HRSA-26-082 Final.pdf

Notice of Funding Opportunity

Application due 07/24/2026

Federal Office of Rural Health Policy Community-Based Division

Rural Health Network Advancement Program Opportunity number: HRSA-26-082

Contents Before you begin 3

Basic information 5

Eligibility 6

Program description 12

Award information 17

Get registered 20

Find the application package 20

Application writing help 21

Application checklist 23

Application contents and format 25

Application review 46

Selection process 54

Award notices 55

Application submission and deadlines 57

Other submissions 58

Post-award requirements and administration 60

Reporting 64

Appendices 68

Endnotes 73

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 07/24/2026.

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 12

Award information 17

Basic information Health Resources Services Administration

Federal Office of Rural Health Policy

Community-Based Division

Supporting integrated health care networks and improving the quality of basic health care services to strengthen rural health care systems.

Summary The Rural Health Network Advancement Program (RHNAP) supports integrated health care networks that:

• Collaborate to achieve efficiencies.

• Expand access to, coordinate, and improve the quality of basic health care services and associated health outcomes.

• Strengthen the rural health care system as a whole.

Funding details Application Types: New

Expected total available funding in FY 2026: $3,000,000

Expected number and type of awards: 6 grants

Funding range per award: Up to $500,000

We plan to fund awards in four 12-month budget periods for a total four-year period of performance from 09/30/2026 to 09/29/2030.

The program and awards depend on the appropriation of funds and are subject to change based on the availability and amount of appropriations.

Have questions?

Go to Contacts and Support.

Key facts Opportunity name:

Rural Health Network number:

version:

Initial

93.912

Key dates

06/24/2026 webinar:

See Webinar Section deadline:

07/24/2026

08/01/2026

09/30/2026

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

Eligibility 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.

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

• 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 Eligible applicants include domestic public or private, non-profit or for-profit entities including:

• Domestic faith-based and community-based organizations.

• Tribes and tribal organizations.

• Federally Qualified Health Centers (FQHCs).

• Community health centers.

• Rural Health Clinics (RHCs).

• Hospitals.

• Rural Emergency Hospitals (REH).

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, it will have impacts on the eligibility and scoring of your application.

State Office of Rural Health

• You have consulted with your State Office of Rural Health (SORH) regarding your intent to apply to this program, as evidenced by required documentation provided under Attachment 5: Documentation from State Office of Rural Health.

• If you are from the U.S. territories and do not have the functional equivalent of a SORH, you are still eligible to apply and document this by indicating your territory does not have a functional equivalent of a SORH under Attachment 5 to complete documentation for requirement.

Non-duplication of federal funding

• To be eligible to receive a grant, the applicant may not previously have received an award (other than a grant for planning activities) for the same or a similar project under 42 U.S.C. 254c(f) (330A(f) of the Public Health Service Act).

• Funding under this program must be used for Rural Health Network Advancement Program (HRSA-26-082) activities that are clearly non-duplicative, coordinated and complementary of other federally funded activities.

https://nosorh.org/

• Failure to respond to non-duplication of federal funding information requested in Attachment 10 may result in your application being marked ineligible.

Network requirements For the purposes of this award, we define networks as a formal and legal organizational agreement among three or more separately owned health care providers.

Health care providers refers to entities that provide or support the delivery of health care services.

Rural health networks are further defined as having a documented formal arrangement detailing how the network acts on behalf of its member hospitals and clinics.

Network members refers to the organizations within a network.

Eligible applicants must meet all network requirements detailed in this section. Failure to provide complete responses to all required network documentation may result in your application being marked ineligible.

These requirements include:

• You must represent a network composed of members (including the applicant organization) comprised of three or more health care providers. This includes:

◦ A minimum of 3 or more separately owned network members with their own EIN/UEI number, unless an exception is requested.

◦ The EIN/UEI number for applicant organization and each network member must be provided in required documentation under Attachment 11.

• You must prove you have experience serving rural medically underserved populations.

