HRSA-26-076 NS-TNGP modified 6-18-26.pdf

Notice of Funding Opportunity

Application due Wednesday, July 8 , 2026

Office for the Advancement of Telehealth

Telehealth Nutrition Services

Network Grant Program

Opportunity number: HRSA-26-076

Modified June 18, 2026: Indirect costs.

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 18

Get registered 19

Find the application package 19

Application writing help 20

Step 3: Build Your Application 21

Application checklist 22

Application contents and format 24

Step 4: Understand Review, Selection, and Award 38

Application review 39

Award notices 45

Step 5: Submit Your Application 46

Application submission and deadlines 47

Other submissions 47

Step 6: Learn What Happens After Award 48

Post-award requirements and administration 49

Reporting 53

Contacts and Support 54

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 Wednesday, July, 8 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.

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

Office for the Advancement of Telehealth

Using telehealth networks to integrate nutrition services into primary and specialty care in rural and medically underserved areas.

Summary The Telehealth Nutrition Services Network Grant Program supports healthcare professionals who provide or help provide nutrition services.

This program supports the use of telehealth networks to integrate nutrition services into primary and specialty care in rural and medically underserved areas. We encourage you to propose new and innovative ways to use telehealth networks to expand access to nutrition care in rural and medically underserved areas.

Funding details Application types: New

Expected total available funding in FY 2026: $5,400,000

Expected number and type of awards: 18 Grants

Funding range per award: Up to $300,000

We plan to fund awards in five 12-month budget periods for a total five- year period of performance from 09/01/2026 to 08/31/2031.

Have questions?

Go to Contacts and

Support.

Key facts

Opportunity name:

Telehealth Nutrition

Services Network Grant

Program number:

version:

Initial

93.468

Key dates

06/05/2026 webinar:

deadline:

07/08/2026

08/03/2026

09/01/2026

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

Eligibility Domestic organizations can apply, including any:

• Public or private, non-profit or for-profit entity.

• Domestic faith-based or community-based organization.

• Tribal (governments, organizations).

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

• State governments.

• County governments.

• City or township governments.

• Special district governments.

• Independent school districts.

• Public and State controlled institutions of higher education.

• Native American tribal governments (Federally recognized).

• Public housing authorities/Indian housing authorities.

• 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 other than small businesses.

• Small businesses.

• Unrestricted (i.e., open to any type of entity above), subject to any clarification in text field entitled “Additional Information on Eligibility”.

Additional information on eligibility

“Domestic” means the 50 states, the District of Columbia, the Commonwealth of Puerto

Rico, the Northern Mariana Islands, American Samoa, Guam, the U.S. Virgin Islands, the

Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.

Individuals are not eligible applicants under this NOFO.

Other eligibility criteria

Geographic requirements

You can use funds under this award for an originating site* only if the originating site is located in a rural and medically underserved area (i.e., a rural area that is also a frontier community, medically underserved area, or has a medically underserved population). Originating sites in rural areas that are not also either frontier communities, medically underserved areas, or have medically underserved populations, may not be funded through this award. Originating sites in urban areas may not be funded through this award.

You can use funds under this award for any distant site, regardless of location.

To determine whether a site is located in a rural and medically underserved area, please refer to the HRSA-supported Rural Health Information Hub – Ami I Rural? Tool

(RHIhub Tool). This page allows you to search by county or street address.

• A site is located in a rural area if the RHIhub Tool indicates that it is in a Federal

Office of Rural Health Policy-defined rural area, meaning a nonmetropolitan county or a rural census tract of a metropolitan county.

• A site is located in a frontier community if the RHIhub Tool indicates that it is in a frontier and/or remote area.

• A site is located in a medically underserved area (MUA) if the RHIhub Tool indicates that it is in a MUA or a medically underserved area—governor’s exception (MUA-GE).

• A site has a medically underserved population (MUP) if the RHIhub Tool indicates that it has a MUP or a medically underserved population—governor’s exception

(MUP-GE).

Your application must propose to use at least 50% of award funding for activities in rural areas.

