HRSA-25-036 Final Mod.pdf

Federal Office of Rural Health Policy (FORHP)

Notice of Funding Opportunity

Application due February 5, 2025

Rural Veterans Health Access Program Opportunity number: HRSA-25-036

Modified on 12/11/2024

Updated Funding details section to clarify language.

Contents Before you begin 4

Step 1: Review the Opportunity 5

Basic information 6

Summary 6

Key facts 6

Key dates 6

Funding details 6

Eligibility 7

Cost sharing 7

Program description 7

Award information 9

Step 2: Get Ready to Apply 12

Get registered 13

Find the application package 13

Application writing help 13

Step 3: Prepare Your Application 15

Application contents and format 16

Step 4: Learn About Review and Award 25

Application review 26

Selection process 31

Award notices 34

Step 5: Submit Your Application 35

Application submission and deadlines 36

Application checklist 37

Contents 2

Step 6: Learn What Happens After Award 39

Post-award requirements and administration 40

Reporting 41

Contacts and Support 42

Contents 3

Before you begin If you believe you are a good candidate for this funding opportunity, secure your SAM.gov and Grants.gov registrations now. If you are already registered, make sure your registrations are active and up-to-date.

SAM.gov registration (this can take several weeks) You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI).

See Step 2: Get Ready to Apply

Grants.gov registration (this can take several days) You must have an active Grants.gov registration. Doing so requires a Login.gov registration as well.

See Step 2: Get Ready to Apply

Apply by the application due date Applications are due by 11:59 p.m. Eastern Time on February 5, 2025.

To help you find what you need, this NOFO uses internal links. In Adobe Reader, you can go back to where you were by pressing Alt + Left Arrow (Windows) or Command + Left Arrow (Mac) on your keyboard.

Before you begin 4 https://sam.gov/ https://grants.gov/

Jump to a step

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 6

Summary 6

Key facts 6

Key dates 6

Funding details 6

Eligibility 7

Cost sharing 7

Program description 7

Award information 9

Basic information Health Resources and Services Administration (HRSA)

Federal Office of Rural Health Policy (FORHP)

Hospital State Division

Real life American veterans, rural life veteran communities.

Have questions? Go to Contacts and Support.

Key facts Opportunity name: Rural Veterans Health Access Program

Opportunity number:

HRSA-25-036

Federal Assistance Listing: 93.241

Key dates NOFO issue date:

December 3, 2024

Informational webinar:

Monday, December 16, 2024 at 1PM ET

Application deadline:

February 5, 2025 at

11:59PM ET

Expected award date:

August 1, 2025

Expected start date:

August 1, 2025

Summary The Rural Veterans Health Access Program provides funding to states to work with providers and other key partners to support health care for veterans living in rural areas. This support includes expanding access to needed health care services and improving coordination of care.

Funding details Type: New, Competing Continuation

Expected total available FY 2025 funding: $600,000”

Expected number and type of awards: Up to three cooperative agreements.

Funding range per award: Up to $200,000 per year

The program and estimated awards depend on the appropriation of funds and are subject to change based on the availability and amount of appropriations.

We plan to fund awards in three 12-month budget periods for a total three-year period of performance of August 1, 2025 to July 31, 2028.

Step 1: Review the Opportunity 6

Eligibility Who can apply Only states that are current Medicare Rural Hospital Flexibility Program award recipients under HRSA-24-002 are eligible to apply.

HRSA will accept only one application from each state.

Cost sharing This program has no cost-sharing requirement. If you choose to share in the costs of the project, we will not consider it during merit review. We will hold you accountable for any funds you add, including through reporting.

Program description Purpose The Rural Veterans Health Access Program (RVHAP) provides funding to states to work with providers and other key partners to support health care for veterans living in rural areas. This support includes expanding access to needed health care services and improving coordination of care.

A key component of RVHAP is to facilitate coordination by the Secretary of Health and Human Services in consultation with the Department of Veterans Affairs (VA). The Federal Office of Rural Health Policy (FORHP) coordinates with the VA Office of Rural Health.

Objectives

The primary objectives of the RVHAP program are to develop regional networks to:

• Improve access to health care services for underserved veteran populations, including geriatric, female, Native American, and minority veteran populations.

• Improve care coordination for veterans seeking care both at the VA system and from other community providers, including the VA community care program.

• Provide benefits counseling for veterans to improve access to mental health services, substance use disorder (SUD) services, or other health care services.

• Help rural providers bill for services provided to local veterans.

Step 1: Review the Opportunity 7

Background A disproportionate share of veterans live in rural areas of the United States. According to the Veterans Health Administration – Office of Rural Health (VHA – ORH), there are 4.4 million veterans living in rural areas, with 2.7 million enrolled in the VA health care system.

Veterans choose to live in rural areas for a variety of reasons, including:

• Proximity to family, friends, and community.

• Open space for recreation.

• More privacy.

• Lower cost of living.

• Less crowded towns and schools.