◦ This is evidenced by describing the buy-in from the rural community or communities your proposed project plans to serve in your responses throughout your project narrative.

▪ Your network will use award funds to serve only HRSA-designated rural areas, as evidenced in project narrative and Attachment 6: Map of Service Area.

▪ You clearly show your network meets all network composition requirements in your project narrative and Attachment 7: Network Documentation and Attestation provided in your application.

Specifically, your network composition includes:

1. Existing governance structure: Has an existing governance structure with a proven history of collaboration.

⁃ Meeting this requirement is evidenced by providing the required network documentation and attestation.

⁃ This proves your network satisfies the network composition requirements requested in Attachment 7: Network Documentation and Attestation.

2. Rural network composition: Represents a network comprised of at least 66% or two-thirds of network members directly involved in the implementation of the proposed project as physically located in a HRSA designated rural area.

⁃ Documentation providing the geographic location and service area for each network member directly involved in the proposed project must be provided under Attachment 8.

The documentation required ensures that applicants prove that they are an established, functioning network with a history of collaboration and the legal and organizational structure necessary to achieve measurable advancement.

For rural health care entities seeking to become a rural health network, the Rural Health Network Planning Program (RHNP) can provide support to help hospitals and clinics take the initial steps toward that goal. The RHNP is a separate HRSA program and available regularly pending available budget. The Rural Health Network Advancement Program Notice of Funding Opportunity is focused on supporting existing networks already in operation and helping them evolve to the next logical step in their development.

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.

• Selects more than one funding track or submits multiple applications that select different funding tracks.

https://www.hrsa.gov/grants/find-funding/HRSA-25-037 https://www.hrsa.gov/grants/find-funding/HRSA-25-037

Application limits Generally, you may not submit multiple applications under the same unique entity identifier (UEI) number or employer identification number (EIN). However, we recognize a trend toward consolidation within the rural health care industry and the possibility that multiple organizations may share the same UEI or EIN with their parent organization.

You may only submit multiple applications under the same UEI or EIN if each application proposes a distinct project. You must also submit Attachment 11: EIN/UEI exception request (if applicable) with your application. We will only review your last validated application for each distinct project before the deadline.

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

If you provide insufficient information in Attachment 11, or submit multiple applications that are nearly identical, we will only accept the last on-time submission associated with the EIN/UEI number. If you submit multiple applications that select different funding tracks, we will only accept the last on-time submission associated with the EIN/UEI number in this case as well.

Tribal exception HRSA is aware that tribes and tribal organizations may not meet the EIN or UEI requirement of this NOFO. Tribes and tribal organizations that only have one EIN or UEI or cannot show that the network is composed of at least three unique entities may request a tribal exception. Applicants must request a tribal EIN exception in Attachment 12: Tribal EIN/UEI exception request.

Cost sharing This program has no cost-sharing requirement. If you choose to share in the costs of the project, we will not consider it during merit review. 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 Designed as a pilot program, RHNAP aims to provide startup funding to support existing Rural Health Networks. The goal is to expand and evolve their work to meet the growing needs of their rural member hospitals and clinics.

This NOFO provides support for Rural Health Networks to:

• Support the advancement of clinical service lines.

• Support operational integration to improve coordinated care delivery.

• Preserve access to essential services.

• Strengthen financial and workforce sustainability.

A key part of the RHNAP is to enhance network operations and financial viability in a structure that allows networks to maintain local autonomy and responsiveness to community needs.

RHNAP intends to support Rural Health Networks at their current stage of development and provides targeted support for their advancement towards sustainability.

You must show how RHNAP funding will serve as a catalyst for measurable advancement, clearly describing their current state, desired future state, and how RHNAP grant funds will bridge that gap to achieve meaningful progress in network integration, service delivery, and/or financial sustainability. Applications will be evaluated in the context of each network’s current state of development.

RHNAP is a pilot program. Information learned from this initiative will inform future funding opportunities and guide FORHP’s ongoing support to Rural Health Networks.

