.9% of patients listed in the SAAT 1.25% reduction

85-89.9% of patients listed in the SAAT 2.5% reduction

1 A Health Center Program look-alike must apply as a new applicant.

http://bphc.hrsa.gov/sac/ http://bphc.hrsa.gov/sac/ http://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/programopportunities/fundingopportunities/sac/patientbudgetcalculator.html http://bphc.hrsa.gov/sac/

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80-84.9% of patients listed in the SAAT 3.75% reduction

75-79.9% of patients listed in the SAAT 5% reduction < 75% of patients listed in the SAAT Not eligible for funding

We will assess your performance based on the Budget Period Progress Report (BPR), site visits, and Uniform Data System (UDS) data. In the future, we may adjust service area funding amounts, patient targets, or zip codes as needed to ensure continuity of care in the communities and populations served by the Health Center Program.

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

III. Eligibility Information

1. Eligible Applicants

Eligibility Requirement What We Check

1) Your organization must be a private, non-profit entity or a public agency in the United States or its territories. Tribal and urban Indian organizations may apply.2

• Attachment 11: Evidence of Nonprofit or Public Center Status3 for new applicants

2) Your organization must provide all required health services4 available and accessible in the service area without regard for ability to pay. You may not propose to provide only a single service or any subset of the required primary health care services.

• Project Narrative RESPONSE section

• Form 5A: Services Provided (Columns 1, 2, and 3)

3) Your organization must provide General Primary Medical Care directly and/or through contracts the health center pays for.

• Form 5A: Services Provided (Columns 1 and 2)

4) Your organization must perform a substantive role in the project.

• Budget Narrative

• Attachment 2: Bylaws

2 Refer to Chapter 1: Health Center Program Eligibility of the Compliance Manual.

3 Only public agency health centers can have a co-applicant. The co-applicant functions as the health center’s governing board when the public agency cannot meet the Health Center Program governing board requirements directly (Section 330(r)(2)(A) of the Public Health Service Act).

4 Refer to the Service Descriptors for Form 5A: Services Provided, for details regarding required primary health care services.

http://bphc.hrsa.gov/sac/ http://bphc.hrsa.gov/sac/ http://bphc.hrsa.gov/sac/ https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5a.pdf https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-1.html https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html

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Eligibility Requirement What We Check

• Form 5A: Services Provided (Column 1)

• Form 8: Health Center Agreements and its attachments

5) You must make services accessible to all.

You may not propose to serve only a single age group or address a single health issue or disease. If you propose a site that targets only a sub-population (e.g., a school-based site), you must explain how you will make all required services available to the entire underserved population in the service area.

• Project Narrative RESPONSE section

6) Your organization must provide continuity of care to patients in an announced service area. You must:

• Service Area ID: Include the three-digit service area ID number from the SAAT that is announced under this NOFO.

• Patients: Project to serve at least 75 percent of the SAAT Patient Target.

• Services: Project to serve patients in all of the service types listed on the SAAT for your proposed service area (e.g., Medical, Dental, Mental Health, Substance Abuse, Vision, Enabling).

• Service Area Zip Codes: (New or Competing Supplement Applicants) Enter zip codes for service delivery sites that include a combination of SAAT Service Area Zip Codes in which patient percentages total at least 75 percent. If the sum of all zip code patient percentages is less than 75 percent, you must include all SAAT Service Area Zip

• Service Area ID: Project Abstract and Summary Page

• Patients: The total number of unduplicated patients for calendar year 2026 (January 1

– December 31, 2026) on Form 1A: General Information Worksheet

• Services: The patients listed for each service type on Form 1A: General Information Worksheet

• Service Area Zip Codes:

The zip codes listed on Form 5B: Service Sites (administrative-only sites will not be considered)5

• Special Populations: The funding distribution on the SF- 424A: Budget Information Form

5 We consider service area overlap when making funding determinations for new or competing supplement applicants if you propose zip codes on Form 5B: Service Sites that are not listed in the SAAT.

