HRSA-25-084 (H8J) Expanded Hours_Final.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2025

Bureau of Primary Health Care

Health Center Program

Expanded Hours

Funding Opportunity Number: HRSA-25-084

Funding Opportunity Type(s): New

Assistance Listing Number: 93.224

Application Due Date in Grants.gov: June 24, 2024

Supplemental Information Due Date in HRSA EHBs: July 23, 2024 Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

We will not approve deadline extensions for lack of registration.

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

Issuance Date: May 21, 2024

Tyler Bysshe and Claire Giammaria Public Health Analysts, Bureau of Primary Health Care Call: 301-594-4300 Contact: BPHC Contact Form

Expanded Hours (EH) technical assistance (TA) webpage

See Section VII for a complete list of agency contacts.

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

HRSA-25-084 EH i

508 COMPLIANCE DISCLAIMER

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

SUMMARY

Funding Opportunity Title: Expanded Hours

Funding Opportunity Number: HRSA-25-084

Assistance Listing Number: 93.224

Due Date for Applications – Grants.gov:

Phase 1: June 24, 2024 (11:59 p.m. ET)

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

Phase 2: July 23, 2024 (5 p.m. ET)

Purpose: Expanded Hours (EH) funding will expand access to health center services by increasing health center operating hours to meet identified patient and community needs.

Program Objective: Expand access and alleviate barriers to high-quality primary care by increasing the number of hours during which you provide services to patients.

Eligible Applicants:

Current Health Center Program operational (H80) grant award recipients. See Section III for complete eligibility information.

Anticipated FY 2025 Total Available Funding:

$60 million

Estimated Number and Type of Award(s):

Approximately 120 new grants

Estimated Annual Award Amount:

Up to $500,000 per year. Your funding request should be scaled to reflect the size and scope of your proposed project.

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Minor Alteration/Renovation (A/R) and Equipment Costs Allowed:

Yes, you may request up to $150,000 of the $500,000 in year 1 for minor alteration/renovation and equipment costs.

Cost Sharing or Matching Required:

No

Period of Performance: December 1, 2024 through November 30, 2026 (2 years)

Agency Contacts: Business, administrative, or fiscal issues:

Clare Oscar and Saul Arana Grants Management Specialists Division of Grants Management Operations, OFAM Email: coscar@hrsa.gov and sarana@hrsa.gov

Program issues or technical assistance:

Tyler Bysshe and Claire Giammaria Public Health Analysts, Office of Policy and Program Development Bureau of Primary Health Care Contact: BPHC Contact Form

• Under Funding, select Applications for Notice of Funding Opportunities, then Expanded Hours

Application Guide

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

Technical Assistance

The EH TA webpage includes:

• Application resources, such as example forms and documents.

• Answers to frequently asked questions.

• Details about our pre-application TA webinar.

• Contact information for questions.

The HRSA-supported Health Center Resource Clearinghouse also provides training and TA resources for health centers nationwide.

mailto:coscar@hrsa.gov mailto:sarana@hrsa.gov https://www.hrsa.gov/about/contact/bphc.aspx http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://bphc.hrsa.gov/funding/funding-opportunities/expanded-hours https://www.healthcenterinfo.org/

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING OR MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Program-Specific Forms (Submit in EHBs)

vi. Attachments

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

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: PAGE LIMIT WORKSHEET

APPENDIX B: EQUIPMENT AND MINOR A/R REQUIREMENTS

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I. Program Funding Opportunity Description

1. Purpose

This Notice of Funding Opportunity (NOFO) announces the opportunity to apply for funding under the fiscal year (FY) 2025 Expanded Hours (EH) program. EH funding will expand access to health center services by increasing health center operating hours to meet identified patient and community needs.

See Program Requirements and Recommendations for more details.

2. Background

The Health Center Program is authorized by 42 U.S.C. § 254b (Title III, § 330 of the Public Health Service (PHS) Act). For the purpose of this NOFO, health centers are defined as those receiving Health Center Program operational funding under Sections 330(e), (g), (h) or (i), otherwise referred to as H80 funding.

Increasing access to preventive care is a Healthy People 2030 goal.1 In 2020, only 5.3 percent of adults received recommended evidence-based preventive health care.2 Delayed care is often the result of barriers such as lack of health insurance, lack of access to transportation, lack of availability of appointments, and inability to take time off work to attend appointments.3 In 2020, 46 percent of households surveyed nationwide reported negative health consequences as a result of not being able to get an appointment during the hours needed.4

In 2022, health centers provided access to primary care services for 30.5 million patients at more than 15,000 service sites.5 Health centers address financial barriers to accessing care by offering health care regardless of ability to pay based on a sliding fee.6 To further address access, health centers’ operating hours must be responsive to

1 Healthy People 2030. Health care access and quality. https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality (accessed May 25, 2023).