Funding opportunity goals

• Provide seed funding for networks to establish or strengthen clinical service lines to increase volume and revenue while also meeting local needs of the network’s hospitals and or clinics.

• Provide funding for networks to expand operational services and infrastructure across network members to achieve economies of scale and bring efficiencies to the network’s hospitals and clinics.

• Implement sustainable activities and services to improve the financial viability of the network and its hospital and clinics.

Background In response to the growing pressures for expanded delivery of health care services in rural areas, the Rural Health Network Advancement Program aims to support existing Rural Health Networks in implementing projects that advance clinical or operational integration to improve coordinated care delivery, preserve access to essential services, and strengthen financial and workforce sustainability in rural areas.

For over three decades, Rural Health Networks have been and continue to be a vital strategy to address challenges rural health providers face in their respective communities, including workforce shortages, access issues, financial instability and limited economies of scale.[1],[2] Since then, the rural health care landscape has continued to become more complex with increased administrative burden, payer complexity, and further capital constraints. According to a recent report from the HHS Assistant Secretary for Planning and Evaluation, rural hospitals face unique challenges that make them especially vulnerable to closure or conversion to outpatient-only facilities. While 8% of rural hospitals have closed or converted since 2010, only 3.5% of urban hospitals have done so during the same period. [3]

Program requirements and expectations You must meet all the requirements stated in the Eligibility and Other Eligibility criteria sections.

• You are also expected to meet all program requirements and expectations.

• Successful applicants clearly demonstrate responsiveness to the program requirements and expectations outlined in this section in responses provided in the application project narrative.

• Failure to respond to these requirements will impact your application’s score.

Funding Tracks Through two funding track options, applicants are encouraged to focus on projects that:

• Advance coordination of rural health care delivery.

• Enhance the financial sustainability of Rural Health Networks.

You must select one of the two funding tracks to apply for the Rural Health Network Advancement Program. Funding track selection must be provided in your Attachment 9: Funding Track Participation Statement.

If you select more than one funding track, you will be considered non-responsive to the NOFO and ineligible for review.

If you submit multiple applications that select different funding tracks, we will only accept the last on-time submission associated with the EIN/UEI number.

Track #1: Operational Track Operational Track applicants can request up to $500,000 a year, for the four-year period of performance.

Successful Operational Track applicants are expected to meet all network composition requirements and successfully respond to Operational Track requirements throughout the project narrative.

The Operational Track funds projects that improve the financial viability, efficiency, and infrastructure of rural networks through shared operational services and integration strategies.

Goals include:

• Demonstrating enhanced billing and revenue across member organizations.

• Shared savings.

• Demonstrated improvements in payer negotiation outcomes.

To accomplish Operational Track goals, activities may include, but are not limited to:

• Development or expansion of centralized billing and coding infrastructure to increase revenue capture.

• Implementation of shared human resource or staffing models.

• Joint contracting with commercial or public payers to improve reimbursement rates.

• Establishment of data analytics platforms to:

◦ Track service use.

◦ Identify gaps.

◦ Inform strategic planning efforts.

• Enhanced coordination across electronic health record platforms and support for health information exchange.

• Attainment of a Utilization Review Accreditation Commission (URAC) Certification, including a Clinically Integrated Network (CIN) Accreditation.

• Putting in place revenue cycle management strategies to enhance:

◦ Billing accuracy.

◦ Reimbursement processes.

◦ Financial sustainability.

Track #2: Clinical Services Track Clinical Services Track applicants can request up to $500,000 a year, for the 4-year period of performance.

Successful Clinical Services Track applicants must meet all network composition requirements and successfully respond to Clinical Services Track requirements throughout the project narrative.

If you are selecting the clinical services track, you must also indicate your project’s focus area under this track in Attachment 9: Funding Track Participation Statement.

