HRSA-26-073 FINAL.pdf

Notice of Funding Opportunity

Application due 7/17/2026

Federal Office of Rural Health Policy Hospital State Division

Delta Rural Integrated Health Network Program Opportunity number: HRSA-26-073

Contents Before you begin 3

Step 1: Review the Opportunity 4 Basic information 5

Eligibility 6

Program description 10

Award information 15

Step 2: Get Ready to Apply 17 Get registered 18

Find the application package 18

Application writing help 19

Step 3: Build Your Application 20 Application checklist 21

Application contents and format 23

Step 4: Understand Review, Selection, and Award 37 Application review 38

Selection process 43

Award notices 43

Step 5: Submit Your Application 44 Application submission and deadlines 45

Other submissions 46

Step 6: Learn What Happens After Award 47 Post-award requirements and administration 48

Reporting 51

Contacts and Support 52

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 7/17/2026.

All activities proposed in your application and budget narrative must align with applicable law, including but not limited to statutes, executive orders, federal regulations and applicable judicial holdings. Accordingly, discretionary awards shall not be used to fund, promote, encourage, subsidize, or facilitate: racial preferences or other forms of racial discrimination by the recipient, including activities where race or intentional proxies for race will be used as a selection criterion for employment or program participation; denial by the recipient of the sex binary in humans, or the belief that sex is a chosen or mutable characteristic; illegal immigration; or any other initiatives that compromise public safety. If an application does not align, the application will not receive funding to the extent permitted by law and applicable court orders.

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.

https://sam.gov/ https://grants.gov/

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 5

Eligibility 6

Program description 10

Award information 15

Basic information Health Resources and Services Administration

Federal Office of Rural Health Policy

Hospital State Division

A program to help rural health facilities in the Delta Region create integrated care networks.

Summary The Delta Rural Integrated Health Network Program seeks to improve healthcare delivery in the region by supporting the development of integrated health networks among rural hospitals, primary care clinics, behavioral health providers, and other essential healthcare organizations. Networks can include groups of healthcare organizations (such as rural hospitals or clinics) and we are particularly interested in networks and proposed networks that include both hospitals and clinics.

Funding details Application Types: Limited competition, New

Expected total available funding in FY2026: $2,800,000

Expected number and type of awards: 8 grants

Funding range per award: Up to $350,000

We plan to fund awards in two 12-month budget periods for a total 2-year period of performance from 09/30/2026 to 09/29/2028.

Have questions?

Go to Contacts and Support.

Key facts

Opportunity name:

Delta Rural Integrated Health Network Program number:

HRSA-26-073

version:

Initial

93.619

Key dates

06/16/2026 webinar:

Will be posted on grants.gov deadline:

7/17/2026

09/01/2026

09/30/2026

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

Eligibility 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:

• State governments.

• County governments.

• City or township governments.

• Special district governments.

• Public and State controlled institutions of higher education.

• Native American tribal governments (federally recognized).

• Native American tribal organizations (other than federally recognized tribal governments).

• Nonprofits having a 501(c)(3) status with the IRS, other than institutions of higher education.

• Nonprofits without 501(c)(3) status with the IRS, other than institutions of higher education.

• Private institutions of higher education.

• For profit organizations.

• Small businesses.

• Others. (See text field entitled “Additional Information on Eligibility” for clarification.)

Additional information on eligibility You must target rural healthcare organizations located in the Delta region.

The applicant organization may be located in a rural or urban area but must have demonstrated experience serving, or capacity to serve, medically underserved populations in rural areas.

Individuals are not eligible applicants under this NOFO.

Other eligibility criteria Applicants must meet all the requirements in the eligibility section, as well as the following additional criteria. If you do not meet all these requirements, or if you do not provide all the required network documentation, your application will be marked ineligible.

• You must represent a group composed of three or more healthcare organizations (including the applicant organization).

• Organizations in the network may include:

◦ Rural hospitals such as Critical Access Hospitals (CAH), Prospective Payment System Hospitals (PPS), Rural Emergency Hospitals (REH), Disproportionate Share Hospitals (DSH), Sole Community Hospitals (SCH), Indian Health Service (IHS) Hospitals, and Tribal Hospitals, etc.

◦ Rural health clinics.

◦ Federally qualified health centers.