*For quick reference, telehealth services have an originating site and a distant site. The originating site is the location of the patient receiving medical services through telehealth. The distant site is the location where the physician or practitioner is providing services through telehealth. HRSA acknowledges the temporary Medicare policy changes in place.

https://www.ruralhealthinfo.org/am-i-rural#/ https://telehealth.hhs.gov/providers/telehealth-policy/telehealth-policy-updates

Composition of the telehealth network

To be eligible for the award, you must demonstrate that you will provide services through a telehealth network. The entities participating in the telehealth network may be nonprofit or for-profit. The telehealth network must include at least one distant site and at least two of the following entities as originating sites. Additionally, at least one originating site must be a community-based health care provider, and all originating sites must be located in rural and medically underserved areas:

• All types of community health centers or other Federally Qualified Health Centers.

• Health care providers, including pharmacists, in private practice.

• Entities operating clinics, including Rural Health Clinics.

• Local health departments.

• Nonprofit hospitals, including Critical Access Hospitals.

• Other publicly funded health or social service agencies.

• Long-term care providers.

• Providers of health care services in the home.

• Providers of outpatient mental health services and substance use disorder services, and entities operating these facilities.

• Local or regional emergency health care providers.

• Institutions of higher education.

• Entities operating dental clinics.

• Providers of prenatal, labor care, birthing, and postpartum care services, including hospitals that operate obstetric care units.

Telehealth networks are encouraged to include direct primary care clinics in their telehealth networks.

These community-based health care providers may also utilize mobile health units that are part of their organization/facility. The applicant organization must participate in the network, and all entities participating in the network must be owned domestic entities.

Networks that fulfill certain criteria will get funding preference. Please see the funding preference section.

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.

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 purpose of the Telehealth Nutrition Services Network Grant Program is to integrate nutrition services into primary and specialty care settings using telehealth technology through telehealth networks.

The program’s goal is to support evidence-based projects that expand telehealth access to nutrition services through telehealth networks in rural and medically underserved areas. In this NOFO, a rural and medically underserved area is a rural area that is also a frontier community, medically underserved area, or has a medically underserved population.

The program will:

• Improve access to integrated nutrition services (nutrition screening and treatment) in primary and specialty care settings.

• Expand and improve the quality of nutrition-related health information available to health care providers, patients, and their families.

To do this, you are strongly encouraged to propose established telehealth networks to provide nutrition services that are integrated into primary and specialty care for groups with health challenges. We aim to support telehealth networks and strategies that improve access to nutrition screenings, registered dietitians, and MNT. Through this program, telehealth programs and their networks will connect registered dietitians to primary and specialty care providers so the target population can access nutrition services. Telehealth networks will also strengthen how nutrition services are delivered and expanded, including by increasing the use and availability of community health workers and other providers.

Funding opportunity goals

• Program results will include:

◦ Expanding nutrition services to rural and medically underserved communities in primary and specialty care settings.

◦ Increasing the capacity of telehealth networks.

◦ Developing innovative strategies, methods, or tools to integrate nutrition services into primary and specialty care settings.

◦ Generating data to help evaluate the program and activities.

https://www.cancer.gov/publications/dictionaries/cancer-terms/def/medical-nutrition-therapy

Background HRSA’s Office for the Advancement of Telehealth (OAT) supports the advancement of telehealth by improving access to quality health care through integrated telehealth services.

The Telehealth Nutrition Services Network Grant Program builds on HRSA’s experience supporting telehealth, telehealth network models, and evidence-based initiatives. This program allows telehealth networks to expand telehealth nutrition services through collaboration among distant-site professionals, originating-site clinical providers, and community-based partners.

Nutrition plays a critical role in preventing, managing, and treating many of the most common and costly chronic diseases in the United States, including obesity, diabetes, cardiovascular disease, hypertension, kidney disease, and cancer. About 75% of adults have one or more chronic diseases, and more than half have two or more. Poor nutrition is a major risk factor for chronic diseases that lead to more health care use, avoidable hospital stays, and lower quality of life. Evidence-based nutrition care, including medical nutrition therapy (MNT) provided by registered dietitians, can improve clinical outcomes, help manage diseases, and decrease health care costs.