2 Healthy People 2030. Increase the proportion of adults who get recommended evidence-based preventative health care. https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality/increase-proportion-adults-who-get-recommended-evidence-based-preventive-health-care-ahs-08/data (accessed July 17, 2023).

3 Healthy People 2030. Access to Primary Care. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/access-primary-care (accessed July 17, 2023).

4 NPR, Robert Wood Johnson Foundation, & Harvard TH Chan School of Public Health, 2020. The Impact of Coronavirus on Households Across America. https://www.hsph.harvard.edu/wp-content/uploads/sites/94/2020/09/NPR-RWJF-Harvard-National-Report_092220_Final-1.pdf (accessed August 4, 2023).

5 HRSA. 2022. Health Center Program: Impact and growth. https://bphc.hrsa.gov/about-health-centers/health-center-program-impact-growth (accessed August 8, 2023).

6 HRSA. 2018. Health Center Program Compliance Manual, Chapter 9: Sliding fee discount program.

https://bphc.hrsa.gov/compliance/compliance-manual/chapter9 (accessed May 3, 2023).

http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality/increase-proportion-adults-who-get-recommended-evidence-based-preventive-health-care-ahs-08/data https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality/increase-proportion-adults-who-get-recommended-evidence-based-preventive-health-care-ahs-08/data https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality/increase-proportion-adults-who-get-recommended-evidence-based-preventive-health-care-ahs-08/data https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/access-primary-care https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/access-primary-care https://www.hsph.harvard.edu/wp-content/uploads/sites/94/2020/09/NPR-RWJF-Harvard-National-Report_092220_Final-1.pdf https://www.hsph.harvard.edu/wp-content/uploads/sites/94/2020/09/NPR-RWJF-Harvard-National-Report_092220_Final-1.pdf https://bphc.hrsa.gov/about-health-centers/health-center-program-impact-growth https://bphc.hrsa.gov/about-health-centers/health-center-program-impact-growth https://bphc.hrsa.gov/compliance/compliance-manual/chapter9

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patients’ needs,7 and they must have arrangements for promptly responding to medical emergencies after hours.8

Health centers will use EH funding to further ease patients’ ability to access essential health center services during new operating hours such as early weekday mornings, weekday evenings, and weekends, when access to primary care may otherwise be limited or nonexistent in their community. New operating hours will support patients to receive care in a primary care setting, reducing visits to emergency departments. This will reduce health care costs and preserve emergency department capacity for patients with acute needs.

II. Award Information

1. Type of Application and Award

Application type: New.

We will fund you via a grant.

2. Summary of Funding

We estimate $60 million will be available each year to fund approximately 120 awards.

You may apply for up to $500,000 annually (reflecting direct and indirect costs).

The period of performance is December 1, 2024, to November 30, 2026 (2 years).

Support beyond the first budget year will depend on:

• Appropriations

• Satisfactory progress in meeting the project’s objectives

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

We may adjust the final award amounts or number of awards based on the number of fundable applications.

If funded, we will award EH funding as a new grant award, separate from your Health Center Program operational (H80) award. Under 45 CFR § 75.302, you must document use of EH funds separately and distinctly from other Health Center Program funds and other federal award funds. You must maintain your H80 award status throughout the 2-year period of performance to maintain your EH funding.

All uses of EH funds must align with your H80 scope of project. Your scope of project includes the approved service sites, services, providers, service area, and target

7 HRSA. 2018. Health Center Program Compliance Manual, Chapter 6: Accessible locations and hours of operation. https://bphc.hrsa.gov/compliance/compliance-manual/chapter6 (accessed May 3, 2023).

8 HRSA. 2018. Health Center Program Compliance Manual, Chapter 7: Coverage for medical emergencies during and after hours. https://bphc.hrsa.gov/compliance/compliance-manual/chapter7 (accessed May 3, 2023).

https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.302 https://bphc.hrsa.gov/compliance/scope-project https://bphc.hrsa.gov/compliance/compliance-manual/chapter6 https://bphc.hrsa.gov/compliance/compliance-manual/chapter7

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population that are supported (wholly or in part) under your total approved health center budget. You must comply with all Health Center Program requirements as described in the Health Center Program Compliance Manual, and applicable law and regulations.9

We will assess your performance based on your approved scope adjustments and documented increase in operating hours 18 months after the award start date, compared to the increase in hours proposed in your application. We will use these assessments to determine if you will receive increased, continued, reduced, or no funding beyond the initial 2-year funding period. If HRSA continues funding, we may supplement this initial award and/or provide further funding under your H80 award.