◦ Health centers.

◦ PACE organizations.

◦ Physical and occupational therapy practices.

◦ Dental clinics.

◦ Behavioral health clinics.

◦ Emergency medical services (EMS) agencies.

◦ Independent clinics and other organizations that provide direct patient care

◦ Convening organizations for healthcare providers, such as state rural health associations, state hospital associations, or other organizations focused on rural healthcare network development.

◦ Networks may be composed of organizations of the same type, for example, all rural hospitals, or networks may be composed of different types of organizations, for example, rural hospitals and clinics.

• You must represent a network comprised of at least 66% of participant organizations physically located in HRSA-designated rural areas in the Delta Regional Authority (DRA) region, which includes 255 counties and parishes across eight states: Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee.

◦ You can determine the rural or urban designation of each participant organization using HRSA’s Rural Health Grants Eligibility Analyzer and location in the DRA region using the DRA Service Maps.

◦ You must verify and indicate the rural or urban designation for each network participant in Attachment 5. If you propose to serve a rural census tract in a partially rural county, the rural census tract must be indicated.

◦ The applicant organization and each network participant must have their own Employer Identification Number (EIN) number unless an exception is requested. The EIN number for applicant organization and each network participant must be provided in Attachment 6.

• The applicant organization is not required to represent a fully established rural health network at the time of submission. However, you must provide https://data.hrsa.gov/tools/rural-health https://dra.gov/map-room/ documentation that demonstrates that your network meets network requirements in Attachment 4: Agreements with other entities, and Attachment 6:

Network organization chart and member information, and Attachment 7:

Letter of commitment.

• Existing networks are eligible to apply for funding to plan for the development of a more integrated network. If the applicant is an existing network, please provide the network’s articles of incorporation or copies of Memoranda of Understanding (MOUs) signed by all network participants as Attachment 4.

• All applicants must provide a scanned, signed copy of a letter of commitment from each of the network participants in Attachment 7.

• You must have demonstrated experience serving, or capacity to serve, rural populations. You can demonstrate this by describing the buy-in from the rural community your proposed project plans to serve in the project narrative and letters of support from community-based organizations in the rural community.

• Your network will use grant funds to serve only HRSA-designated rural areas in the DRA region for planning activities that meet funding policies and limitations and budget requirements.

• Funding under this program (42.U.S.C. 254c(f)) must be used for planning activities that are clearly non-duplicative of other federally funded programs.

Planning activities are those that prepare a community to provide direct health services. Planning activities grant funds can be used for can include but are not limited to:

◦ Rural health care network integration.

◦ Strengthening operations.

◦ Creating or improving care coordination policies and procedures.

◦ Convening participating organizations for strategic planning.

◦ Contracting with other organizations to provide facilitation services, legal services, financial feasibility analysis and other services necessary to create an integrated rural health care network.

• You must not previously have received a grant under this subsection (other than a grant for planning activities) for the same or a similar project.

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.

• Does not include all required documents.

• Fails to select one of the funding tracks.

• Proposes to use award funds to pay for the direct provision of clinical health services or other activities unrelated to creating or integrating a network.

Application limits You may not submit more than one application. If you submit more than one application, we will only accept the last on-time submission.

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. Recipients agree that once committed, cost sharing amounts are enforceable and subject to reporting and auditing requirements under 2 CFR 200.

Post-award requirements

Before you apply, make sure you understand the requirements that come with an award.

See Step 6: Learn What Happens After Award for information on regulations that apply, reporting, and more.

Program description Purpose The Delta Rural Integrated Health Network Program supports the planning and development of rural integrated healthcare networks in the Delta Region. This approach links rural healthcare network participants together to improve collective capacity to address local challenges, expand access, and improve care quality in the rural communities they serve. For new networks, the goal is to develop integrated networks in one or more of the following areas: clinical, administrative, and operational. For existing networks, the goal is to strengthen integration in ways that best serve its member healthcare organizations and patients.

The program helps network participants work together on three aims:

• Greater efficiency.

• Expanded access, coordinated care, and improved healthcare quality and health outcomes.

• A stronger rural healthcare system.

Funding opportunity goals

• Promote cooperation among healthcare organizations to achieve efficiencies and improve access to quality healthcare services and outcomes in rural areas.

