hrsa-25-101_final2.pdf

Notice of Funding Opportunity

Application due April 17, 2025

Federal Office of Rural Health Policy Community-Based Division

Rural Program of All-Inclusive Care for the Elderly (PACE) Planning and Development Opportunity number: HRSA-25-101

Contents Before you begin 4

Step 1: Review the Opportunity 5

Basic information 6

Eligibility 7

Program description 9

Award information 14

Step 2: Get Ready to Apply 16

Get registered 17

Find the application package 17

Application writing help 17

Step 3: Prepare Your Application 19

Application contents and format 20

Step 4: Learn About Review and Award 36

Application review 37

Selection process 43

Award notices 44

Step 5: Submit Your Application 45

Application submission and deadlines 46

Application checklist 48

Step 6: Learn What Happens After Award 50

Post-award requirements and administration 51

Contacts and Support 55

Contents 2

Endnotes 61

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 17, 2025.

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

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

Jump to a step

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

Step 1:

Review the Opportunity

In this step

Basic information 6

Eligibility 7

Program description 9

Award information 14

Basic information Health Resources and Services Administration (HRSA)

Federal Office of Rural Health Policy

Community-Based Division

Increasing access to Program of All-Inclusive Care for the Elderly (PACE) in rural areas.

Have questions?

Go to Contacts and Support.

Key facts

Opportunity name: Rural Program of All-Inclusive Care for the Elderly (PACE) Planning and Development

Opportunity number:

HRSA-25-101

Announcement version:

New

Federal assistance listing:

93.912

Statutory authority: Social Security Act, §711(b) (42 U.S.C. 912(b))

Key dates

NOFO issue date:

January 17, 2025

Informational webinar:

February 11, 2025

Application deadline:

April 17, 2025

Expected award date is by:

September 1, 2025

Expected start date:

September 30, 2025

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

Summary The Rural Program of All-Inclusive Care for the Elderly (PACE) Planning and Development supports organizations in the development or expansion of sustainable PACE programs to improve delivery of comprehensive medical and social services tailored to the needs of elderly individuals in rural areas.

Funding details Application Types: New

Expected total available funding in FY 2025: $2,000,000.00

Expected number and type of awards: 4 grants

Funding range per award: $500,000

We plan to fund awards in four 12-month budget periods for a total 4-year period of performance 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.

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

Step 1: Review the Opportunity 6 https://nih-my.sharepoint.com/personal/klloyd_hrsa_gov/Documents/i_Drive/CBD/Deputy/CBD%20NOFOS/FY25/Rural%20PACE/USCODE-2022-title42-chap7-subchapVII-sec912.pdf https://nih-my.sharepoint.com/personal/klloyd_hrsa_gov/Documents/i_Drive/CBD/Deputy/CBD%20NOFOS/FY25/Rural%20PACE/USCODE-2022-title42-chap7-subchapVII-sec912.pdf https://nih-my.sharepoint.com/personal/klloyd_hrsa_gov/Documents/i_Drive/CBD/Deputy/CBD%20NOFOS/FY25/Rural%20PACE/USCODE-2022-title42-chap7-subchapVII-sec912.pdf

Eligibility Who can apply You can apply if you are a domestic* public or private, non-profit, or for-profit entity.

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

• State and county health departments

• Hospitals, including rural emergency hospitals

• Community-based organizations

• 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.

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

We will not consider an application that:

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

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

• Is submitted after the deadline.

Step 1: Review the Opportunity 7

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 10: 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 10 , 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.

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

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

Step 1: Review the Opportunity 8 https://nofo.rodeo/nofos/(#58--step-3-prepare-your-application--attachment-10-ein-uei-exception-request)

Program description Purpose The purpose of this Rural Program of All-Inclusive Care for the Elderly (PACE) Planning and Development program is to improve health care in rural areas, including expanding access to medical care and long-term services, for rural aging populations by expanding PACE programs into rural areas.

Goals The program goals are to:

• Provide start-up funding for organizations to develop a new PACE site serving the aging rural population.

• Provide funding for organizations to expand existing PACE programs into rural areas through service area expansion.

• Implement sustainable PACE programs that will effectively serve critical health care needs for rural aging populations.