The Clinical Services Track funds projects that establish or strengthen clinical service lines, expand access to care, and improve clinical and financial sustainability. It is designed to enable networks to meet emerging needs through sustainable service expansion that can be sustained through future billing and reimbursement. Successful Clinical Service Track projects are representative of community needs and realistic for long-term service retention.

Clinical Services Track goals include:

• Increased patient volume.

• Increased service utilization.

• Improved quality measures.

• Improved health outcomes.

• New or sustained revenue streams for participating providers.

◦ These should also meet quantified patient needs in the network’s service area.

You should also seek to reduce patient bypass of patients traveling to other sources of distant care that could ideally be provided locally.[4],[5],[6]

To accomplish Clinical Services Track goals, activities may include, but are not limited to:

• Establishing new clinical service lines.

◦ These include but are not limited to service lines for behavioral health, oncology/infusion, cardiology, maternal health, pulmonary and cardiac rehabilitation.

• Expanding workforce capacity and acquiring resources necessary to establish or strengthen clinical service lines.

• Implementing evidence-based quality improvement initiatives.

• Establishing software and technology platforms that support care provision.

◦ These include telehealth, electronic health records, or care coordination systems.

• Support for peer and affinity groups related to improving clinical services.

• Sharing of specialty clinical services through rotating specialists for member hospitals and clinics.

Aligning with HHS priorities If applicable, applicants electing the operational track should note where their efforts align with HHS priorities related to participating in value-based care models.

If applicable, applicants selecting the Clinical Services Track should also note where their proposed activities align with HHS priorities including any:

• Focus on nutrition.

• Disease prevention.

• Fighting chronic disease

• Mental health.

• Expanding access to primary care.

• Strengthening services to tribes.

Program data collection

• Successful award recipients will be required to report measures to a centralized program outcomes reporting system.

• A final set of measures will be provided by FORHP post-award.

◦ To help prepare for data collection, consider the draft measures included in Appendix C.

• All recipients (Operational and Clinical Services Tracks) will work closely with technical assistance (TA) providers throughout the four-year period of performance. The targeted TA will assist award recipients with achieving desired project outcomes, sustainability, and strategic planning, and will ensure alignment of the awarded project with the RHNAP goals. The TA is provided to award recipients at no additional cost. If funded, award recipients will learn more about the targeted technical assistance and evaluation support.

Statutory authority 42 U.S.C. 254c(f) (330A(f) of the Public Health Service Act)

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 Section 3.1. of the Two-Tier 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. For https://www.ecfr.gov/current/title-2/part-200 https://www.hrsa.gov/sites/default/files/hrsa/grants/two-tier-application-guide.pdf#page%3D17 https://www.hrsa.gov/sites/default/files/hrsa/grants/two-tier-application-guide.pdf#page%3D17 https://www.ecfr.gov/current/title-2/part-200/subject-group-ECFRed1f39f9b3d4e72 https://www.hhs.gov/sites/default/files/hhs-grants-policy-statement-april-2025-archived.pdf#page%3D81 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) help calculating salaries under this limit, read more at “salary rate limitation” in the Two-Tier Application Guide [PDF].

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

• To build or acquire real property.

• For construction.

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

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

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

To 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.

https://www.hrsa.gov/sites/default/files/hrsa/grants/two-tier-application-guide.pdf#page%3D19 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 20

Find the application package 20

Application writing help 21

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-26-082.

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

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 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.

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 23

Application contents and format 25

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.

form Included in

Project Narrative Attachment form.

Budget Narrative Attachment form.

Included in

No

2. Staffing plan and job description

4. Funding preference documentation No

5. Documentation from State Office of Rural Health No

No

7. Network documentation and attestation No

8. Network organizational chart No

9. Funding track participation statement No

No

Component Included in page limit*?

12. Tribal exception request No

13.–15. Other relevant documents Yes

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

Forms

Application for Federal Assistance (SF-424)

Project/Performance Site Location(s)

Project Abstract Summary form

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

Grants.gov Lobbying form

Key contacts

Submission requirement

With application.

