hrsa-25-038 v6.pdf

Notice of Funding Opportunity

Application due January 27, 2025

Federal Office of Rural Health Policy Community-Based Division

Rural Health Care Services Outreach Program Opportunity number: HRSA-25-038

Contents Before you begin 4

Step 1: Review the Opportunity 5

Basic information 6

Eligibility 7

Program description 9

Award information 15

Step 2: Get Ready to Apply 17

Get registered 18

Find the application package 18

Application writing help 18

Step 3: Prepare Your Application 20

Application contents and format 21

Step 4: Learn About Review and Award 38

Application review 39

Selection process 47

Award notices 48

Step 5: Submit Your Application 49

Application submission and deadlines 50

Application checklist 52

Step 6: Learn What Happens After Award 55

Post-award requirements and administration 56

Reporting 58

Contents 2

Contacts and Support 61

Appendix A: Rural Health Care Services Outreach Program Measures Sample 66

Appendix B: Rural Health Care Services Outreach Program Definitions 69

Appendix C: Regular Track and Special Track Comparison Table 71

Appendix D: Rural Eligibility 73

Endnotes 76

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 January 27, 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

Eligibility 7

Program description 9

Award information 15

Basic information Health Resources and Services Administration (HRSA)

Federal Office of Rural Health Policy

Community-Based Division

Expand and enhance the delivery of health care services to promote outreach in rural communities.

Have questions? Go to Contacts and Support.

Key facts

Opportunity name: Rural Health Care Services Outreach Program

Opportunity number: HRSA-25-038

Announcement version:

New

Federal assistance listing: 93.912

Statutory authority: 42 U.S.C. 254c(e) (Section 330A(e) of the Public Health Service Act)

Key dates

NOFO issue date:

December 5, 2024

Informational webinar:

December 11, 2024

Application deadline:

January 27, 2025

Expected award date is by: April 1, 2025

Expected start date: May 1, 2025

Summary Support organizations to promote rural health care services outreach by improving and expanding the delivery of health care services to include new and enhanced services in rural areas.

Funding details Application type: New

Expected total available funding in FY 2025: $13,000,000

Expected number and type of awards: Up to 50 total grants

• Up to 40 Regular Track awards

• Up to 10 Special Track awards

Funding range per award:

• Up to $250,000 for Regular Track each budget period, or

• Up to $300,000 for Special Track each budget period

We plan to fund awards in 12-month budget periods for a total four-year period of performance from May 1, 2025, to April 30, 2029.

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

Step 1: Review the Opportunity 6

Eligibility Who can apply All domestic* public or private, non-profit, and for-profit entities are eligible to apply.

Types of eligible organizations This includes entities such as non-profits with a 501(c)(3) and non-profits with an IRS status other than a 501(c)(3). Other eligible entities may include but are not limited to:

• Public and private institutions of higher education

• State and county health departments

• Hospitals, including rural emergency hospitals

• Native American tribal government and organizations

• Community-based organization

• Federally qualified health centers

• Rural health clinics

Tribal exception: HRSA is aware that tribes and tribal organizations may not meet the Employer Identification Number (EIN) or Unique Entity Identifier (UEI) requirement of this NOFO. As a result, tribes and tribal organizations that only have one EIN or UEI or are unable to demonstrate that the network is composed of at least three unique entities, may request a tribal exception. Applicants must request a tribal EIN exception in Attachment 14: Tribal EIN exception request.

* “Domestic” means the 50 states, the District of Columbia, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, Guam, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.

Individuals are not eligible applicants under this NOFO.

Other eligibility criteria In addition, per statute, you must meet the requirements in this list. Failure to respond to these requirements will impact your application’s score.

• Have demonstrated experience serving, or capacity to serve, rural underserved populations.

• Include only rural counties and census tracts in HRSA-designated rural areas as target service areas served by grant funds from this program, if awarded. Refer to and provide required documentation in Attachment 3: Map of service area.

Step 1: Review the Opportunity 7

• Represents a consortium that meets all Program Requirements and Expectations

• Have not previously received an award under this program for the same or similar project unless the proposing to expand the scope of the project or area that will be served through the project.