Despite the benefits of nutrition care, many people still have limited access to registered dietitians and nutrition services, especially those living in rural and medically underserved communities. Many rural areas often experience shortages of health professionals along with barriers such as geographic isolation, transportation challenges, and less access to specialty services. Integrating nutrition care into primary and specialty care settings is critical to address these challenges and the chronic disease burden, while advancing whole-person, team-based care.

Telehealth plays a key role in expanding access to nutrition care. Telehealth nutrition services can reduce travel burdens, increase available appointments, and help patients stay connected to care, particularly for patients with chronic diseases requiring nutrition management. Through telehealth technologies, registered dietitians can provide timely, evidence-based nutrition services across geographic areas, collaborate with primary and specialty care providers, and engage patients in personalized nutrition counseling and follow-up. Community health workers contribute to nutrition care by helping patients navigate care, providing education, collecting information, and connecting patients with health services.

This program aims to include innovative strategies that integrate high-quality nutrition care through telehealth into primary and specialty care to help prevent and manage chronic diseases.

https://www.cdc.gov/chronic-disease/data-research/facts-stats/index.html https://www.cdc.gov/chronic-disease/about/index.html https://www.cdc.gov/chronic-disease/about/index.html https://www.cdc.gov/cdi/indicator-definitions/npao.html https://www.cdc.gov/cdi/indicator-definitions/npao.html https://www.ruralhealthinfo.org/topics/health-care-workforce#workforce https://www.ruralhealthinfo.org/topics/health-care-workforce#workforce https://www.ruralhealthinfo.org/topics/health-care-workforce#workforce https://telehealth.hhs.gov/providers/best-practice-guides/telehealth-nutrition-care-and-services/getting-started-telenutrition https://telehealth.hhs.gov/providers/best-practice-guides/telehealth-nutrition-care-and-services/getting-started-telenutrition https://telehealth.hhs.gov/providers/best-practice-guides/telehealth-prevention-and-management-chronic-disease

Activities should advance one or more of the Make America Healthy Again (MAHA) priorities through telehealth nutrition services network. Strategies to consider include work that:

• Addresses root causes of poor health.

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

• Expands nutrition programs or chronic disease prevention.

• Supports early childhood development or autism services.

• Prepares systems for value-based care.

• Partners with tribal health systems.

Applicants may consider including organizations with telehealth accreditation that may help ensure that programs meet standards, evidence-based best practices, and regulations.

Program requirements and expectations Telehealth Nutrition Services Network Grant Program recipients will enhance access to, coordinate, and improve the quality of health care and nutrition services. Projects must expand and improve the quality of nutrition-related health care and information for health care providers, patients, and their families.

Chronic disease nutrition interventions

If funded, you must deliver nutrition services for prevention and treatment in support of the MAHA initiative that includes MNT, individual nutrition counseling, group classes and/or nutrition screenings. Your nutrition care program must provide nutrition interventions targeting at least two chronic diseases, such as:

• Autoimmune disorders.

• Asthma.

• Allergies.

• Cancer.

• Cardiovascular disease.

• Diabetes.

• Mental health.

• Neurodevelopmental disorders.

• Obesity.

You should use remote patient monitoring (RPM), which can include AI-driven RPM or other telehealth technology, to assess, evaluate, and track patient progress.

The program must incorporate community health workers to expand nutrition access and improve health outcomes for the targeted population. You must integrate nutrition services into an interdisciplinary care team made of health professionals such as:

• Registered dietitians (at least 1 full-time equivalent (FTE)).

• Nutrition professionals.

• Community health workers (at least 0.5 FTE).

• Physicians.

• Nurses.

• Other relevant health professionals.

You must ensure that the total combined effort for any individual does not exceed 1.0

FTE across all federal awards.

Administrative requirements

You will be required to work with a HRSA-funded technical assistance provider during the period of performance. We will provide additional guidance on technical assistance during the period of performance.

You must, when possible, collaborate to provide services with public, private organizations, centers, or programs that receive federal or state funding to offer telehealth services or related activities.