This funding will support organizations to develop an initial PACE program or expand an existing PACE organization into rural areas. Successful Rural PACE Planning and Development award recipients will be required to work with their State Administering Agency (SAA) and Centers for Medicare & Medicaid Services (CMS) on completing and submitting their PACE application. By the end of the 4-year period of performance, award recipients are expected have a plan in place for long term financial sustainability of the new or expanded PACE organization.

Note: This funding does not guarantee that an organization will receive approval of their PACE application and does not provide long term funding for the delivery of clinical services to PACE clients.

Background The Program for All-Inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program that helps people meet their health care needs in the community instead of going to a nursing home or other care facility. Since its inception in the 1970s, the PACE model has expanded to 33 states with 180 PACE organizations[1]. PACE programs provide, and are financially responsible for, all health care services of their enrollees.

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

Step 1: Review the Opportunity 9 https://www.cms.gov/medicare/medicaid-coordination/about/pace https://www.cms.gov/medicare/medicaid-coordination/about/pace

The PACE model provides care management to enrollees, and the PACE center serves as a central hub for adult day care services where enrollees can receive primary care, therapy, meals, recreation, and socialization. The PACE model can address issues related to transportation and affordability for eligible participants, and the PACE program pays for all services and provides transportation. Studies have found that PACE participants have a lower mortality rate and lower use of acute care hospitals.

97% of family members of a PACE participant would recommend PACE services to other families, and 58% reported lower caregiver burden [2]. Since most PACE enrollees are dually eligible for Medicare and Medicaid, it is critical for PACE organizations to have a steady patient volume to sustain its PACE program.

According to the National Advisory Committee on Rural Health and Human Services 2023 policy brief, the start-up and application process to become a certified PACE provider with CMS may present some challenges in rural areas[3]. With a focus on supporting rural community capacity and infrastructure to support seniors locally, Rural PACE Planning and Development is designed to support improving access to and delivery of comprehensive and sustainable medical and social services for adults 55 and older living in rural areas by allowing organizations to plan, develop and apply for an initial or expanded PACE Program through CMS.

Through two funding pathway options, recipients are funded to improve health care in rural areas by implementing projects to develop an initial PACE program or expand existing certified CMS PACE programs into rural areas through PACE service area expansion.

Program Guidance All applications must meet the requirements stated in the Eligibility criteria section of this NOFO. Your application is also expected to meet the program guidance outlined in this section by detailing how your project will address the program guidance outlined in your application’s project narrative description. Failure to respond to this guidance can impact your application’s score.

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

Step 1: Review the Opportunity 10 https://www.hrsa.gov/sites/default/files/hrsa/rural-health/resources/nac-policy-brief.pdf https://www.hrsa.gov/sites/default/files/hrsa/rural-health/resources/nac-policy-brief.pdf

Service Area Guidance Services for Rural Areas

This program aims to improve and expand access to long term elder care services in rural areas by expanding PACE services into rural areas.

• Applicants are expected to prioritize improving delivery and access to PACE program services in rural areas and for beneficiaries enrolled in PACE and living in rural areas, as evidenced consistently throughout the project narrative and supported through inclusion of information in Attachment 3: Map of service area and Attachment 6: PACE Beneficiary Enrollment Plan

◦ For the purposes of this NOFO, rural service areas are defined as a county or census tract is located in a HRSA-designated rural area. Please refer to Appendix A: Determining a rural service area.

• Applicants must have demonstrated experience serving, or the capacity to serve, rural underserved populations as evidenced in the corresponding rural service area section of the Project Narrative.

Partner Collaboration Plan

Applicants must provide a clear business plan that identifies any organization, provider, or service partners that will be involved in the project. This is evidenced by providing all required documentation requested in Attachment 2: Agreements with other entities and supported by your project description provided in your corresponding project narrative.

Non-duplication of services

We recognize that more than one PACE organization may provide complementary services in a rural area. If you are aware of other PACE organizations in the service area you are proposing to serve, you must detail in Attachment 7: Non-duplication of services how you will avoid duplicating efforts of the other PACE organizations in any areas of overlap

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

Step 1: Review the Opportunity 11 https://www.hrsa.gov/rural-health/about-us/what-is-rural

Funding Pathways This program includes two funding pathways. You are required to select one of these two funding pathways for your proposed project:

Funding Pathway 1: Initial PACE Program

This funding pathway supports new CMS applicants seeking to become a PACE organization in a rural area for the first time:

• To qualify for this funding pathway, you must not have previously registered with CMS as a certified PACE provider.

