HRSA-25-041_FINAL.pdf

Notice of Funding Opportunity

Application due April 22, 2025

Federal Office of Rural Health Policy Community-Based Division

Rural Maternity and Obstetrics Management Strategies Program (Rural MOMS) Opportunity number: HRSA-25-041

Contents Before you begin 4

Step 1: Review the Opportunity 5

Basic information 6

Eligibility 7

Program description 11

Award information 15

Step 2: Get Ready to Apply 18

Get registered 19

Find the application package 19

Application writing help 19

Step 3: Prepare Your Application 21

Application contents and format 22

Step 4: Learn About Review and Award 40

Application review 41

Selection process 48

Award notices 49

Step 5: Submit Your Application 50

Application submission and deadlines 51

Application checklist 53

Step 6: Learn What Happens After Award 55

Post-award requirements and administration 56

Contacts and Support 60

Contents 2

Appendix A: Top 10 States with the Highest Average MCTA Scores 65

Appendix B: Types of Rural MOMS Network Partners 66

Appendix C: Glossary 68

Appendix D: Determining Rural Status 71

Endnotes 73

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 April 22, 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 11

Award information 15

Basic information Health Resources and Services Administration

Federal Office of Rural Health Policy

Community-Based Division

Creating collaborative networks to improve maternal and infant health in rural communities.

Have questions?

See Contacts and Support.

Key facts

Opportunity name: Rural Maternity and Obstetrics Management Strategies Program (Rural MOMS)

Opportunity number:

HRSA-25-041

Announcement version:

New

Federal Assistance Listing:

93.912

Statutory authority: 42 USC 254c-1b (§ 330A-2 of the Public Health Service Act)

Key dates

NOFO issue date:

January 17, 2025

Informational webinar:

February 12, 2025

Application deadline:

April 22, 2025

Expected award date is by:

August 1, 2025

Expected start date:

September 30, 2025

See other submissions for other time frames that may apply to this NOFO.

Summary The Rural Maternity and Obstetrics Management Strategies Program provides support to establish innovative, collaborative rural obstetric networks to improve maternity care and access to care in rural communities. The ultimate goal of the program is to improve maternal and infant health outcomes and access.

Funding details Application Types: New

Expected total available funding in FY25: $3,000,000

Expected number and type of awards: 3 cooperative agreements

Funding range per award: $1,000,000 per year

We plan to fund awards in four 12-month budget periods for a total 4-year period of performance of from September 30, 2025, to September 29, 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 You can apply if you are a domestic public or private, non-profit, or for-profit entity providing prenatal care, labor care, birthing, and postpartum care services in rural areas, frontier areas, or medically underserved areas, or to medically underserved populations or Indian Tribes or Tribal organizations.[1]

Types of eligible organizations These types of domestic* organizations may apply:

• Public institutions of higher education.

• Private institutions of higher education.

• Non-profits with or without a 501(c)(3) IRS status.

• For-profit organizations, including small businesses.

• State, county, city, township, and special district governments, including the District of Columbia, domestic territories, and freely associated states.

• Independent school districts.

• Native American tribal governments.

• Native American tribal organizations.

• Hospitals, including rural emergency hospitals.

• Community-based organizations.

• Community health centers, including federally qualified health centers.

• Rural health clinics.

*“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 You must also meet the other eligibility requirements in this list. If you do not meet these requirements, your application will not be deemed eligible by HRSA to be reviewed by the merit review committee.

Step 1: Review the Opportunity 7

• Represent a network composition that meets all the Program Requirements and Expectations

• Must target populations residing in a HRSA-designated rural area.

• State Office of Rural Health Consultation.

◦ You have consulted with your State Office of Rural Health (SORH) regarding your intent to apply to this program.

◦ You provide the required documentation in Attachment 10: Required documentation from State Office of Rural Health.

◦ If you are from the U.S. territories and do not have the functional equivalent of a SORH, you are still eligible to apply and state that your territory does not have a functional equivalent of a SORH to complete documentation for requirement.