Veterans (and their caregivers) face many of the same challenges with accessing health care and other services as any rural resident, including:

• Limited broadband.

• Greater geographic and distance barriers.

• Hospital closures due to financial instability.

• Higher uninsured rates.

• Longer wait times for care.

• Fewer transportation options.

• Fewer housing and employment options.

• Fewer options for care, particularly specialty care.

Veterans also face unique challenges with care coordination as they routinely access care from multiple locations and can be included in multiple health care systems. For example, many veterans access care both through the VA system and through community providers.

RVHAP aims to increase enrollment of veterans living in rural areas in the VA benefits system. Enrollment improves veterans’ access to care by letting them receive VA services and benefits. This program also allows recipients to identify and work with a variety of providers in rural areas who can help rural veterans meet their health care needs.

FORHP collaborates with the VHA-ORH’s Veterans Rural Health Resource Centers (VRHRCs) to strengthen partnerships between rural health providers and the VA system.

VRHRCs are VHA-ORH’s field-based satellite offices and serve as hubs of rural health care research, innovation, and dissemination. The VRHRCs are located within the VA medical centers in:

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 8 https://www.ruralhealth.va.gov/aboutus/ruralvets.asp https://www.ruralhealth.va.gov/aboutus/vrhrc.asp

• Iowa City, Iowa

• Salt Lake City, Utah

• White River Junction, Vermont

• Portland, Oregon

• Gainesville, Florida

Applicants do not need to be located near any of the five VRHRC locations to apply.

Congressional Mandate 38 USC § 7308 defines VRHRCs’ mission to:

• Improve understanding of the challenges faced by veterans living in rural areas.

• Identify disparities in the availability of health care to veterans living in rural areas.

• Formulate practices or programs to enhance the delivery of health care to veterans living in rural areas.

• Develop special practices and products for the benefit of veterans living in rural areas and for implementation of such practices and products across the VA system.

Award information Cooperative agreement terms Our responsibilities Aside from monitoring and technical assistance, we also get involved in these ways:

• Advising on performance measures to ensure that HRSA can capture any cross-cutting outcomes among award recipients.

• Facilitating partnerships with the VHA-ORH.

• Facilitating sharing of best practices and resources with other relevant stakeholders.

Your responsibilities You must follow all relevant laws and policies. Your other responsibilities will include:

• Collaborating with HRSA and the VHA-ORH (including VRHRCs) in implementing program objectives, measuring program progress, and assessing program effectiveness.

• Executing program activities to meet the objectives of the project, with ongoing input from HRSA.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 9 https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-chapter73&edition=prelim

• Engaging with providers and stakeholders in your state to increase access to care and coordination of care for veterans in rural areas. This includes assisting rural veterans secure health benefits for which they are eligible and working with rural hospitals, clinics and other providers to bill for services for enrolled veterans at their facility.

• Sharing best practices and resources developed to benefit interested stakeholders.

Funding policies and limitations Policies

• We will only make awards if this program receives funding. If Congress appropriates funds for this purpose, we will move forward with the review and award process.

• Support beyond the first budget year will depend on:

◦ Appropriation of funds.

◦ Satisfactory progress in meeting the project’s objectives.

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

• If we receive more funding for this program, we consider options such as:

◦ Funding more applicants from the rank order list.

◦ Extending the period of performance.

• Awarding supplemental funding.

General limitations

• For guidance on some types of costs we do not allow or restrict, see Budget in

Section 3.1.4 of the Application Guide. You can also see 45 CFR part 75, General Provisions for Selected Items of Cost.

• For-profit organizations cannot earn profit from the federal award. See 45 CFR 75.400(g).

• Congress’s current appropriations act includes a salary limitation, which applies to this program. As of January 2024, the salary rate limitation is $221,900. This limitation may be updated.

Program-specific limitations

• Your organization cannot spend more than 15% of the award on administrative expenses. This rule is set by statute.

• See Manage Your Grant for other information on costs and financial management.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 10 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=19 https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR5d90ba314caea08 https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR5d90ba314caea08 https://www.ecfr.gov/current/title-45/part-75#p-75.216(b) https://www.ecfr.gov/current/title-45/part-75#p-75.216(b) https://www.ssa.gov/OP_Home/ssact/title18/1820.htm https://www.hrsa.gov/grants/manage-your-grant

Program income Program income is money earned from your project activities. You must use any program income you generate from awarded funds for approved project-related activities.

Find more about program income at 45 CFR 75.307.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 11 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.307

Step 2:

Get Ready to Apply

In this step

Get registered 13

Find the application package 13

Application writing help 13

Get registered SAM.gov You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI). SAM.gov registration can take several weeks. Begin that process today.

To register, go to SAM.gov Entity Registration and select Get Started. From the same page, you can also select the Entity Registration Checklist to find out what you’ll need to register.

Grants.gov You must also have an active account with Grants.gov. You can see step-by-step instructions at the Grants.gov Quick Start Guide for Applicants.