• Under this funding pathway, Rural PACE Planning and Development grant funding can be used to apply for PACE certification from CMS and implement approved PACE programs in a designated rural geographic area and to provide sustainable PACE services to rural recipients by the end of the 4-year funding period.

Funding Pathway 2: Service Area Expansion

This funding pathway supports the expansion of existing PACE organizations who are seeking to expand the service area to a HRSA-designated rural area. This includes an expansion of the currently approved geographic service area and/or the addition of a new PACE center site.

• To qualify for this funding pathway, you must be currently registered with CMS as a certified PACE provider and pursuing expanding to a HRSA-designated rural area.

• Under this funding pathway, Rural PACE Planning and Development grant funding can be used to support PACE service area expansion applications to CMS and to provide sustainable expanded PACE services to rural recipients resulting from approve service expansion by the end of the 4-year funding period.

Funding pathway selection requirement

To select a Funding Pathway, you must clearly state your application’s Funding Pathway selection in the Project abstract and provide the required documentation requested under Attachment 9: Funding Pathway Participation Statement.

Funding pathway requirements

Funding Pathway 1: Initial PACE Program

To accomplish the goal of this funding pathway, you are expected to use Rural PACE Planning and Development funds to implement activities that:

• Lead to the successful submission of an initial PACE organization application with CMS to become a PACE organization in a HRSA-designated rural area for the first time.

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

Step 1: Review the Opportunity 12 https://www.cms.gov/files/document/pace-initial-and-service-area-expansion-applicationupdated-2022-pdf.pdf https://www.cms.gov/files/document/pace-initial-and-service-area-expansion-applicationupdated-2022-pdf.pdf https://www.hrsa.gov/rural-health/about-us/what-is-rural https://www.cms.gov/files/document/pace-initial-and-service-area-expansion-applicationupdated-2022-pdf.pdf https://www.cms.gov/files/document/pace-initial-and-service-area-expansion-applicationupdated-2022-pdf.pdf

Funding Pathway 2: Service Area Expansion

To accomplish the goal of this funding pathway, you are expected to use Rural PACE Planning and Development funds to implement activities that:

• Lead to the successful submission of a PACE service area expansion application with CMS to expand the service area to a HRSA-designated rural area.

As part of this funding pathway, there are 3 possible expansion avenues for current PACE organizations to expand service to HRSA-designated rural areas through PACE service area expansion:[3]

1. A current PACE organization requesting to expand into a HRSA-designated rural area without adding an additional PACE center.

2. A current PACE organization requesting to add a new PACE center in their existing HRSA-designated rural area.

3. A current PACE organization requesting to expand into a HRSA-designated rural area and add a new PACE center in the expanded area.

Program requirements and expectations All applicants proposing projects that align under either funding pathway are required to meet all additional program guidance listed in this section:

• Successful award recipients of Rural PACE Planning and Development funding are required to work directly with their State Administering Agency (SAA) and Centers for Medicare & Medicaid Services (CMS) to complete the appropriate PACE application submission, review and approval process respective to the awarded funding pathway.

• Successful award recipients are responsible for following their SAA and CMS’ application and approval processes (including meeting CMS’ and any State agency deadlines).

Program Funding Notes

• Funding under this program does not guarantee award recipients will receive CMS approval of any PACE applications submitted through funded grant activities.

• If a PACE application submitted by a successful award recipient of this grant funding is not approved by their SAA or by CMS, HRSA reserves the right to terminate grant funding.

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

Step 1: Review the Opportunity 13 https://www.hrsa.gov/rural-health/about-us/what-is-rural https://www.cms.gov/medicare/health-plans/pace/expansions https://www.cms.gov/medicare/health-plans/pace/expansions https://www.hrsa.gov/rural-health/about-us/what-is-rural https://www.cms.gov/medicare/medicaid-coordination/pace https://www.cms.gov/medicare/medicaid-coordination/pace

Program data collection Award recipients of this grant funding will be required to report measures annually to HRSA through an electronic performance measurement data collection system.

A final set of measures will be provided by FORHP to award recipient following receipt of award.

Award recipient will be expected to collect, track, and report on data for recipients of funded PACE program over time, including at least one year during the period of performance following CMS certification as a PACE organization under the initial PACE program funding pathway or service area expansion funding pathway.

Award information Funding policies and limitations Policies

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

• Support beyond the first budget year will depend on:

◦ Appropriation of funds.