• Prior Award. You have not previously received an award under this program for the same or similar project.

• Network composition.

◦ Represent a network of three or more separately owned health care provider organizations (see Appendix C). If your organization is a health care provider organization, please provide supporting information.

◦ Have signed agreements in place with all proposed network partners.

▪ You must provide evidence of this partnership in attachment 9: List of network members.

▪ You are required to include at least one tertiary provider as described in Appendix C. If your organization is a tertiary provider, please provide supporting information.

▪ You are required to include your State Medicaid Office in your network composition. You are required to have a signed agreement in place with your state’s Medicaid Office. If your organization is the State Medicaid agency, please provide supporting information. You must provide evidence of this agreement by submitting with your application one of these two options in attachment 4:

⁃ A signed memorandum of agreement/understanding (MOA/U) or other applicable written agreements, or

⁃ A signed letter of commitment.

▪ You are strongly encouraged to include network partners as described in Appendix B: Types of Rural MOMS Network Partners.

• Network service.

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

Step 1: Review the Opportunity 8 https://nosorh.org/

◦ Your network has the capacity to serve rural areas.

▪ Your network has demonstrated experience serving, or the capacity to serve, rural underserved populations, as evidenced in your project narrative.

▪ The network will use award funds to serve only HRSA-designated rural areas, as evidenced in project narrative and attachment 6: map of network service area.

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, other eligibility criteria or program requirements and expectations.

• 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) number or employer identification number (EIN). However, we recognize a trend toward consolidation within the rural health care industry and the possibility that multiple organizations may share the same UEI or EIN with their parent organization.

You may only submit multiple applications under the same UEI or EIN if each application proposes a distinct project. You must also submit Attachment 12: EIN/UEI exception request (if applicable) with your application. We will only review your last validated application for each distinct project before the deadline.

NOTE: Single organizations (e.g., a parent organization/headquarters) may not apply more than once for this funding opportunity on behalf of its satellite offices.

If you provide insufficient information in Attachment 12, or submit multiple applications that are nearly identical, we will only accept the last on-time submission associated with the EIN/UEI number.

Tribal exception: HRSA is aware that tribes and tribal organizations may not meet the EIN or UEI requirement of this NOFO. As a result, tribes and tribal organizations that only have one EIN or UEI or cannot 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 11: Tribal EIN/UEI exception request.

Step 1: Review the Opportunity 9

Cost sharing This program has no cost-sharing requirements. 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.

Step 1: Review the Opportunity 10

Program description Purpose The purpose of the Rural Maternity and Obstetrics Management Strategies (Rural MOMS) program is to support collaborative improvement and innovation networks to improve access to and delivery of maternity and obstetrics care in rural areas.

Goals

• Identify and implement evidence-based and sustainable delivery models to provide maternal and obstetrics care in rural hospitals and communities to reduce risks associated with maternal mortality.

• Enhance and preserve access to maternal and obstetric services in rural hospitals, including by developing an approach to aggregate, coordinate, and sustain the delivery of and access to preconception, prenatal, pregnancy, labor and delivery, and postpartum services.

• Provide training for professionals in health care settings that do not have specialty maternity care. This should involve collaborating with academic institutions or other similar regional entities, that can:

◦ Provide regional clinical expertise, such as specialty expertise and provider support, using a variety of modalities, including telehealth services. Other examples include conducting simulations to prepare for obstetric emergencies, in-person workshops, and virtual classes.

◦ Help identify barriers to providing maternal health care and strategies for addressing such barriers.

• Assess and address disparities in infant and maternal health outcomes, including among rural underserved populations.

Background Rural MOMS funds networks that establish or continue collaborative improvement and innovative models that can provide long-term sustainable and financially viable service delivery to improve maternal and infant health outcomes. The work of these networks help to reduce preventable maternal mortality risks and decrease severe maternal morbidity in rural areas.