Find the application package The application package has all the forms you need to apply. You can find it online. Go to Grants Search at Grants.gov and search for opportunity number HRSA 25-036.

After you select the opportunity, we recommend that you click the Subscribe button to get updates.

Application writing help Visit HHS Tips for Preparing Grant Proposals.

Visit HRSA’s How to Prepare Your Application page for more guidance.

See Apply for a Grant for other help and resources.

Join the webinar For more information about this opportunity, join the webinar on Monday, December 16, 2024 at 1:00 PM ET. You can join at https://hrsa-gov.zoomgov.com/j/ 1607618773?pwd=IKhd3GDn8d9s6DXFBpKjcBgOIWpE71.1.

If you are not able to join through your computer, you can call in at 1-833-568-8864 with meeting ID:1607618773 and passcode: 91173665.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 2: Get Ready to Apply 13 https://sam.gov/content/entity-registration https://grants.gov/applicants/applicant-registration http://www.grants.gov/quick-start-guide/applicants https://www.grants.gov/search-grants https://www.hhs.gov/grants-contracts/grants/get-ready-for-grants-management/tips-for-preparing-grant-proposals/index.html https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://www.hrsa.gov/grants/apply-for-a-grant https://hrsa-gov.zoomgov.com/j/1607618773?pwd=IKhd3GDn8d9s6DXFBpKjcBgOIWpE71.1 https://hrsa-gov.zoomgov.com/j/1607618773?pwd=IKhd3GDn8d9s6DXFBpKjcBgOIWpE71.1

We will record the webinar. If you are not able to join live, please contact Jessica Sanders at jsanders@hrsa.gov.

Need Help? See Contacts and Support.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 2: Get Ready to Apply 14 https://nofo.rodeo/nofos/jsanders@hrsa.gov

Step 3:

Prepare Your Application

In this step

Application contents and format 16

Application contents and format Applications include five main components. This section includes guidance on each.

There is a 50-page limit for the overall application.

Submit your information in English and express whole number budget figures using U.S. dollars.

Make sure you include each of these:

Components Submission format Included in the page limit?

Project abstract Use the Project Abstract Summary form. No

Project narrative Use the Project Narrative Attachment form. Yes

Budget narrative Use the Budget Narrative Attachment form. Yes

Attachments Insert each in the Other Attachments form. Yes, unless otherwise marked.

Other required forms Upload using each required form. No

Required format You must format your narratives and attachments using our required formats for fonts, size, and margins. See the formatting guidelines in section 3.1 of the Application Guide.

Project abstract Complete the information in the Project Abstract Summary form. Include a short description of your proposed project. Include the needs you plan to address, the proposed services, and the population groups you plan to serve. For more information, see Section 3.1.2 of the Application Guide.

Project narrative In this section, you will describe all aspects of your project. Project activities must comply with the nondiscrimination requirements.

Use the section headers and the order listed here.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 16 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=13

Introduction See merit review criterion 1: Need

• Briefly describe the purpose of your project. Explain how it meets the objectives of the RVHAP program.

Need See merit review criterion 1: Need

This section will help reviewers understand the needs and health care gaps of rural veterans in your state.

• Describe the demographics of the rural veteran population you will serve in your state. Use and reference demographic data whenever possible.

• Discuss the unmet health needs of the rural veteran populations, including those who suffer from poorer health outcomes, health disparities, and other inequalities and whether veterans eligible for benefits are aware of how to apply for those benefits and assisting in that process. These rural veteran populations may include but are not limited to:

◦ Black, Latino, and Indigenous and Native American people.

◦ Asian Americans and Pacific Islanders.

◦ Other people of color.

◦ Geriatric people.

◦ Women veterans.

◦ People adversely affected by persistent poverty or inequality.

• Discuss gaps in rural veterans’ ability to receive care within their community.

Describe how this project will complement, but not supplant, existing programs, where applicable.

• Discuss any existing resources to help rural veterans get mental health care, crisis intervention, care for post-traumatic stress disorder (PTSD), or other necessary health care services.

• Describe any existing efforts to coordinate care and provide benefits counseling to help veterans receive care from community providers and VA providers.

• Discusses any existing efforts to help providers bill the VA directly for services provided to veterans and the awareness by providers of the opportunity to bill for those services for enrolled veterans.

Step 3: Prepare Your Application 17

Approach See merit review criteria 2: Response and 4: Impact

Program needs and objectives

• Describe how you will improve health care for rural veterans by addressing the stated needs and meet the RHVAP program objectives, including:

◦ Improving the capacity of rural health care organizations to meet the needs of rural and underserved veterans in rural areas, including assisting providers with making connections to the Department of Veterans Affairs (VA) system.

◦ Developing a regional network to provide benefits counseling to assist eligible veterans enroll in the VA Health system and help providers bill for services provided to enrolled veterans. The networks you develop may also include:

▪ Critical Access Hospitals (CAHs).