◦ Your satisfactory progress in meeting the project’s objectives.

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

• 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 14

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. This limitation may be updated.

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

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

Program income Program income is money earned as a result of your award-supported project activities. You must use any program income you generate from awarded funds for approved project-related activities. Find more about program income at 45 CFR 75.307.

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

Step 1: Review the Opportunity 15 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=13 https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR5d90ba314caea08 https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR5d90ba314caea08 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75#75.400 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 17

Find the application package 17

Application writing help 17

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 to find out what you’ll need to register.

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

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

Find the application package The application package has all the forms you need to apply. You can find it online. Go to Grants Search at Grants.gov and search for opportunity number HRSA-25-101.

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

Application writing help Visit HHS Tips for Preparing Grant Proposals.

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

See Apply for a Grant for other help and resources.

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

Step 2: Get Ready to Apply 17 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 11, 2025 at 2:30pm ET.

More information on HRSA 25-101’s webinar will be posted at a later date to the related documents tab here: https://grants.gov/search-results-detail/358301

We recommend you “Subscribe” to the NOFO on Grants.gov to recieve updates when documents are posted.

We will record the webinar. Visit the HRSA’s open opportunities website to learn more about the resources available for this funding opportunity.

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 18 https://grants.gov/search-results-detail/358301 https://www.hrsa.gov/grants/find-funding

Step 3:

Prepare Your Application

In this step

Application contents and format 20

Application contents and format Applications include 5 main components. This section includes guidance on each.

Application page limit: 50 pages.

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

Make sure you include each of these:

Components Submission format

Project abstract Use the Project Abstract Summary form.

Project narrative Use the Project Narrative Attachment form.

Budget narrative Use the Budget Narrative Attachment form.

Attachments Insert each in the Attachments form.

Other required forms Upload using each required form.

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

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

Step 3: Prepare Your Application 20 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=24

Project abstract Complete the information in the Project Abstract Summary form. All applicants are required to include the following in the Project Abstract field:

• A short description of your proposed project.

• Your application’s funding pathway selection for your project. You many only select one of the two available funding pathways: 1.) Initial PACE Program Funding Pathway or 2.) Service Area Expansion Funding Pathway.

• Briefly describe the target population you will serve.

• Identify and describe the proposed project goals and objectives as it related to the needs you plan to address.

• Proposed rural service area(s), including rural census tracts.

• Proposed services.

For more information, see Section 3.1.2 of the Application Guide.

Project narrative In this section, you will describe all aspects of your project.

Project activities must comply with the non-discrimination requirements and align with Rural PACE Planning and Development program guidance.

All applicants under both Funding Pathways must complete responses to all respective sections of the project narrative. Failure to respond to these instructions will impact your application’s score.

Use the section headers and the order listed.

Introduction See merit review criterion 1: Need

• Describe the purpose of your project, including the funding pathway selection and overview rural geographic area that the new or expanded PACE program will serve. Include a summary of your proposed project that discusses how your proposed project will best support the needs of your project’s identified service area and target population.

• Outline the goals and expected outcomes of the proposed project, include specifics relevant to the selected funding pathway your proposed project will implement, including which of the three specific expansion avenues your project will address, if applying under the Service Area Expansion funding pathway.

• Describe unmet health care needs that the PACE program will address.

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

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

Applicants selecting to participate in the Service Area Expansion funding pathway must include the following items in list format:

• Name of PACE organization

• PACE Center address(es)

• PACE organization’s eligibility qualifications

• Current service area(s)

• Current PACE beneficiary enrollment

• Anticipated service area expansion

Applicants selecting to participate in Initial PACE funding pathway must describe the details of your proposed PACE program and application status.

Need See merit review criterion 1: Need

• Describe the target population and their unmet health needs related to long term services and supports, including the level of care that may be required, and how the PACE program will address these needs for the community in the proposed service area(s).

• Outline the community or organization’s needs you plan to address, including the delivery of comprehensive, integrated acute and long-term care services.

• Use and cite demographic data whenever possible to support the health care needs of your project’s identified target population, including any available data or details on demographic, social, or other key health care needs of the population the project will serve, as well as any available data or details on barriers to accessing care, such as transportation, among others.

• Describe the HRSA-designated rural geographic area you plan to expand or implement new PACE services and explain why you chose this target area.