National trends in maternal health have worsened over time, and the risk of maternal mortality is higher among African Americans, American Indians/Alaskan Natives, low-income people, and rural residents. For example, rural residents have a 9% greater

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

Step 1: Review the Opportunity 11 https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00805 chance of experiencing severe maternal morbidity and mortality compared with urban residents.[2]

Over half of rural counties have no hospital-based obstetric services, and rural counties have a higher risk of losing more services compared to urban counties. It is more common for rural obstetric units to close[3] in smaller hospitals and communities with a limited obstetric workforce.

Rural MOMS networks Rural MOMS funding is focused on networks who can successfully increase access to and sustain maternal health services in rural areas that reduce risk factors associated with maternal mortality and improve maternal health outcomes long-term. Recent practices in the healthcare sector have evidenced success of regional networks made up of several rural hospitals and health organizations, including behavioral health organizations, in this area.

Networks that include partners such as federally qualified health centers (FQHCs) or FQHC look a-likes, rural health clinics (RHCs), critical access hospitals (CAHs) and other partners such as behavioral health organizations, within a rural region who collaborate to revive, provide, sustain, and expand rural obstetric and maternal service have demonstrated how use of financial and billing strategies can support network service sustainability long-term, both during and after Rural MOMS funding.

If you receive this funding, we encourage you to explore these sustainability strategies:

• Innovative billing strategies implemented collectively among network partners to bill for prenatal services through RHCs and FQHCs (including FQHC look a-likes), given their enhanced Medicaid payment rate. This could allow patients to make more regular visits and enhance their care in a financially sustainable way.

• Collaboration with multiple payers and funders to support sustainability of the network’s maternal health care services after funding ends. This could include rural hospitals, in partnership with network partners, Medicaid, and other payers.

Program requirements and expectations Successful award recipients will be required to adhere to the requirements and expectations listed in this section, if awarded. All requirements in this section are expected to be fully addressed by the proposed project and included in your project narrative.

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

Step 1: Review the Opportunity 12 https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00805 https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00805 https://www.ruralhealthresearch.org/projects/1078 https://pmc.ncbi.nlm.nih.gov/articles/PMC4946037/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4946037/

Network collaboration requirements

• You have a network strategy for long-term sustainability.

◦ The network has a strategy for sustaining the project over the long term after the award funding ends. HRSA encourages networks to explore creative financial strategies, such as partnering with rural hospitals, Medicaid, and other payers.

◦ This strategy must include a financial sustainability plan.

◦ You provide evidence of this strategy in your project narrative.

• You have a network strategy for data collection and sharing.

◦ The network has a strategy for collecting and sharing data among network members.

◦ The strategy includes a clear approach for collecting and sharing data among network members that involves responding to these risk reduction measures over the program’s four-year period of performance.

◦ You provide evidence of this strategy in your project narrative and documentation provided in Attachment 4: Memoranda of agreement/ understanding or other written agreements or Attachment 5: Data use and sharing agreement.

◦ You describe planned strategies for outreach, collaboration, and feedback collection that involves patients, families, and communities.

◦ Processes for collecting feedback from other stakeholders in the community and surrounding areas who are not part of the Rural MOMS network.

Examples include local businesses, health care organizations, schools, childcare centers, or other organizations that may affect the population you serve.

• You have a network strategy for effective collaboration and communication.

◦ You describe how you engage network members to ensure effective collaboration among network members.

◦ You have processes or describe planned processes for communication, coordination, and feedback collection from network members.

◦ You describe your shared governance model, including how you will ensure that all network members perspectives are included and contribute to decision-making.

◦ You have at least one point of contact from each network member to actively participate in carrying out project activities, as shown in Attachment 1: work plan.

Step 1: Review the Opportunity 13

Data reporting requirements

• Your network works with HRSA-funded data support provider to collect data from network partners and report data on a regular basis throughout the period of performance to inform progress on your project work plan, perform continuous quality improvement and help to identify gaps in perinatal care within the targeted rural service area.

• Examples of data* to be collected across the network may include:

◦ Number and name of counties served in project.