▪ Rural Health Clinics (RHCs).

▪ Federally Qualified Health Center (FQHCs).

▪ Native American and tribal organizations.

▪ Home health agencies.

▪ Mental health providers and community mental health centers.

▪ Pharmacists.

▪ Social service providers.

▪ Local government.

▪ Other rural health organizations or providers who can help meet the needs of veterans.

◦ Establishing or participating in advisory panels, task forces, committees, network development, or coalitions that address program development, health systems planning, and strategic planning. This can include addressing challenging health issues for rural veterans, such as:

▪ Mental health.

▪ Aging.

▪ Population health.

▪ Racial and ethnic health disparities.

▪ SUD services.

▪ Social determinants of health (SDOH).

Step 3: Prepare Your Application 18

◦ Improving the coordination of care for rural veterans, which can include efforts with community health care providers and coordination of the VA system.

• Explain how you will work with providers and partners to address the gaps noted in the need section of your narrative. Include gaps in care coordination for veterans receiving care from multiple systems and partnering with local veteran service organizations and associations (e.g., Veterans of Foreign Wars and the American Legion).

• Describe your plan to develop effective tools and strategies for ongoing staff training, outreach, collaborations, clear communication, and information sharing.

Include efforts to involve patients, caregivers, families, and communities with veterans in need of health services.

• Describe your plan to disseminate reports, products, or project outputs to key audiences.

• Discuss any innovative methods that you will use to address the needs of the rural veteran population. Some examples may include establishing or improving access to existing telehealth or telemedicine services.

• Describe how you will sustain the project after the period of federal funding ends.

Stakeholder engagement Engaging with the VA is a required component of the project. VRHRCs can help you navigate partnerships within the VA system. Each VRHRC has specific focus areas: s:

• White River Junction: Research and care coordination.

• Iowa City: Health information exchange, opioids, telehealth, and FQHC pilot programs.

• Salt Lake City: Geriatric care, Native American veterans, and telehealth.

• Portland: Pain management, suicide prevention, and vulnerable populations.

• Gainesville: Rehabilitation and independent living for rural veterans, rural workforce recruitment and retention, and education.

The proposed project objectives should have relevant focus areas from at least one of the VRHRCs. You should work with the VRHRC whose focus area most closely matches your proposed project. Include a letter acknowledging support from one of the VRHRCs for project collaboration and project sustainability in Attachment #4.

In this section of your project narrative, describe how you plan to facilitate state partnerships with the VA, including:

• How you plan to consult or collaborate with one of the five VRHRCs on activities.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 19

• How that partnership will ensure that RVHAP funds complement existing VHA-ORH work.

• How that partnership will improve health for veterans in rural areas.

Your narrative should also include:

• A discussion of how you have engaged with providers and partners in the development of your proposal. Include their planned involvement with project implementation.

• A discussion of how you will get input from key stakeholders during project planning and implementation. Your key stakeholders must include rural veteran populations, including geriatric, female, Native American, and minority veterans.

• A plan for how you will share best practices implemented or resources developed during your project for the benefit of interested stakeholders.

• A description of how your collaborations will address challenging health issues for rural veterans, including:

◦ Access to broadband.

◦ Telehealth and telemedicine.

◦ Mental health.

◦ Aging.

◦ Population health.

◦ Racial and ethnic health disparities.

◦ SUD.

◦ Social determinants of health (SDOH).

High-level work plan See merit review criteria 2: Response and 4: Impact

• Describe the activities or steps that you will use to achieve each of the objectives proposed during the entire period of performance.

• You will include a more detailed work plan as Attachment #1. In that attachment, include:

◦ A succinct overview of project objectives, activities, and projected outcomes.

We recommend that you format this information as a table.

◦ Each activity, responsible staff, estimated completion dates, progress or process measures, and intended outcomes.

◦ As appropriate, identify meaningful support and collaboration with key stakeholders or partners in planning, designing, and implementing all activities, including developing the application.

Step 3: Prepare Your Application 20

Resolving challenges See merit review criterion 2: Response

Discuss challenges that you are likely to encounter in designing and implementing the activities described in the work plan, and approaches that you will use to resolve such challenges. Include any unique challenges related to geographical isolation and serving underserved rural veteran populations.

Performance reporting and evaluation See merit review criteria 3: Evaluation measures and 5: Resources and capabilities

• Describe your plan for the program performance evaluation that will contribute to continuous quality improvement. The program performance evaluation should monitor ongoing processes and the progress towards the goals and objectives of the project.

• Describe the systems and processes that will support tracking of performance outcomes, including a description of how the organization will collect and manage data (for example, assigned skilled staff or data management software) in a way that allows for accurate and timely reporting of performance outcomes.

• You should use quantitative and qualitative data to capture program performance and impact, including:

◦ Number of veterans receiving care or services

◦ The types of care or services provided to veterans

◦ Number of veterans or number of sites enrolled in the VA system

◦ Number of TA provided to providers on billing services rendered to veterans

• Performance measurement and reporting

◦ Describe how you will collect and report required performance data accurately and on time.