• Consult your State Office of Rural Health (SORH) regarding your intent to apply to this program. If you are from the U.S. territories and do not have the functional equivalent of a SORH, you are still eligible to apply without completion of this requirement. Refer to Attachment 1: Required documentation from State Office of Rural Health for required documentation from SORH required documentation from SORH.

Completeness and responsiveness criteria We will review your application to make sure it meets these basic requirements to forward in the competition.

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.

Application limits Generally, you may not submit multiple applications under the same Unique Entity Identifier (UEI) (previously DUNS) number and/or EIN.

You may only submit multiple applications under the same Unique Entity Identifier (UEI) number and/or EIN, if each proposes distinct projects and an appropriate EIN Exception Request is submitted with your application. We will only review your last validated application for each distinct project before the deadline.

For more information about UEI/EIN exceptions request, please see Attachment 13:

EIN/UEI exception request and Attachment 14: Tribal EIN/UEI exception request.

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.

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

Step 1: Review the Opportunity 8 https://www.hrsa.gov/rural-health/grants/rural-hospitals/sorh

Program description Purpose This community-based grant program aims to support organizations to promote rural health care services outreach by improving and expanding the delivery of health care services to include new and enhanced services in rural areas.

To achieve this purpose, the program also aims to strengthen local resources and capacity in rural communities. Through collaborative consortiums that include three or more health care providers, each community can develop innovative approaches to solve their own unique challenges and factors underlying rural health disparities.

Goals

• Expand the delivery of health care services to include new and enhanced services exclusively in rural communities.

• Deliver health care services through a strong consortium, in which every consortium member organization is actively involved and engaged in the planning and delivery of services.

• Use community engagement and evidence-based or innovative, evidence-informed model(s) in the delivery of health care services.

• Improve population health and demonstrate health outcomes and sustainability.

Background The Rural Health Care Services Outreach Program (Outreach Program) enables award recipients to use federal funding to design and implement projects that are specifically tailored to meet rural populations’ unique health needs. Funding can be used for a broad range of health care services that are based on each rural community’s needs.

The Outreach Program offers an opportunity for award recipients to work collaboratively with rural communities to adapt to the emerging trends in rural health care and meet the unique needs of the people they serve. Building on previous efforts, the Outreach Program is continuing the existing Special Track in the FY 2025-2029 funding cycle and adding maternal health as a new focus area. As trends in maternal health have worsened over time and risk from maternal death rates is unevenly distributed across low-income persons and rural residents, maternal health has been an important focus across the country, including in rural areas.[1] Rural residents have a 9 percent greater chance of experiencing severe maternal disease and death rates compared with urban residents.[2] Applicants are encouraged to focus on reducing risk factors for pregnant persons during and after pregnancy through screening and referral

Step 1: Review the Opportunity 9 to needed services and interventions to appropriate consortium members to provide those services.

Previously funded Outreach programs provided good examples of how award recipients have used this funding to address health challenges and how the flexible nature of the program can target a community’s unique health needs, including those that directly address rural health disparities. To view the project descriptions for the FY 2021 Outreach cohort, please visit: https://www.ruralhealthinfo.org/assets/ 4663-20745/2021-2025-outreach-program-directory.pdf.

To view the abstracts of previous Outreach awards, visit the HRSA Data Warehouse:

https://data.hrsa.gov/tools/find-grants.

Program requirements and expectations You must meet all the requirements stated in the Eligibility and Other Eligibility criteria sections. You are also expected to meet the requirements and expectations outlined in this section. Failure to respond to these requirements will impact your application’s score.

Consortium requirements

• Specify at least three health care provider organizations that are separately owned entities (including the applicant organization) that will serve as members of your consortium. Include this information in Attachment 8: Consortium member list.

• Demonstrate that at least sixty-six percent (66%) or two-thirds of the consortium members are located within a HRSA-designated rural area Include this information in Attachment 8: Consortium member list.

Rural service area requirements

• Specify a target rural service area the proposed project will serve. Only counties and/or census tracts that are a HRSA-designated rural area are eligible to as target rural service areas under this grant program. Include this information in Attachment 3: Map of service area.

• Demonstrate your experience serving, or the capacity to serve rural underserved populations by including your organization’s experience in serving, or the capacity to serve, rural underserved populations, such as any existing or prior collaboration and working within the target service area(s) in the Project narrative under organization information section and in the Project abstract.