◦ Number of people in the target population.

◦ Number of unique individuals from your target population who received direct services during the reporting period.

◦ Number of unique women from your target population who received direct services during the reporting period.

◦ Number of pregnant people who receive a prenatal visit.

◦ Number of new mothers who receive a postpartum visit.

◦ Number of high-risk pregnancies.

◦ Number of pregnant people and new mothers with hypertension.

◦ Number of pregnant people and new mothers that received mental health screening.

◦ Number of infants with low birth weight.

◦ Number of pregnant people and new mothers screened for high blood sugar.

◦ Number of pregnant people, new mothers, and their families screened for potential home visiting services.

◦ Number of visits performed by clinicians travelling into the area and/or number of hours of mobile clinic services added in target counties.

*Please note that these are examples of data award recipients may be expected to collect and report. The final list of required data may differ from the list above.

Additional information will be provided by the Federal Office of Rural Health Policy. You are expected to include these risk-reduction measures and related activities into your work plan described in the project narrative and as part of Attachment 1: Work plan.

Step 1: Review the Opportunity 14

Award information Cooperative agreement terms Our responsibilities We get involved in these ways:

• Monitoring your progress and providing technical assistance.

• Providing a list of measures and data elements that you must report on.

• Helping plan and develop the qualitative and quantitative data collection measures.

• Reviewing your activities and providing guidance in your planning and implementation activities.

• Consulting with the network on outreach and dissemination activities, as appropriate.

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

• Ongoing collaboration with HRSA and HRSA-funded Rural MOMS partners throughout the period of performance. This includes active collaboration with:

◦ The Rural Maternal Health Data Support Provider (RHMD) to HRSA data efforts, including collecting, sharing, and reporting data.

◦ Program Technical Assistance (TA) Coaches, among other similar HRSA identified support teams to support project implementation.

◦ HRSA programmatic, grant and other relevant HRSA representatives, including responding to HRSA requests, comments, and questions on a timely basis, including potential presentation opportunities (as time and availability allow).

• Providing information and data requested by HRSA. This includes:

◦ Networks are expected to regularly report on program measures, including preventive clinical measures, for all rural maternal health care recipients served by your project. This NOFO contains a list of draft measures that will be included in the type of measures funded networks will be required to report on.

◦ Completing required Rural MOMS program deliverables and reports.

Step 1: Review the Opportunity 15

• Ongoing program participation throughout the period of performance. This includes:

◦ Participation of at least two team members in annual two-day awardee meetings. One of the attendees must be the project director, unless HRSA makes an exception for you.

◦ Attending monthly TA meetings with HRSA, the TA coach, and the RMHD support provider, including submitting a detailed agenda ahead of each meeting.

• Ensuring all project activities are not duplicative and are provided in HRSA-designated rural counties or rural county census tracts. This includes:

◦ Working with other federal and state maternal and child health programs and federally funded health centers, such as community health centers, FQHCs and FQHC look a-likes, to ensure that you do not duplicate efforts.

• Ensuring perspectives from all network partners are involved in decision making and resource allocation. This includes:

◦ Establishing a governance model within your network that incorporates perspectives from all members that shows high-level engagement and provides safeguards to ensure a collaborative decision-making process that empowers all network members to address program goals.

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 may:

• Fund more applicants from the rank order list.

• Extend the period of performance.

• Award supplemental funding.

Step 1: Review the Opportunity 16

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 2025, the salary rate limitation is $225,700. We will update this limitation in future years.

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.

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).

To charge indirect costs you can select one of two methods:

Method 1 — Approved rate. You currently have an indirect cost rate approved by your cognizant federal agency at the time of award.

Method 2 — De minimis rate. Per 2 CFR 200.414 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 17 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=13 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/subtitle-A/subchapter-A/part-75/subpart-E/subject-group-ECFRa03ab635e0c38d8/section-75.400 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 19

Find the application package 19

Application writing help 19

Get registered SAM.gov You must have an active account with SAM.gov to apply. 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 for the information 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 Search Grants at Grants.gov and search for opportunity number HRSA-25-041.