◦ Describe how you will manage and securely store data.

◦ Describe how you will monitor and analyze performance data to support continuous quality improvement.

See Reporting for more information.

Organizational information See merit review criterion 5: Resources and capabilities

• Describe your organization’s current mission, structure, and activities, including previous experience working with the veteran population and knowledge on veteran’s health benefits enrollment. Describe how these elements all contribute

Step 3: Prepare Your Application 21 to the organization’s ability to implement the program requirements and meet program expectations.

• Include an organizational chart as Attachment #5.

• Include a staffing plan and job descriptions for key personnel as Attachment #2.

• Include biographical sketches of key personnel as Attachment #3.

• Discuss any subcontracts that you are proposing and describe your oversight role.

Discuss how you will follow the approved plan, as outlined in the application, properly account for the federal funds, and document all costs to avoid audit findings.

Budget and budget narrative See merit review criterion 6: Support Requested

Your budget should follow the instructions in Section 3.1.2 Budget of the Application Guide and any specific instructions listed in this section. Your budget should show a well-organized plan.

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

The budget narrative supports the information you provide in Standard Form 424-A.

See other required forms. The merit review committee reviews both.

The budget narrative includes added detail and justifies the costs you ask for. As you develop your budget, consider:

• If the costs are reasonable and consistent with your project’s purpose and activities.

• The restrictions on spending funds. See funding policies and limitations.

To create your budget narrative, see detailed instructions in Section 3.1 of the Application Guide.

Attachments Place your attachments in order in the Other Attachments form.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 22 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=19 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=19 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=19

Attachment 1: Work plan Counts toward page limit.

Attach the project’s work plan. Make sure it includes everything required in the project narrative section.

Attachment 2: Staffing plan and job descriptions for key personnel Counts toward page limit.

See Section 4.1.v of the Application Guide.

Include a staffing plan that shows the staff positions that will support the project and key information about each. Justify your staffing choices, including education and experience qualifications and your reasons for the amount of time you request for each staff position.

For key personnel, attach a one-page job description. It must include the role, responsibilities, and qualifications.

Attachment 3: Biographical sketches for key personnel Does not count toward the page limit.

Include biographical sketches for people who will hold the key positions you describe in Attachment #2.

Each biographical sketch should be no more than two pages. Do not include personally identifiable information. If you include someone you have not hired yet, provide a letter of commitment from that person with the biographical sketch.

Attachment 4: VHA-ORH VRHRC letter of support Counts toward page limit.

Provide a letter acknowledging support from the VHA-ORH VRHRC that you will collaborate with on this project.

Attachment 5: Project organizational chart Counts toward page limit.

Provide a one-page diagram that shows the project’s organizational structure.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 23 https://www.hrsa.gov/sites/default/files/hrsa/grants/sf424-application-guide.pdf#page=33

Attachment 6-15: Other documents (optional) Counts toward page limit.

Include here any other documents that are relevant to the application, including letters of support from organizations other than VRHRCs. Letters of support from the VRHRCs should be included in Attachment #4. Any letters of support you include in this attachment must be dated and indicate a specific commitment to the project, such as in-kind services, funds, staff, space, or equipment.

Other required forms You will need to complete some other forms. Upload the following forms at Grants.gov.

You can find them in the NOFO application package or review them and any available instructions at Grants.gov Forms.

Forms Submission Requirement

Application for Federal Assistance (SF-424) With application.

Budget Information for Non-Construction Programs (SF-424A)

With application.

Disclosure of Lobbying Activities (SF-LLL) If applicable, with the application or before award.

Project/Performance Site Location(s) With application.

Grants.gov Lobbying Form With application.

Key Contacts With application.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 24 https://www.grants.gov/forms

Step 4:

Learn About Review and Award

In this step

Application review 26

Selection process 31

Award notices 34

Application review Initial review We review each application to make sure it meets basic requirements. We will not consider an application that:

• Is from an organization that does not meet all eligibility criteria.

• Requests funding above the award ceiling shown in the funding range.

• Is submitted after the deadline.

We will not review any pages over the page limit.

Merit review A panel reviews all applications that pass the initial review. The members use the following criteria.

Criterion Total number of points = 100

1. Need 10 points

2. Response 35 points

3. Performance reporting and evaluation 15 points

4. Impact 15 points

5. Resources and capabilities 15 points

6. Support requested 10 points

Criterion 1: Need 10 points.

See Project Narrative Introduction and Need sections.

How well the application:

• Describes the purpose of the proposed project. The project must meet RVHAP program needs and objectives .

• Describes the rural veteran population and their unmet health needs in the applicant’s state and includes demographic data in their discussion.

• Discusses the unmet health needs specific to underserved rural veteran populations in the applicant’s state. These underserved populations can include

Step 4: Learn About Review and Award 26 those who suffer from poorer health outcomes, health disparities, and other inequalities.