• Cite the number of dually eligible Medicare and Medicaid beneficiaries (ages 55 and older) in the proposed service area(s).

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

Step 3: Prepare Your Application 22

Approach See merit review criterion 2: Response

• Describe your readiness to initiate a new PACE program or expand existing PACE organization into a designated rural service area.

• Tell us how you will address the needs you described and meet the program guidance, including the funding pathway requirements for the funding pathway selection identified in your application.

• Describe how you will establish an interdisciplinary team approach to care management and service delivery to keep the elderly population in the community safe.

• Include strategies for ongoing staff training, teamwork, and information sharing as well as strategies for outreach and collaboration to involve patients, families, and communities.

• Describe how you’ll implement PACE into your initial or expanded site, as it relates to the funding pathway your project aligns to.

• Detail how your organization has demonstrated capacity to fund an Initial PACE Program or a Service Area Expansion.

If you are selecting to participate in the Initial PACE program funding pathway, you must include a description that details:

• How you will approach PACE program application feasibility analysis and planning.

• Your approach and plans for interdisciplinary team development.

• Your education and outreach plans. Please note, organizations are not permitted to promote any PACE sites/services being developed through this grant until they have been approved by CMS.

• How you will sustain costs until PACE organization reaches sufficient enrollment size.

• Any other efforts your organization determines as critical to its successful start-up.

If you are selecting to participate in the Service Area Expansion Funding Pathway, you must include a description that details:

• Identification of the services that will be directly provided by the PACE Organization and those to be provided under contract and details your capacity to support individuals transitioning from acute care and individuals transitioning from institutional long-term care.

• How you will sustain costs until the provider reaches sufficient enrollment size.

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

Step 3: Prepare Your Application 23

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

This section will help reviewers understand how you will achieve each of the objectives during the 4-year grant period of performance.

The details listed in this section asks you to describe specific elements of your work plan and must clearly align to the work plan provided in table format in Attachment 4:

Work plan.

• Describe how your work plan will meet the goal of commencing your selected funding pathway for either an Initial PACE Program or an existing PACE organization service area expansion, including:

◦ How your work plan will support advancement of the overall purpose, goals, objectives, and activities of the proposed project

◦ How the timeline for proposed activities during the project’s funding cycle is appropriate for project implementation.

◦ Who will be responsible for overseeing implementation for work plan activities.

◦ Any support or collaboration from identified project partners and key stakeholders to plan, design, and implement work plan activities.

◦ Performance, outcome measures, and/or benchmarks to help monitor progress for work plan activities.

◦ Expected results, outcomes and/or impact on the target population.

◦ Timeline of your plan to work with respective State agencies and submission of the appropriate PACE application to CMS, including all respective application requirements.

Step 3: Prepare Your Application 24

Resolving challenges See merit review criterion 2: Response

This section will help reviewers understand how you will address anticipated challenges and barriers throughout the project period.

Discuss any anticipated challenges and barriers you will likely encounter in your project. This includes description of anticipated challenges and barriers that detail:

• what the specific challenges and barriers are and how you plan to address them with respect to establishing and implementing your proposed project’s PACE program in your target rural service area.

• Please include how you will address solutions and approaches to identified challenges and barriers including how you handle:

◦ outreach to the target population,

◦ securing specialty providers and other needed staff, including training

◦ beneficiary enrollment, including low initial enrollment.

◦ delivery and coordination of care

◦ transportation for beneficiaries

◦ electronic medical record system management for beneficiaries

◦ financial viability and sustainability

◦ maintenance and adherence to PACE program CMS policies and regulations

◦ Any State level barriers, such as, no State Plan Option for PACE or duplication of services. This may also include any anticipated challenges or barriers related to working directly with related state agencies or CMS on the PACE application review and approval process.

◦ Any challenges or barriers likely to be encountered with implementing a PACE program in a rural geographic area.

◦ Any expected internal challenges (such as managing expectations among key partners and interdisciplinary team members, data sharing, and reporting) and external challenges (like regulatory changes) that may directly or indirectly affect the development of the rural PACE program, including how the organization will become an approved PACE site.

◦ Process for handling participant grievances and appeals.

◦ Any other relevant challenges or barriers identified with approaches for resolving them.

Step 3: Prepare Your Application 25

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

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

Expected Outcomes. Program success will be measured by:

• The number of award recipients who successfully submit a timely PACE program application.

• The number of award recipients who receive PACE program approval.