After you select the opportunity, we recommend that you select 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 19 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 February 12, 2025, at 2:00 PM EST.

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

• Phone number: 833 568 8864

• Meeting ID: 161 246 6003

• Passcode: 76372445

We will record the webinar. If you are not able to join live, please reach out to RMOMS@hrsa.gov for a link to the recording.

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 20 https://hrsa-gov.zoomgov.com/j/1612466003?pwd=iH8pIl3zMQgpJc2GFUcXu2d6SThAHs.1 mailto:RMOMS@hrsa.gov

Step 3:

Prepare Your Application

In this step

Application contents and format 22

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 budget figures using U.S. dollars.

Make sure you include each of these:

Component 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, and margins. See the formatting guidelines in section 4.2 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 4.1.ix of the Application Guide.

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

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

Use the section headers and the order below.

Introduction See merit review criterion 1: Need

Describe the following about your proposed project.

• Summary of your project’s specific purpose, goals, objectives, and expected outcomes.

• Overview of planned activities, target population(s), service area, and network members involved in the project, as it relates to your project’s purpose and goals, including:

◦ How project activities and strategies will improve coordination of health care services that help pregnant people access and utilize prenatal care, labor care, birthing, and postpartum care services.

◦ How project activities will support addressing barriers to access and provision of maternal health services for the proposed target area(s).

◦ How project activities will support sustaining or enhancing obstetric services in rural hospitals within the service area.

◦ How the network will reduce risk factors associated with managing complex pregnancies and deliveries associated with maternal mortality.

◦ How the network will address perinatal mental and behavioral health risk factors.

◦ How the network as a whole will collaborate toward the goals of financial sustainability and viability to sustain and enhance and preserve obstetrics services in rural hospitals, provide comprehensive maternal health services, and continue nonclinical support activities after federal funding ends.

◦ How the network will leverage existing infrastructure or create an organized process for collaboration and communication.

Need See merit review criterion 1: Need

Describe the populations you will serve. Include citations referencing any relevant federal, state, or local data. If data is limited or not available, indicate this and use alternative means to document how you assessed these needs.

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

Step 3: Prepare Your Application 23 https://www.hhs.gov/civil-rights/for-individuals/nondiscrimination/index.html

Describe the need in your proposed service area, from both a patient and provider perspective. The service area must be a HRSA-designated rural area, Include:

• National and/or local rankings data, including the number of maternal deaths or most recent maternal mortality ratio, social vulnerability index, or other maternal health indicators that support the service area need identified. If applicable, also include data such as health indicators by race and ethnicity or other demographic characteristics.

• The need for coordinated maternal services in your target service area to reduce risk factors associated with managing complex pregnancies and deliveries associated with maternal mortality such as gestational diabetes, hypertension, and perinatal mental and behavioral health conditions such as depression.

• Health-related challenges in the service area and factors that contribute to those challenges, such as geography, socioeconomic status, disability status, primary language, and health literacy, and other relevant elements in the proposed service area.

• Demographic characteristics of the proposed project target population. If the service area has a low population density where such data could affect patient privacy, include contextual information about the total population in the service area.

• How you will serve people with disabilities, non-English speaking populations, people with limited health literacy, or any other specific groups within the maternal and infant population your project will serve. If this is not applicable to your service area, please state this clearly.

• The health care services available in or near the target service area and any gaps in comprehensive perinatal (prenatal, delivery, and postpartum) health services. This description should include:

◦ The potential or current providers in your proposed service area, including those that are not a part of your Rural MOMS network, with whom you may share patients, work together in some capacity, and potentially collect data from.

◦ The role of FQHCs, FQHC lookalikes, RHCs, and CAHs in your network, if applicable, given the enhanced Medicaid payment rate, they can bring in serving Medicaid patients for maternal health services.