• Explains the current gaps in rural veterans’ ability to receive care within their communities and describes how this project will complement, but not supplant, existing programs.

• Describes any existing resources to assist rural veterans in receiving mental health care, crisis intervention, care for PTSD, and other health care services.

• Discusses any existing efforts to coordinate care and provide benefits counseling to help veterans receive care from both community care providers and VA providers.

• Discusses any existing efforts to help providers bill the VA directly for services provided to veterans.

Criterion 2: Response 35 points.

See Project Narrative Approach, High-Level Work Plan, and Resolving Challenges sections.

How well the proposed project responds to the identified needs. This includes the strength of the activities described in the application to meet the proposed goals and objectives.

Approach: Program needs and objectives (10 points) How well the application:

• Describes the methods the applicant will use to improve health care for rural veterans and meet the RVHAP program purpose and objectives. This must include a thorough discussion on how they will:

◦ Improve the capacity of rural health care organizations to meet the needs of rural and underserved veterans in rural areas, including assisting providers with making connections to the VA system.

◦ Develop a regional network to provide benefits counseling to assist eligible veterans enroll in the VA Health system and help providers bill for services provided to enrolled veterans.

◦ Establish or participate in advisory panels, task forces, committees, network development, or coalitions that address program development, health systems planning, and strategic planning. This can include addressing challenging health issues for rural veterans such as: mental health, aging, population health, racial and ethnic health disparities, SUD services, and social determinants of health (SDOH) factors.

Step 4: Learn About Review and Award 27

◦ Improve the coordination of care for rural veterans, which can include efforts with community health care providers and coordination of the VA system.

• Discusses any innovative methods to address the needs of the rural veteran population. Some examples may include establishing or improving telehealth or telemedicine services that improve access to care for rural veterans.

Approach: Stakeholder engagement (10 points) How well the applicant:

• Thoroughly describes how they will partner with one of the five VRHRCs to meet project goals and includes a letter acknowledging support from one of the VRHRCs in Attachment #4.

• Clearly explains how they have engaged with providers and partners in the development of their proposal and how those partners will be involved in project implementation.

• Clearly details the process to gather input from key stakeholders during project planning and implementation, including rural veteran populations. Those populations should include geriatric, female, Native American, and minority veteran populations.

• Thoroughly details the collaborative efforts planned to address challenging health issues for rural veterans, including: access to broadband, telehealth and telemedicine, mental health, aging, population health, racial and ethnic health disparities, SUD, and SDOH, if applicable.

High-level work plan (10 points) How well the application:

• Describes the project’s objectives, activities, and projected outcomes.

• Describes each activity, responsible staff, estimated completion dates, progress or process measures, and intended outcomes.

• Describes support and collaboration with key stakeholders or partners in planning, designing, and implementing the project.

Resolution of challenges (5 points)

• Describes the challenges that the applicant is likely to encounter when designing and implementing activities.

• Describes approaches to resolving potential challenges to implementing the proposed project.

Step 4: Learn About Review and Award 28

Criterion 3: Evaluation measures 15 points.

See Project Narrative Performance Reporting and Evaluation section.

How well the application:

• Describes a strategy to collect, analyze, and track data to measure process and outcomes. The strategy should include a thorough explanation of how the data will be used to inform program development and service delivery.

• Clearly explains the strategies that will contribute to continuous quality improvement.

• Clearly explains the applicant’s capacity to work with HRSA and the VHA-ORH to adjust measures, collect data, and demonstrate the impact of the program.

• Clearly describes the program’s performance data that will be monitored and tracked throughout the period of performance and clearly explains how the measures will demonstrate the effectiveness of the project.

• Includes a thorough evaluation plan the clearly details the performance health data measures, and inclusion of additional measures if applicable, for assessment of program performance.

Criterion 4: Impact 15 points.

See Project Narrative Approach section.

How well the application:

• Clearly describes a plan for sharing best practices implemented or resources developed during the project.

• Clearly describes any innovative methods or strategies used to address the stated needs.

• Clearly details a plan to disseminate reports, products, or project outputs to key audiences.

• Clearly explains a plan for project sustainability after the period of federal funding ends.

Step 4: Learn About Review and Award 29

Criterion 5: Resources and capabilities 15 points.

See Project Narrative Organizational Information and Evaluation Measures and Technical Support Capacity sections.

How well the application:

• Succinctly describes the organization’s current mission, structure (including an organizational chart as Attachment #5), activities, previous experience working with the veteran population, knowledge of veteran health benefits, and explains how these elements contribute to the organization’s ability to meet program objectives.

• Proposes an adequate staffing plan to meet the needs of the project (Attachment #2).

• Includes key personnel (Attachment #3) with relevant skills to achieve the objectives of the project.

• Thoroughly explains the role of any subcontractors and the applicant’s oversight role.