When we assess your performance, we may also consider activity progress and increases in the:

• Number of patients and visits.

• Hours across all service delivery sites.

• Number of sites with increased hours.

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

III. Eligibility Information

1. Eligible Applicants

You can apply if your organization is a Health Center Program award recipient10 with an active H80 grant award.

2. Cost Sharing or Matching

Cost sharing or matching is not required for this program.

3. Other

We may consider your application ineligible for review if it:

• Requests more than $500,000 annually.

• Does not include a Project Narrative.

• Fails to meet the deadline referenced in Section IV.4.

9 Requirements are stated in 42 USC § 254b (section 330 of the PHS Act), and in applicable program regulations (42 CFR parts 51c and 56, as appropriate), grants regulations (45 CFR part 75), and grants policy (HHS Grants Policy Statement).

10 Funded under 42 U.S.C. § 254b(e), (g), (h), and/or (i).

https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim https://www.ecfr.gov/current/title-42/chapter-I/subchapter-D/part-51c https://www.ecfr.gov/current/title-42/chapter-I/subchapter-D/part-56?toc=1 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.302

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Multiple Applications

We will only review your first validated application under HRSA-25-084 in Grants.gov. If you wish to change attachments submitted in a Grants.gov application, you may do so in the HRSA EHBs application phase.

IV. Application and Submission Information

1. Address to Request Application Package

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

• Phase 1 – Grants.gov – You must submit your application via Grants.gov by June 24, 2024 at 11:59 p.m. ET.

• Phase 2 – EHBs – You must submit supplemental information via EHBs by July 23, 2024 at 5 p.m. ET.

Only applicants who successfully submit the workspace application package associated with this NOFO in Grants.gov (Phase 1) by the due date may submit the additional required information in EHBs (Phase 2). If you wish to change information you submitted in EHBs, you may reopen and revise your application before the EHBs deadline. For more details, see Sections 3 and 4 of the Two-Tier Application Guide. Note: Grants.gov calls the NOFO, “Instructions.”

Select “Subscribe” and enter your email address for HRSA-25-084 to receive emails about changes, clarifications, or instances where we republish the NOFO. You will also be notified by email of documents we place in the RELATED DOCUMENTS tab that may affect the NOFO and your application. You’re responsible for reviewing all information that relates to this NOFO.

2. Content and Form of Application Submission

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

In Grants.gov (Phase 1), submit your:

• Application for Federal Assistance (SF-424)

• Project Abstract Summary

• Project/Performance Site Locations

• Grants.gov Lobbying Form https://grants.hrsa.gov/2010/WebEPSExternal/Interface/Common/AccessControl/Login.aspx https://www.grants.gov/applicants/grant-applications/how-to-apply-for-grants

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• Key Contacts

In EHBs (Phase 2), submit your:

• Project Narrative

• SF-424A Budget Information Form

• Budget Narrative and Table of Personnel Paid with Federal Funds

• Program-Specific Forms

• Attachments, if applicable

Application Page Limit

The page limit for your application is 50 pages. We will not review any pages that exceed the page limit. Using the pages within the page limit, we will determine eligibility using Section III. Eligibility Information of the NOFO.

These items do not count toward the page limit:

• Standard OMB-approved forms in the NOFO’s workspace application package and program-specific forms in EHBs

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

• Indirect Cost Rate Agreement

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

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

If you use an OMB-approved form that is not in the HRSA-25-084 workspace application package or EHBs application, it may count toward the page limit. Therefore, we recommend you only use Grants.gov and EHBs workspace forms for this NOFO to avoid exceeding the page limit.

It is important to ensure your application does not exceed the specified page limit. See Appendix A: Applicant Page Limit Worksheet for additional information.

Applications must be complete, validated by Grants.gov, and submitted under HRSA-25-084 before the Grants.gov and EHBs deadlines.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

• When you submit your application, you certify that you and your principals11 (for example, program director) can participate in receiving award funds to carry out a

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

https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180/subpart-I/section-180.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995

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proposed project. That is, no federal department or agency has debarred, suspended, proposed for debarment, claimed you ineligible, or you have voluntarily excluded yourself from participating.

• If you fail to make mandatory disclosures, we may take an action like those in 45 CFR § 75.371. This includes suspending or debarring you.12

• If you cannot certify this, you must explain why in Attachment 1: Other Relevant Documents.

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

Program Requirements and Recommendations

Program Requirements

• You must propose to use EH funds to increase the number of health center operating hours. Expanded hours are defined as an increase in the number of operating hours over your current operating hours by 1 or more hour each week.13

• You must expand hours for one or more in-scope service delivery sites.14

• Your expanded hours must be responsive to the needs of patients and residents of your service area.