For more information about service area overlap, refer to Policy Information Notice 2007-09.

https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-8.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-8.pdf https://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/sites/default/files/bphc/funding/summary-page.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5b.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5b.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/sample-sf-424a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/sample-sf-424a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/sample-sf-424a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5b.pdf http://bphc.hrsa.gov/programrequirements/policies/pin200709.html

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Eligibility Requirement What We Check Codes for the proposed service area.

Current Service Area Zip codes will auto-populate for Competing Continuation applicants.

• Special Populations: Propose to maintain services to all currently served population types (Community Health Centers (CHC), Migrant Health Centers (MHC), Health Care for the Homeless (HCH), Public Housing Primary Care (PHPC). You will do this by maintaining the funding distribution of those population types listed in the SAAT where the funding level is not $0.

7) New or competing supplement applicants must propose at least one new full-time (open at least 40 hours per week) permanent, fixed building service site.6 7

• The valid street address for each proposed site on Form 5B: Service Sites and the proposed hours of operation for each site

8) PUBLIC HOUSING PRIMARY CARE

APPLICANTS: New or competing supplement applicants applying for PHPC funding must show that you consulted with public housing residents as you plan your new site(s). You must also explain how you will have ongoing input from public housing residents.

• Project Narrative COLLABORATION section

9) HEALTH CARE FOR THE HOMELESS AND

PUBLIC HOUSING PRIMARY CARE

APPLICANTS: New or competing supplement applicants applying for HCH or PHPC funding must use this funding to supplement, and not supplant, the expenditures of the health center and the value of in-kind contributions for the delivery of services to these populations.

• Attestation on the Summary Page

6 Policy Information Notice 2008-01: Def ining Scope of Project and Policy for Requesting Changes describes and def ines the term “service sites.”

7 If you propose to serve only migratory and seasonal agricultural workers, you may propose a full-time seasonal (rather than permanent) service site.

https://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5b.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5b.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/summary-page.pdf http://bphc.hrsa.gov/programrequirements/scope.html

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2. Cost Sharing or Matching

Cost sharing or matching is not required for this program.

3. Other

We may consider your application ineligible for review if it:

• Requests more than the Total Funding amount listed on the SAAT for Year 1.

• Does not include the Project Narrative as described.

• Does not include Attachment 6: Co-Applicant Agreement, if you are a public agency with a co-applicant.

• Does not include Attachment 11: Evidence of Nonprofit or Public Center Status.

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

Multiple Applications

You may submit multiple applications under the same Unique Entity Identifier (UEI), if each proposes to serve a different service area. We will only review your last validated application for each announced service area before the Grants.gov due date. If you plan to apply to serve two or more service areas announced under this NOFO, you must contact the SAC Team through the BPHC Contact Form for guidance.

IV. Application and Submission Information

1. Address to Request Application Package

We require you to apply online through Grants.gov and EHBs. Use the SF-424 application package associated with this NOFO. You must use a two-phase submission process. Follow these directions: How to Apply for Grants and those in EHBs.

• Phase 1 – Grants.gov – You must submit your application via Grants.gov by October 15, 2024, at 11:59 p.m. ET; and

• Phase 2 – EHBs – You must submit supplemental information via EHBs by November 14, 2024, at 5 p.m. ET.

Only applicants who successfully submit the application package associated with this NOFO in Grants.Gov (Phase 1) by the due date may submit the additional required information in EHBs (Phase 2). If you wish to change https://www.gsa.gov/about-us/organization/federal-acquisition-service/technology-transformation-services/integrated-award-environment-iae/iae-systems-information-kit/unique-entity-identifier-update https://hrsa.my.site.com/support/s/ http://www.grants.gov/applicants/apply-for-grants.html

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attachments submitted in Grants.gov, you may do so in the EHBs application phase. If you wish to change information you submitted in EHBs, you may reopen and revise your application before the EHBs deadline. For more details, see Sections 3 and 4 of the Two-Tier Application Guide.