You are encouraged to evaluate the integration of nutrition services into primary and secondary care settings and the effectiveness of your services.

You will be required to report data requested by OAT, including in HRSA’s Data

Collection Platform (DCP), that captures data to monitor project progress. This could include, for example, the number of telehealth encounters or number of patients receiving telehealth. OAT will provide more information about this requirement during the project period. You will not be required to provide performance measures and results on a form that is not Paperwork Reduction Act approved.

Your telehealth network must bill all services covered by a third-party reimbursement plan and make every effort to obtain payments throughout all five years of the period of performance. If you provide services that could be reimbursed by Medicaid, Children’s Health Insurance Programs (CHIP), Medicare, or private insurance, you must be able to develop a sustainable network through your state’s reimbursement environment. Find more information about state-specific telehealth reimbursement at the Center for Connected Health Policy’s Compare State Policies page.

Note: You may not deny services to any individuals because they cannot pay. You may allocate award funding to pay providers for telehealth services, only if you first document that you attempted to get third-party reimbursement and/or explain why it https://www.cchpca.org/compare/ is not possible to receive reimbursement. The HRSA project officer will have to approve any payments to providers for telehealth services.

During your project, you must work with the network members that you list in your application. If you do not, we may reduce your award amount in later budget periods.

You will be required to submit memoranda of agreement (MOA) that describe how you will work with each telehealth network member. Each MOA should be signed by an authorized official from the originating sites and distant site with authority to commit the site to the project. HRSA will provide detailed instructions about this requirement after September 1, 2026. If you do not bring on board network members as indicated in the application, you may receive a decrease in your award amount.

You are required to consult your State Office of Rural Health (SORH) or other appropriate state entity prior to submitting your application. The SORH may be able to provide consultations; share information on model programs and data resources;

provide technical assistance; or support information sharing.

Statutory authority 42 U.S.C. § 254c-14(d)(1) (§ 330I(d)(1) of the Public Health Service Act) https://uscode.house.gov/view.xhtml?req=(title%3A42%20section%3A254c-14%20edition%3Aprelim)

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.

https://www.ecfr.gov/current/title-2/part-200

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.

Program-specific statutory or regulatory limitations

Use of funds

You may use funds received through this award for salaries, equipment, and operating, or other costs. This includes the costs of:

• Developing and delivering telehealth nutrition services that enhance access to community-based health care services in rural areas, frontier communities, or medically underserved areas, or for medically underserved populations.

• Developing and acquiring, through lease or purchase, equipment that furthers the objectives of the program.

• Developing and providing distance education that enhances access to care in rural areas, frontier communities, or medically underserved areas, or for medically underserved populations.

• Mentoring, precepting, or supervising health care providers and students seeking to become health care providers in a manner that enhances access to care in the target areas and communities or for the target populations.

• Developing and acquiring instructional programming.

• Communicating medical data and maintaining equipment.

• Compensating specialists, including travel expenses.

• Paying health care providers who provide telehealth services, if third-party payment is not available.

https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf 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.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)

• Developing projects to use telehealth technology to facilitate collaboration between health care providers.

• Collecting and analyzing usage statistics and data to document the cost-effectiveness of the telehealth services.

• Carrying out other activities to achieve the objectives of this program, as approved by HRSA.

Prohibited uses of funds

You cannot use funds:

• To acquire real property.

• For expenditures to purchase or lease equipment, to the extent that those expenditures would exceed 20% of the total grant funds.

• To purchase or install transmission equipment.

• To pay for any equipment or transmission costs not directly related to the purpose of this program.

• To purchase or install general purpose voice telephone systems.

• For construction.

• For expenditures for indirect costs (as determined by the Secretary), to the extent that the expenditures would exceed 15% of the total grant funds.

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.

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.

https://www.hrsa.gov/grants/manage-your-grant https://www.ecfr.gov/current/title-2/section-200.307

Step 2:

Get Ready to Apply

Get registered 19

Find the application package 19

Application writing help 20

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-26-076.

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 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/search-grants

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.

Join the webinar For more information about this opportunity, join the webinar. More information on the

HRSA-26-076 webinar will be posted at a later date to the documents tab in Grants.gov.