• You must provide in-person appointments during your expanded hours.15

• You must maintain compliance with all Health Center Program requirements and all other applicable federal, state, and local laws and regulations.

• Within 6 months of award, you must begin to increase operating hours at one or more of your proposed sites and document the increase through a Form 5B Scope Adjustment Request in EHBs.16 If you do not add hours within 6 months of award, HRSA may impose additional award conditions per 45 CFR § 75.207, 12 See also 2 CFR parts 180 and 376, 31 U.S.C. § 3354, and 45 CFR § 75.113.

13 For the purpose of this NOFO, current operating hours are the hours captured in the EHBs, with information pre-populated from your approved scope of project (on Form 5B) as of the time of this NOFO’s release.

14 You may propose to increase hours of operation at any service delivery site in your approved scope of project (on Form 5B) as of the time of this NOFO’s release.

15 You may offer telehealth services in addition to in-person appointments during your expanded hours.

For information about telehealth and your health center scope of project, refer to PAL 2020-01.

16 For information on Scope Adjustment Requests, refer to the Scope of Project page and the Change in Scope questions under Scope of Project at Health Center Program Compliance Frequently Asked Questions.

https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-C/section-75.207 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376 https://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-prelim-title31-chapter33&edition=prelim https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-B/section-75.113 https://bphc.hrsa.gov/sites/default/files/bphc/compliance/telehealth-pal-2020-01.pdf https://bphc.hrsa.gov/compliance/scope-project https://bphc.hrsa.gov/compliance/health-center-program-compliance-faqs#:%7E:text=a%20significant%20change.-,Scope%20Adjustment,-%2D%20a%20scope%20adjustment https://bphc.hrsa.gov/compliance/health-center-program-compliance-faqs#:%7E:text=a%20significant%20change.-,Scope%20Adjustment,-%2D%20a%20scope%20adjustment

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which may include additional project monitoring or draw down restriction. If you do not resolve such conditions within the specified timeframe, HRSA may terminate all, or part, of your EH award per 45 CFR § 75.371.

• Within 18 months of award (6 months prior to the end of the 2-year period of performance), you must implement your entire proposed increase in hours of operation and document the increase through a Form 5B Scope Adjustment Request in EHBs.

We will consider your proposed versus actual increase in hours of operation 18 months after award (6 months prior to the end of the 2-year period of performance) to inform ongoing funding decisions.

Program Recommendations

When designing your project, consider:

• The maximum number of sites at which you can expand hours to support patient access to health center services.

• Addressing issues that contribute to health disparities among current patients and other residents in the service area.

• Your team’s cultural and clinical competence.17

• Scheduling barriers that impede patients’ ability to access care during your current operating hours, including patients’ nontraditional work schedules, lack of sick leave, and childcare needs.

• Other barriers to care that may include transportation issues, language assistance, and the need for other non-clinical services that support access to health care and improved health outcomes.

• Your workforce well-being and safety.

• Establishing or enhancing partnerships to support referring patients who can benefit from your increased hours of operation.

You can change the way services are delivered, but you may not add a new service to scope with this funding.18

17 Refer to the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care for additional information.

18 All uses of EH funds must align with your H80 scope of project. Refer to the Change in Scope questions under Scope of Project at Health Center Program Compliance Frequently Asked Questions and Updating Form 5A: Services Provided for more information. As a reminder, you must request all scope adjustments outside of this application.

https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFRb1309e6966399c7/section-75.371 https://thinkculturalhealth.hhs.gov/clas https://thinkculturalhealth.hhs.gov/clas https://bphc.hrsa.gov/compliance/scope-project https://bphc.hrsa.gov/compliance/health-center-program-compliance-faqs#:%7E:text=a%20significant%20change.-,Scope%20Adjustment,-%2D%20a%20scope%20adjustment https://bphc.hrsa.gov/sites/default/files/bphc/compliance/updating-form-5a.pdf

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If you use broadband or telecommunications services to provide health care, discounts are available through the Federal Communication Commission’s Universal Service Program. For more information, see the Rural Health Care Program. The Affordable Connectivity Program (ACP) and Lifeline are federal programs that help eligible households pay for internet services and internet connected devices. Patients living on tribal lands may be eligible for additional benefits through ACP.

Program-Specific Instructions Include application requirements and instructions from Sections 4 and 5 of the Two-Tier Application Guide (budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract). Also include the following:

i. Project Abstract

Use the Standard OMB-approved Project Abstract Summary Form in the workspace application package. Do not upload the abstract as an attachment or it may count toward the page limit. For information you must include in the Project Abstract Summary Form, see Section 5.1.ix of the Two-Tier Application Guide. In addition, provide your Health Center Program grant number (H80CSXXXXX) and a brief summary of how your proposal for increasing hours of operation will meet identified needs in your community.