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

Select “Subscribe” and enter your email address for HRSA-25-016 to receive emails about changes, clarifications, or instances where we republish the NOFO. You will also be notified by email of documents we place in the RELATED DOCUMENTS tab that may affect the NOFO and your application. You’re responsible for reviewing all information that relates to this NOFO.

2. Content and Form of Application Submission

Application Format Requirements

Follow the instructions in Sections 4 and 5 of the Two-Tier Application Guide and this NOFO. Write your application in English. Use U.S. dollars for your budget. There’s an Application Completeness Checklist in the Two-Tier Application Guide to help you.

Application Page Limit

The page limit for your application is 90 pages. We will not review any pages that exceed the page limit. Using the pages within the page limit, we 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 application package, including the program-specific forms in EHBs

• Attachments that are uploaded to program-specific forms in EHBs

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

• Indirect Cost Rate Agreement

• Attachments to determine eligibility (Attachment 6: Co-Applicant Agreement and

Attachment 11: Evidence of Nonprofit or Public Center Status if applicable)

• Attachment 1: Service Area Map and Table

• Attachment 2: Bylaws

• Attachment 9: Collaboration Documentation

• Attachment 13: Health Center Program Compliance

If you use an OMB-approved form that isn’t in the HRSA-25-016 workspace application package or EHBs application, it may count toward the page limit. Therefore, we recommend you only use the forms available in Grants.gov and EHBs.

https://grants.hrsa.gov/2010/WebEPSExternal/Interface/Common/AccessControl/Login.aspx https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-app-guide-2-tier.pdf#page=61

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Applications must be complete, validated by Grants.gov, and submitted under HRSA-25-016 before the Grants.gov and EHBs deadlines.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

• When you submit your application, you certify that you and your principals8 (e.g., program director) 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 explain why in Attachment 14: Other Relevant Documents.

See Section 5.1.viii – Certifications of the Two-Tier Application Guide.

Program Requirements and Expectations

Funding Requirements

Your application must document an understanding of the need for primary health care services in the service area. You must also propose a comprehensive plan to ensure the availability and accessibility of primary health care services to all individuals in the service area and target population, regardless of ability to pay. Your plan must include collaborative and coordinated delivery systems for the provision of health care to the underserved.

We expect SAC award recipients to make every reasonable effort to provide services to the number of unduplicated patients you project to serve on Form 1A: General Information Worksheet in calendar year 2026. We will track progress toward meeting the total unduplicated patient projection, which may include projections from other funded applications, using the Uniform Data System (UDS) report. For more information, visit the Patient Target FAQs. If there is a downward three-year patient trend in the service area for two consecutive SAC periods of performance (e.g., 6 years), HRSA may compete the area in the next SAC competition with a different funding allocation, patient target, or service area zip codes.

You must comply with all Health Center Program requirements as described in the Health Center Program Compliance Manual and applicable law and regulations. Failure to fulfill Health Center Program requirements may jeopardize Health Center Program award funding per Uniform Guidance 2 CFR Part 200, as codified by the United States

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

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://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf https://bphc.hrsa.gov/funding/funding-opportunities/service-area-competition/patient-target-faq https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200?toc=1 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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Department of Health and Human Services (HHS) at 45 CFR Part 75. Appendix A:

Health Center Program Compliance outlines the required responses and documentation.

• If you do not demonstrate compliance, you may receive a condition on your award and a 1-year period of performance.

• If you do not resolve conditions through the progressive action process outlined in Chapter 2: Health Center Program Oversight of the Health Center Program Compliance Manual, HRSA will terminate your award.

• You must attest on the Summary Page form that if you receive a 1-year period of performance, you will submit a Compliance Achievement Plan for HRSA approval within 120 days of award. If you do not provide the attestation, HRSA may place a condition on your award.

• If you receive a 1-year period of performance and you do not submit the required Compliance Achievement Plan10 within 120 days of award or demonstrate good cause for not submitting it, HRSA will terminate your award.

• HRSA will not award funding for a third consecutive 1-year period of performance unless we determine that you are compliant with all program requirements.