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

Step 1: Review the Opportunity 10 https://www.ruralhealthinfo.org/assets/4663-20745/2021-2025-outreach-program-directory.pdf https://www.ruralhealthinfo.org/assets/4663-20745/2021-2025-outreach-program-directory.pdf https://data.hrsa.gov/tools/find-grants

Funding track selection requirements You are required to select one of these two funding tracks to apply for Outreach Program funding:

1. Regular Track

2. Special Track

Your funding track selection must be provided in the Project abstract and Attachment 10: Special track participation statement.

Objective reviews of applications will be completed for all eligible applicants based on the funding track identified.

Funding track project requirements Successful applicants are expected to fulfill the requirements of the funding track identified in the application.

A full list of requirements for each funding track is provided in this section.

Requirements for each funding track are applicable to the Outreach Program’s four-year period of performance May 1, 2025, to April 30, 2029. For more information on the track’s comparison, refer to Appendix C: Regular Track and Special Track Comparison Table.

Regular Track Applicants to the Outreach Program Regular Track can request up to $250,000 a year, for the four-year period of performance.

The purpose of the Regular Track is to fund projects that expand access to health care in rural communities, improve the delivery of health care services, and strengthen resources and capacity in rural communities through collaborative consortiums. These projects are community driven and focus on outreach and education activities targeting unique health needs in rural communities. Goals include demonstrating improvement in health outcomes and creating long-term sustainability through funded projects. To accomplish these goals, successful Regular Track applicants are expected to use of Outreach program funds to implement activities that:

• Develop and implement an evidence-based, innovative or evidence-informed intervention that promotes health services by enhancing health delivery to rural underserved populations based on the identified needs of the community or region projects propose to address.

• Focuses on outreach and delivery of health care services, including social and other health-related service needs, to address and improve outcomes of targeted

Step 1: Review the Opportunity 11 health care needs for the rural service areas the project serves during the four-year funding period.

• Actively collaborates and involves rural community and consortium members in project implementation throughout the duration of the four-year period of performance.

• In collaboration with rural community and consortium members, implements project activities and informs plans for sustainability and possible replication or expansion of projects in other rural settings, after federal funding ends.

Special Track Applicants to the Outreach Program Special Track can request up to $300,000 a year for the four-year period of performance.

The purpose of the Special Track is to fund projects that address the underlying factors that drive rural health disparities related to stroke, heart disease, chronic lower respiratory disease, unintentional injury, cancer, and maternal health. The goals of Special Track projects are to demonstrate a collective impact to better manage conditions, address risk factors, and focus on prevention.

Successful Special Track applicants are also expected to implement projects able to fulfill these requirements:

• Clearly indicates selection of one or more of the Special Track focus areas:

◦ Stroke

◦ Heart disease

◦ Chronic lower respiratory disease

◦ Unintentional injury

◦ Cancer

◦ Maternal health

• Focuses project design on evidence-based, innovative, or evidence-informed intervention effectively to address the identified focus area(s) for the clearly defined rural population(s) who receive grant project intervention services.

• Implements activities and possesses project capacity to demonstrate improvements in key health indicators and/or outcomes for the rural target population that can be attributed to the project intervention during the four-year period of performance.

• Clearly defines the individuals from the rural target population who are the intended beneficiaries of funded project intervention activities that will be assessed for improvement in key health indicators and/or outcomes measured.

Step 1: Review the Opportunity 12

• Collects and tracks ongoing relevant data over the course of the four-year period of performance to effectively assess the impact of grant project activities on the identified rural target population(s) for the selected Special Track focus area(s).

• Produces sustainable initiatives to inform replication or expansion of similar prevention and health promotion models in other rural settings addressing risk factors and prevention for the selected Special Track focus area(s). As such, we highly encourage you to:

◦ Incorporate new Medicare billing codes for community and behavioral services.

◦ Consider participation in incentive programs and to leverage reimbursement strategies as a means for project sustainability. Incentives refer to improving the way providers are paid and offering incentive payments for providing high quality health care. This includes participation in value-based payment systems, such as accountable care organizations (ACO), patient centered medical homes (PCMH), bundled payments, and other shared savings models. Such incentives offer opportunities that can contribute to project sustainability.