NARRATIVE GUIDANCE

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

Narrative Section, Forms, Attachments Review Criteria

Need section Criterion 1: Need

Response section Project Overview Form Form 5B - Select Site(s) From Scope Form

Criterion 2: Response

Collaboration section Criterion 3: Collaboration

Resources/Capabilities section Project Overview Form Equipment List Form (if applicable) Minor A/R Budget Justification (as part of the A/R Project Cover Page, if applicable)

Criterion 4:

Resources/Capabilities

Impact section Project Overview Form

Criterion 5: Impact https://www.usac.org/rural-health-care/ https://www.affordableconnectivity.gov/ https://www.affordableconnectivity.gov/ https://www.lifelinesupport.org/

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Narrative Section, Forms, Attachments Review Criteria

Budget Narrative SF-424A Budget Information Form Equipment List Form (if applicable) Minor A/R Budget Justification (as part of the A/R Project Cover Page, if applicable)

Criterion 6: Support Requested

ii. Project Narrative

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

Provide the following information in the following order. Use the section headers. This ensures reviewers can understand your proposed project. The Support Requested section does not require a written narrative and will be scored based upon information in other application components.

NEED-- Corresponds to Section V. Review Criterion 1: Need

1. Describe how you determine that your current hours of operation are responsive to patient and community needs. Include how you collect patient input to determine your hours and how you ensure that your hours continue to meet patient needs over time.

2. Describe the needs that your proposed expanded hours, and services to be provided in those hours, will address. Be specific to the needs of current patients and other service area residents, including those experiencing health disparities.

Support your description with data from each of the following sources.

a. Your latest health center needs assessment;19

b. Your patient service utilization data;20

c. Community-wide health needs assessments (such as those conducted by a hospital, health department, or other organization that serves the service area);

d. Patient input from sources such as annual surveys, focus groups, patient board members, and other means; and

e. Information provided by other service area residents who are not current patients.

Provide an explanation if any of these data sources are unavailable, or not current or specific to your patients and service area residents.

19 Refer to Chapter 3: Needs Assessment of the Compliance Manual.

20 Use the utilization data that best supports your proposed project. For example, if you are adding more weekend operating hours, consider including data you have collected that demonstrates wait times for weekend appointments are longest.

https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-3.html

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RESPONSE-- Corresponds to Section V. Review Criterion 2: Response

Complete the Project Overview Form in EHBs. In this form, you will provide site-specific details about your proposed project, including key, time-framed tasks for adding hours.

Reviewers will assess information you provide in the Project Overview Form together with the responses to the questions below to provide a score for your Response. Refer to the EH technical assistance webpage for an example Project Overview Form.

1. Describe how you determined the following, and include how these decisions will maximize the benefit of expanded hours to your patients and community by addressing identified needs described in the NEED section:

a. The number of sites where you will increase hours of operation.

b. Which sites would be selected.

c. The types of services you plan to offer during the additional hours.

2. Describe your proposed increase in hours of operation, including:

a. The additional hours your sites will be open, such as new weekend or evening hours.

b. The other options available for your patients to access primary health care services during your additional hours, other than at your health center.

c. How the additional hours are responsive to the identified needs described in the NEED section.

3. Describe how the services that will be available during increased hours of operation address needs described in the NEED section. The service information you describe here will be more detailed than the service categories you selected on the Project Overview Form. For example, if you selected medical on the Project Overview Form, you should describe the specific services you’ll offer during your increased hours of operation (such as gynecological or pediatric).21

4. Describe how the additional operational hours will reduce non-urgent visits to emergency departments.

5. Describe how you will advertise your increased hours of operation to your current patients and other residents of your service area.

COLLABORATION-- Corresponds to Section V. Review Criterion 3: Collaboration

1. Describe any existing or new partnerships or collaborative arrangements that will support implementation of your proposed project. Include partners that will promote your increased hours of operation, refer patients to the health center, and address patients’ health related social needs that impact access to care.

21 Reminder: in-person services are required. Telehealth is optional.

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2. If applicable, describe how you will coordinate with other providers in your service area (such as other health centers, rural health clinics, and critical access hospitals) to ensure that you address patients’ comprehensive needs during your expanded hours.

RESOURCES/CAPABILITIES-- Corresponds to Section V. Review Criterion 4:

Resources/Capabilities

1. Describe your past expansion efforts (such as changes in hours, services, and/or minor A/R projects) and how lessons learned informed your proposed project.