We recommend that you “Subscribe” to the NOFO on Grants.gov to receive updates when we post documents.

We will record the webinar.

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 22

Application contents and format 24

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

I form Included in

Project narrative attachment form

Budget narrative attachment form

Attachments nsert each in the Attachments form in this order.

2. Staffing plan and job descriptions

4. Multi-year budgets, fifth-year budget No

6. Project organizational chart

No

8. Network site commitment

10. Proof of existing telehealth services No

Component page limit*?

12-15. Other relevant documents Yes

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

Form Submission requirement

Application for Federal Assistance (SF-424) With application.

Project Abstract Summary Form With application.

Grants.gov Lobbying Form With application.

Disclosure of Lobbying Activities (SF-LLL), optional With application.

Project/Performance Site Location(s) With application.

Budget Information for Non-Construction Programs (SF 424A) With application.

Key Contacts 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: 60

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: 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

In this section, you will describe the purpose, goals, objectives, activities, and expected outcomes of the proposed project.

You should:

• Provide a brief overview of the project, telehealth network members, and target population.

• Briefly describe your collaborative plans for expanding nutrition services, such as providing MNT for chronic disease management and prevention, individual counseling, group counseling, or nutrition screening.

• Specify the nutrition services and chronic diseases that you will address and support through this program. You must address at least two chronic diseases in the proposed service area.

See a suggested list of chronic diseases in the program description.

Need

See merit review criterion 1: Need

In this section, you will detail the needs of the populations you will serve. Include citations referencing federal, state, or local data, if possible. Where data is limited, note this and use other means to document the needs assessment.

You should:

• Describe the target population and their unmet health needs.

• Identify rural and medically underserved patient groups, including their demographics, who face significant barriers to health and health care.

◦ Describe this population’s nutrition-related health challenges and unmet needs, including chronic disease prevalence, health outcomes, and key nutrition issues. Explain their impact on patients.

https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf

◦ Explain the opportunity for telehealth nutrition services within the target population. Include existing health care delivery support and the proposed number of rural and medically underserved originating sites and patients you will serve.

• Outline the community or organization needs you plan to address.

◦ Detail the availability of nutrition services in your organization and/or community.

◦ Describe the nutrition providers and community organizations located in and near the service area. Include their role in meeting nutrition needs.

◦ Explain how the project will benefit and support the community, organization, and providers.

◦ Describe local support for the project and how you will involve the community in development and ongoing operations of your project. This could include rural community members; patients; representatives of local, regional, tribal, and/or state governments; and non-government organizations. Explain how they will be involved in implementing your project.

• Discuss any relevant barriers to nutrition care, telehealth services, or other challenges that may impact your ability to develop or implement the project.

Approach

See merit review criterion 2: Response

In this section, you will describe how you will address the stated needs and meet the program requirements and expectations described in this funding opportunity.

You should:

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

• Explain how your project will meet the needs identified for the target population, including any subpopulations. Include a map of the service area in Attachment 9:

Map of service area.

• Identify the selected telehealth sites and explain why you chose them, using supporting data. Describe plans to collaborate with local providers to maximize patient reach and encounters.

• Explain how you will integrate nutrition services provided through telehealth into primary and specialty care settings at the distant and originating sites to prevent and manage chronic diseases.

◦ Detail how the telehealth program and its network will connect registered dietitians to primary and specialty care providers to expand access to and improve the quality of telehealth nutrition services for the target population.

◦ List the disciplines of the health care team that you will integrate telehealth nutrition services into.

◦ Describe the nutrition services (screening, treatment, and prevention) and chronic diseases you will address, the settings and specialties into which you will integrate them, the technology you will use, and how these services will help prevent and manage chronic diseases with telehealth. See the Chronic

Disease Nutrition Interventions section.

◦ Specify how you will use RPM, AI-driven RPM, or other telehealth technologies to assess and track patient progress, conduct nutrition screenings, and deliver MNT to prevent and treat chronic diseases. Explain how the technology supports accurate, cost-effective, user-friendly care, meets federal and industry standards, integrates into care practices, avoids redundancy, and works with telehealth platforms, nutrition software, and electronic health record (EHR) systems.