• Strengthen the rural healthcare system by fostering partnerships among healthcare organizations.

• Enhance local capacity to improve rural community health interventions and coordinate care effectively.

• Support the financial stability of member healthcare organizations so they can continue to provide care in their communities.

Background The Delta Rural Integrated Health Network Program seeks to improve healthcare delivery in the region by supporting the development of integrated health networks among rural hospitals, primary care clinics, behavioral health providers and other essential healthcare organizations. The network model helps rural providers achieve economies of scale that can lower costs and expand administrative and clinical capacity. Because providers in the region are small and have limited resources, individual clinics and hospitals face ongoing challenges meeting their communities’ needs. This funding will help new networks develop the legal and administrative infrastructure to work collectively while preserving local autonomy.

Creating new networks will help Delta healthcare organizations enhance clinical service delivery, improve their financial operations, and achieve other operational efficiencies not otherwise available to small individual healthcare organizations. As these networks grow and mature, they will also be able to integrate further to stabilize services, expand access to care, and improve population health. By strengthening the systems of care in the rural Delta region, the networks will be able to preserve access to care and address long-standing challenges related to higher rates of chronic disease, higher mortality and lower life expectancy.

This program supports HRSA’s coordination with the Delta Regional Authority (DRA) to enhance healthcare delivery in the rural counties and parishes of the Delta region. This collaboration began in 2017 when HRSA funded the Delta Region Community Health Systems Development (DRCHSD) Program under a cooperative agreement to provide free, intensive, multiyear technical assistance to rural healthcare organizations located in the Delta region. Through this work, HRSA has identified the need to support the creation of integrated networks in the Delta region.

HRSA currently works with the DRA on two initiatives:

• The DRCHSD Program, which provides intensive, multiyear technical assistance to healthcare facilities across the 252 parishes and counties in the Delta region.

• The Delta Health Systems Implementation Program which provides funding to rural hospitals that previously received technical assistance through the Federal Office of Rural Health Policy (FORHP). Projects focus on financial sustainability based on recommendations from technical assistance consultations.

The Delta Rural Integrated Health Network Program helps advance the Making America Healthy Again (MAHA) priorities including:

• Preventive health.

• Reducing chronic disease.

• Mental health.

• Nutrition.

• Primary and value-based care.

https://dra.gov/ https://www.hrsa.gov/rural-health/grants/rural-community/delta https://www.hrsa.gov/rural-health/grants/rural-community/delta https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.hhs.gov%2Fmaha%2Findex.html&data=05%7C02%7CCEdwards%40hrsa.gov%7C7724151cd28e4341cfe508de7ed96cd7%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C639087669461691184%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=MwzcOX0pO%2FkrT0%2FD4Oka5D3qC%2BJb4U6KqrPiAj6Pteo%3D&reserved=0 https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.hhs.gov%2Fmaha%2Findex.html&data=05%7C02%7CCEdwards%40hrsa.gov%7C7724151cd28e4341cfe508de7ed96cd7%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C639087669461691184%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=MwzcOX0pO%2FkrT0%2FD4Oka5D3qC%2BJb4U6KqrPiAj6Pteo%3D&reserved=0

Program requirements and expectations You must meet all the requirements stated in the Eligibility section, including Other eligibility criteria. You must also meet all program requirements and expectations outlined in this section.

Funding tracks You must select one of two funding tracks to apply for the Delta Rural Integrated Health Network Program. Applications that do not clearly select a single funding track will be considered non-responsive to the NOFO and will not be reviewed.

Track 1: Create a new network Applicants who are not currently part of a network, but are seeking to develop one, must choose this track. Planning activities may include, but are not limited to:

• Conducting community health and/or provider needs assessments at the regional and/or local level.

• Identifying additional network participants in the community or region.

• Identifying financial gaps or resources available to support services.

• Developing a network business or operations plan to address a local healthcare challenge, which may include:

◦ Establishing a formal memorandum of agreement or understanding (MOA or MOU) or legal articles of incorporation.

◦ Developing a shared mission statement.

◦ Identifying the appropriate governance structure for participants for the planned network.

◦ Establishing a governance board or other decision-making structure for the network.

◦ Creating a set of network bylaws.

◦ Identifying the roles and responsibilities of the network participants or a developing business model.