Clearly describes the organization’s ability to follow the approved plan as outlined in the application, properly account for the federal funds, and document all costs to prevent audit findings.

• Clearly describes how the organization will routinely assess and improve the project to meet the unique needs of rural veteran populations.

Criterion 6: Support requested 10 points.

See Budget and Budget Narrative section.

• How reasonable the proposed budget is for each year of the period of performance in relation to the objectives, the complexity of the activities, and the anticipated results.

• Whether costs are reasonable given the scope of work.

• Whether key personnel have adequate time devoted to the project to achieve project objectives.

Step 4: Learn About Review and Award 30

Risk review Before making an award, we review the risk that you will not manage federal funds in prudent ways. We need to make sure you’ve handled any past federal awards well and demonstrated sound business practices. As part of this review, we use SAM.gov Entity Information Responsibility / Qualification to check your history for all awards likely to be more than $250,000 over the period of performance. You can comment on your organization’s information in SAM.gov. We’ll consider your comments before making a decision about your level of risk.

We:

• Review any applicable past performance.

• Review audit reports and findings.

• Analyze the budget.

• Assess your management systems.

• Ensure you continue to be eligible.

• Make sure you comply with any public policies.

We may ask you to submit additional information.

If we find a significant risk, we may choose not to fund your application or to place specific conditions on the award.

For more details, see 45 CFR 75.205.

Selection process When making funding decisions, we consider:

• Merit review results. These are key in making decisions but are not the only factor.

• The amount of available funds.

• Assessed risk.

• The larger portfolio of HRSA-funded projects, including the diversity of project types and geographic distribution.

• The funding priorities, funding preferences, and special considerations listed.

We may:

• Fund out of rank order.

• Fund applications in whole or in part.

• Fund applications at a lower amount than requested.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 4: Learn About Review and Award 31 https://sam.gov/content/entity-information https://www.ecfr.gov/current/title-45/section-75.205

• Decide not to allow a recipient to subaward if they may not be able to monitor and manage subrecipients properly.

• Choose to fund no applications under this NOFO.

Special considerations This program includes special consideration, as authorized by Section 1820(g)(6)(B)(iv).

A special consideration is the favorable consideration of an application by HRSA funding officials, based on the extent to which the application addresses the specific area of special consideration.

HRSA will give special consideration in funding to applications submitted by states in which rural veterans make up 25% of the veteran population in the state, to ensure the program meets the legislative intent of serving states with significant population of rural veterans per the authorizing statute (Title XVIII, Section 1820(g)(6) of the Social Security Act (42 U.S.C. 1395i-4(g)(6)).

Such consideration shall be given without regard to the number of veterans of Operation Iraqi Freedom and Operation Enduring Freedom living in the areas in which mental health services and other health care services would be delivered under the application.

Applications that do not receive special consideration will be given full and equitable consideration during the review process.

To achieve the distribution of awards as stated, HRSA may need to fund out of rank order.

Table: States in which at least 25% of the veteran population lives in rural areas

State Percent of veteran population living in rural areas

Alabama 41.3

Alaska 33.6

Arkansas 48.9

Georgia 28.5

Idaho 33.1

Indiana 30.8

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 4: Learn About Review and Award 32 https://www.ssa.gov/OP_Home/ssact/title18/1820.htm

Iowa 39.2

Kansas 30.0

Kentucky 40.9

Louisiana 29.4

Maine 65.9

Michigan 32.0

Minnesota 33.0

Mississippi 50.0

Missouri 34.5

Montana 47.3

Nebraska 29.1

New Hampshire 44.0

North Carolina 36.1

North Dakota 41.4

Oklahoma 36.9

Oregon 26.3

Pennsylvania 25.3

South Carolina 33.0

South Dakota 45.4

Tennessee 37.3

Vermont 65.1

West Virginia 51.1

Wisconsin 35.2

Step 4: Learn About Review and Award 33

Wyoming 35.2

Source: U.S. Census Bureau, 2011-2015 American Community Survey, 5-year estimates.

For more information about statistical testing of ACS estimate, see https://census.gov/ programs-surveys/acs/guidance/statistical-testing-tool.html

Award notices We issue Notices of Award (NOA) on or around the start date listed in the NOFO. See Section 5.4 of the Application Guide for more information.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 4: Learn About Review and Award 34 https://www.census.gov/library/publications/2017/acs/acs-36.html#:%7E:text=About%205%20million%20veterans%20lived,during%20the%202011%E2%80%932015%20period.&text=The%20U.S.%20Department%20of%20Veterans,as%20a%20population%20of%20interest.

https://census.gov/programs-surveys/acs/guidance/statistical-testing-tool.html https://census.gov/programs-surveys/acs/guidance/statistical-testing-tool.html https://www.hrsa.gov/sites/default/files/hrsa/grants/sf424-application-guide.pdf#page=46

Step 5:

Submit Your Application

In this step

Application submission and deadlines 36

Application checklist 37

Application submission and deadlines Your organization’s authorized official must certify your application. See the section on finding the application package to make sure you have everything you need.