◦ Include a plan for how you will track and address changes in demand for nutrition services over time.

• Explain strategies to expand access to nutrition screenings and treatment by improving access to nutrition professionals, including registered dietitians and

MNT providers, and increasing the use of community health workers and other providers to strengthen service delivery and outreach.

• Identify key stakeholders.

◦ Explain their roles and how you will involve them in planning and implementing your project.

◦ Describe how you will work with your State Office of Rural Health.

• Detail strategies for training and outreach for patients, providers, and the community, such as staff training, information sharing, and patient health education.

• Describe how you will reach different patient communities through innovation in the provider network, including by integrating dietitians, pharmacists, and direct primary care physicians, particularly in areas that lack traditional health care infrastructure.

• Describe the reimbursement landscape for telehealth nutrition services in the service area, its impact on fee-for-service billing, and plans to optimize reimbursement across insurance types and support uninsured patients.

• Clearly demonstrate how providers will implement a promising nutrition care model that includes MNT and nutrition screening, and that strengthens the existing health care infrastructure.

• Describe your plan to collect and evaluate program and nutrition-related data to assess the impact of telehealth nutrition services on the target population, including nutrition measures and health outcomes for chronic diseases.

• Include a plan to distribute reports, products, and project outcomes to your target population, community members, and stakeholders.

• Describe how you will sustain the program beyond the period of performance.

High-level work plan

See merit review criteria 2: Response and 4: Impact

Share how you will meet each of the objectives during the five-year period of performance. You must also include a work plan in a table format in Attachment 1:

Work Plan that aligns with the work plan you describe in this section.

You should describe your work plan, including:

• A brief summary of the purpose, goals, objectives, and activities to expand and integrate nutrition services to prevent and manage chronic diseases. These goals should connect directly to the Need section.

◦ A timeline for planning and implementing the proposed activities during the project’s five-year funding cycle, showing your ability to start upon receipt of the award.

◦ Who will oversee each activity.

◦ How you will collaborate with network members, partners, and key stakeholders to plan, design, and implement the project.

• State the telehealth nutrition services you will provide and to whom you will provide them. Identify when each site will start receiving telehealth nutrition services.

• Identify the overarching evidence-based, evidence-informed, or innovative models that you will use to develop and implement the program.

• Describe how you will monitor progress for each activity by measuring performance, products or deliverables, outcome measures, and/or benchmarks.

• Detail how you will share expected results, outcomes, and/or impact on the target population, including any subpopulations. For example, results may be related to changes in chronic disease rates, improvements in health outcomes, or amount of nutrition services provided.

• Plan to comply with Section 508 of the Rehabilitation Act of 1973, as amended.

This section should reflect the information in the Approach section of the project narrative. Include a more detailed work plan in a table format in Attachment 1: Work Plan.

Resolving challenges

See merit review criterion 2: Response

Explain how you will address challenges or barriers that may come up during the project period. You should:

• Discuss current or expected challenges and barriers you may encounter when implementing telehealth nutrition services. Examples may include partnership or network collaboration, staffing, technology, community challenges, or sustainability.

• Explain how you will resolve each of the challenges and barriers.

Performance management

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

Describe how you will effectively collect, monitor, and evaluate project results and:

• Demonstrate the capacity and ability of your organization and network members to collect and report data on progress, performance, impact, and outcomes, including all measures required by the Office for the Advancement of Telehealth.

• Describe how you will use data to monitor, evaluate, and improve your project.

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

• Explain how you will receive input from the service area and target population on project data collection.

See the Reporting section for more information.

Sustainability

See merit review criterion 4: Impact

You will be expected to sustain project elements that deliver services and improve practices and outcomes for the target population. Discuss your plan to maintain the proposed activities and services after federal funding ends.

• Identify strategies and how you will sustain telehealth nutrition services.

• Include potential sources of support for achieving long-term sustainability after the five-year period of performance.

• Discuss challenges that you will likely encounter in sustaining the program and how you will resolve each challenge.