◦ Reimbursement strategies leverage payment reimbursements for certain services to qualified patient populations. Many of the Centers for Medicare & Medicaid (CMS) programs, such as the Chronic Care Management and Diabetes Prevention Program, incentivize provision of preventive services and chronic disease management for Medicare patients, offering reimbursements when services are provided.

◦ Consider a network service model where members use a dues structure to continue successful services after the completion of the grant.

◦ Improve outcomes and achieve savings by reducing inappropriate emergency department billing or avoidable hospital re-admissions and using those savings to form a revenue stream to sustain the project.

• Actively collaborates and involves rural community and consortium members in project implementation throughout the duration of the four-year period of performance.

◦ In an effort to promote expanded or scaled impact of your project, we highly encourage you to work with a regional or state-based entity as one of the consortium members, such as a state Medicaid office, regional managed care association or regional health care foundation.

• Uses the first year of the grant period of performance strategically to include a community assessment that informs the intervention and selected Special Track focus area(s) and rural target population(s).

Step 1: Review the Opportunity 13

• Has the capacity to track the recipients of project intervention services over the duration of program to determine improvement over time and report on performance measures (which includes cost-savings analysis, risk reduction, etc.), project specific measures and program deliverables.

◦ For Special Track projects focusing on maternal health, tracking recipients of project intervention services over time to determine improvement of perinatal outcomes for at least one year within the period of performance, following receipt of services.

Program data collection

• If you receive an award, you will report measures to a centralized program outcomes reporting system.

• A final set of measures will be provided by FORHP post-award. To help prepare for data collection, consider the draft measures included in Appendix A: Rural Health Care Services Outreach Program Measures Sample.

• Special Track applicants are expected to collect, track, and report on data for the project’s clearly defined intervention recipients over time to respond to measures related to the project’s selected focus area(s), including potential cost-savings resulting from prevention and risk reduction activities, for the four-year period of performance.

◦ For Special Track projects focusing on maternal health, should collect, track, and report on data for the project’s clearly defined intervention recipients over time to determine improvement of perinatal outcomes for at least one year during the period of performance, following receipt of services.

• All recipients (Regular and Special Tracks) will work closely with technical assistance (TA) providers throughout the four-year period of performance. The targeted TA will assist award recipients with achieving desired project outcomes, sustainability, and strategic planning, and will ensure alignment of the awarded project with the Outreach Program goals. The TA is provided to award recipients at no additional cost. This HRSA investment helps ensure the projects’ success. We have found that most award recipients benefit greatly from the support provided through these collaborations. If funded, award recipients will learn more about the targeted technical assistance and evaluation support.

Step 1: Review the Opportunity 14

Award information 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

◦ Your satisfactory progress in meeting the project’s objectives

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

• Travel funds for two staff members to attend a two-day grant program meeting must be included as a budget line-item A. To determine estimated travel costs to Washington, D.C., see the U.S. General Services Administration (GSA) per diem rates for FY 2025.

• If we receive more funding for this program, we may:

◦ Fund more applicants from the rank order list

◦ Extend the period of performance

◦ Award supplemental funding

General limitations

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

Budget Information in Section 3.1.4 of the Application Guide. You can also see 45 CFR part 75, or any superseding regulation, General Provisions for Selected Items of Cost.

• You 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 statutory or regulatory limitations You cannot use funds:

• To build or acquire real property

• For construction

• To pay for equipment costs not directly related to the award

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

Step 1: Review the Opportunity 15 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=13 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)

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

Indirect costs Indirect costs are costs you charge across more than one project that cannot be easily separated by project. For example, this could include utilities for a building that supports multiple projects.

Indirect costs are determined using one of two methods:

Method 1 – Approved rate. You currently have an indirect cost rate approved by your cognizant federal agency.

Method 2 – De minimis rate. Per 2 CFR 200.414(f), if you have never received a negotiated indirect cost rate, you may elect to charge a de minimis rate. If you choose this method, costs included in the indirect cost pool must not be charged as direct costs.

This rate is 15% of modified total direct costs (MTDC). See 2 CFR 200.1 for the definition of MTDC. You can use this rate indefinitely.