◦ How your project would work with other federally funded programs in the service area to support continuum of care, such as Healthy Start, Home Visiting, Alliance for Innovation on Maternal Health (AIM), Perinatal Quality Collaboratives (PQCs), and Maternal Mortality Review Committees (MMRCs).

Step 3: Prepare Your Application 24

◦ How you will integrate your project with existing available community-based health-related and social services (e.g. county health units) while addressing the gaps in the service area.

◦ How your project will address gaps in the regional continuum of health care, obstetric services, and prenatal and postnatal care. Include any recent or pending changes to obstetric services in your service area, such as labor and delivery unit closures, OB-GYN practice closures, or hospital consolidation.

Where possible, indicate the month and year of these changes.

Approach See merit review criterion 2: Response

In this section, you will describe how you will address your stated needs. Include the following information about your proposed network.

Network Approach

• Describe how the planned network will address the needs of the proposed service area and fulfill the network requirements listed in the other eligibility criteria and program requirements and expectations sections as well as the considerations in Appendix B: Types of Rural MOMS Network Partners.

• Describe how your network will collaborate with one or more available academic institution that can provide regional expertise, help identify barriers to providing maternal health care, and provide strategies for addressing these barriers.

◦ If collaboration with an academic institution is not available in your region, please indicate this. Describe other types of collaborations that will help provide your network regional expertise, help identify barriers to providing maternal health care, and implement strategies to address them.

• If you are part of an existing Rural MOMS network, have previously received funding for this project, or have completed a similar project, describe how your proposed project will expand the scope of the project or areas you will serve, and the number of people you plan to support. Examples of expanding scope or project area include:

◦ Serving additional counties or states.

◦ Providing additional healthcare and support services, such as provision of perinatal mental and behavioral health services adding new telehealth-enabled services, hiring additional maternal health providers, opening more clinics, or developing obstetrics training programs and services.

◦ A combination of the above, expanding both the service area and the services offered.

Step 3: Prepare Your Application 25

• Identify potential regional or state-based entities beyond the requirements for network partners that you will plan to add to the network during the Rural MOMS period of performance and/or beyond.

Network Collaboration

• Describe how network members will collaborate effectively. Include:

◦ How you will engage network members to ensure effective collaboration among network members.

◦ How you will communicate with, coordinate, and collect feedback from network members.

• Describe how the network will create and implement a shared network governance model. Include:

◦ How the shared network governance model will ensure high-level engagement from every Rural MOMS network member.

◦ How the shared network governance model will ensure that all network members perspectives are included and contribute to decision-making.

• Describe how you will share communications, updates, reports, products, or project outputs with network members. If applicable, include strategies for staff training.

• Your plan for including at least one person from each network member to actively participate in carrying out project activities, as shown in Attachment 1: Work plan and Attachment 4: Memoranda of agreement/understanding or other written agreements. Some organizations may have a senior leadership as the signatory on the MOU/MOA and will designate another staff member to partner with or represent their network organization.

• Strategies for outreach, collaboration, and feedback collection that involves patients, families, and communities.

• Processes for collecting feedback from other stakeholders in the community and surrounding areas who are not part of the Rural MOMS network. Examples include local businesses, health care organizations, schools, childcare centers, or other organizations that may affect the population you serve.

Network Services Describe how your project will provide services to meet the needs of the population in your proposed service area, address gaps in services, and increase access to maternal and obstetric services in rural hospitals. Include:

• How your network will aggregate, coordinate, and sustain the delivery and access to preconception, prenatal, pregnancy, labor and delivery, and postpartum services, including applicable perinatal mental and behavioral health services.

Step 3: Prepare Your Application 26

• How your network will provide risk-appropriate care to ensure pregnant patients in your service area receive care in a facility that best meets their needs, including working with tertiary providers as available in your region. Tertiary providers should be able to support:

◦ Enhancing clinical case management of higher-risk pregnant patients living in geographically isolated areas. Providing obstetric emergency training.

Providing perinatal mental and behavioral health services.

◦ Developing a process for patient transfers and care coordination.