New and competing supplement applicants must also meet the following requirements:

• Open all proposed sites within 120 days of the Notice of Award (NoA). Staff and systems must be in place to deliver all required primary health services and proposed additional services to the target population. Sites and services must be consistent with Form 5B: Service Sites, Form 5A: Services Provided, the Project Narrative and Attachment 12: Operational Plan.11

• If you do not verify that all sites are operational within 120 days of award, HRSA will place a condition on your award that will allow 180 days for resolution. If you do not resolve a site-related condition within the specified time frame, HRSA may terminate all, or part, of your SAC award per. 45 CFR § 75.371.

• Open all proposed sites for the proposed hours of operation within one year of the Notice of Award. Sites and services must be consistent with Form 5B: Service Sites, Form 5A: Services Provided, the Project Narrative, and Attachment 12: Operational Plan.

10 Refer to Section 330(e)(1)(B) of the PHS Act.

11 HRSA may release NoAs up to 60 days prior to the period of performance start date.

https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-2.html https://bphc.hrsa.gov/compliance/compliance-manual https://bphc.hrsa.gov/compliance/compliance-manual https://bphc.hrsa.gov/sites/default/files/bphc/funding/summary-page.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5b.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5a.pdf https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFRb1309e6966399c7/section-75.371 https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5b.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5a.pdf

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Applicants for special populations funding must also meet the following requirements:

• Comply with additional requirements of the PHS Act:

o Section 330(g) for Migrant Health Center applicants.

o Section 330(h) for Health Care of the Homeless applicants.

o Section 330(i) for Public Housing Primary Care applicants.

• Use Health Care for the Homeless (HCH) and Public Housing Primary Care (PHPC) funding to supplement, and not supplant, other resources for the delivery of services to these populations.

Program-Specific Instructions Include application requirements and instructions from Section 5 of the Two-Tier 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 5.1.ix of the Two-Tier Application Guide.

The abstract must include:

• Your Health Center Program award number if available (H80CSXXXXX)

• The proposed service area identification number (ID), city, and state (available in the SAAT), and

• The total number of unduplicated patients that you project to serve in calendar year 2026.

NARRATIVE GUIDANCE

The following table ensures the application aligns with the review criteria. Make sure you’ve addressed everything. We will consider any forms or attachments you reference in a narrative section during the merit review.

HRSA-25-016 SAC 11

Narrative Section, Forms, Attachments Review Criteria

• Need section of the Project Narrative

• Attachment 1: Service Area Map and Table, Form 5B: Service Sites

Criterion 1: NEED

• Response section of the Project Narrative

• Form 5A: Services Provided, Form 5B:

Service Sites, Attachment 12:

Operational Plan

Criterion 2: RESPONSE

• Collaboration section of the Project Narrative

• Attachment 9: Collaboration Documentation

Criterion 3: COLLABORATION

• Resources and Capabilities section of the Project Narrative

• Attachment 2: Bylaws, Attachment 3:

Project Organizational Chart, Attachment 6: Co-Applicant Agreement, Attachment 7: Summary of Contracts and Agreements, Form 8: Health Center Agreements

Criterion 4:

RESOURCES/CAPABILITIES

• Impact section of the Project Narrative Criterion 5: IMPACT

• Governance section of the Project Narrative

• Form 6A: Current Board Member Characteristics

Criterion 6: GOVERNANCE

• Support Requested section of the Project Narrative

• Form 1A: General Information Worksheet

Criterion 7: SUPPORT

REQUESTED

ii. Project Narrative

This section must describe all aspects of the proposed project. Responses should be brief and clear.

https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5b.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5b.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5b.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-8.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-8.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-6a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-6a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-1a.pdf

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Provide information in the order described in the sections below. Use the section headers to ensure that reviewers can understand your proposed project.

• For competing continuations, the Project Narrative must reflect your approved scope of project. You must request any needed changes in scope separately through EHBs.12

• For competing supplements, the Project Narrative must reflect the proposed project for the announced service area. In addition to the required new full-time permanent site, you may propose additional sites and include current sites in scope if they will provide services to new patients in the announced service area. You may reference current services, policies, procedures, and capacity (e.g., experience, resources) if they relate to the announced service area.13

• For new applicants, the Project Narrative must reflect your entire proposed project for the announced service area.