Program income Program income is money earned as a result of your award-supported 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 16 https://www.hrsa.gov/grants/manage-your-grant https://www.ecfr.gov/current/title-2/section-200.414 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Modified%20Total%20Direct%20Cost%20(MTDC)) 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 18

Find the application package 18

Application writing help 18

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 will need to register.

When you register or update your SAM.gov registration, you must agree to the financial assistance general certifications and representations. You must agree to those for grants specifically, as opposed to contracts, because the two sets of agreements are different. You will have to maintain your registration throughout the life of any award.

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-25-038.

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.

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

Step 2: Get Ready to Apply 18 https://sam.gov/content/entity-registration 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 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

Join the webinar For more information about this opportunity, join the webinar on Wednesday, December 11, 2024, at 2pm Eastern. You can join at HRSA’s Zoom.

If you are not able to join through your computer, you can call in:

• Phone number: 833-568-8864

• Participant code: 06113963.

We will record the webinar. If you are not able to join the webinar live, you can request a recording by emailing ruraloutreachprogram@hrsa.gov.

Have questions? Go to Contacts and Support.

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

Step 2: Get Ready to Apply 19 https://hrsa-gov.zoomgov.com/j/1606576148?pwd=cW9FWGs4eXM5M0NIaThjSE1NbjZqZz09 mailto:ruraloutreachprogram@hrsa.gov

Step 3:

Prepare Your Application

In this step

Application contents and format 21

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

Application page limit: 50 pages

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

Project abstract Use the Project Abstract Summary form

Project narrative Use the Project Narrative Attachment form

Budget narrative Use the Budget Narrative Attachment form

Attachments Insert each in the Attachments form

Other required forms Upload using each required form

Required format You must format your narratives and attachments using our required formats for fonts, size, color, format, and margins. See the formatting guidelines in Section 3.2 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.

Include:

• Only one of these funding tracks:

◦ Regular Track or Special Track.

Refer to the Funding Track Selection under program requirements and expectations and Attachment 10: Special track participation statement.

• Your focus area(s).

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

Step 3: Prepare Your Application 21 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=24 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=13

◦ If the Special Track is selected, you must select one or more of these focus areas (stroke, heart disease, cancer, chronic lower respiratory disease, unintentional injury, cancer, or maternal health) and design your proposed project on addressing the underlying factors related to the focus area(s).

• Proposed rural service area, which includes counties and states.

In Project Abstract field:

• Briefly describe the target population you will serve.

• Include any rural underserved populations who have historically suffered from poor health outcomes, health disparities, and other inequities.

• Identify and describe proposed project goals and objectives, as it relates to community needs.

• Provide the name of evidence-based or evidence-informed model(s) your proposed project will use.

• Briefly describe the expected outcome(s) of the proposed project.

• Briefly describe your capacity to serve rural underserved populations such as a history or ability to form consortiums, organizational expertise and capacity, or experience in similar work.

• Indicate if you qualify for a funding preference.

• If you do qualify for a funding preference, please include concise statement making it clear to HRSA which funding preference you qualify for and provide the required documentation requested in Attachment 11: Funding preference documentation.

• If you do not qualify for or choose not to request a funding preference, please state that in your project abstract here. See Selection process under funding preferences and Attachment 11: Funding preference documentation for information.

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

All applicants (both Regular and Special Tracks) are expected to and must complete responses stated under the project narrative. Failure to respond to these instructions will impact your application’s score. Both Tracks must use the section headers and the order listed. If you are applying to the Special Track, you must also:

• Follow the instructions titled Special Track only and;

Step 3: Prepare Your Application 22

• Complete responses to all the information requested in the project narrative AND responses to the Special Track only instructions, for your project’s Special Track focus area(s)

Introduction See merit review criterion 1: Need

• Describe the purpose of your project. Include a summary of your proposed project.

◦ Outline your project goals and expected outcomes.

• Evidence-based or innovative, evidence-informed model(s) that will be used.

◦ If applicable, briefly describe any modification(s) made to the model your project proposes to use.

• Special Track only (in addition all other information requested in this section):

◦ Clearly specify the Special Track focus area(s) your project will focus on (stroke, heart disease, cancer, chronic lower respiratory disease, unintentional injury, cancer, and maternal health)

Need See merit review criterion 1: Need

This section will help reviewers understand who you will serve. Complete responses include citations referencing any relevant federal, state, local data, if possible. If availability of data is limited to cite, indicate this and use alternative means to document how needs were assessed.