• The successful implementation of the PACE model in a HRSA-designated rural area.

Performance measurement and reporting.

• Describe how you will effectively collect, share, and report required performance measures to HRSA during the 4-year grant period. While a final list of performance measures will be provided to award recipients upon award, successful award recipients will be expected to report HRSA performance measures that detail PACE program implementation and outcomes for rural beneficiaries that include measures such as:

◦ The number of rural counties with PACE services available as a result of this program’s grant funding.

◦ The number of eligible beneficiaries identified (early in the grant)

◦ The number of eligible beneficiaries enrolled (at end of the project period)

◦ The number of rural residents 55 years and older who have increased access to services that were not previously available prior to PACE model implementation supported by this program’s grant funding.

• Describe how you will coordinate, manage, and securely store data, including tracking of data across systems and how you will protect data against cybersecurity threats, breaches, or other loss of data integrity.

• Describe how you and any relevant key partners will collaborate to use data, including but not limited to HRSA performance measures, to collect, share, report and continuously improve services throughout project implementation.

Program assessment.

Describe how you will assess the success and outcomes of your funded project. The assessment should examine processes and progress towards goals, program objectives, and expected outcomes. This includes description that addresses the following:

Step 3: Prepare Your Application 26

• Assessment questions, methods, data you will collect, and timeline for assessing the program, including working directly with related state agencies and CMS for PACE model application review and approval process and implementation of the PACE program identified in your funding pathway selection. How you will assess effectiveness and make any identified adjustments needed on an ongoing basis as a result of assessment for execution of your project and accomplish of project goals.

• The capacity of your organization and staff to assess the program.

Sustainability See merit review criterion 4: Impact

We expect you to sustain key project elements that improve practices and outcomes for the target population.

Propose a plan for project sustainability after the 4-year grant period of funding from this program ends and include in your plan approaches to sustainability that includes:

• How you will approach and implement plans for long-term sustainability of the anticipated service area expansion after the 4-year grant period ends.

• Key elements of your project that your organization plans to sustain after this grant funding ends. Examples include training methods or strategies that have been effective in improving practices.

• Plans for achieving financial soundness of your organization’s ability to maintain PACE program implementation in a rural geographic area.

• Describe how you will sustain costs until the PACE provider/site reaches sufficient enrollment size. Describe the estimated enrollment level you must maintain to sustain the PACE program after this grant period is over.

• Discuss challenges that you’ll likely encounter in sustaining the program. Include how you will resolve these challenges.

• Propose a plan for continuing the project when federal funding ends. Successful plans include a clear timeline for implementation of a sustainability plan and how it supports long-term implementation of your project’s respective proposed PACE model implementation. We expect you to keep up key strategies or services and actions that have led to improved practices and outcomes for the target population.

Step 3: Prepare Your Application 27

Organizational information See merit review criterion 5: Resources and capabilities

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

Complete responses to this section also include:

• Your organizational chart in Attachment 9: Organizational chart

• A list of and description of all key staff members conducting activities within this program, including the project director, as requested in Attachment 5: Staffing Plan and Job Descriptions.

• Your project’s partner collaborations and any Memorandum of Understanding/ Agreement (MOU/A) or a letter of agreement signed and dated by partners as requested in Attachment 2: Agreements with other entities.

• Describe your organization’s experience and capacity serving, or the capacity to serve rural underserved populations. Include the following:

◦ Identify activities that build, strengthen, and maintain the necessary competencies and resources needed to sustain or improve the delivery of health services including but not limited to long-term support services in rural areas.

◦ Discuss the organizational expertise and capacity as it relates to the scope of the work proposed including demonstrated experience with evidence-based care management, population health, and working with an older adult population. Include a brief overview of the organization’s assets, skills, and qualifications to carry out the project.

• The relationship to the proposed rural service area and your plans to ensure that rural populations are served.

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

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

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

• The project director who will be responsible for project monitoring and carrying out award activities. The project director is strongly encouraged to dedicate sufficient time to the program and the application should note the experience of the project director and their experience managing multiple organizational arrangements.

Step 3: Prepare Your Application 28

If you are selecting to participate in the Initial PACE Program funding Pathway include:

• how you plan to recruit, hire, and maintain an interdisciplinary staff to implement the PACE model in your rural service area.

If you are selecting to participate in the Service Area Expansion funding Pathway include:

• A list of your Interdisciplinary Team members. Include name, role, credentials, length of employment for each member and where the individual is a PACE employee or contractor.