◦ Identifying ways to encourage cross-organizational cooperation and leadership commitment to improve health in the region.

◦ Assessing whether the planned network can initially launch successfully and continue to succeed over time.

◦ Identifying and establishing ways to obtain regional or local community support around network development.

Track 2: Strengthen or expand an existing network Existing networks must choose this track. Planning activities may include:

• Conducting community health and/or provider needs assessments at the regional and/or local level.

• Identifying additional cooperating network participants in the community or region.

• Identifying additional opportunities for greater cooperation among network participants to improve patient care and enhance the sustainability of the network.

◦ Assessing whether clinical and/or administrative integration is practical.

◦ Creating a plan for clinical and/or administrative integration.

◦ Identifying workforce issues and developing a plan to address them on behalf of member healthcare organizations.

• Integrating health and human services, improving access for people with disabilities, and developing a plan to maintain access to services such as cancer screening, chronic disease management, nutrition, oral health, and behavioral healthcare.

• Developing a plan to expand the role of EMS in the community, including planning for service gaps that may result from a hospital closure or conversion and ensuring EMS readiness to support labor and delivery.

• Developing a data use and sharing agreement to facilitate strategic and sustainability planning.

• Assessing whether the planned network can initially launch successfully and continue to succeed over time.

• Identifying strategies to communicate with the community about changes in the healthcare landscape and how they can maintain access to healthcare services.

• Identifying a strategy to use broadband connectivity to support health information technology applications in rural communities.

• Identifying a plan to develop regional systems of care to better meet rural patient concerns.

• Identifying opportunities for the network to better address regional or local health population needs.

• Helping member healthcare organizations participate in value-based care efforts, including new primary care models like direct primary care.

Activities should advance one or more of the MAHA priorities. Strategies to consider include:

• Addressing root causes of poor health.

• Improving access to primary care, behavioral health, preventive care, or developmental services.

• Expanding nutrition programs or chronic disease prevention.

• Preparing systems for value-based care.

Statutory authority 42 U.S.C. 254c(f) (§ 330A(f) of the Public Health Service Act https://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-2012-title42-section254c&num=0&edition=2012

Award information Funding policies and limitations Changes in HHS regulations As of October 1, 2025, HHS has adopted 2 CFR Part 200, with some modifications included in 2 CFR Part 300. These regulations replace those in 45 CFR Part 75.

Policies

• To make an award, funding must be available and allocated for this program and purpose, at which point we will move forward with the review and award process.

• Have clear policies and good financial practices to avoid spending HRSA funds on unallowable activities. Like other award rules, we may audit your policies, procedures, and controls.

• 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.

General limitations

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

• Project Budget Information in the Application Guide [PDF].

• 2 CFR Part 200 Subpart E - General Provisions for Selected Items of Cost.

• Allowable and Unallowable Costs and Activities in the HHS Grants Policy Statement.

• All costs must be reasonable, necessary, allocable to the award, and adequately documented (2 CFR 200.403).

• You cannot earn profit from the federal award. See 2 CFR § 200.400(g).

• Current appropriations law includes a salary limit of $228,000 as of January 2026 that applies to this program. You may pay salaries at a higher rate if the rate beyond the salary rate limit (Executive Level II) is paid with non-HHS funds.

https://www.ecfr.gov/current/title-2/part-200 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page%3D13 https://www.ecfr.gov/current/title-2/part-200/subject-group-ECFRed1f39f9b3d4e72 https://www.hhs.gov/grants-contracts/grants/grants-policies-regulations/index.html https://www.hhs.gov/grants-contracts/grants/grants-policies-regulations/index.html https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-E/subject-group-ECFRea20080eff2ea53/section-200.404 https://www.ecfr.gov/current/title-2/section-200.405 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-E/subject-group-ECFRea20080eff2ea53/section-200.403 https://www.ecfr.gov/current/title-2/part-200#p-200.400(g)

Program-specific statutory or regulatory limitations You cannot use funds:

• To build or acquire real property.

• For construction.

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

• To pay for the direct provision of clinical health services.

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

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

To incur 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 do not have a current 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 up to 15% of modified total direct costs (MTDC). See 2 CFR § 200.1 for the definition of MTDC. You can use this rate indefinitely for all your federal awards or until you choose to receive a negotiated rate.