With application.

With application

With application.

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

• Describe the overall purpose of your project.

◦ State the selected funding track (Operational Track or Clinical Services Track) you are applying for.

◦ Explain how the project supports the goals of the Rural Health Network Advancement Program (RHNAP).

• Summarize the project’s goals, objectives, and expected outcomes.

◦ Explain how your activities will move the network forward in measurable ways based on its current stage of development.

• Describe the activities you plan to carry out. Explain how they will:

◦ Advance or strengthen clinical service lines or operational integration.

◦ Improve coordinated care of delivery and preserve access to essential services.

◦ Strengthen financial and workforce sustainability in rural areas.

• If applicable, describe how the proposed project aligns with HHS priorities.

Need See merit review criterion 1: Need

This section will help reviewers understand who you will serve. Complete responses include citations referencing any relevant federal, state, local data, if possible. If availability of data is limited to cite, indicate this and use alternative means to document how needs were assessed.

• Describe the populations you will serve.

◦ Complete responses address the collective rural populations served across the network and its hospitals and clinics.

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

◦ If possible, include demographic, geographic, or other relevant characteristics of the service area.

• Outline the community or network’s needs you plan to address. Your response should explain:

◦ The needs or challenges that led to the creation of the existing network that your proposed project seeks to advance and;

◦ The key services, programs or functions the network currently provides to its hospital and clinics.

▪ Clearly address what needs these services address.

• How funding through the relevant track will help the network in its ongoing evolution to meet the needs of patients in its collective service area.

• Describe any barriers in the service area related to access to care, care coordination, financial sustainability, or workforce sustainability. Explain how your project will help address them.

Approach See merit review criterion 2: Response

This section will help reviewers understand how you will address your stated needs and meet the program requirements and expectations, including the funding track selection described in this NOFO.

• Describe your network’s readiness to advance clinical service lines or operational integration. Include information that position the network to successfully carry out the proposed project, such as:

◦ Existing capacity.

◦ Experience.

◦ Partnerships.

◦ Prior initiatives.

• Explain how the proposed approach will:

◦ Address the needs identified in the Need section.

◦ Meet the program requirements and expectations.

◦ Include how the selected funding track informs the project’s design, activities, and implementation strategy.

• Describe how the network will collaborate to carry out the proposed project activities. Include:

◦ Roles and responsibilities.

◦ How partners will coordinate.

◦ How you will communicate.

◦ How shared decision-making or accountability will be supported across hospitals and clinics.

• Include workforce development and organizational learning strategies for ongoing staff training, teamwork, and information sharing.

• Describe your network’s approach and plan to sustain key project activities beyond the period of federal funding. We expect you to maintain key strategies or services and actions that have led to improved practices and outcomes for the target population.

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

This section will help reviewers understand how you will achieve each of the objectives during the period of performance. You must also include a work plan in table format in Attachment 1: Work Plan that aligns with the requirements described here.

• Describe your work plan, including how proposed activities will align with the project’s purpose, goals, and objectives and support RHNAP goals. The description should include:

◦ List the key activities you will carry out during the period of performance.

Include a timeline for each activity. Show that your plan is realistic and achievable.

◦ Identify who is responsible for each activity. Include key staff and network members. Clearly state who will oversee and carry out the work.

◦ Explain how network members will work together to plan, design, and carry out the activities in the workplan.

◦ Identify the measures you will use to track progress for each activity. These may include process measures, outcome measures, or benchmarks. Explain how you will use them to monitor progress and determine whether you are meeting your objectives.

◦ Describe the expected results of your activities. Explain how they will affect the target population, the network, and network members.

• Explain how you will share reports, products, and results. Include how you will communicate with network members and other key stakeholders.

You will also include a more detailed work plan in your attachments.

Resolving challenges See merit review criterion 2: Response

This section will help reviewers understand how you will address anticipated challenges and barriers.

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

◦ Staff turnover/workforce instability.