• How you currently implement, or plan to implement, trainings to ensure your staff can fulfill the objectives of the PACE model.

• The effectiveness of the methods and/or activities employed to improve healthcare services in rural areas.

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

Your budget should follow the instructions in Section 3.1.4 Project Budget Information

– Non-Construction Programs (SF-424A) of the Application Guide and the instructions listed in this section. Your budget should show a well-organized plan.

HHS now uses the definitions for equipment and supply in 2 CFR 200.1. The new definitions change the threshold for equipment to the lesser of the recipient’s capitalization level or $10,000 and the threshold for supplies to below that amount.

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

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

See other required forms. It includes an itemized breakdown and a clear justification of the costs you request. The merit review committee reviews both.

As you develop your budget, consider:

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

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

• Travel: Allocate travel funds for up to two (2) program staff to attend an annual 2.5-day technical assistance workshop in Washington, DC and include the cost in this budget line item. To determine estimated travel costs to Washington, D.C., see the U.S. General Services Administration (GSA) per diem rates for FY 2025.

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

Step 3: Prepare Your Application 29 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=13 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Equipment) https://www.ecfr.gov/current/title-2/part-200#p-200.1(Supplies)

• Contractual: You are responsible for ensuring that your organization or institution has in place an established and adequate procurement system with fully developed written procedures for awarding and monitoring all contracts.

Consistent with 45 CFR 75, you must provide a clear explanation of the purpose of each contract, how the costs were estimated, and the specific contract deliverables.

• Budget for Multi-Year Award: You must include a budget narrative for each year of the four-year period of performance submitted with your application.

◦ Funding beyond the one-year budget period is subject to the availability of funds, satisfactory progress of the awardee, and a determination that continued funding would be in the best interest of the Federal Government.

• Minor Alterations/Renovations are allowable.

• For organizations applying for the New/Initial PACE Program Pathway: clearly document the start-up costs that you plan to use with this grant funding.

• In alignment with CMS PACE Model requirements, preclusion for use of any grant funding to advertise and/or promote any PACE model implementation before it opens for services.

• Grant funds cannot be used for delivery of clinical services.

To create your budget narrative, see detailed instructions in Section 3.1.5 of the Application Guide.

Attachments Place your attachments in this order in the Attachments Form. See application checklist to determine if they count toward the page limit.

Attachment 1: Required documentation from State Administering Agency Include a letter of support from your State Administering Agency.

For applicants selecting participation in the service area expansion funding pathway, this documentation should indicate awareness from respective State agency organizations, as applicable, for your proposed PACE service area expansion application.

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

Step 3: Prepare Your Application 30 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=18

Attachment 2: Agreements with other entities Provide any documents that describe working relationships between your organization and others you mention in your project narrative. If you include documents that confirm actual or pending contracts or agreements, the documents should clearly describe the roles of subrecipients and contractors and any deliverables. It is not necessary to include the entire contents of lengthy agreements, so long as the portions you include describe the working relationship between you and the other organization.

Make sure any letters of agreement are signed and dated.

Attachment 3: Map of Service Area Include a legible map that clearly shows the geographic area that will be served by the proposed project, including the location of key organizations and/or partners supporting proposed project implementation. Include any other information that will help reviewers visualize and understand the scope of the proposed project activities.

You must specify a target rural service area the proposed project will serve. Only counties and/or census tracts that are a HRSA-designated rural area are eligible to as target rural service areas under this grant program.

Attachment 4: Work plan Attach your project’s work plan. Make sure it includes each year of the grant program’s 4-year period of performance and aligns with the description provided in your application’s project narrative work plan section.

The work plan must:

• Outline the person responsible for carrying out each activity.

• Include a timeline for all four years of the period of performance.

• The minimum timeline increment is by quarter.

We recommend a table format and the sample headings outlined here:

• Goals and objectives

• Key action steps (including target population where applicable)

• Activities

• Outputs, data source, and program self-assessment methods (these might include the direct products or deliverables of program activities and how you will assess them)

• Outcome and measurement (these might include the result of a program, typically describing a change in people or systems)

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

Step 3: Prepare Your Application 31

• Responsible person

• Anticipated completion date

Attachment 5: Staffing plan and Job Descriptions See Section 3.1.7 of the Application Guide.

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

For…