2. Describe your clinical and non-clinical workforce plan to support successfully increasing hours of operation at your service sites.

3. Describe your plans to help ensure safety of patients and staff, as applicable. For example, if you propose to stay open late in the evening and security is a concern, you may tell us about your plans to expand or add new trauma informed safety practices or personnel.

4. If your proposal includes minor alteration and renovation activities (A/R), describe how they are necessary to successfully implement your project and your ability to complete your planned minor A/R activities within 12 months of award.

5. Describe how you will maintain additional operating hours and sustain services provided with EH funding throughout the 2-year period of performance and beyond.

IMPACT-- Corresponds to Section V. Review Criterion 5: Impact

1. Describe how you estimated the proposed increase in patients based on the identified need and increased hours of operation noted on your Project Overview form.

2. Describe how and how often you will assess the extent to which the hours, site(s), and services you selected are:

a. Meeting the identified needs of current patients and other residents of your service area.

b. Increasing patients/visits.

c. Reducing patients’ non-urgent use of emergency departments.

3. Describe how you will use your findings from your assessments noted above to adjust your project over the 2-year period of performance.

SUPPORT REQUESTED-- Corresponds to Section V. Review Criterion 6

Attach the budget narrative and complete the SF-424A, Equipment List (if applicable), and Minor A/R Budget Justification form (as part of the A/R Project Cover Page, if applicable) in EHBs to reflect a proposed budget that will reasonably support the size and scope of your proposed project, including total number of additional hours, number

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of sites, and service types. To access complete instructions and preview the forms to be completed in EHBs, visit the EH TA webpage. You are not required to write a Support Requested section in your Project Narrative.

iii. Budget

Follow the instructions in Section 5.1. iv Budget of the Two-Tier Application Guide and any specific instructions listed in this section. Your total budget22 for EH should show a well-organized plan.

Reminder: The total budget for this project are all allowable (direct and indirect) costs23 used for EH. This includes costs charged to the award and non-federal funds used to support the project.

If you’ve never received a negotiated indirect cost rate, you may elect to charge a de minimis rate of 10 percent of modified total direct costs (MTDC)*. You may use this for the life of the award. If you choose this method, you must use it for all federal awards until you choose to negotiate for a rate. You may apply to do so at any time. See Section 5.1.v. Budget Narrative in the Two-Tier Application Guide.

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

You may use up to $150,000 in year 1 for one-time costs necessary to meet the EH objectives, including:

• Minor alteration/renovation (as defined in Appendix B: Equipment and Minor A/R Requirements, the total federal and non-federal cost of the alteration/renovation project must be less than $1,000,000, excluding the cost of moveable equipment), and/or

• Moveable equipment that costs $5,000 or more.

Your total budget must:

• Include the amount of EH funds to be awarded (up to $500,000 each year).

• Include all non-federal funds that will support your proposed project.

• Comply with all related HHS policies and other federal requirements.22 You have discretion about how you propose to allocate the total budget between EH federal funds and other funding that supports the project if you are following the outlined policies and federal requirements.

• Directly relate to and support the proposed project.

22 See Chapter 17: Budget of the Compliance Manual.

23 For details on allowable costs, see 45 CFR part 75 at https://www.ecfr.gov/current/title-45/part-75.

https://bphc.hrsa.gov/funding/funding-opportunities/expanded-hours https://bphc.hrsa.gov/compliance/compliance-manual/chapter17 https://www.ecfr.gov/current/title-45/part-75

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All activities must be carried out consistent with Health Center Program requirements as described in the Health Center Program Compliance Manual, including those associated with Chapter 9: Sliding Fee Discount Program and Chapter 17: Budget.

Program Income

The non-federal share of the project budget includes all program income sources such as fees, premiums, third party reimbursements, and payments that are generated from the delivery of services, and from other revenue sources such as state, local, or other federal grants or contracts; private support; and income generated from fundraising, and donations/contributions.

In accordance with § 330(e)(5)(D) of the PHS Act relating to the use of non-grant funds, health centers shall use non-grant funds, including funds in excess of those originally expected, “as permitted under this section [§ 330],” and may use such funds “for such other purposes as are not specifically prohibited under this section [§ 330] if such use furthers the objectives of the project.”

Specific Instructions

As required by the Further Consolidated Appropriations Act, 2024 (P.L. 118-47), Division D, Title II § 202, “None of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of Executive Level II.” Effective January 2024, the salary rate limitation is $221,900. As required by law, salary rate limitations may apply in future years and will be updated.