• Describe the target population you will serve. Consider health-related challenges and contributing factors to those challenges such as, geography, socioeconomic status, disability status, primary language, health literacy, and other relevant elements. You should also consider people with disabilities; non-English speaking populations; people with limited health literacy; or any other populations that may otherwise be overlooked when identifying target populations.

◦ Based on your target population, describe any relevant subpopulations who have historically suffered from poorer health outcomes, health disparities, and other inequities among the target population are included in the population you propose to serve. If there are no relevant subpopulations to describe, please state this, as applicable. Describe how rural consortium members and the rural communities in service area(s) will be involved in your project planning, development, and implementation.

• Describe the type of community involvement, such as, rural community members, patients, representatives of local, regional, tribal and/or state government(s) and

Step 3: Prepare Your Application 23 non-government organizations, involved in the planning process of your project, and how they will be involved in the implementation of your project, if funded.

• Discuss relevant barriers to utilization and access to services among the target population your project will address.

• Describe the existing health care, health-related, and social services available in your service area(s).

• Describe the gaps in the existing health care services and activities that the consortium will perform to fill those gaps (i.e., personnel, service delivery needs, shared resources, etc.)

• Describe how your proposed project could be integrated with existing available health care, health-related, and social services and addressing the gaps in the service area(s).

• Special Track only (in addition all other information requested in this section):

◦ Include a description of any policy and/or workforce barriers associated with your projects’ Special Track focus area(s).

◦ Include information about the intended beneficiaries of funded activities from the project’ s rural target population who will be involved throughout project implementation.

▪ This should include details that clearly define the needs of the project intervention recipients and how those needs will be tracked to determine improvement over time resulting from funded project implementation.

▪ For Special Track applicant projects focusing on maternal health, the needs of the beneficiaries intended to receive project services should be clearly defined and how those needs will be tracked to determine improvement of perinatal outcomes for at least one year during the period of performance, following receipt of services.

Approach See merit review criterion 2: Response

This section will help reviewers understand how you will address your stated needs and meet the program requirements and expectations described in this NOFO.

• Define the proposed goals and objectives of your project. These should be specific, measurable, realistic, and achievable in a specific timeframe.

• Explain how your project will meet the needs of the target population(s), including any applicable subpopulation(s).

• Describe how your project will address barriers and health disparities related to access and utilization of health care, as well as health-related and social services

Step 3: Prepare Your Application 24 in the service area(s). Include a map of the service area(s) in Attachment 3: Map of service area.

• Identify and clearly describe the evidence-based or innovative, evidence-informed model(s) your project will use and the reasons why the model(s) is appropriate and relevant to rural community and target population your project will serve.

Complete responses also include response to all information requested in Attachment 7: Evidence-based or evidence-informed model(s).

• Describe any modification(s), made to the model(s) your project will use, if applicable. Include how any modifications made will better support use of the model(s) for the project and rural community the project will serve.

• Discuss your preliminary plan for sustaining the proposed activities after federal funding ends. The plan should include:

◦ Sustainable impact of the program.

◦ Proposed strategies to achieve the desired sustainable impact.

◦ Potential sources of support for achieving sustainability after the four-year period of performance has ended.

• Special Track only (in addition all other information requested in this section):

◦ Include any sustainable impact related to policy changes and/or workforce development, if applicable.

◦ Incorporate new Medicare billing codes for community and behavioral services, if applicable.

◦ Consider participation in incentive programs and to leverage reimbursement strategies as a means for project sustainability. Incentives refer to improving the way providers are paid and offering incentive payments for providing high quality health care. This includes participation in value-based payment systems, such as accountable care organizations (ACO), patient centered medical homes (PCMH), bundled payments, and other shared savings models. Such incentives offer opportunities that can contribute to project sustainability.

◦ Reimbursement strategies leverage payment reimbursements for certain services to qualified patient populations. Many of the Centers for Medicare & Medicaid (CMS) programs, such as the Chronic Care Management and Diabetes Prevention Program, incentivize provision of preventive services and chronic disease management for Medicare patients, offering reimbursements when services are provided.