▪ How you will ensure smooth staff transitions and maintain operations if staff changes occur within the network or among network members.

◦ Changes in policy, systems, or the operating environment that could affect project implementation.

◦ Barriers to assessing network or project performance and your plan to address those barriers.

◦ Challenges related to advancing or scaling network operations across multiple hospitals and clinics beyond the network’s current operating stage.

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

▪ Explain how you will ensure fair participation, shared decision-making, and continued engagement of rural partners and rural communities throughout the project period.

Program self-assessment See merit review criteria 3: Performance reporting and evaluation and 5: Resources and capabilities

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

• Outcomes

◦ Describe the expected outcomes of the proposed project activities.

◦ Explain how the results will advance clinical service lines or operational integration to:

▪ Improve coordinated care delivery.

▪ Preserve access to essential services.

▪ Strengthen financial and workforce sustainability in rural areas.

• Performance measurement and reporting

◦ Describe your network’s ability to collect, manage, and report required data.

◦ Describe the system and processes you will use to track performance and process or outcome measures, including:

▪ How you will collect and manage data to ensure accurate and timely reporting.

◦ Describe how you will coordinate, manage, and securely store data, including:

▪ How you will protect data against cybersecurity threats, breaches, or other loss of data integrity.

• Program self-assessment

◦ Describe how you will evaluate the results of your project and monitor progress toward goals, objectives, and expected outcomes. Complete responses address the following:

▪ The assessment questions, methods, data sources, and timeline you will use to assess project implementation and progress.

▪ Anticipated challenges in assessing your project and how these challenges will be addressed.

▪ How you will review findings during the project and use them to guide decisions and adjust activities, as needed.

▪ How findings will be shared with network members and relevant stakeholders.

▪ How you will assess whether information is being used effectively.

▪ How you will apply successful practices or lessons learned across the network.

See the reporting section for more information.

Sustainability See merit review criterion 4: Impact

You must include and describe your sustainability plans in the project narrative.

For the purposes of RHNAP, sustainability refers to sustainability of the proposed projects under the selected funding track.

You do not need to prove the sustainability of the rural health network itself. Funded applicants are presumed to be financially viable networks under the RHNAP funding opportunity.

This section will help reviewers understand your plan to sustain key functions, activities, or services of the proposed project, based on the funding track you selected.

Include:

• Describe how your network will document the value of your proposed project’s selected funding track and services.

◦ Your response should clearly explain how the network will address factors that affect the success of proposed intervention.

◦ Focus on how you will sustain the funded activities and support the financial viability of the network and member hospitals and clinics after federal funding ends.

▪ For projects proposed under the Operational Track selection, describe how proposed activities will result in either cost savings, efficiencies, or shared service(s) benefits to the network or member hospitals and clinics.

▪ For projects proposed under the Clinical Services Track selection, describe how the proposed activities will be financially and operationally viable at the network level for member hospitals and clinics.

• The network’s approach to sustainability planning over the four-year period of performance.

◦ Align the plan with your proposed project intervention and selected funding track.

◦ Explain how the network will assess and strengthen sustainability strategies at key milestones.

• Describe how achieving project goals will support the long-term sustainability of the proposed project.

◦ Explain how this relates to your network’s operational or clinical services, as based on your selected funding track.

• Describe how your proposed project will advance the sustainability of your network as a whole. Specifically:

◦ For Operational Track projects, describe how either cost savings, efficiencies, or shared services generated through the proposed operational project will be maintained by the network and its hospitals and clinics.

◦ For Clinical Services Track projects, describe how the proposed activities will generate ongoing revenue or cost offsets for the network and its hospitals and clinics that support continuation beyond the period of federal funding.

• Discuss any anticipated challenges you will likely encounter sustaining proposed project interventions based on your funding track selection.

◦ Include how you will resolve these challenges.