Budget Information Form (SF-424A)

Complete the Budget Information Form in EHBs. The budget information in these sections must match the total cost of your EH project for year 1, except Section E, which records year 2. You should scale the federal funding amount you request to reflect the size and scope of your proposed project, including total number of additional hours, number of sites, and types of services you can support with the requested budget.

• Section A – Budget Summary: Under New or Revised Budget, in the Federal column, enter the federal funding requested for year 1 (up to $500,000) for each type of Section 330 funding that you currently receive. The types are:

o Section 330(e) Community Health Center o Section 330(g) Migrant Health Center o Section 330(h) Health Care for the Homeless o Section 330(i) Public Housing Primary Care

We will award funding based on your current H80 award proportions. Enter all other project costs in the Non-Federal column. Leave the Estimate Obligated Funds column blank.

https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-9.html#titletop https://bphc.hrsa.gov/compliance/compliance-manual/chapter17

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• Section B – Budget Categories: Enter an object class category (line item) budget for year 1, broken out by federal and non-federal funding. The amounts for each category in the Federal and Non-Federal columns, as well as the totals, should align with the Budget Narrative. You may request up to $150,000 for equipment and/or minor A/R. If you request funds for equipment, include that amount on the equipment line. If you request funds for minor A/R, include that amount on the construction line. Plan to complete minor A/R in year 1.

• Section C – Non-Federal Resources: Enter all sources of funding for year 1 except for the federal funding request. The total in Section C must be consistent with the Non-Federal Total in Section A. When providing Non-Federal Resources by funding source, include other federal funds supporting the proposed project in the “other” category.

• Section D – Forecasted Cash Needs: Leave this section blank.

• Section E – Budget Estimates of Federal Funds Needed for Balance of the Project: Enter the federal funding request (up to $500,000) for year 2 in the (a) First column. The other columns must remain $0.

• Section F – Other Budget Information: If applicable, explain amounts for individual object class categories that may appear to be out of the ordinary in Direct Charges. Enter the type of indirect rate (provisional, predetermined, final, fixed, or de minimis) that will be in effect during the period of performance.

iv. Budget Narrative

EH requires a detailed budget narrative that outlines federal and non-federal costs by object class category for each requested 12-month period (budget year) of the 2-year period of performance. The sum of line-item costs for each category must align with those presented on the SF-424A Budget Information Form. See Section 5.1.v. of the Two-Tier Application Guide.

For year 2, the narrative should highlight the changes from year 1 or clearly indicate that there are no substantive changes. See the EH TA webpage for an example Budget Narrative.

Your budget narrative must:

• Demonstrate that you will use EH funds to increase the number of hours that you provide services to patients.

• Clearly detail proposed costs for each line item on your SF-424A Budget Information Form, section B, with calculations for how you estimated each cost.

• Not include ineligible costs.

• Not exceed $150,000 in one-time costs.

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• Provide us with enough information to determine that you will use EH funds separately and distinctly from other Health Center Program support (for example, H80 awards).

• Include a Table of Personnel to be Paid with Federal Funds, as shown in the example in the Two-Tier Application Guide.

• Align with your minor A/R project budget justification (uploaded as part of the A/R Project Cover Page) and the Equipment List Form, as applicable.

All contractual arrangements must be appropriate for health center oversight of the proposed project and include any contractors and sub-recipients.

Format the budget narrative to have all columns fit on an 8.5 x 11” page when printed.

v. Program-Specific Forms (Submit in EHBs)

For Phase 1, you will submit the required SF-424 information through Grants.gov. For Phase 2, you will submit supplemental information through EHBs.

All of the following forms are required, as applicable. Because information you provide in some forms will automatically populate in other forms, you should fill out these forms in the following order:

1) H80 Grant Number

2) Form 1B – Funding Request Summary

3) Form 5B – Select Site(s) from Scope

4) Alteration/Renovation (A/R) Information (if applicable)

5) Alteration/Renovation (A/R) Project Cover Page (if applicable)

6) Other Requirements for Sites (if applicable)

7) Project Overview

8) Equipment List (if applicable)

To access complete instructions and preview the forms you will complete in EHBs, visit the EH technical assistance webpage.

vi. Attachments

Provide the following attachments in the order we list them.

Most attachments count toward the application page limit. Indirect cost rate agreement and proof of non-profit status (if it applies) are the only exceptions. They will not count toward the page limit.

Clearly label each attachment. Upload attachments into the application. Reviewers will not open any attachments you link to.

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Attachment 1: Other Relevant Documents (if applicable)

• Upload an indirect cost rate agreement, if applicable.

• Include other relevant documents to support the proposed project.

• Do not upload more than five files.