Consider your indirect costs when developing your budget.

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 2 CFR 200.307.

• 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.

https://www.hrsa.gov/grants/manage-your-grant https://www.ecfr.gov/current/title-2/section-200.414 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Modified%20Total%20Direct%20Cost%20(MTDC)) https://www.ecfr.gov/current/title-2/section-200.307

Step 2:

Get Ready to Apply

Get registered 18

Find the application package 18

Application writing help 19

Get registered SAM.gov You must have an active account with SAM.gov to apply. SAM.gov registration can take several weeks. Begin that process today.

To register:

• Go to SAM.gov Entity Registration and select Get Started. From the same page, you can also select the Entity Registration Checklist for the information you will need to register.

• You must agree to the financial assistance general certifications and representations specifically. Those for contracts are different.

When you register, you will also receive your required Unique Entity Identifier (UEI).

Once you register:

• You will have to maintain your registration throughout the life of any award.

• If your organization has multiple UEIs, use the one associated with your physical location.

If you need additional information about user roles in SAM.gov, see “Get registered:

SAM.gov user roles” in the Application Guide [PDF].

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 and How to Apply for Grants.

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-26-073.

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

https://sam.gov/content/entity-registration https://www.hhs.gov/sites/default/files/financial-assistance-general-certification-representations.pdf https://www.hhs.gov/sites/default/files/financial-assistance-general-certification-representations.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page%3D4 https://grants.gov/applicants/applicant-registration http://www.grants.gov/quick-start-guide/applicants https://www.grants.gov/applicants/grant-applications/how-to-apply-for-grants https://www.grants.gov/applicants/grant-applications/how-to-apply-for-grants https://www.grants.gov/search-grants

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

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.

FAQs will be posted on Grants.gov Related Documents tab.

Join the webinar Webinar information will be posted to the Related Documents tab on Grants.gov. We recommend you “Subscribe” to the NOFO on Grants.gov to receive updates when documents are posted.

Have questions? Go to Contacts and Support.

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

Step 3:

Build Your Application

Application checklist 21

Application contents and format 23

Application checklist There are two types of forms in Grants.gov.

• Some forms allow you to upload components of your application to the form.

These include components like your project narrative, budget and budget narrative, and attachments, as applicable.

• Other forms are more typical, fill-in-the-blank forms.

Make sure that you have everything you need to apply.

Narratives

Attachments Insert each in the Attachments form in this order.

Component Included in page limit*?

◻ 1. Work plan Yes

◻ 2. Staffing plan and job descriptions Yes

◻ 3. Biographical sketches Yes

◻ 4. Agreements with other entities No

◻ 5. Areas of impact & proof of location in rural Delta region No

◻ 6. Network organizational chart and network member information No

◻ 7. Letters of commitment No

◻ 8. EIN/UEI exception request Yes

◻ 9. Tribal EIN/UEI exception request Yes

◻ 10. Funding Preference documentation Yes

◻ 11. Other relevant document Yes

◻ 12. Other relevant document Yes

◻ 13. Other relevant document Yes

◻ 14. Other relevant document Yes

◻ 15. Other relevant document Yes form Included in

Project narrative attachment form Yes

Budget narrative attachment form Yes

Other required forms Upload using each required form in Grants.gov.

Forms Submission requirement

Application for federal assistance (SF-424) With application.

Project abstract summary form With application.

Grants.gov lobbying form With application.

*Only what you attach in these forms counts toward the page limit. The forms themselves do not count.

Application contents and format This section includes guidance on each component found in the application checklist.

Application page limit: 50

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

Required format Required format for project summary, project narrative, budget narrative, and attachments.

Font: Use a readable font like Arial, Courier, CG Times, or Times New Roman.

File format: We only accept the following document formats:

• .PDF - Adobe Portable Document Format

• .DOC/.DOCX - Microsoft Word

• .RTF - Rich Text Format

• .TXT - Text

• .WPD - Word Perfect Document

• .XLS/.XLSX - Microsoft Excel

• .VSD - Microsoft Visio

Size: 12-point font Footnotes, charts, graphics, and budget tables may be 10-point or higher.

Ink color: Black

Spacing: Single-spaced, including all text and tables.