◦ Enhancing and preserving the ability of participating rural hospitals to provide obstetric services.

◦ Managing and treating risk factors associated with high-risk pregnancies and deliveries.

• Your network’s plan to provide coordinated care to reduce risks associated with maternal mortality, including blood pressure monitoring, diabetes management, mental/behavioral health needs, and other evidence-based clinical and support interventions.

• How your network will train professionals in health care settings that do not have specialty maternity care or have lower volumes of obstetric patients to promote obstetric emergency readiness and reduce risk of maternal mortality.

• How your network plans to use innovative strategies to meet the unique needs of pregnant people and new mothers in your proposed service area. Include examples of these strategies and why you chose them. Examples of strategies may include:

◦ Educating pregnant people and new mothers.

▪ Education on healthy nutrition and how it can promote a healthy pregnancy, improve infant health outcomes, and reduce the risk of maternal health conditions such as hypertension, gestational diabetes, and anemia.

▪ Resources and education to help manage hypertension at home and self-monitor and report blood pressure.

◦ Referring pregnant people and new mothers to support services, including:

▪ Screening and referral of mental health issues such as depression and anxiety, including HRSA’s Maternal Mental Health Hotline (1-833-TLC-

MAMA).

▪ Referrals of pregnant people and new mothers to online or local support groups.

◦ Recruiting and training providers and services.

Step 3: Prepare Your Application 27

▪ Doula and midwifery services, community health workers, nurses, and maternal fetal medicine specialist services.

▪ Training for different types of providers, based on the needs of the region.

◦ Providing direct support to pregnant people and new mothers as part of implementing sustainable delivery models.

▪ Resources such as transportation, infant care supplies, and maternity care supplies.

▪ Supporting costs for maternal health specialists to travel to pregnant people.

▪ Support for childcare for pregnant people and new parents during prenatal and postpartum care visits.

◦ Using innovative solutions to improve access to care

▪ Supporting patient care through telehealth. Describe how your project will use telehealth and other technology to support rural clinicians and obstetric patients.

▪ Educating and supporting pregnant people through Centering Pregnancy visits (group prenatal care).

▪ Providing mobile prenatal and postpartum care visits for pregnant people and new mothers.

▪ Using development dyad models (mother and infant) to support combined postpartum and infant checkup visits.

▪ Including and making mental and behavioral health services available as part prenatal and postpartum care, when needed.

Network Sustainability Describe the strategies you will use to sustain the network and services provided after the federal funding ends such as:

• Leveraging billing and reimbursement strategies.

◦ Billing as a network, such as collaborating with RHCs, FQHCs, and FQHC lookalikes to use Medicaid encounter rates from treating pediatric patients and billing for prenatal and postpartum services.

◦ Employer-based contracting, where the network contracts with regional employers to provide health services.

◦ Strategies to ensure payer support for patient care, such as helping patients enroll in health care, including applying for Medicaid or selecting a CMS Marketplace health plan, or providing other benefit counseling.

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

Step 3: Prepare Your Application 28 https://www.centeringhealthcare.org/what-we-do/centering-pregnancy https://www.centeringhealthcare.org/what-we-do/centering-pregnancy

• Incentive program participation.

◦ Participation in incentive payment programs that offer incentive payments to providers for providing high-quality health care, such as, shared saving models such as accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and bundled payments.

• Network service model strategies.

◦ Use of a member dues structure to sustain network-wide initiatives.

◦ Workforce pooling, sharing services, and resources across network partners, such as network-wide IT and cybersecurity contracts, billing and coding support, provider credentialing and privileging, hospital laundry, professional education services, and shared clinical staff.

Work plan See merit review criteria 4: Impact

In this section, you will describe how you will achieve your project objectives within the Rural MOMS program parameters during the period of performance. You must also include a work plan in table format in attachment 1: Work plan that aligns with the requirements described here.

HRSA has designated Year 1 as a planning year and Years 2 through 4 as implementation years to give you enough time to design, refine, and update your project to account for any changes since you applied. You can begin implementation in Year 1 if your network is ready.