NEED – Corresponds to Section V’s Review Criterion 1

1) Describe the proposed service area (consistent with Attachment 1: Service Area Map and Table), including:

a. The service area boundaries.

b. If the service area is located in an Opportunity Zone (if applicable).14

c. How you determined and will annually review the proposed service area, including the zip codes listed on Form 5B: Service Sites, based on where the proposed patients reside. Your explanation should include how the boundaries of the announced service area 1) ensure that the services provided are available and accessible to the residents of the area, 2) overlap with political subdivisions, school districts, and areas served by Federal and State health and social service programs; and 3) eliminate barriers to access.

Competing continuation applicants must provide updates consistent with data reported in the Uniform Data System (UDS) (e.g., service area zip codes listed on Form 5B: Service Sites represent those where 75 percent of current patients reside). Competing supplement applicants must address how you annually review the combined announced and currently funded service areas.

2) Describe how you determined the number of:

a. Unduplicated patients that you project to serve in calendar year 2026. If your projection is different than the Patient Target advertised in the SAAT, explain why.

12 Refer to the Scope of Project guidance for details.

13 If a competing supplement’s application is successful, the resulting service area will include both the announced service area and the currently funded service area.

14 The lists of Qualif ied Opportunity Zones are available at IRS Notices 2018-48 and 2019-42.

https://www.irs.gov/credits-deductions/opportunity-zones-frequently-asked-questions https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5b.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5b.pdf https://bphc.hrsa.gov/sac/ https://bphc.hrsa.gov/programrequirements/scope.html https://www.irs.gov/pub/irs-drop/n-18-48.pdf https://www.irs.gov/pub/irs-drop/n-19-42.pdf

HRSA-25-016 SAC 13

b. Patients that you project to serve for each service type that is required for the service area. (Services listed in the Service Type column of the SAAT).

3) Describe health care needs in the announced service area, including those that are met by the current Health Center Program award recipient. Address the needs of each special population identified in the SAAT, if applicable. Cite relevant data and their sources, which may include the unmet need score. Address the following:

a. Comprehensive health care services.

b. Enabling services (e.g., outreach, transportation, translation/interpretation).

c. Patient-centered care coordination, including health-related social needs.

d. Any other unique needs that impact health status (e.g., food insecurity, housing insecurity, neighborhood and the built environment, environmental issues or changes, intimate partner violence, human trafficking).

4) Describe any recent or potential changes in the local health care landscape and how those changes affect the needs of the target population.

5) Describe how you will conduct and update the needs assessment and regularly update your Scope of Project to reflect needs for additional services. Include how you will use patient and community input to inform and improve service delivery.

RESPONSE – Corresponds to Section V’s Review Criterion 2

1) Describe how the proposed service delivery sites on Form 5B: Service Sites assure equitable availability and accessibility of services (consistent with Form 5A: Services Provided) and minimize barriers within the proposed service area, including:

a. Your plans for service delivery sites in relation to where the target population lives and works.

b. How you will address geographic barriers, location of sites, and hours of operation.

c. Competing supplement applicants: If the proposed service area is not contiguous with the Health Center Program service area for which you are currently funded, how you will make all required and additional services accessible to all patients in the resulting combined service area. (The combined service area will include both the announced service area and your currently funded service area.15)

2) Describe how your services will be comprehensive, affordable, and culturally and linguistically appropriate for all patients. Include how you will provide:

a. Comprehensive services, including those that are required on Form 5A: Services

15 HRSA may not fund an application for an announced service area if the applicant would not make services available and accessible to residents of the area, if the service area would not conform to boundaries of political subdivisions, school districts, and areas served by federal and State health and social service programs, and if the service area would not eliminate barriers to access. See Chapter 3:

Needs Assessment of the Compliance Manual.