Alignment: Left

Headings: Bold all headings and align left.

Size: 8.5 x 11 (Make sure the print area is set and allows printing to 8.5 x 11.)

Margins: 1-inch on all sides

Footer: On each page as the footer, include your organization’s name and page numbers. If a competing continuation or competing supplement, also include your 10-digit award number.

Page numbering:

• Do not number the standard OMB-approved forms.

• Number each attachment page sequentially (that is, 1, 2, 3).

• Reset the numbering for each attachment.

• Treat each attachment as a separate section.

File names: You can find guidance for naming your files in the Application Guide [PDF].

Project narrative Introduction See merit review criterion 1: Need

• Describe your organization’s focus area, funding track selection, proposed project goals and objectives, and expected outcomes as they relate to community needs.

• Describe the participating healthcare organizations and discuss the reasons they are creating a new network or building a more integrated one. Organizations in the network may include:

◦ Rural hospitals such as Critical Access Hospitals (CAH), Prospective Payment System Hospitals (PPS), Rural Emergency Hospitals (REH), Disproportionate Share Hospitals (DSH), Sole Community Hospitals (SCH), Indian Health Service (IHS) Hospitals, and Tribal Hospitals, etc.

◦ Rural health clinics.

◦ Federally qualified health centers.

◦ Health centers.

◦ PACE organizations.

◦ Physical and occupational therapy practices.

◦ Dental clinics.

◦ Behavioral health clinics.

◦ Emergency medical services (EMS) agencies.

◦ Independent clinics and other organizations that provide direct patient care.

◦ Convening organizations for healthcare providers, such as state rural health associations, state hospital associations, or other organizations focused on rural healthcare network development.

• Discuss how your proposed project goals and planning activities will support the Delta Rural Integrated Health Network Program aims and goals as outlined in the purpose section.

https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page%3D26

Need See merit review criterion 1: Need

This section will help reviewers understand who you will serve. You must address the following items:

• Describe the service area of the network or planned network, and the local healthcare service environment. Include supporting information from appropriate data sources, such as local, tribal, state, or federal data.

• Identify the structural challenges affecting healthcare in the service area. When possible, use and cite data to support your description. Challenges might include:

◦ Poverty.

◦ Uninsured or underinsured populations.

◦ Chronic disease burdens.

◦ Social drivers of health such as transportation barriers and food insecurity.

◦ Access to disability services.

◦ Lack of administrative resources for grant writing.

◦ Funding.

• Discuss rural community needs, including all of the following:

◦ How the rural community participated in identifying the needs and focus area.

◦ How the network participants will work together to address the identified rural community needs identified, as well as gaps in the existing healthcare system, such as in personnel, service delivery, and shared resources.

◦ Activities that the network will perform to fill those gaps.

• Describe the need for creating a network or strengthening an existing one to address the identified focus area. Discuss how a Delta Rural Integrated Health Network award would support the development of a formal network and address unmet community needs.

• Describe how the network plans to address health needs within the target service area.

Approach See merit review criterion 2: Response

• Describe the methods you will use to address the specified needs and meet the goals and program requirements of the Delta Rural Integrated Health Network program.

• Describe your plan for creating a new network (Track 1) or strengthening an existing network (Track 2).

• Describe how the planned or existing network’s planning activities will increase access to quality healthcare services across the continuum of care for rural populations in the service area.

• Describe how those populations will be involved in the development and ongoing operations of the network, including strategies for ongoing staff training, teamwork, and information sharing.

• Include strategies for outreach and cooperation to involve patients, families, and communities.

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

• Describe how you will achieve each of your goals during the period of performance. This description should align with the program purpose and identify key milestones to measure success.

• Provide a timeline that includes each activity for the entire period of performance and identifies the individual or role responsible for each activity. As needed, identify how key stakeholders will help plan, design, and carry out these activities.

• Describe how often proposed network participants will meet, how they will communicate their decisions, and how they will track their progress on work plan activities.

You will also include a more detailed work plan in Attachment 1.

Resolving challenges See merit review criterion 2: Response

• Discuss challenges that you are likely to encounter in designing and implementing the activities described in your work plan.

• Explain the approaches that you will use to resolve them.

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

• Describe the expected outcome (desired results) of the funded activities such as a strategic plan to integrate your network or articles of incorporation for a new network.