Make sure you are current with SAM.gov and UEI requirements. When you register or update your SAM.gov registration, you must agree to the financial assistance general certifications and representations, and specifically with regard to grants.

Make sure that your SAM.gov registration is accurate for both contracts and grants, as these registrations differ. See information on getting registered. You will have to maintain your registration throughout the life of any award.

Deadlines You must submit your application by February 5, 2025 at 11:59 p.m. ET.

Grants.gov creates a date and time record when it receives the application. If you submit the same application more than once, we will accept the last on-time submission.

You may submit more than one application if each proposes a distinct project. We will only review your last validated application for each distinct project before the deadline.

Submission method Grants.gov You must submit your application through Grants.gov. See get registered.

For instructions on how to submit in Grants.gov, see the Quick Start Guide for Applicants. Make sure that your application passes the Grants.gov validation checks, or we may not get it. Do not encrypt, zip, or password protect any files.

See Contacts and Support if you need help.

Other submissions Intergovernmental review This NOFO is not subject to Executive Order 12372, Intergovernmental Review of Federal Programs. No action is needed.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 5: Submit Your Application 36 https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application/assurances-non-construction-programs https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application/assurances-non-construction-programs http://www.grants.gov/quick-start-guide/applicants http://www.grants.gov/quick-start-guide/applicants https://www.archives.gov/federal-register/codification/executive-order/12372.html

Application checklist Make sure that you have everything you need to apply:

Component How to upload Included in page limit?

Project abstract Use the Project Abstract Summary Form. No

Project narrative Use the Project Narrative Attachment form.

Yes

Budget narrative Use the Budget Narrative Attachment form.

Yes

Attachments Insert each in a single Other Attachments form.

Attachment 1: Work plan Yes

Attachment 2: Staffing plan and job descriptions for key personnel

Yes

Attachment 3: Biographical sketches for key personnel

No

Attachment 4: VHA-ORH VRHRC letter of support

Yes

Attachment 5: Project organizational chart

Yes

Attachment 6 – 15: Other documents Yes

Other required forms * Upload using each required form.

Application for Federal Assistance

(SF-424)

No

Budget Information for Non-Construction Programs (SF-424A)

No

Disclosure of Lobbying Activities (SF-LLL) No

Project/Performance Site Location(s) No

Grants.gov Lobbying Form No

Key Contacts No

Step 5: Submit Your Application 37

* Only what you attach in these forms counts against the page limit. The form itself does not count.

Step 5: Submit Your Application 38

Step 6:

Learn What Happens After Award

In this step

Post-award requirements and administration 40

Reporting 41

Post-award requirements and administration Administrative and national policy requirements There are important rules you need to know if you get an award. You must follow:

• All terms and conditions in the Notice of Award (NOA).

• The regulations at 45 CFR part 75, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards.

• The termination provisions in 45 CFR 75.372.

• The HHS Grants Policy Statement (GPS). This document is incorporated by reference in your NOA. If there are any exceptions to the GPS, they’ll be listed in your NOA.

• All federal statutes and regulations relevant to federal financial assistance, including those highlighted in HHS Administrative and National Policy Requirements.

• See the requirements for performance management in 2 CFR 200.301.

Health information technology interoperability If you receive an award, you must agree that where your activities involve implementing, acquiring, or upgrading health IT, you, and all your subrecipients will:

• Meet the standards and specifications in 45 CFR part 170, subpart B, if those standards support the activity.

• If the activities relate to activities of eligible clinicians in ambulatory settings or hospitals under Sections 4101, 4102, and 4201 of the HITECH Act, that you will use only health IT certified by the Office of the National Coordinator for Health Information Technology (ONC) Health IT Certification Program.

If standards and implementation specifications in 45 CFR part 170, subpart B cannot support the activity, we encourage you to use health IT that meets non-proprietary standards and specifications of consensus-based standards development organizations. This may include standards identified in the ONC Interoperability Standards Advisory.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 6: Learn What Happens After Award 40 https://www.ecfr.gov/current/title-45/part-75 https://www.ecfr.gov/current/title-45/section-75.372 https://www.hhs.gov/grants-contracts/grants/grants-policies-regulations/index.html https://www.hhs.gov/sites/default/files/hhs-administrative-national-policy-requirements.pdf https://www.hhs.gov/sites/default/files/hhs-administrative-national-policy-requirements.pdf https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-D/section-200.301 https://www.ecfr.gov/current/title-45/part-170/subpart-B https://www.healthit.gov/topic/certification-ehrs/certification-health-it-1 https://www.healthit.gov/topic/certification-ehrs/certification-health-it-1 https://www.ecfr.gov/current/title-45/part-170/subpart-B https://www.healthit.gov/isa/ https://www.healthit.gov/isa/

Non-discrimination and assurance If you receive an award, you must follow all applicable nondiscrimination laws. You agree to this when you register in SAM.gov.