3. Unique Entity Identifier (UEI) and System for Award Management (SAM)

A UEI is required to apply for this funding. You must register in the SAM.gov to receive your UEI.

You cannot use a Data Universal Numbering System (DUNS) number to apply. For more details, visit the General Service Administration’s UEI Update webpage.

After you register with SAM, maintain it. Keep your information updated when you have:

• An active federal award,

• An application, or

• A plan that an agency is considering.24

When you register, you must submit a notarized letter naming the authorized Entity Administrator.

We will not make an award until you comply with all relevant SAM requirements. If you have not met the requirements by the time we’re ready to make an award, we will deem you unqualified and award another applicant.

If you already registered on Grants.gov, confirm that the registration is active and that the Authorized Organization Representative (AOR) is approved.

To register in Grants.gov, submit information in two systems:

• System for Award Management (SAM) (SAM Knowledge Base)

• Grants.gov

Effective March 3, 2023, individuals assigned a SAM.gov Entity Administrator role must be an employee, officer, or board member, and cannot be a non-employee. This change is to ensure entities are in control of who has permission to control roles within their entity.

Here’s what this means:

• Entity Administrators assigning roles to non-employees will only be able to assign a Data Entry role or lower.

24 Unless 2 CFR § 25.110(b) or (c) exempts you from those requirements or the agency approved an exemption for you under 2 CFR § 25.110(d)).

https://www.gsa.gov/entityid https://sam.gov/content/home https://www.fsd.gov/gsafsd_sp?id=gsa_kb_view2&kb_id=f66d8e6cdb76d4100d73f81d0f9619c6 https://www.grants.gov/ https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.fsd.gov%2Fgsafsd_sp%3Fid%3Dkb_article_view%26sysparm_article%3DKB0017347&data=05%7C01%7CDDixon%40hrsa.gov%7C80dfe1e3c58a4e26cd0008db143e65c3%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C638126030447564740%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=nnDr7%2B8Bn1g9416eowK4Vwfx%2BO2%2BuUP1Nlu9KkvZoa4%3D&reserved=0

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• Any entities assigning Entity Administrator roles using an Entity Administrator Role Request Letter (formerly called “notarized letter”) will no longer be able to assign the Entity Administrator role to a non-employee.

• Entity Administrator roles assigned to non-employees will be converted to Data Entry roles. With a Data Entry role, non-employees can still create and manage registration data entry but cannot manage roles.

If you are an entity using a non-employee or if you are a non-employee working with an entity to manage registrations, please read (and share) more about this change on the BUY.GSA.gov blog to know what to expect.

For more details, see Section 3.2 of the Two-Tier Application Guide.

Note: Allow enough time to register with SAM and Grants.gov. We do not grant application extensions or waivers if you fail to register in time.

4. Submission Dates and Times

Application Due Dates

• Your application is due in Grants.gov (Phase 1) by June 24, 2024 at 11:59 p.m.

ET.

• Your supplemental application is due in EHBs (Phase 2) by July 23, 2024 at 5 p.m. ET.

We suggest you submit your application to Grants.gov at least 3 calendar days before the deadline to allow for any unexpected events. See the Two-Tier Application Guide’s Section 9.2.5 – Summary of emails from Grants.gov.

EHBs allows the authorizing official (AO) to reopen the application in EHBs before the EHBs deadline. For additional details and step-by-step instructions with screenshots, refer to the Reopen Submitted Applications webpage. The AO must resubmit the reopened application in EHBs by 5 p.m. ET on the EHBs due date for the application to be considered.

5. Intergovernmental Review

The Health Center Program must follow the terms of Executive Order 12372 in 45 CFR part 100.

See Section 5.1 ii of the Two-Tier Application Guide for more information.

6. Funding Restrictions

The General Provisions in Division D, Titles II and V, that reference the Further Consolidated Appropriations Act, 2024 (P.L. 118-47) apply to this program. See Section

5.1 of the Application Guide for information. Note that these and other restrictions will apply in fiscal years that follow, as the law requires.

45 CFR part 75 and the HHS Grants Policy Statement (HHS GPS) include information about allowable expenses. You cannot use EH funds for the following:

https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fbuy.gsa.gov%2Finteract%2Fcommunity%2F47%2Factivity-feed%2Fpost%2Fa14726f4-e2a9-47b3-80ec-7ceff5108706%2FA_Change_in_SAM_gov_will_Affect_Access_for_Some_Entity_Administrators&data=05%7C01%7CDDixon%40hrsa.gov%7C80dfe1e3c58a4e26cd0008db143e65c3%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C638126030447564740%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=ZTRBuys3iNJZeAUQ7rDx56aVR1BrI3wE4z%2FHBoFbQTU%3D&reserved=0…