• Describe how you will determine if you have achieved the expected outcomes, including what data you will collect.

• Describe the milestones you will use to track progress toward your outcomes by the end of the project period.

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

• Describe how you will manage and securely store data and protect it from cybersecurity threats, breaches, or other loss of integrity.

• Describe how you will monitor and analyze progress to continually improve your program.

• Describe how you will share results and how you will assess whether you are sharing results effectively.

• Review and describe your collected data for its clarity and appropriateness to inform network activities.

Organizational information See merit review criterion 5: Resources and capabilities

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

Explain how they will help you carry out the program requirements. Include a project organizational chart in Attachment 6.

• Discuss how you’ll follow the approved project, keep track of all federal funds, and record all costs to avoid issues during the project audit.

• Describe how you’ll assess the unique needs of the people who live in the community you serve.

• Describe your organizational profile, budget, network participants, partners, key processes, and your key staff’s experience, skills, and knowledge to carry out project activities.

Network participants

• Describe how the rural network organizations in your service area will participate in the network’s development and ongoing operations. Your descriptions should reflect a shared decision-making structure and capacity. You will include a detailed list of all network participants in Attachment 6.

• Provide the following information about the network:

◦ Outline the roles and responsibilities of each network participant.

◦ Explain the rationale for selecting each participant.

◦ Describe prior cooperative activities among participants.

◦ Describe participants’ readiness to integrate their functions.

◦ Address participants’ capacity to achieve the program goals.

◦ Describe how network participants reflect the rural service area or population specified in this NOFO.

• Show that at least 66% of the proposed network participants are located in eligible HRSA-designated rural areas within the DRA region.

• Discuss network participants’ experience serving, or capacity to serve, rural populations. Ensure that this discussion aligns with and expands on your description of rural community buy-in to the proposed project plans provided in your project narrative.

Key personnel

• Describe key personnel roles and their relationship to the network and planning project. Key personnel are individuals who would receive funds from this award or people who conduct activities central to this program. You will include more information in Attachment 4.

• Include the project director’s name in the project abstract and Attachment 4. The project director will be responsible for project monitoring and carrying out the award activities.

◦ If the applicant organization has an interim project director or has not yet hired one, describe the process and timeline for hiring a permanent project director.

• Identify a network director for your project. The network must have either a permanent network director or an interim network director capable of overseeing the network’s administrative, fiscal, and business operations at the time of the award.

◦ If the applicant organization has an interim network director, describe the process and timeline for hiring a permanent network director.

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

Your budget should follow the instructions in budget narrative: detailed instructions section 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. 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, allowable and allocable, and consistent with your project’s purpose and activities.

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

• Personnel: HRSA recommends allocating funds for a network director with 1.0 full-time equivalent (FTE), and Project Director at least 0.25 FTE to carry out program activities and that your staffing plan include supporting and key personnel that total at least one full-time equivalent (FTE) at the time of application. Ideally, you should have one project director rather than splitting the allotted time among multiple staff members. Additionally, your staffing plan should include supporting and key personnel that total at least one full-time equivalent (FTE) at the time of application.

• Equipment: You may allocate no more than 5% of the total award amount towards equipment purchases.

• Legal costs: You may allocate no more than 20% of the total award amount towards legal costs. Legal costs include services and activities such as consultations, 501(c)(3) application preparation, and development of articles of incorporation and by-laws.

• Contractual: You are responsible for ensuring that your organization or institution has an established procurement system with fully developed written procedures for awarding and monitoring contracts. Consistent with 2 CFR 200, you must https://www.ecfr.gov/current/title-2/part-200#p-200.1(Equipment) https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200#p-200.1(Supply) provide a clear explanation of the purpose of each contract, how the costs were estimated, and the specific contract deliverables.

• Planning Activities: You may use grant funds towards planning activities only.

Planning activities are those that prepare a community to provide direct health services, such as:

◦ Rural healthcare network integration.

◦ Strengthening operations.

◦ Creating or improving care coordination policies and procedures.

◦ Convening participating organizations for strategic planning.

◦ Contracting with other organizations to provide facilitation services, legal services, financial feasibility analysis and other services necessary to create an integrated rural health care network.