https://bphc.hrsa.gov/sac/ https://data.hrsa.gov/topics/health-centers/sanam https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5b.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5a.pdf https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-5a.pdf https://bphc.hrsa.gov/compliance/compliance-manual/chapter3 https://bphc.hrsa.gov/compliance/compliance-manual/chapter3

HRSA-25-016 SAC 14

Provided and, as appropriate and feasible, other additional services that are identified in your needs assessment.

b. Enabling services (e.g., outreach, transportation, translation/interpretation) to address health-related social needs, enhance patient experience, and facilitate access to care.

c. Patient-centered care coordination, informing patients about public and private health insurance options, helping patients apply for government assistance programs, and linking to community partners.

d. Additional services to address unique needs that impact health status (e.g., food insecurity, housing insecurity, neighborhood and the built environment, environmental issues or changes, intimate partner violence, and human trafficking).

3) Describe how you will maintain access to any expanded services that HRSA has previously supported through a supplemental award in the announced service area.

Address supplements awarded since FY 2020, as listed on the SAC TA webpage.

Include:

a. What level of services you currently provide and how you will continue to provide, change, or expand these services to meet the ongoing needs of your patients and your service area as identified in your needs assessment.

b. Competing supplement and new applicants: Describe your plans for maintaining continued access to the services the Health Center Program award recipient currently serving the announced service area provides.

4) Describe how your sliding fee discount policies and schedule ensure that services are affordable for your target population. Describe how you will inform the public that you offer services on a sliding fee discount schedule and without regard to the ability to pay.

5) Describe how you provide care that is respectful of and responsive to individual preferences, cultures, needs, and values. Include how you will:

a. Engage patients to participate in their care and maximize their experience of their care.

b. Create partnerships with families and caregivers.

c. Train providers on cultural competence and working with underserved populations.

6) Describe your communication tools and protocols, referral processes, and electronic exchange of patient health records that support continuity of care, including:

a. Hospital admitting privileges.

b. Receipt, follow-up, and recording of medical information from referral sources.

c. Follow-up for patients who are hospitalized or visit a hospital’s emergency department.

HRSA-25-016 SAC 15

7) New or competing supplement applicants: Describe plans to limit disruption for patients (as noted in the SAAT) that may result from transition of the award to a new recipient16 (consistent with Attachment 12: Operational Plan).

COLLABORATION – Corresponds to Section V’s Review Criterion 3

1) Describe your collaboration with diverse partners to increase awareness of the community’s health needs and social risk factors.

2) Describe how you coordinate services with other providers in your service area and submit Letters of Support from the providers you work with in Attachment 9:

Collaboration Documentation. Include:

a. Other community health centers, including look-alikes. (If you cannot obtain a requested letter of support from other health centers, include documentation of efforts made to obtain the letter).

b. Providers of specialty services and other services not available through your health center.

c. Local hospitals, to reduce non-urgent use of hospital emergency departments.

d. Others that serve similar populations (such as health departments, schools, community organizations, environmental organizations, homeless shelters, and Indian Health Services health facilities).

3) Describe how you collaborate with the Primary Care Association (PCA) in your state or region and, if you are a participating health center in a Health Center Controlled Network (HCCN), how you engage with that network to leverage information technology and data to improve patient care.

4) Applicants requesting PHPC Funding: Describe how the service delivery plan was developed in consultation with residents of the targeted public housing, and how residents of public housing will be involved in administration of the proposed project.

RESOURCES AND CAPABILITIES – Corresponds to Section V’s Review Criterion 4

1) Describe your organizational structure, including:

a. How your organization will play a substantive role in the implementation of the health center project and will not pass the award through to another organization.

b. How any subrecipients and contractors will assist in carrying out the proposed project (consistent with Attachments 2: Bylaws and 3: Project Organizational Chart, and, as applicable, Attachments 6: Co-Applicant Agreement, and 7:

16 The current award recipient’s health center sites do not transfer to the new recipient unless the organizations have entered into agreements for this type of transfer. Regulations concerning record-keeping and disposition and transfer of equipment are found at 45 CFR § 75.320(e). Note: If a new or competing supplement applicant is awarded a service area through this NOFO, HRSA may consider a request by the current award recipient for up to a 120-day period of performance extension, with a commensurate level of funding, to support the orderly phase-out of award activities and transition of patients, as appropriate.