◦ Consider a network service model where members use a dues structure to continue successful services after the completion of the grant, if applicable.

Step 3: Prepare Your Application 25

◦ Improve outcomes and achieve savings by reducing inappropriate emergency department billing or avoidable hospital re-admissions and using those savings to form a revenue stream to sustain the project, if applicable.

Work plan See merit review criteria 2: Response and 4: Impact

This section will help reviewers understand how you will achieve each of the objectives during the period of performance.

You must also include a work plan in a table format in Attachment 4: Work plan that aligns to with the work plan described in this section.

• Describe your work plan. The description should include:

◦ A brief description of purpose, goals, objectives, and activities.

◦ An appropriate timeline for proposed activities during the project’s funding cycle.

◦ Who will be responsible for overseeing implementation for each activity.

◦ Detail of the support and collaboration with consortium members and key stakeholders to plan, design, and implement all activities.

◦ Performance, outcome measures, and/or benchmarks to help monitor progress for each activity.

◦ Expected results, outcomes and/or impact on the target population, including any applicable subpopulations from the project based on the evidence-based or innovative, evidence-informed model(s).

▪ For example, expected outcomes could include changes in disease and death rates, maintenance of desired behavior, policy implications, and reeducation in social and economic burdens associated with uninsurance status, and mitigation in access to care barriers.

• Include a plan to distribute reports, products, and/or project outcomes to your target audiences, such as target populations, consortium members, and key stakeholders.

• Special Track only (in addition all other information requested in this section):

◦ Include how your project may be repeated in or expanded to other rural setting to address risk factors and prevention related to the selected Special Track focus area(s).

Step 3: Prepare Your Application 26

Resolving challenges See merit review criterion 2: Response

This section will help reviewers understand how you will address anticipated challenges barriers.

• Discuss anticipated challenges and barriers you will likely encounter in your project. Potential challenges may include, but not limited to, keeping the rural consortium members and communities actively engaged, addressing staff turnover, and/or changes in policy, systems, or environment.

• Explain approaches that will be used to resolve challenges and barriers, such as keeping the rural consortium members and communities actively engaged, addressing staff turnover, and/or changes in policy, systems, or environment.

Program self-assessment See merit review criteria 3: Evaluation measures and 5: Resources and capabilities

This section will help reviewers understand your plan for assessing project performance and outcomes.

• Describe how you will ensure consortium members will effectively collect, share, and report required HRSA performance measures, listed in the Appendix A: Rural Health Care Services Outreach Program Measures Sample.

• Describe how you will use data, including but not limited to required HRSA performance measures, for the continuous improvement of services through the project implementation.

• Discuss your plan for ensuring that you and your consortium members receive input from the service area(s) and target population in the project data design and implementation.

• Discuss anticipated challenges working with the consortium on collecting, sharing, and reporting HRSA performance measures (for example, data sharing, consortium disagreements, personnel actions, expenditure activities, etc.) and identify approaches that can be used to resolve the challenges.

• Special Track only (in addition all other information requested in this section):

◦ Describe how you will track recipients of project intervention services over the duration of the four-year period of performance to effectively determine improvement over time and report ongoing relevant data on the impact of grant project activities on the identified rural target population(s) for the selected Special Track focus area(s).

▪ For Special Track projects focusing on maternal health, describe how you will track recipients of project intervention services over time to

Step 3: Prepare Your Application 27 determine improvement of perinatal outcomes for at least one year during the period of performance, following receipt of services.

▪ Describe how you could potentially monitor any anticipated cost-savings resulting from prevention and risk reduction activities from the selected Special Track focus area(s) throughout the project implementation.

Organizational information See merit review criterion 5: Resources and capabilities

This section will help the reviewers understand how you and your consortium have resources and capabilities carry out the program requirements.

• Complete responses to this section also include:

◦ Your organizational chart in Attachment 9: Applicant organizational chart.

◦ A list of and description of all key staff members conducting activities within this program, including the project director, as requested in Attachment 5:

Staffing plan and job descriptions.

◦ Biographical sketches of all key staff members, as requested in Attachment 6:

Biographical sketches.

◦ Your consortium members list, as requested in Attachment 8: Consortium member list.