Organizational information

See merit review criterion 5: Resources and capabilities

You should describe the organizational structure of your organization and the proposed telehealth network and its ability to implement activities in the work plan.

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

Explain how they support your ability to carry out the program requirements.

Complete Attachment 6: Project organizational chart.

• Describe the organizational and staffing capacity to implement and sustain the project. Include a staffing plan and job descriptions for key faculty and staff in

Attachment 2: Staffing plan and job descriptions.

• Describe the organizations you will partner with, what type of collaboration it is, and how you will specifically work together to meet program goals and objectives.

Include additional information in Attachment 8: Network site commitment.

• Detail the key project staff, including their roles, qualifications, and FTE levels for the program. HRSA recommends you have at least 2.0 total FTEs with the following:

◦ At least 0.25 FTE dedicated to the project director, who provides strategic oversight and oversees daily operations, including administrative, technical, and financial responsibilities.

◦ At least 1 FTE for one or more registered dietitians to support nutrition services and provide MNT.

◦ At least 0.50 FTE for a community health worker. Describe how they will facilitate nutrition education and coordinate with the sites, providers, and patients.

• In Attachment 11: Other U.S. Department of Health and Human Services (HHS) awards, describe your organization’s history of and ongoing federally funded activities.

• Discuss how you will follow the approved plan, track all federal funds, and record all costs to avoid audit findings.

• Provide evidence of institutional commitment to the project at your organization.

Telehealth network site identification

Provide additional information for each network member site. You will also submit other information in Attachment 7: Rural and medically underserved site identification.

• Provide the total number of sites, the number of originating sites and distant sites, and the number of urban (distant) and rural sites. Indicate whether the site is https://telehealth.hhs.gov/documents/Community_Health_Workers_07-30-24.pdf located in a HRSA-designated rural county or rural census tract, using the Rural

Health Grants Eligibility Analyzer.

• Describe how many distant or originating sites will be new to the network, and how many sites will be added to the network, and when they will be added.

• Identify how many counties are represented and the population of the counties served by sites using the most recent census or HRSA data.

• Detail how many and the types of facilities you will use, including if they are in a

Health Professional Shortage Area (HPSA, partial HPSA, MUA), or MUA-GE, as determined by the RHIhub Tool.

• Indicate whether and how many network sites have committed to the project.

Include additional information in Attachment 8: Network site commitment.

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 [PDF] 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.

• Budget and budget narrative for multi-year awards:

◦ Present each network member site’s name (with the applicant site first), each site’s corresponding costs, and a thorough explanation of what the costs will be used for. Label each site as being distant or originating and rural or urban.

You may identify a range of partners in your network, such as local health https://data.hrsa.gov/topics/rural-health/rural-health-eligibility https://data.hrsa.gov/topics/rural-health/rural-health-eligibility https://www.ruralhealthinfo.org/am-i-rural#/ https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf 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) departments, institutions of higher education, and other community-based or clinical partners.

◦ Confirm that your application proposes to use at least 50% of award funding for activities in rural areas.

◦ Under Personnel, list each position and the person’s name, with annual salary, FTE, percentage of fringe benefits paid, and salary charged to the award for each site.

◦ List equipment under the site where the equipment will be used. List the types of equipment to be funded at each site. Only list equipment expenditures here. Personnel costs for equipment installation should be listed in the “Other” category. Expenditures to purchase or lease equipment are limited to 20% of the total grant funds.

• List clinician payments in the “Other” category. See Program requirements and expectations – Administrative Requirements.

• Include travel funds for at least two staff members to attend at least one annual recipient meeting.

• Include information on the source and amount of non-federal funds you will provide for the project.

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

Your work plan must contain all required elements for the project and be in a table format. It should include a timeline for all five years of the award, list the steps for each activity, and identify the individual and/or organization responsible for each activity.

• Describe the steps and activities you will carry out during the project, using a clear timeline that shows each activity, who is responsible, and when it will be completed.

• Make sure the work plan lines up with the project’s goals and objectives and shows the goals, objectives, strategies, activities, how progress will be measured, and outcome indicators.

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

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