http://bphc.hrsa.gov/sac/ https://www.ihs.gov/locations/ http://www.ecfr.gov/cgi-bin/text-idx?SID=2a8a9d22ec2c87952bc6e90576833ffe&mc=true&node=se45.1.75_1320&rgn=div8

HRSA-25-016 SAC 16

Summary of Contracts and Agreements).

c. If your organization is part of a parent, affiliate, or subsidiary organization

(consistent with Form 8: Health Center Agreements), describe these relationships.

2) Describe the key management team, including the project director (PD) or chief executive officer (CEO), clinical director (CD), and chief financial officer (CFO) (consistent with Attachment 5: Biographical Sketches for Key Management Staff).

Include:

a. Why this team is best qualified to guide operations and provide oversight of the project.

b. How they will promote innovation and a culture of quality improvement that is responsive to needs of the community.

3) Describe how you recruit, develop, engage, and retain the appropriate staffing mix of qualified providers to provide care to your target population.

4) Describe how your financial accounting and internal control systems and policies:

a. Ensure effective control over all health center funds, property, and other assets.

b. Track the financial performance of the health center.

c. Separate accounting for this award from other federal awards, including documentation of the receipt and expenditure of SAC funds.

d. Mitigate conflict of interest by board members, employees, and others when buying supplies, property, equipment, and services.

5) Describe your past experience and plans for maintaining continuity of services and responding to urgent primary health care needs during natural or man-made disasters and public health emergencies.17 18

6) Competing continuation applicants: Citing your UDS data for the number of unduplicated patients served in calendar year 2023, describe factors that have affected your 3-year patient trend since your last SAC application. Explain any downward trend in your total unduplicated patients.

IMPACT – Corresponds to Section V’s Review Criterion 5

1) Describe how the health center’s Quality Improvement/Quality Assurance program:

a. Addresses patient safety.

b. Improves patient experience and satisfaction.

c. Uses systems such as electronic health records or population management systems to monitor and track social risk factors that impact health and collect UDS data.

17 Including natural or manmade disasters, as well as emergent or established public health emergencies.

18 Consistent with the Center for Medicare & Medicaid Services (CMS) national emergency preparedness requirements. See details at https://www.cms.gov/Medicare/Provider-Enrollment-and- Certif ication/SurveyCertEmergPrep/Emergency-Prep-Rule.

https://bphc.hrsa.gov/sites/default/files/bphc/funding/form-8.pdf https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Emergency-Prep-Rule https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Emergency-Prep-Rule

HRSA-25-016 SAC 17

2) Describe how you will improve clinical quality, health outcomes, and reduce health disparities within your patient population, including within the following specified areas:

a. Hypertension (e.g., controlling high blood pressure)

b. Diabetes (e.g., hemoglobin A1c (HbA1c) poor control (>9%))

c. Mental health (e.g., screening for depression and follow-up plan, depression remission at 12 months).

d. Substance use disorder (e.g., access to medication-assisted treatment (MAT)).

e. Maternal and child health (e.g., early entry into prenatal care, low birth weight, childhood immunization status, dental sealants).

f. Ending the HIV epidemic (e.g., HIV screening, HIV linkage to care, pre-exposure prophylaxis (PrEP)).

g. Cancer screening (e.g., cervical cancer screening, breast cancer screening, colorectal cancer screening).

GOVERNANCE – Corresponds to Section V’s Review Criterion 6 Items 1 and 2 do not apply Native American tribes or tribal, Native American or Urban Indian organizations.

1) Describe how your governing board reflects the community you serve and how board members engage with patients to ensure that the health center is responsive to patient needs.

2) Describe how you have implemented effective governance to continually promote excellence in the delivery of care to your community. Specifically address:

a. How the governing board leverages their expertise (consistent with Form 6A:

Current Board Member Characteristics) to improve patient-centered care provided by the health…