Organizational information See merit review criterion 5: Resources and capabilities

This section will help reviewers understand how you and your network have the resources, infrastructure and capabilities to carry out the proposed project and meet program requirements. Information provided should be consistent with documentation provided in referenced attachments and all other eligibility criteria.

Include:

• Your network’s organizational infrastructure and sustainability model, including:

◦ Administrative and operational functions.

◦ Current network-level staff.

◦ Revenue streams and financial strategies that support ongoing network operations.

• How achieving the proposed project goals for your specific track will support your network’s infrastructure and overall sustainability model. Specifically:

◦ For proposed projects under the operational funding track selection, how your proposed operational initiative will create efficiencies that will support your network’s infrastructure and overall sustainability model for the network and its hospitals and clinics.

◦ For proposed project under the clinical services track selection, how your proposed clinical service lines will support your network’s infrastructure and overall sustainability model for the network and its hospitals and clinics.

• Describe your network’s organizational profile, network member profiles, key staff’s experience, skills, and knowledge, as evidenced in Attachment 2: Staffing plan and job descriptions and Attachment 8: Network Organizational Chart.

Successful responses align with the list of biographical sketches of all key staff members provided in Attachment 3: Key Biographical Sketches.

• Provide evidence proving you are a network, as requested in Attachment 7:

Network documentation and Attestation.

• Describe how network members will deliver services, contribute to the network, and meet the needs of the proposed project.

• Provide justification demonstrating the network’s experience serving, or capacity to serve, rural medically underserved populations as described in Attachment 8: Network Organizational Chart.

• Detail network members’ expertise, addressing why each member is an appropriate collaborator on the proposed project. Your response should:

◦ Include a description of each member’s involvement, roles, responsibilities, contributions, and commitment to sustain project services and activities.

◦ Provide details on how you will collaborate with faith-based and community-based social service organizations as members of the network.

◦ Align with responses provided in Attachment 8: Network Organizational Chart.

• Describe how your network’s sustainability plan will show the network’s organizational capacity to:

◦ Maintain and carry out project activities.

◦ Achieve RHNAP goals.

◦ Sustain services and activities over time.

• Include how your proposed project, based on your proposed funding track selection will:

◦ Advance your network’s infrastructure.

◦ Create efficiencies and operations for network members and its hospitals and clinics after federal funding ends.

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.

• Travel: Allocate travel funds for up to two (2) program staff to attend an annual 2.5-day technical assistance workshop in Washington, DC and include the cost in this budget line item. To determine estimated travel costs to Washington, D.C., see the U.S. General Services Administration (GSA) per diem rates for FY 2026.

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

◦ Consistent with 2 CFR 200, you must provide a clear explanation of the purpose of each contract, how the costs were estimated, and the specific contract deliverables.

• Technology: You may use no more than 60% of the award budget to purchase or upgrade electronic health record systems or other health information technology.

◦ Any supplies equal to or exceeding $10k should be listed as equipment.

◦ If you propose to allocate 40%-60% of RHNAP funds towards technology, you must provide a clear and detailed justification in the project narrative and budget narrative demonstrating how funds will directly:

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) https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.gsa.gov%2Ftravel%2Fplan-book%2Fper-diem-rates&data=05%7C02%7Cmnunez%40hrsa.gov%7C64373bbe9da84f79d0a608de7a26fc66%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C639082506333627977%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=UTkSpuTLRgIOSmvhtoA6CQetW3fHRlBeVLaURfLNf8I%3D&reserved=0

▪ Advance network initiatives.

▪ Generate measurable return on investment.

▪ Contribute to long-term financial sustainability.

◦ You may also upload an optional business model or business plan as an Attachment 13-15 Other Relevant Documents.

◦ If your proposed project and budget include the maximum allowed cost for technology, you must clearly explain in the project and budget narrative how these investments will advance network initiatives and support a path to sustainability.

• Budget for multi-year award: You include a budget narrative for each year of the four-year period of performance submitted with your application.

◦ Funding beyond the one-year budget period is subject to availability of funds, satisfactory progress of the…