Include the following information in your work plan:

• A brief description of work plan activities, including how the activities will help meet the goals of your project during the period of performance.

• How you will collaborate with network members and key stakeholders to plan, design, and carry out activities in your work plan.

• A timeline of project activities for each year of the four-year period of performance. The timeline should reflect Year 1 as a planning year and Years 2 through 4 as implementation years.

• Who will oversee the implementation of each activity. You are encouraged to have more than one person responsible for each activity.

• Performance, outcome measures, or benchmarks you will use to monitor progress of each activity. Please also describe how you will incorporate metrics from the Rural Maternal Health Data Support Technical Assistance Provider and other HRSA-specific data or measures.

Step 3: Prepare Your Application 29

• The results, outcomes, or impact you expect your activities to have on your proposed service area.

• How you will share reports, products, and/or project outcomes to network members, key stakeholders, and communities in your service area.

• How your project could potentially be repeated in or expanded to other rural settings.

Resolving challenges See merit review criterion 2: Response

In this section, you will discuss anticipated challenges you will likely encounter in your project and strategies you will use to resolve them.

• You must discuss the following potential challenges and how you will resolve them:

◦ Staff turnover and how you will ensure smooth transitions and continuity of operations if staff changes occur at network partners.

◦ Changes in policy, systems, or environment.

◦ Barriers to assessing network performance and your plan to address them.

• Discuss any other potential challenges you anticipate and how you will resolve them, such as keeping rural network members and communities actively engaged.

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

In this section, you will describe your plan for assessing project performance and outcomes. Include:

• The systems and processes you will use to track performance outcomes, including how you will collect and manage data so you can report performance outcomes accurately and on time. These systems could include staff specialized skills and/or data management software.

• The capacity of network partners to collect and report data to you, as the applicant organization.

• Your capacity to oversee the data collection, cleaning, and reporting to HRSA, as specified in the cooperative agreement terms.

• How you will assess collaboration within your network.

• Your plan for assessing project performance and monitor progress toward project goals and objectives.

• How your network will handle changes to the work plan.

Step 3: Prepare Your Application 30

• How your results will improve access to care.

• Your network’s strategy for receiving input from your target population, network partners, community-level partners who are not part of your network, and the community at large when designing, implementing, and assessing your project.

Organizational information See merit review criterion 5: Resources and capabilities

In this section, you will describe your network’s resources and capabilities to carry out your proposed project and meet program requirements. Include:

• The ability of the network members to deliver services, contribute to the network, and meet the needs of the project.

• The expertise of the network members and why they are appropriate collaborators on the project.

• Each member’s involvement, roles, responsibilities, contributions, and commitment to sustain project services and activities.

• How your network will be able to carry out project activities to meet the goals of the Rural MOMS program and sustain services and activities.

• How your network partners will collaborate to sustain project activities financially after the federal funding ends.

• How your network will collaborate with specialty care and tertiary providers (level III and level IV facilities, as documented in attachment 9) and required as part of your network composition) to meet the network collaboration requirements.

• How your network will collaborate with behavioral health organizations.

• How federal award funds will be distributed to network members.

• Your organizational profile, partners’ organizations profiles, key staff’s experience, skills, and knowledge.

◦ Discuss your key staff’s skills and experience in data analysis, financial analysis, and benefits counseling.

◦ Identify a project director and a support team. The project director will be responsible for carrying out project activities and monitoring the project.

Project directors should have management experience involving managing partnerships among different organizations as part of a network.

▪ HRSA strongly recommends a project management team comprised of a full-time project director (1.0 FTE) along with multiple team members supporting the project director to lead various aspects of the proposed project.

• You will provide the following additional information in your attachments:

Step 3: Prepare Your Application 31

◦ Your network’s organizational chart in attachment 8: Network organizational chart.

◦ Your network member list in attachment 9: List of network members.

◦ The memorandum of agreement/understanding (MOA/U) or other type…