To create your budget narrative, see budget narrative detailed instructions in the Application Guide [PDF].

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

Unless the instructions below require it, do not submit organizational brochures or other promotional materials (for example, slides, films, clips).

Attachment 1: Work plan Attach the project’s work plan. Make sure it includes everything required in the project narrative section.

This attachment is required in addition to the project narrative work plan section.

The work plan must:

• Outline the individual or organization responsible for carrying out each activity.

• Include a timeline for the period of performance. The minimum timeline increment is one quarter.

We recommend using a table format with these headings:

• Goals and objectives.

• Key action steps, including target population where applicable.

• Activities.

• Outputs, data sources, and program assessment methods. Include the direct products or deliverables of program activities and how you will assess them.

https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page%3D18

• Outcomes and measurements. Include the expected results of the program, typically changes in people or systems.

• Responsible individual and organization.

• Performance period and completion date.

Attachment 2: Staffing plan and job descriptions See Section 3.1.7 of the Application Guide [PDF].

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 each key staff member, attach a one-page job description. It must include their role, responsibilities, and qualifications.

Attachment 3: Biographical sketches Include biographical sketches for people who will hold the key positions you describe in Attachment 2.

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

Attachment 4: Agreements with other entities Provide any documents that describe working relationships between your organization and others you mention in your project narrative. If the applicant organization or any participating entity is an existing network, please provide a copy of the articles of incorporation, or Memoranda of Understanding. If you include documents that confirm actual or pending contracts or agreements, the documents should clearly describe the roles of sub-recipients 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. If none of the participating organizations is a network, please provide, at a minimum, letters of agreement signed by every participating organization. Make sure letters of agreement are signed and dated.

https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page%3D21 https://grants.gov/learn-grants/grant-terminology#p

Attachment 5: Areas of impact & proof of location in rural Delta region You must specify the proposed target service area(s) that will be served under this project and demonstrate that the network participants are physically located in a HRSA-designated rural area in the DRA region. You must include the following information:

• A list of the proposed target service areas, counties/parishes, cities, and HRSA rural designation status;

• A legible map that clearly shows the locations of all network participants.

◦ The map must include the counties and census tracts of all network participants. If the network participant is located in a rural census tract of an urban county, the rural census tract must be clearly identified on the map.

• Proof of network participant location in a HRSA-designated rural area in the DRA region.

◦ You may use DRA’s Service Area Map to determine whether the organization are in the DRA region. This webpage shows the 252 counties and parishes in the Delta region. Click on the county/parish and take a screenshot. Include a screenshot for every organization that will participate in the network to demonstrate that at least 66% of network participants are located within the Delta region.

◦ You may use HRSA’s Rural Health Grants Eligibility Analyzer to determine whether the organizations are located in areas designated rural by HRSA.

Refer to Appendix A for more information.

Attachment 6: Network organizational chart and network participant information Provide a one-page network organizational chart that includes how decisions will be made and how communication will flow. Describe the history of any collaborative activities carried out by the proposed network participants, describe the degree to which network participants are ready to integrate their functions, and their capacity to carry out program goals.

Provide a list of all network participants that includes:

• The organization’s name and type (such as a community health center, hospital, or health department).

• Whether the organization is part of a system.

https://dra.gov/map-room/ https://data.hrsa.gov/topics/rural-health/rural-health-eligibility

• The organization’s physical address. This will be the address used to determine qualifying eligible HRSA-designated rural status.

• Provide the name of the county or parish in which each participating organization is located.

• The name of the key person from the organization who will be working on the program.

• The organization’s anticipated role and responsibility in the Delta Rural Integrated Health Network Program.

• EIN of each proposed network participant, unless the applicant is a tribe or requests a multiple EIN exception.

Attachment 7: Letters of commitment You must provide a scanned, signed copy of a letter of commitment from each network participants. Signed copies of the letters of commitment should be provided for all network participants listed in Attachment 6. Letters of commitment must clearly identify, for each network participant:

• Roles and responsibilities in the network and project.

• Activities they will be included in.

• How their expertise is pertinent to the project.

Each letter must also include a statement indicating that the proposed partner understands that the award funds must be used for the development of a healthcare network and cannot be used for the exclusive benefit of any one network partner or to provide clinical services.

If a network participant or planned network participant is part of a…