◦ A Memorandum of Understanding/Agreement (MOU/A) or a letter of agreement signed and dated by all consortium members as Attachment 2:

Agreements with other entities.

• Describe your organization’s experience in serving, or the capacity to serve rural underserved populations. Demonstrating this capacity may include a history or ability to:

◦ Identify activities that build, strengthen, and maintain the necessary competencies and resources needed to sustain or improve health services delivery in rural populations.

◦ Discuss organizational expertise and capacity as it relates to the scope of work proposed. Include a brief overview of the organization’s assets, skills, and qualifications to carry on the project.

◦ Describe current experience, including consortiums, activities, program implementation and previous work of a similar nature.

◦ Discuss the effectiveness of methods and/or activities employed to improve health care services in rural communities.

Step 3: Prepare Your Application 28

◦ Describe the geographic relationship to the proposed rural service population as well as the plans to ensure that rural populations are served.

• Describe how your organization will assess the unique needs of the people who live in the rural community they serve.

• Describe how your organization will ensure a high degree of rural consortium involvement in project planning and implementation through a shared decision-making structure and capacity that includes rural consortium members and rural community members.

• Briefly describe your organization’s mission, structure, and the scope of your current activities.

• Provide information that demonstrates you have the staffing and infrastructure necessary to oversee program activities by including:

◦ Your organizational profile, budget, collaborators, key staff’s experience, skills, and knowledge, and key processes.

◦ How will you follow the approved plan, account for federal funds, and record all costs to avoid audit findings.

◦ Identify the project director who will be responsible for project/program monitoring and carrying out the award activities. HRSA highly recommends the project director allot at least 1.0 FTE to the program and has management experience involving multiple organizational arrangements.

• Provide information on each consortium member and their experience serving, or capacity to serve, rural areas by including:

◦ Strategies employed for creating the consortium. If applicable, a history of working together.

◦ Each consortium member’s responsibilities and contributions to the project.

◦ Rural consortium members are actively involved collaborators who are included in decision making in order to contribute to the project, including evidence of support from stakeholders and members for the implementation of the proposed project, such as letters of agreement or Memorandum of Understanding/Agreement (MOU/A).

◦ Roles and responsibilities for each consortium organization,

◦ How federal grant funds to rural consortium members will be distributed.

◦ Each organization participating in the consortium to deliver the services, contribute to the consortium, and otherwise meet the needs of the project.

◦ A consortium comprised of at least sixty-six percent (66%), or two-thirds of the consortium composition is located in a HRSA-designated rural area.

Step 3: Prepare Your Application 29

• Discuss why each of your consortium members is an appropriate collaborator and, what expertise they bring to the project. Include their involvement, roles and responsibilities, contributions to your project, and commitment to sustain project services and activities.

• Special Track only (in addition all other information requested in this section):

◦ If applicable, include regional or state-based collaborators as consortium members and/or discuss possible regional or state-based collaborators your project plans to pursue adding as a consortium member.

◦ Discuss the capability and commitment of the current consortium members to develop and sustain provision of Outreach Program services and activities addressing risk factors and prevention for the selected Special Track focus area(s). If applicable,

▪ Include any sustainable impact related to policy changes and/or workforce development.

▪ Incorporate new Medicare billing codes for community and behavioral services.

▪ Consider participation in incentive programs and to leverage reimbursement strategies as a means for project sustainability.

Incentives refer to improving the way providers are paid and offering incentive payments for providing high quality health care. This includes participation in value-based payment systems, such as accountable care organizations (ACO), patient centered medical homes (PCMH), bundled payments, and other shared savings models. Such incentives offer opportunities that can contribute to project sustainability.

▪ Reimbursement strategies leverage payment reimbursements for certain services to qualified patient populations. Many of the Centers for Medicare & Medicaid (CMS) programs, such as the Chronic Care Management and Diabetes Prevention Program, incentivize provision of preventive services and chronic disease management for Medicare patients, offering reimbursements when services are provided.

▪ Consider a network service model where members use a dues structure to continue successful services after the completion of the grant.

▪ Improve outcomes and achieve savings by reducing inappropriate emergency department billing or avoidable hospital re-admissions and using those savings to form a revenue stream to sustain the project.

Step 3:…